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Soon CS, Thota R, Owen L, Tian L, Martin FP, Mantantzis K, Cherta-Murillo A, Campos VC, Chkroun C, Lavalle L, Hartweg M, St-Onge MP, Chee MWL, Darimont C. Mulberry leaf extract combined with tryptophan improves sleep and post wake mood in adults with sleep complaints - A randomized cross-over study. Eur J Nutr 2025; 64:124. [PMID: 40072601 DOI: 10.1007/s00394-025-03643-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2024] [Accepted: 02/18/2025] [Indexed: 03/14/2025]
Abstract
PURPOSE In the current study we evaluated a blend of ingredients containing mulberry leaf extract (to lower postprandial glucose of the evening meal), tryptophan (facilitator of the sleep initiation) to benefit sleep initiation and quality in adults with self-reported difficulties with sleep initiation. METHODS Forty-three adults aged between 25 and 50 years enrolled in a randomized, crossover, double-blind, controlled trial. Participants received standardized meals with a glycemic load of 55 ± 10% and were assigned to receive treatment comprising a combination of mulberry leaf extract (750 mg), whey protein containing 120 mg tryptophan, zinc (1.35 mg), magnesium (12.6 mg), vitamin B3 (1.93 mg) and B6 (0.135 mg) and control (4 g wheat protein hydrolysate). Each intervention phase lasted 14 days separated by a washout period of 28 days. The primary outcomes were actigraphy-measured sleep onset latency and sleep efficiency. Secondary outcomes included continuous glycemic responses, mood, and cognition. RESULTS A linear mixed model intention-to-treat analysis conducted on 42 participants found that the treatment reduced sleep onset latency (actigraphy: -3.82 mins, p = 0.026; self-report: -3.09 mins, p = 0.048). Treatment significantly reduced evening meal's postprandial glucose response (incremental area under the curve, mmol/L*min) at 1 hour by 21% (p < 0.001), incremental maximum concentration by 16% (p = < 0.001) and nocturnal glucose variation over the 14-day period. Participants on treatment reported improved sleep quality (Karolinska Sleepiness Scale, -0.17, p = 0.041) and feeling more relaxed (Brief Mood Introspection Scale, -0.4, p = 0.003) the next morning compared to when taking the control. Additionally, the treatment improved the vigor dimension on the Profile of Mood Scale (0.8, p = 0.038). No effects were observed on the cognitive performance. Lowering postprandial glucose significantly mediated the treatment effect of lowering sleep onset latency and lower nocturnal glucose variation was also associated with improved sleep quality and next-day positive mood. CONCLUSION The evening meal supplement benefited sleep initiation and quality, and also improved post wake mood in adults. TRIAL REGISTRATION Registration number of Clinical Trial - ClinicalTrials.gov NCT05372900.
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Affiliation(s)
- Chun Siong Soon
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Rohith Thota
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland
| | - Lauren Owen
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland
| | - Liang Tian
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | | | | | | | - Célina Chkroun
- Clinical Research Unit, Nestlé Research, Lausanne, Switzerland
| | - Luca Lavalle
- Clinical Research Unit, Nestlé Research, Lausanne, Switzerland
| | - Mickaël Hartweg
- Clinical Research Unit, Nestlé Research, Lausanne, Switzerland
| | - Marie-Pierre St-Onge
- Division of General Medicine and Center of Excellence for Sleep & Circadian Research, Department of Medicine, Columbia University Irving Medical Center, New York, USA
| | - Michael W L Chee
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Christian Darimont
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland.
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Kale H, Zhdanava M, Pilon D, Sheehan J, Drissen T, Boonmak P, Choudhry Z, Shah A, Jha MK. Economic and clinical burden of major depressive disorder with insomnia symptoms in commercially and Medicaid-insured adults in the United States: A retrospective matched cohort study. J Affect Disord 2025; 372:653-664. [PMID: 39694333 DOI: 10.1016/j.jad.2024.12.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 11/26/2024] [Accepted: 12/14/2024] [Indexed: 12/20/2024]
Abstract
BACKGROUND Insomnia is a common symptom of major depressive disorder (MDD). Presence of insomnia symptoms in MDD (MDDIS) has been associated with worse depression severity and outcomes. This study assessed the economic and clinical burden of MDDIS in the United States. METHODS Commercially and Medicaid-insured adults from Merative® MarketScan® Databases (01/2016-06/2021) with ≥1 MDD diagnosis (index date) were included in the MDDIS cohort if they had ≥1 insomnia diagnosis within 12 month afterwards or in the other MDD cohort if they had no insomnia diagnoses/treatments; patients without MDD diagnoses/treatments (random index date) were included in the non-MDD cohort. Cohorts were propensity score-matched. Healthcare resource utilization (HRU), costs, and treatment patterns 12 months post-index were compared between MDDIS and each control cohort using linear and Poisson regressions. RESULTS In both commercially (N = 52,280; mean age: 44 years; 67 % female) and Medicaid-insured (N = 15,653; mean age: 41 years; 73 % female) populations, the MDDIS cohort had significantly higher HRU and cost than the other MDD and non-MDD cohorts. Mean total all-cause healthcare cost difference between the MDDIS and other MDD cohort was $5842 (commercial) and $5152 (Medicaid); between the MDDIS and non-MDD cohort, it was $14,266 (commercial) and $11,314 (Medicaid). MDDIS compared to other MDD was associated with higher use of antidepressants, particularly agents with sedative effect. LIMITATIONS Data were subject to incompleteness that might lead to measurement biases. CONCLUSIONS MDDIS compared to other MDD and non-MDD was associated with significantly higher economic and clinical burden, highlighting the need for effective treatments for this population.
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Affiliation(s)
- Hrishikesh Kale
- Janssen Scientific Affairs, LLC., a Johnson & Johnson company, 1125 Trenton Harbourton Rd, Titusville, NJ 08560, USA.
| | - Maryia Zhdanava
- Analysis Group, Inc., 1190 avenue des Canadiens-de-Montréal, Suite 1500, Montréal, QC H3B 0G7, Canada.
| | - Dominic Pilon
- Analysis Group, Inc., 1190 avenue des Canadiens-de-Montréal, Suite 1500, Montréal, QC H3B 0G7, Canada.
| | - John Sheehan
- Janssen Scientific Affairs, LLC., a Johnson & Johnson company, 1125 Trenton Harbourton Rd, Titusville, NJ 08560, USA.
| | - Tiina Drissen
- Janssen Scientific Affairs, LLC., a Johnson & Johnson company, 1125 Trenton Harbourton Rd, Titusville, NJ 08560, USA.
| | - Porpong Boonmak
- Analysis Group, Inc., 1190 avenue des Canadiens-de-Montréal, Suite 1500, Montréal, QC H3B 0G7, Canada.
| | - Zia Choudhry
- Janssen Scientific Affairs, LLC., a Johnson & Johnson company, 1125 Trenton Harbourton Rd, Titusville, NJ 08560, USA.
| | - Aditi Shah
- Analysis Group, Inc., 1190 avenue des Canadiens-de-Montréal, Suite 1500, Montréal, QC H3B 0G7, Canada.
| | - Manish K Jha
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA.
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LeBlanc ES, Smith N, Hwang D, Young DR, Oshiro C, Mayhew M, Massimino S, Catlin C, Clarke G. The sleep for health study: A randomized clinical trial of the impact of insomnia treatment on glycemia in people with prediabetes. Contemp Clin Trials 2025; 149:107796. [PMID: 39730078 PMCID: PMC11788072 DOI: 10.1016/j.cct.2024.107796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Revised: 12/15/2024] [Accepted: 12/21/2024] [Indexed: 12/29/2024]
Abstract
BACKGROUND Insomnia is a modifiable risk factor for type 2 diabetes. OBJECTIVE Describe the methodology for the Sleep for Health study, a randomized clinical trial examining the effectiveness of digital cognitive behavioral therapy for insomnia (dCBT-I) in reducing hyperglycemia in 300 people with both insomnia and prediabetes. OUTCOMES Primary outcome is glucose level 2 h after a 75-g glucose load. Secondary outcomes include fasting glucose, hemoglobin A1c, insulin resistance score, mean glucose from continuous glucose monitoring (CGM), standard deviation of CGM values, and number of CGM values >140 mg/d. METHODS Participants with a hemoglobin A1c in the prediabetes range (5.7 % to 6.4 %) and clinically significant insomnia are randomized to a dCBT-I program or patient education control program. dCBT-I includes six sessions that focus on changing sleep habits and scheduling factors that affect sleep and addresses misconceptions about sleep and insomnia, utilizing interactive components and goal-setting. Those in the control arm receive access to a sleep-education website, which presents informational content in a simple, static form, without interactive components or active skills training, and all content is provided at once, rather than in modules that unlock over time. At baseline, 11 weeks and 33 weeks after randomization, participants undergo laboratory testing with a 2-h oral glucose tolerance test, hemoglobin A1c, and insulin resistance score. They also undertake 10 days of CGM and actigraphy wear and complete two dietary recalls. SUMMARY This trial is testing whether a program to improve sleep will positively impact glycemia among those with prediabetes. Registration with clinicaltrials.gov on October 3, 2023: NCT06067139.
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Affiliation(s)
- Erin S LeBlanc
- Kaiser Permanente Center for Health Research, Portland, OR, USA.
| | - Ning Smith
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Dennis Hwang
- Kaiser Permanente Southern California, Sleep Medicine, Fontana, CA, USA
| | - Deborah R Young
- Kaiser Permanente Southern California Department of Research & Evaluation, Pasadena, CA, USA
| | - Caryn Oshiro
- Kaiser Permanente Center for Integrated Health Care Research, Honolulu, HI, USA
| | - Meghan Mayhew
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | | | - Chris Catlin
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Gregory Clarke
- Kaiser Permanente Center for Health Research, Portland, OR, USA
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De Longis E, Kassis A, Rémond-Derbez N, Thota R, Darimont C, Donato-Capel L, Hudry J. Cognitive benefits of sleep: a narrative review to explore the relevance of glucose regulation. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2024; 6:zpae095. [PMID: 39850251 PMCID: PMC11756301 DOI: 10.1093/sleepadvances/zpae095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 11/16/2024] [Indexed: 01/25/2025]
Abstract
Sleep is essential for maintaining optimal health. Both sleep duration and quality have been linked to various physiological functions and physical and mental health outcomes. Nutrition has been shown to impact sleep parameters, from the nutrient composition of foods, such as tryptophan levels, to the physiological response to foods, such as the glucose response. However, the relationship between glycemic control and sleep, and its impact on next-day benefits, particularly on cognitive performance, remains complex and is not fully understood. This narrative review aims to explore the relationship between glycemia and sleep, and how it may affect cognitive performance the following day. The review includes data from observational and interventional studies, discussing mechanisms of action that may explain the modulating effect of glycemia on sleep and cognition. The evidence suggests that lower postprandial glucose and low variation of nocturnal glucose are associated with better sleep quality and shorter sleep onset latency. Good sleep quality, in turn, is positively associated with cognitive processes such as sustained attention and memory consolidation measured the next day after sleep. Future research opportunities lie in investigating the effects of modulating the glycemic and insulinemic responses through evening meals on sleep quality and next-day cognitive performance. Well-designed clinical trials involving healthy individuals are necessary to establish the effects of these interventions. Controlling glycemic and insulinemic profiles through the evening meal may have significant implications for improving sleep quality and cognitive performance, with potential impact on individual mental health, productivity, and overall well-being.
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Affiliation(s)
- Evelina De Longis
- Nestlé Institute of Health Sciences, Société des Produits Nestlé S.A., Lausanne, Switzerland
| | | | - Noëla Rémond-Derbez
- Nestlé Institute of Health Sciences, Société des Produits Nestlé S.A., Lausanne, Switzerland
| | - Rohith Thota
- Nestlé Institute of Health Sciences, Société des Produits Nestlé S.A., Lausanne, Switzerland
| | - Christian Darimont
- Nestlé Institute of Health Sciences, Société des Produits Nestlé S.A., Lausanne, Switzerland
| | | | - Julie Hudry
- Nestlé Institute of Health Sciences, Société des Produits Nestlé S.A., Lausanne, Switzerland
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Zhang X, Sun Y, Ye S, Huang Q, Zheng R, Li Z, Yu F, Zhao C, Zhang M, Zhao G, Ai S. Associations between insomnia and cardiovascular diseases: a meta-review and meta-analysis of observational and Mendelian randomization studies. J Clin Sleep Med 2024; 20:1975-1984. [PMID: 39167428 PMCID: PMC11609828 DOI: 10.5664/jcsm.11326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 08/16/2024] [Accepted: 08/16/2024] [Indexed: 08/23/2024]
Abstract
STUDY OBJECTIVES Observational studies suggest associations between insomnia and cardiovascular diseases (CVDs), but the causal mechanism remains unclear. We investigated the potential causal associations between insomnia and CVDs by a combined systematic meta-review and meta-analysis of observational and Mendelian randomization studies. METHODS We searched PubMed, Web of Science, and Embase for English-language articles from inception to July 11, 2023. Two reviewers independently screened the articles to minimize potential bias. We summarized the current evidence on the associations of insomnia with coronary artery disease, atrial fibrillation, heart failure, myocardial infarction, hypertension, and stroke risk by combining meta-analyses of observational and Mendelian randomization studies. RESULTS Four meta-analyses of observational studies and 9 Mendelian randomization studies were included in the final data analysis. A systematic meta-review of observational studies provided strong evidence that insomnia is an independent risk factor for many CVDs, including atrial fibrillation, myocardial infarction, and hypertension. A meta-analysis of Mendelian randomization studies revealed that insomnia may be potentially causally related to coronary artery disease (odds ratio [OR] = 1.14, 95% confidence interval [CI] = 1.10-1.19, I2 = 97%), atrial fibrillation (OR = 1.02, 95% CI = 1.01-1.04, I2 = 94%), heart failure (OR = 1.04, 95% CI = 1.03-1.06, I2 =97%), hypertension (OR = 1.16, 95% CI = 1.13-1.18, I2 = 28%), large artery stroke (OR = 1.14, 95% CI = 1.05-1.24, I2 = 0%), any ischemic stroke (OR = 1.09, 95% CI = 1.03-1.14, I2 = 60%), and primary intracranial hemorrhage (OR = 1.16, 95% CI = 1.05-1.27, I2 = 0%). No evidence suggested that insomnia is causally associated with cardioembolic or small vessel stroke. CONCLUSIONS Our results provide strong evidence supporting a possible causal association between insomnia and CVD risk. Strategies to treat insomnia may be promising targets for preventing CVDs. CITATION Zhang X, Sun Y, Ye S, et al. Associations between insomnia and cardiovascular diseases: a meta-review and meta-analysis of observational and Mendelian randomization studies. J Clin Sleep Med. 2024;20(12):1975-1984.
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Affiliation(s)
- Xuejiao Zhang
- Department of Cardiology, Heart Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Yujing Sun
- Department of Cardiology, Heart Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Shuo Ye
- Department of Cardiology, Heart Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Qingqing Huang
- Department of Cardiology, Heart Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Rui Zheng
- Center for Sleep and Circadian Medicine, The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education China, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhexi Li
- Department of Cardiology, Heart Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Feng Yu
- Department of Cardiology, Heart Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Chenhao Zhao
- Department of Cardiology, Heart Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Min Zhang
- School of Cardiovascular and Metabolic Medicine and Sciences, King’s College London British Heart Foundation Centre of Research Excellence, London, United Kingdom
| | - Guoan Zhao
- Department of Cardiology, Heart Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Sizhi Ai
- Department of Cardiology, Heart Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
- Center for Sleep and Circadian Medicine, The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education China, Guangzhou Medical University, Guangzhou, Guangdong, China
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Song Y, Kim S, Joo Y, Ha E, Shim Y, Lee H, Jeong H, Lyoo I, Yoon S, Lee S. Impact of sleep disturbance in shift workers on hippocampal volume and psychomotor speed. Sleep 2024; 47:zsae100. [PMID: 38666299 DOI: 10.1093/sleep/zsae100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 04/10/2024] [Indexed: 09/10/2024] Open
Abstract
STUDY OBJECTIVES Shift work interferes with circadian rhythms, affecting sleep quality and cognitive function. Poor sleep quality in shift worker (SW)s can impair psychomotor performance due to fatigue and sleepiness, increasing the risk of errors, accidents, and reduced productivity. Given the potential for atrophic changes in the hippocampus due to sleep disturbances, our study investigates how poor sleep quality correlates with hippocampal structural alterations and impacts psychomotor performance among SWs. METHODS We recruited 100 SWs, classifying them based on sleep quality into two groups: good sleep-SW group (n = 59) and poor sleep-SW group (n = 41). Sleep quality was assessed using both 7-day actigraphy for sleep efficiency and the Pittsburgh Sleep Quality Index. A control group of 106 non-SWs without sleep problems (non-SW group) was also included for comparison. The outcome measures were psychomotor speed and hippocampal volumes, both total and by subfield. RESULTS The poor sleep-SW group showed significantly smaller hippocampal volumes than both the good sleep-SW group (p < .001) and the non-SW group (p = .003). Longer shift work years correlated with greater reductions in hippocampal volume in this group (r = -0.42, p = .009), unlike in the good sleep-SW group (r = 0.08, p = .541). Furthermore, they demonstrated declines in psychomotor speed relative to the non-SW group (p = .006), which correlated with smaller hippocampal volumes (r = 0.37, p = .020). CONCLUSIONS SWs with poor sleep quality exhibit significant hippocampal volume reductions and psychomotor speed decline, underscoring the importance of early intervention and support for sleep issues in this population.
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Affiliation(s)
- Yumi Song
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Shinhye Kim
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Yoonji Joo
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
| | - Eunji Ha
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
| | - Youngeun Shim
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Hyeonji Lee
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Hyeonseok Jeong
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - InKyoon Lyoo
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
- Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, South Korea
| | - Sujung Yoon
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Suji Lee
- College of Pharmacy, Dongduk Women's University, Seoul, South Korea
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Huang Y, Shi W, He Q, Tan J, Tong J, Yu B. Racial and ethnic influences on carotid atherosclerosis: Epidemiology and risk factors. SAGE Open Med 2024; 12:20503121241261840. [PMID: 39045542 PMCID: PMC11265241 DOI: 10.1177/20503121241261840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 05/28/2024] [Indexed: 07/25/2024] Open
Abstract
Carotid atherosclerosis-related stenosis, marked by atherosclerotic plaque formation in the carotid artery, significantly increases ischemic stroke risk. Its prevalence varies across ethnic groups, reflecting racial disparities. Epidemiological studies have highlighted different susceptibilities to carotid stenosis among racial groups. Native Americans and Whites show greater vulnerability, indicating genetic and environmental influences. The impact of carotid stenosis is more severe in Hispanic and Black populations, with a higher incidence of related brain injuries, underscoring the need for targeted interventions. Comparative imaging studies between Chinese and White individuals reveal unique patterns of carotid stenosis, enhancing understanding of its pathophysiology and management across ethnicities. This review also categorizes risk factors, distinguishing those with racial disparity (such as genetic loci, sleep apnea, and emotional factors, socioeconomic status) from those without. In summary, racial disparities affect carotid stenosis, leading to varying susceptibilities and outcomes among ethnic groups. Recognizing these differences is essential for developing effective prevention, diagnosis, and management strategies. Addressing these disparities is critical to reducing ischemic stroke's burden across populations. Continued research and targeted interventions are crucial to improve outcomes for individuals at risk of carotid stenosis and its complications.
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Affiliation(s)
- Yijun Huang
- Department of General Surgery, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Weihao Shi
- Department of General Surgery, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Qing He
- Department of General Surgery, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Jinyun Tan
- Department of General Surgery, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Jindong Tong
- Department of Vascular Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
- Shanghai Key Laboratory of Vascular Lesions Regulation and Remodeling, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
| | - Bo Yu
- Department of General Surgery, Huashan Hospital Affiliated to Fudan University, Shanghai, China
- Department of Vascular Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
- Shanghai Key Laboratory of Vascular Lesions Regulation and Remodeling, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
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Mayer-Suess L, Ibrahim A, Moelgg K, Cesari M, Knoflach M, Högl B, Stefani A, Kiechl S, Heidbreder A. Sleep disorders as both risk factors for, and a consequence of, stroke: A narrative review. Int J Stroke 2024; 19:490-498. [PMID: 37885093 PMCID: PMC11134986 DOI: 10.1177/17474930231212349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND AND PURPOSE Sleep disorders are increasingly implicated as risk factors for stroke, as well as a determinant of stroke outcome. They can also occur secondary to the stroke itself. In this review, we describe the variety of different sleep disorders associated with stroke and analyze their effect on stroke risk and outcome. METHODS A search term-based literature review ("sleep," "insomnia," "narcolepsy," "restless legs syndrome," "periodic limb movements during sleep," "excessive daytime sleepiness" AND "stroke" OR "cerebrovascular" in PubMed; "stroke" and "sleep" in ClinicalTrials.gov) was performed. English articles from 1990 to March 2023 were considered. RESULTS Increasing evidence suggests that sleep disorders are risk factors for stroke. In addition, sleep disturbance has been reported in half of all stroke sufferers; specifically, an increase is not only sleep-related breathing disorders but also periodic limb movements during sleep, narcolepsy, rapid eye movement (REM) sleep behavior disorder, insomnia, sleep duration, and circadian rhythm sleep-wake disorders. Poststroke sleep disturbance has been associated with worse outcome. CONCLUSION Sleep disorders are risk factors for stroke and associated with worse stroke outcome. They are also a common consequence of stroke. Recent guidelines suggest screening for sleep disorders after stroke. It is possible that treatment of sleep disorders could both reduce stroke risk and improve stroke outcome, although further data from clinical trials are required.
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Affiliation(s)
- Lukas Mayer-Suess
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Abubaker Ibrahim
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Kurt Moelgg
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Matteo Cesari
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Knoflach
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- VASCage—Research Centre on Clinical Stroke Research, Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Neurological Clinical Research Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- VASCage—Research Centre on Clinical Stroke Research, Innsbruck, Austria
| | - Anna Heidbreder
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Neurology, Johannes Kepler University Linz, Linz, Austria
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Cribbet MR, Thayer JF, Jarczok MN, Fischer JE. High-Frequency Heart Rate Variability Is Prospectively Associated With Sleep Complaints in a Healthy Working Cohort. Psychosom Med 2024; 86:342-348. [PMID: 38724040 PMCID: PMC11090416 DOI: 10.1097/psy.0000000000001302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/15/2024]
Abstract
OBJECTIVE Vagus nerve functioning, as indexed by high-frequency heart rate variability (HF-HRV), has been implicated in a wide range of mental and physical health conditions, including sleep complaints. This study aimed to test associations between HF-HRV measured during sleep (sleep HF-HRV) and subjective sleep complaints 4 years later. METHODS One hundred forty-three healthy employees (91% male; MAge = 47.8 years [time 2], SD = 8.3 years) of an industrial company in Southern Germany completed the Jenkins Sleep Problems Scale, participated in a voluntary health assessment, and were given a 24-hour ambulatory heart rate recording device in 2007. Employees returned for a health assessment and completed the Jenkins Sleep Problems Scale 4 years later. RESULTS Hierarchical regression analyses showed that lower sleep HF-HRV measured in 2007 was associated with higher self-reported sleep complaints 4 years later after controlling for covariates (rab,c = -0.096, b = -0.108, 95% CI, -0.298 to 0.081, ΔR2 = 0.009, p = .050). CONCLUSIONS These data are the first to show that lower sleep HF-HRV predicted worse sleep 4 years later, highlighting the importance of vagus nerve functioning in adaptability and health.
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Affiliation(s)
- Matthew R. Cribbet
- Department of Psychology, The University of Alabama, Tuscaloosa, Alabama
| | - Julian F. Thayer
- Department of Psychological Science, The University of California at Irvine, Irvine, CA
| | - Marc N. Jarczok
- Clinic for Psychosomatic Medicine and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Joachim E. Fischer
- General Medicine, Center for Preventive Medicine and Digital Health, Mannheim Medical Facility, Heidelberg University, Mannheim, Germany
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de la Calle M, Bartha JL, Martin Mens A, Arribas SM, Ramiro-Cortijo D. Assessment of Sleep Quality in Spanish Twin Pregnancy: An Observational Single-Center Study. Twin Res Hum Genet 2024; 27:97-104. [PMID: 38505981 DOI: 10.1017/thg.2024.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Women with twin pregnancies experience greater sleep disturbance compared to women with singleton pregnancies. The aims of this study were to explore the sleep quality in women with twin pregnancies and to compare their sleep dimensions with coetaneous single pregnancies. This was an observational study in which women were enrolled at the end of pregnancy in the Obstetric Service of Hospital La Paz (Spain). The women were classified as single (n = 143) or twin pregnancy (n = 62). Pregnant women responded to the Pittsburgh Sleep Quality Index to evaluate sleep quality, latency, duration, efficiency, perturbance, use of medication, and daytime dysfunction. The higher the index, the greater the alteration of sleep quality. Without statistical differences, a poor sleep quality was higher in women with single (66.7%) than women with twin pregnancies (22.8%). The good sleeper slept 6.8 h/day in single pregnancy and 7.3 h/day in twin pregnancy. The sleep perturbation and dysfunctionality were higher in women with twin than single pregnancies. The use of medication to sleep was significantly lower in women with twin than single pregnancies. In women with twin pregnancy, the body weight gain during first trimester had a positive correlation with worse sleep quality and sleep perturbations. Twin pregnancy needed more than 7 h/day to have a high sleep quality, showing greater sleep perturbations and daytime dysfunction than single pregnancies. The control of gestational body weight can improve the sleep quality, disturbances, and duration in twin gestations. Sleep screening during pregnancy would be necessary to handle sleep issues and increase benefits in twin gestational outcomes.
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Affiliation(s)
- María de la Calle
- Obstetric and Gynecology Service, Hospital Universitario La Paz, Madrid, Spain
| | - Jose L Bartha
- Obstetric and Gynecology Service, Hospital Universitario La Paz, Madrid, Spain
| | - Abigail Martin Mens
- Obstetric and Gynecology Service, Hospital Universitario La Paz, Madrid, Spain
| | - Silvia M Arribas
- Department of Physiology, Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Instituto Universitario de Estudios de la Mujer, Universidad Autónoma de Madrid, Madrid, Spain
- Grupo de investigación en Alimentación, Estrés Oxidativo y Salud Cardiovascular (FOSCH), Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - David Ramiro-Cortijo
- Department of Physiology, Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Instituto Universitario de Estudios de la Mujer, Universidad Autónoma de Madrid, Madrid, Spain
- Grupo de investigación en Alimentación, Estrés Oxidativo y Salud Cardiovascular (FOSCH), Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
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11
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Chen DM, Taporoski TP, Alexandria SJ, Aaby DA, Beijamini F, Krieger JE, von Schantz M, Pereira AC, Knutson KL. Altered sleep architecture in diabetes and prediabetes: findings from the Baependi Heart Study. Sleep 2024; 47:zsad229. [PMID: 37658822 DOI: 10.1093/sleep/zsad229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/16/2023] [Indexed: 09/05/2023] Open
Abstract
STUDY OBJECTIVES People with diabetes and prediabetes are more likely to have sleep-disordered breathing (SDB), but few studies examined sleep architecture in people with diabetes or prediabetes in the absence of moderate-severe SDB, which was the aim of our cross-sectional study. METHODS This cross-sectional sample is from the Baependi Heart Study, a family-based cohort of adults in Brazil. About 1074 participants underwent at-home polysomnography (PSG). Diabetes was defined as fasting glucose >125 mg/dL or HbA1c > 6.4 mmol/mol or taking diabetic medication, and prediabetes was defined as HbA1c ≥ 5.7 & <6.5 mmol/mol or fasting glucose ≥ 100 & ≤125 mg/dl. We excluded participants with an apnea-hypopnea index (AHI) ≥ 30 in primary analyses and ≥ 15 in secondary analysis. We compared sleep stages among the 3 diabetes groups (prediabetes, diabetes, neither). RESULTS Compared to those without diabetes, we found shorter REM duration for participants with diabetes (-6.7 min, 95%CI -13.2, -0.1) and prediabetes (-5.9 min, 95%CI -10.5, -1.3), even after adjusting for age, gender, BMI, and AHI. Diabetes was also associated with lower total sleep time (-13.7 min, 95%CI -26.8, -0.6), longer slow-wave sleep (N3) duration (+7.6 min, 95%CI 0.6, 14.6) and higher N3 percentage (+2.4%, 95%CI 0.6, 4.2), compared to those without diabetes. Results were similar when restricting to AHI < 15. CONCLUSIONS People with diabetes and prediabetes had less REM sleep than people without either condition. People with diabetes also had more N3 sleep. These results suggest that diabetes and prediabetes are associated with differences in sleep architecture, even in the absence of moderate-severe sleep apnea.
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Affiliation(s)
- Daniel M Chen
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | | | - David A Aaby
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - José E Krieger
- University of São Paulo School of Medicine, São Paulo, São Paulo, Brazil
| | - Malcolm von Schantz
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Alexandre C Pereira
- University of São Paulo School of Medicine, São Paulo, São Paulo, Brazil
- Brigham and Women´s Hospital, Harvard Medical School, Boston, MA, USA
| | - Kristen L Knutson
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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12
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Winkelman JW, Wipper B, Zackon J, Hoeppner BB. Lack of Efficacy of Suvorexant in People with Insomnia and Poorly Controlled Type 2 Diabetes. Nat Sci Sleep 2023; 15:1117-1128. [PMID: 38152441 PMCID: PMC10752032 DOI: 10.2147/nss.s434058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 12/12/2023] [Indexed: 12/29/2023] Open
Abstract
Objective/Background Sleep disturbance is a common and underappreciated feature of diabetes and sleep may contribute to glycemic control in people with type 2 diabetes (T2D). We conducted a 3-month trial to examine the efficacy of suvorexant in improving sleep and health outcomes in people with suboptimally controlled T2D and insomnia. Participants/Methods This parallel, double-blind, randomized placebo-controlled trial was conducted using the sequential parallel comparison design (SPCD). Sixty-nine people with poorly controlled T2D (HbA1c ≥ 6.5) were randomized to placebo and/or suvorexant (10-20 mg). The primary outcome was subjective total sleep time (sTST), and secondary outcomes were Insomnia Severity Index (ISI) score and wake time after sleep onset (WASO). Exploratory outcomes included sleep efficiency, hemoglobin A1c (HbA1c), and C-reactive protein (CRP). Exploratory analyses were conducted on relationships between sleep and diabetes outcomes. Results There were no significant improvements in sTST (p = 0.27), ISI (p = 0.86), or WASO (p = 0.94) among participants taking suvorexant compared to placebo. There were also no significant changes in any of the exploratory endpoints. Improvements in sleep were associated with improvements in both objective (ie, HbA1c) and subjective (ie, Diabetes Distress Scale) measures of diabetes, as well as reductions in depressive symptoms, independent of treatment assignment. Conclusion The study did not find evidence that suvorexant is efficacious for insomnia in people with poorly controlled T2D. The associations of improved sleep with improvements in both diabetes-related metrics and depressive symptoms across groups highlight the importance of identifying and treating sleeping difficulties in this population. CT Registration # Nct03818581.
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Grants
- research grant from Investigator-Initiated Studies Program of Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA
- this paper are those of the authors and do not necessarily represent those of Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA
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Affiliation(s)
- John W Winkelman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Jordana Zackon
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Bettina B Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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13
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Depner CM. Biomarkers linking habitual short sleep duration with risk of cardiometabolic disease: current progress and future directions. FRONTIERS IN SLEEP 2023; 2:1293941. [PMID: 39041043 PMCID: PMC11262587 DOI: 10.3389/frsle.2023.1293941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
Approximately one in three adults in the United States sleeps less than the recommended 7 h per night. Decades of epidemiological data and data from experimental sleep restriction studies demonstrate short sleep duration is associated with adverse cardiometabolic risk, including risk of type 2 diabetes and cardiovascular disease. However, the precise mechanisms underlying this risk are not fully elucidated and there is a lack of sleep-based interventions designed to mitigate such risk. One strategy to overcome these limitations is to develop biomarkers that link habitual short sleep duration with adverse cardiometabolic risk. Such biomarkers could inform biochemical mechanisms, identify new targets for interventions, support precision medicine by identifying individuals most likely to benefit from sleep-based interventions, and ultimately lead to improved cardiometabolic health in people with habitual short sleep durations. Early progress demonstrates proof-of-principle that omics-based technologies are a viable approach to create biochemical signatures (biomarkers) of short sleep duration, primarily derived from acute studies of experimental sleep restriction. Yet, much work remains. Notably, studies that translate early findings from experimental sleep restriction to free-living adults with habitual short sleep duration have high potential to advance the field. Such studies also create an exciting opportunity for larger randomized controlled trials that simultaneously identify biomarkers of habitual short sleep duration and evaluate the efficacy of sleep-based interventions. Ultimately, early progress in developing molecular biomarkers of short sleep duration combined with the prior decades of progress in the sleep and metabolism fields provide the foundation for exciting progress in the biomarker development space.
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Affiliation(s)
- Christopher M. Depner
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, United States
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14
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Wang X, Zhao C, Feng H, Li G, He L, Yang L, Liang Y, Tan X, Xu Y, Cui R, Sun Y, Guo S, Zhao G, Zhang J, Ai S. Associations of Insomnia With Insulin Resistance Traits: A Cross-sectional and Mendelian Randomization Study. J Clin Endocrinol Metab 2023; 108:e574-e582. [PMID: 36794917 DOI: 10.1210/clinem/dgad089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/17/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023]
Abstract
CONTEXT Insomnia is associated with insulin resistance (IR) in observational studies; however, whether insomnia is causally associated with IR remains unestablished. OBJECTIVE This study aims to estimate the causal associations of insomnia with IR and its related traits. METHODS In primary analyses, multivariable regression (MVR) and 1-sample Mendelian randomization (1SMR) analyses were performed to estimate the associations of insomnia with IR (triglyceride-glucose index and triglyceride to high-density lipoprotein cholesterol [TG/HDL-C] ratio) and its related traits (glucose level, TG, and HDL-C) in the UK Biobank. Thereafter, 2-sample MR (2SMR) analyses were used to validate the findings from primary analyses. Finally, the potential mediating effects of IR on the pathway of insomnia giving rise to type 2 diabetes (T2D) were examined using a 2-step MR design. RESULTS Across the MVR, 1SMR, and their sensitivity analyses, we found consistent evidence suggesting that more frequent insomnia symptoms were significantly associated with higher values of triglyceride-glucose index (MVR, β = 0.024, P < 2.00E-16; 1SMR, β = 0.343, P < 2.00E-16), TG/HDL-C ratio (MVR, β = 0.016, P = 1.75E-13; 1SMR, β = 0.445, P < 2.00E-16), and TG level (MVR, β = 0.019 log mg/dL, P < 2.00E-16, 1SMR: β = 0.289 log mg/dL, P < 2.00E-16) after Bonferroni adjustment. Similar evidence was obtained by using 2SMR, and mediation analysis suggested that about one-quarter (25.21%) of the association between insomnia symptoms and T2D was mediated by IR. CONCLUSIONS This study provides robust evidence supporting that more frequent insomnia symptoms are associated with IR and its related traits across different angles. These findings indicate that insomnia symptoms can be served as a promising target to improve IR and prevent subsequent T2D.
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Affiliation(s)
- Xiaoyu Wang
- Department of Cardiology, Life Science Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, China
| | - Chenhao Zhao
- Department of Cardiology, Life Science Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, China
| | - Hongliang Feng
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510000, China
| | - Guohua Li
- Department of Cardiology, Life Science Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, China
| | - Lei He
- Department of Cardiology, Life Science Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, China
| | - Lulu Yang
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510000, China
| | - Yan Liang
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510000, China
| | - Xiao Tan
- Department of Neuroscience (Sleep Science, BMC), Uppsala University, Uppsala SE-75105, Sweden
| | - Yanmin Xu
- Department of Cardiology, Life Science Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, China
| | - Ruixiang Cui
- Department of Cardiology, Life Science Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, China
| | - Yujing Sun
- Department of Cardiology, Life Science Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, China
| | - Sheng Guo
- Department of Cardiology, Life Science Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, China
| | - Guoan Zhao
- Department of Cardiology, Life Science Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, China
| | - Jihui Zhang
- Center for Sleep and Circadian Medicine, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510370, China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR 999077, China
- The Second School of Clinical Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
| | - Sizhi Ai
- Department of Cardiology, Life Science Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, China
- Center for Sleep and Circadian Medicine, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510370, China
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15
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Hannan M, Jeamjitvibool T, Luo Q, Izci-Balserak B, Ajilore O, Lash JP, Zhou XJ, Bronas UG. The Relationship Between Sleep and Brain Function in Older Adults With Chronic Kidney Disease and Self-Identified Cognitive Impairment. J Gerontol Nurs 2023; 49:31-39. [PMID: 37379049 PMCID: PMC10393368 DOI: 10.3928/00989134-20230616-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
Older adults with chronic kidney disease (CKD) are at risk for cognitive impairment and sleep disturbances. The purpose of the current study was to investigate the relationship between sleep and brain structure/function in older adults with CKD and self-identified cognitive impairment. The sample (N = 37) had a mean age of 68 years (SD = 4.9 years), estimated glomerular filtration rate of 43.7 mL/min/1.73m2 (SD = 10.98), median sleep time of 7.4 hours, and was 70% female. Sleeping <7.4 hours, compared to ≥7.4 hours, was associated with better attention/information processing (β = 11.46, 95% confidence interval [CI] [3.85, 19.06]) and better learning/memory (β = 2.06, 95% CI [0.37, 3.75]). Better sleep efficiency was associated with better global cerebral blood flow (β = 3.30, 95% CI [0.65, 5.95]). Longer awake length after sleep onset was associated with worse fractional anisotropy of the cingulum (β = -0.01, 95% CI [-0.02, -0.003]). Sleep duration and continuity may be related to brain function in older adults with CKD and self-identified cognitive impairment. [Journal of Gerontological Nursing, 49(7), 31-39.].
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Affiliation(s)
- Mary Hannan
- College of Nursing, University of Illinois Chicago, Chicago, IL
| | - Thanakrit Jeamjitvibool
- College of Nursing, University of Illinois Chicago, Chicago, IL
- Princess Agrarajakumari College of Nursing, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Qingfei Luo
- Center for Magnetic Resonance Research, College of Medicine, University of Illinois Chicago, Chicago, IL
| | | | - Olu Ajilore
- College of Medicine, University of Illinois Chicago, Chicago, IL
| | - James P. Lash
- College of Medicine, University of Illinois Chicago, Chicago, IL
| | - Xiaohong Joe Zhou
- Center for Magnetic Resonance Research, College of Medicine, University of Illinois Chicago, Chicago, IL
- Department of Radiology, College of Medicine, University of Illinois Chicago, Chicago, IL
| | - Ulf G. Bronas
- College of Nursing, University of Illinois Chicago, Chicago, IL
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16
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Pyatak EA, Spruijt-Metz D, Schneider S, Hernandez R, Pham LT, Hoogendoorn CJ, Peters AL, Crandall J, Jin H, Lee PJ, Gonzalez JS. Impact of Overnight Glucose on Next-Day Functioning in Adults With Type 1 Diabetes: An Exploratory Intensive Longitudinal Study. Diabetes Care 2023; 46:1345-1353. [PMID: 36862940 PMCID: PMC10300522 DOI: 10.2337/dc22-2008] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 02/13/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVE While there is evidence that functioning, or ability to perform daily life activities, can be adversely influenced by type 1 diabetes, the impact of acute fluctuations in glucose levels on functioning is poorly understood. RESEARCH DESIGN AND METHODS Using dynamic structural equation modeling, we examined whether overnight glucose (coefficient of variation[CV], percent time <70 mg/dL, percent time >250 mg/dL) predicted seven next-day functioning outcomes (mobile cognitive tasks, accelerometry-derived physical activity, self-reported activity participation) in adults with type 1 diabetes. We examined mediation, moderation, and whether short-term relationships were predictive of global patient-reported outcomes. RESULTS Overall next-day functioning was significantly predicted from overnight CV (P = 0.017) and percent time >250 mg/dL (P = 0.037). Pairwise tests indicate that higher CV is associated with poorer sustained attention (P = 0.028) and lower engagement in demanding activities (P = 0.028), time <70 mg/dL is associated with poorer sustained attention (P = 0.007), and time >250 mg/dL is associated with more sedentary time (P = 0.024). The impact of CV on sustained attention is partially mediated by sleep fragmentation. Individual differences in the effect of overnight time <70 mg/dL on sustained attention predict global illness intrusiveness (P = 0.016) and diabetes-related quality of life (P = 0.036). CONCLUSIONS Overnight glucose predicts problems with objective and self-reported next-day functioning and can adversely impact global patient-reported outcomes. These findings across diverse outcomes highlight the wide-ranging effects of glucose fluctuations on functioning in adults with type 1 diabetes.
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Affiliation(s)
- Elizabeth A. Pyatak
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA
| | - Donna Spruijt-Metz
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA
- Keck School of Medicine, University of Southern California, Los Angeles, CA
- Department of Psychology, University of Southern California, Los Angeles, CA
| | - Stefan Schneider
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA
- Department of Psychology, University of Southern California, Los Angeles, CA
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA
| | - Raymond Hernandez
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA
| | - Loree T. Pham
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA
| | - Claire J. Hoogendoorn
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
- Fleischer Institute for Diabetes and Metabolism, Division of Endocrinology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Anne L. Peters
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Jill Crandall
- Fleischer Institute for Diabetes and Metabolism, Division of Endocrinology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Haomiao Jin
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA
- Faculty of Health and Medical Sciences, School of Health Sciences, University of Surrey, Guildford, U.K
| | - Pey-Jiuan Lee
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA
| | - Jeffrey S. Gonzalez
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
- Fleischer Institute for Diabetes and Metabolism, Division of Endocrinology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
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17
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Sigurdardottir FD, Bertisch SM, Reid ML, deFilippi CR, Lima JAC, Redline S, Omland T. Association between insomnia phenotypes and subclinical myocardial injury: the Multi-Ethnic Study of Atherosclerosis. Sleep 2023; 46:zsac318. [PMID: 36579654 PMCID: PMC10091090 DOI: 10.1093/sleep/zsac318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 11/04/2022] [Indexed: 12/30/2022] Open
Abstract
STUDY OBJECTIVES To assess whether the association between insomnia and subclinical myocardial injury, as measured by cardiac troponin T (cTnT), differs across insomnia phenotypes. METHODS We measured cTnT in 2188 participants in the Multi-Ethnic Study of Atherosclerosis study who had completed sleep questionnaires and undergone unattended polysomnography (PSG) and 7-day actigraphy. Insomnia symptoms were defined as reporting at least one of the following ≥5 nights/week over the past 4 weeks: trouble falling asleep, waking up several times a night, having trouble getting back to sleep after waking up too early, or taking sleeping pills to help falling asleep. Obstructive sleep apnea (OSA) was defined as an apnea-hypopnea index (AHI >15 events/h). Participants were classified into insomnia phenotypes, including comorbid insomnia and OSA (COMISA) and insomnia associated with actigraphy-estimated short sleep (<6 h) or sleep fragmentation. RESULTS The mean age was 68.8 (SD 9.2) years, 53.6% were male. In total, 47.8% met threshold levels for insomnia symptoms, and 43.1% had an AHI >15. In adjusted linear regression models COMISA (β 0.08 [standard error (SE) 0.03], p < .01) and insomnia with short sleep duration (β 0.07 [SE 0.03], p < .05) were each associated with higher cTnT compared to a reference group with no insomnia. Insomnia with fragmented sleep (β 0.03 [SE 0.02]) was not associated with higher cTnT (p > .05) in adjusted analyses. OSA was associated with higher cTnT (β 0.09 [SE 0.03], p < .01) in adjusted models. CONCLUSIONS COMISA and insomnia with short sleep duration, but not insomnia symptoms alone or fragmented sleep, were associated with increased circulating cTnT in older adults.
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Affiliation(s)
- Fjola D Sigurdardottir
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Suzanne M Bertisch
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Michelle L Reid
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA
| | | | - Joao A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Torbjørn Omland
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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18
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Chen DM, Taporoski TP, Alexandria SJ, Aaby DA, Beijamini F, Krieger JE, von Schantz M, Pereira A, Knutson KL. Altered sleep architecture in diabetes and prediabetes: findings from the Baependi Heart Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.23.23287631. [PMID: 36993582 PMCID: PMC10055606 DOI: 10.1101/2023.03.23.23287631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Objective People with diabetes are more likely to have obstructive sleep apnea, but there are few studies examining sleep architecture in people with diabetes, especially in the absence of moderate-severe sleep apnea. Therefore, we compared sleep architecture among people with diabetes, prediabetes or neither condition, whilst excluding people with moderate-severe sleep apnea. Research design and methods This sample is from the Baependi Heart Study, a prospective, family-based cohort of adults in Brazil. 1,074 participants underwent at-home polysomnography (PSG). Diabetes was defined as 1) FBG>125 OR 2) HbA1c>6.4 OR 3) taking diabetic medication, and prediabetes was defined as 1) [(5.7≤HbA1c≤6.4) OR (100≤FBG≤125)] AND 2) not taking diabetic medication. We excluded participants that had an apnea-hypopnea index (AHI)>30 from these analyses to reduce confounding due to severe sleep apnea. We compared sleep stages among the 3 groups. Results Compared to those without diabetes, we found shorter REM duration for participants with diabetes (-6.7min, 95%CI -13.2, -0.1) or prediabetes (-5.9min, 95%CI -10.5, -1.3), even after adjusting for age, gender, BMI, and AHI. Diabetes was also associated with lower total sleep time (-13.7min, 95%CI -26.8, -0.6), longer slow-wave sleep (N3) duration (+7.6min, 95%CI 0.6, 14.6) and higher N3 percentage (+2.4%, 95%CI 0.6, 4.2), compared to those without diabetes. Conclusions People with diabetes and prediabetes had less REM sleep after taking into account potential confounders, including AHI. People with diabetes also had more N3 sleep. These results suggest that diabetes is associated with different sleep architecture, even in the absence of moderate-severe sleep apnea.
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19
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Full KM, Huang T, Shah NA, Allison MA, Michos ED, Duprez DA, Redline S, Lutsey PL. Sleep Irregularity and Subclinical Markers of Cardiovascular Disease: The Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc 2023; 12:e027361. [PMID: 36789869 PMCID: PMC10111477 DOI: 10.1161/jaha.122.027361] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/02/2022] [Indexed: 02/16/2023]
Abstract
Background Sleep irregularity has been linked to incident cardiovascular disease. Less is known about associations of sleep regularity with atherosclerosis. We examined cross-sectional associations of actigraphy-assessed sleep duration and sleep timing regularity with subclinical atherosclerosis in the community-based MESA (Multi-Ethnic Study of Atherosclerosis). Methods and Results MESA Sleep Ancillary Study participants (N=2032; mean age, 68.6±9.2 years; 37.9% White) completed 7-day wrist actigraphy. Participants underwent assessments of coronary artery calcium, carotid plaque presence, carotid intima-media thickness, and the ankle-brachial index. Sleep regularity was quantified by the 7-day with-in person SD of sleep duration and sleep onset timing. Relative risk regression models were used to calculate prevalence ratios and 95% CIs. Models are adjusted for demographics, cardiovascular disease risk factors, and other objectively assessed sleep characteristics including obstructive sleep apnea, sleep duration, and sleep fragmentation. After adjustment, compared with participants with more regular sleep durations (SD ≤60 minutes), participants with greater sleep duration irregularity (SD >120 minutes) were more likely to have high coronary artery calcium burden (>300; prevalence ratio, 1.33 [95% CI, 1.03-1.71]) and abnormal ankle-brachial index (<0.9; prevalence ratio, 1.75 [95% CI, 1.03-2.95]). Compared with participants with more regular sleep timing (SD ≤30 minutes), participants with irregular sleep timing (SD >90 minutes) were more likely to have high coronary artery calcium burden (prevalence ratio, 1.39 [95% CI, 1.07-1.82]). Associations persisted after adjustment for cardiovascular disease risk factors and average sleep duration, obstructive sleep apnea, and sleep fragmentation. Conclusions Sleep irregularity, particularly sleep duration irregularity, was associated with several measures of subclinical atherosclerosis. Sleep regularity may be a modifiable target for reducing atherosclerosis risk. Future investigation into cardiovascular risk reduction interventions targeting sleep irregularity may be warranted.
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Affiliation(s)
- Kelsie M. Full
- Division of Epidemiology and Community HealthUniversity of Minnesota School of Public HealthMinneapolisMN
| | - Tianyi Huang
- Channing Division of Network Medicine, Brigham and Women’s HospitalHarvard UniversityBostonMA
- Division of Sleep MedicineHarvard Medical SchoolBostonMA
| | - Neomi A. Shah
- Division of Pulmonary, Critical Care and Sleep MedicineIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Matthew A. Allison
- Division of Preventive MedicineUniversity of California San DiegoSan DiegoCA
| | - Erin D. Michos
- Division of CardiologyJohns Hopkins School of MedicineBaltimoreMD
| | - Daniel A. Duprez
- Cardiovascular DivisionUniversity of Minnesota School of MedicineMinneapolisMN
| | - Susan Redline
- Division of Sleep MedicineHarvard Medical SchoolBostonMA
- Brigham and Women’s Hospital, Division of Sleep and Circadian DisordersHarvard Medical SchoolBostonMA
| | - Pamela L. Lutsey
- Division of Epidemiology and Community HealthUniversity of Minnesota School of Public HealthMinneapolisMN
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20
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Duan D, Kim LJ, Jun JC, Polotsky VY. Connecting insufficient sleep and insomnia with metabolic dysfunction. Ann N Y Acad Sci 2023; 1519:94-117. [PMID: 36373239 PMCID: PMC9839511 DOI: 10.1111/nyas.14926] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The global epidemic of obesity and type 2 diabetes parallels the rampant state of sleep deprivation in our society. Epidemiological studies consistently show an association between insufficient sleep and metabolic dysfunction. Mechanistically, sleep and circadian rhythm exert considerable influences on hormones involved in appetite regulation and energy metabolism. As such, data from experimental sleep deprivation in humans demonstrate that insufficient sleep induces a positive energy balance with resultant weight gain, due to increased energy intake that far exceeds the additional energy expenditure of nocturnal wakefulness, and adversely impacts glucose metabolism. Conversely, animal models have found that sleep loss-induced energy expenditure exceeds caloric intake resulting in net weight loss. However, animal models have significant limitations, which may diminish the clinical relevance of their metabolic findings. Clinically, insomnia disorder and insomnia symptoms are associated with adverse glucose outcomes, though it remains challenging to isolate the effects of insomnia on metabolic outcomes independent of comorbidities and insufficient sleep durations. Furthermore, both pharmacological and behavioral interventions for insomnia may have direct metabolic effects. The goal of this review is to establish an updated framework for the causal links between insufficient sleep and insomnia and risks for type 2 diabetes and obesity.
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Affiliation(s)
- Daisy Duan
- Division of Endocrinology, Diabetes, and Metabolism; Department of Medicine; Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lenise J. Kim
- Division of Pulmonary and Critical Care; Department of Medicine; Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jonathan C. Jun
- Division of Pulmonary and Critical Care; Department of Medicine; Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vsevolod Y. Polotsky
- Division of Pulmonary and Critical Care; Department of Medicine; Johns Hopkins University School of Medicine, Baltimore, Maryland
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21
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Hussein YHH, Soliman AZM. Dietary habits, lifestyle changes, and glycemic control in patients with type 2 diabetes mellitus during coronavirus disease 2019 (COVID-19): A cross-sectional study in Egypt. J Family Community Med 2023; 30:1-11. [PMID: 36843862 PMCID: PMC9954427 DOI: 10.4103/jfcm.jfcm_114_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/26/2022] [Accepted: 07/12/2022] [Indexed: 02/28/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) lockdown had a significant effect on people's lifestyles and dietary habits resulting in a possible negative health impact, particularly for patients with type-2 diabetes mellitus (T2DM). The objective of the study was to assess the changes in dietary habits and lifestyle and how these relate to glycemic control in patients with type 2 diabetes (T2D), who attended Zagazig Diabetes Clinic, Sharkia Governorate, Egypt, during the COVID-19 pandemic. MATERIALS AND METHODS A total of 402 patients with T2D were included in this cross-sectional study. A semistructured questionnaire was used to collect information on socioeconomic status, dietary habits, lifestyle changes, and previous medical history. Weight and height were also measured, and hemoglobin A1C levels before and after lockdown were compared. Data analysis was performed using the SPSS. To determine statistical significance, Chi-square test was used for categorical variables whereas, paired t-test or McN-Nemar test, as appropriate, was used to compare change in HbA1c before and after lockdown. Ordinal logistic regression was used to determine factors associated with weight change, whereas binary logistic regression was used to determine factors related with glycemic control. RESULTS During the COVID-19 pandemic, 43.8% of the studied groups consumed more than their usual diet with an increase in fruits, vegetables, and immunity-boosting food; 57% depended on home-cooked food, 48.3% did not practice exercise. About 57% reported to have gained weight, 70.9% suffered from mental stress, and 66.7% reported inadequate sleep. Collectively, there was a statistically significant decrease in the percentage of good glycemic control in the studied groups (28.1% vs. 15.9%) before and after the COVID-19 lockdown, respectively (P < 0.001). Weight gain, physical inactivity, mental stress, and inadequate sleep were significantly associated with poor glycemic control. CONCLUSION COVID-19 pandemic has had a negative impact on the lifestyle and dietary habits of the studied groups. Therefore, it is very important to ensure better diabetes management in this critical period.
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Affiliation(s)
| | - Al-Zahraa M. Soliman
- Department of Public Health and Community Medicine, Faculty of Medicine, Zagazig University, Egypt
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22
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Sivakumaran K, Ritonja JA, Palmer N, Pasumarthi T, Waseem H, Yu T, Denning A, Michaud D, Morgan RL. Effect of sleep disturbance on biomarkers related to the development of adverse health outcomes: A systematic review of the human literature. J Sleep Res 2022; 32:e13775. [PMID: 36330773 DOI: 10.1111/jsr.13775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 10/11/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022]
Abstract
Literature suggests that unrestricted and undisturbed sleep is vital for basic human function and performance; however, it is unclear as to what amount of sleep disturbance leads to dysregulation in biomarkers, which may underscore the development of adverse health effects. This systematic review aims to identify the amount of sleep disturbance that contributes to biomarker changes as a potential precursor to the development of adverse health effects. English-language comparative studies available in PubMed, Cochrane Central, EMBASE, and CINAHL databases from 1 January 1980 to 31 July 2021 were searched. Where possible, random-effects meta-analyses were used to examine the effect of sleep disturbances on adverse health effects. The risk of bias of individual studies was assessed using the Cochrane Risk of Bias Tool and the Risk of Bias of Nonrandomised Studies - of Exposures instruments and the certainty of the body of evidence for each outcome was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. The search identified 92 primary studies reporting on blood pressure, hypertension, heart rate, cardiac arrhythmia, cardiac output, waist circumference, cortisol, adrenaline, noradrenaline, immune system markers, glucose, insulin, cholesterol, and triglyceride levels. Although some meta-analyses suggested there may be an association between sleep disturbances and certain outcomes, the certainty in the evidence was very low due to concerns with risk of bias, inconsistency across exposures, populations, and imprecision in the estimates of effects. Further research is needed to explore the point at which types, levels and duration of sleep disturbances may begin to increase the risk of developing adverse health outcomes to inform and tailor health interventions.
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Affiliation(s)
| | - Jennifer A. Ritonja
- Université de Montréal Hospital Research Centre (CRCHUM) Montreal Quebec Canada
- Department of Social and Preventive Medicine Université de Montréal Montreal Quebec Canada
| | | | - Tejanth Pasumarthi
- Evidence Foundation Cleveland Heights Ohio USA
- School of Interdisciplinary Science McMaster University Hamilton Ontario Canada
| | - Haya Waseem
- Evidence Foundation Cleveland Heights Ohio USA
| | - Tiffany Yu
- Evidence Foundation Cleveland Heights Ohio USA
- Faculty of Health Sciences McMaster University Hamilton Ontario Canada
| | - Allison Denning
- Health Canada, Environmental and Radiation Health Sciences Directorate Consumer & Clinical Radiation Protection Bureau Ottawa Ontario Canada
| | - David Michaud
- Health Canada, Environmental and Radiation Health Sciences Directorate Consumer & Clinical Radiation Protection Bureau Ottawa Ontario Canada
| | - Rebecca L. Morgan
- Evidence Foundation Cleveland Heights Ohio USA
- Department of Health Research Methods, Evidence and Impact McMaster University Hamilton Ontario Canada
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23
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Hermanns N, Ehrmann D, Shapira A, Kulzer B, Schmitt A, Laffel L. Coordination of glucose monitoring, self-care behaviour and mental health: achieving precision monitoring in diabetes. Diabetologia 2022; 65:1883-1894. [PMID: 35380233 PMCID: PMC9522821 DOI: 10.1007/s00125-022-05685-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/06/2022] [Indexed: 02/02/2023]
Abstract
Monitoring of glucose plays an essential role in the management of diabetes. However, to fully understand and meaningfully interpret glucose levels, additional information on context is necessary. Important contextual factors include data on behaviours such as eating, exercise, medication-taking and sleep, as well as data on mental health aspects such as stress, affect, diabetes distress and depressive symptoms. This narrative review provides an overview of the current state and future directions of precision monitoring in diabetes. Precision monitoring of glucose has made great progress over the last 5 years with the emergence of continuous glucose monitoring (CGM), automated analysis of new glucose variables and visualisation of CGM data via the ambulatory glucose profile. Interestingly, there has been little progress in the identification of subgroups of people with diabetes based on their glycaemic profile. The integration of behavioural and mental health data could enrich such identification of subgroups to stimulate precision medicine. There are a handful of studies that have used innovative methodology such as ecological momentary assessment to monitor behaviour and mental health in people's everyday life. These studies indicate the importance of the interplay between behaviour, mental health and glucose. However, automated integration and intelligent interpretation of these data sources are currently not available. Automated integration of behaviour, mental health and glucose could lead to the identification of certain subgroups that, for example, show a strong association between mental health and glucose in contrast to subgroups that show independence of mental health and glucose. This could inform precision diagnostics and precision therapeutics. We identified just-in-time adaptive interventions as a potential means by which precision monitoring could lead to precision therapeutics. Just-in-time adaptive interventions consist of micro-interventions that are triggered in people's everyday lives when a certain problem is identified using monitored behaviour, mental health and glucose variables. Thus, these micro-interventions are responsive to real-life circumstances and are adaptive to the specific needs of an individual with diabetes. We conclude that, with current developments in big data analysis, there is a huge potential for precision monitoring in diabetes.
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Affiliation(s)
- Norbert Hermanns
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany.
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany.
- German Center for Diabetes Research (DZD), Muenchen-Neuherberg, Germany.
| | - Dominic Ehrmann
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
- German Center for Diabetes Research (DZD), Muenchen-Neuherberg, Germany
| | - Amit Shapira
- Harvard Medical School, Joslin Diabetes Center, Boston, MA, USA
| | - Bernhard Kulzer
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
- German Center for Diabetes Research (DZD), Muenchen-Neuherberg, Germany
| | - Andreas Schmitt
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- German Center for Diabetes Research (DZD), Muenchen-Neuherberg, Germany
| | - Lori Laffel
- Harvard Medical School, Joslin Diabetes Center, Boston, MA, USA
- Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
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24
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So HK, Chua GT, Yip KM, Tung KTS, Wong RS, Louie LHT, Tso WWY, Wong ICK, Yam JC, Kwan MYW, Lau KK, Kong JKW, Wong WHS, Ip P. Impact of COVID-19 Pandemic on School-Aged Children's Physical Activity, Screen Time, and Sleep in Hong Kong: A Cross-Sectional Repeated Measures Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10539. [PMID: 36078256 PMCID: PMC9517856 DOI: 10.3390/ijerph191710539] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/16/2022] [Accepted: 08/21/2022] [Indexed: 06/15/2023]
Abstract
Despite concerns about the negative effects of social distancing and prolonged school closures on children's lifestyle and physical activity (PA) during the COVID-19 pandemic, robust evidence is lacking on the impact of the pandemic-related school closures and social distancing on children's wellbeing and daily life. This study aimed to examine changes in the PA levels, sleep patterns, and screen time of school-aged children during the different phases of the COVID-19 outbreak in Hong Kong using a repeated cross-sectional design. School students (grades 1 to 12) were asked to report their daily electronic device usage and to fill in a sleep diary, recording their daily sleep onset and wake-up time. They were equipped with a PA monitor, Actigraph wGT3X-BT, to obtain objective data on their PA levels and sleep patterns. Students were recruited before the pandemic (September 2019-January 2020; n = 577), during school closures (March 2020-April 2020; n = 146), and after schools partially reopened (October 2020-July 2021; n = 227). Our results indicated lower PA levels, longer sleep duration, and longer screen time among participants recruited during school closures than those recruited before the COVID-19 outbreak. Primary school students were found to sleep on average for an extra hour during school closures. The later sleep onset and increased screen time documented during school closures persisted when schools partially reopened. Our findings illustrate the significant impact of social distancing policies during the COVID-19 pandemic on the sleep pattern, screen time, and PA level in school-aged children in Hong Kong. Professionals should urgently reinforce the importance of improving physically activity, good sleep hygiene, and regulated use of electronic devices for parents and school-aged children during this unprecedented time.
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Affiliation(s)
- Hung-Kwan So
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Gilbert T. Chua
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ka-Man Yip
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Keith T. S. Tung
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Rosa S. Wong
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Lobo H. T. Louie
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong, China
| | - Winnie W. Y. Tso
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ian C. K. Wong
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Jason C. Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Mike Y. W. Kwan
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong, China
| | - Kui-Kai Lau
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | | | - Wilfred H. S. Wong
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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25
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Campbell LM, Kohli M, Lee EE, Kaufmann CN, Higgins M, Delgadillo JD, Heaton RK, Cherner M, Ellis RJ, Moore DJ, Moore RC. Objective and subjective sleep measures are associated with neurocognition in aging adults with and without HIV. Clin Neuropsychol 2022; 36:1352-1371. [PMID: 32993422 PMCID: PMC8007669 DOI: 10.1080/13854046.2020.1824280] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 09/10/2020] [Accepted: 09/12/2020] [Indexed: 02/01/2023]
Abstract
Objective: Poor sleep quality is related to worse neurocognition in older adults and in people with HIV (PWH); however, many previous studies have relied only on self-report sleep questionnaires, which are inconsistently correlated with objective sleep measures. We examined relationships between objective and subjective sleep quality and neurocognition in persons with and without HIV, aged 50 and older. Method: Eighty-five adults (PWH n = 52, HIV-negative n = 32) completed comprehensive neuropsychological testing to assess global and domain-specific neurocognition. Objective sleep quality was assessed with wrist actigraphy (total sleep time, efficiency, sleep fragmentation) for five to 14 nights. Subjective sleep quality was assessed with the Pittsburgh Sleep Quality Index. Results: Objective and subjective sleep measures were unrelated (p's > 0.30). Compared to HIV-negative participants, PWH had greater sleep efficiency (80% vs. 75%, p = 0.05) and were more likely to be using prescription and/or over the counter sleep medication (p = 0.04). In the whole sample, better sleep efficiency (p < 0.01) and greater total sleep time (p = 0.05) were associated with better learning. Less sleep fragmentation was associated with better learning (p < 0.01) and recall (p = 0.04). While PWH had slightly stronger relationships between total sleep time and sleep fragmentation, it is not clear if these differences are clinically meaningful. Better subjective sleep quality was associated with better executive function (p < 0.01) and working memory (p = 0.05); this relationship was primarily driven by the HIV-negative group. Conclusions: Objective sleep quality was associated with learning and recall whereas subjective sleep quality was associated with executive function and working memory. Therefore, assessing objective and subjective sleep quality could be clinically useful, as they are both related to important domains of cognition frequently impacted in HIV-associated neurocognitive disorders as well as neurodegenerative disorders associated with aging. Future studies should evaluate if behavioral sleep interventions can improve neurocognition.
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Affiliation(s)
- Laura M. Campbell
- SDSU/UC San Diego Joint Doctoral Program in Clinical
Psychology, San Diego, CA
- Department of Psychiatry, University of California San
Diego, San Diego, CA
| | - Maulika Kohli
- SDSU/UC San Diego Joint Doctoral Program in Clinical
Psychology, San Diego, CA
- Department of Psychiatry, University of California San
Diego, San Diego, CA
| | - Ellen E. Lee
- Department of Psychiatry, University of California San
Diego, San Diego, CA
- VA San Diego Healthcare System, San Diego, California,
U.S.A
- Sam and Rose Stein Institute for Research on Aging,
University of California San Diego, La Jolla, California, U.S.A
| | - Christopher N. Kaufmann
- VA San Diego Healthcare System, San Diego, California,
U.S.A
- Division of Geriatrics and Gerontology, Department of
Medicine, University of California San Diego, La Jolla, California, U.S.A
| | - Michael Higgins
- Department of Family Medicine and Public Health, University
of California San Diego, San Diego, CA
| | - Jeremy D. Delgadillo
- Advancing Diversity in Aging Research (ADAR) Program, San
Diego State University, San Diego, CA
| | - Robert K. Heaton
- Department of Psychiatry, University of California San
Diego, San Diego, CA
| | - Mariana Cherner
- Department of Psychiatry, University of California San
Diego, San Diego, CA
| | - Ronald J. Ellis
- Department of Psychiatry, University of California San
Diego, San Diego, CA
- Department of Neurosciences, University of California San
Diego, San Diego, CA
| | - David J. Moore
- Department of Psychiatry, University of California San
Diego, San Diego, CA
| | - Raeanne C. Moore
- Department of Psychiatry, University of California San
Diego, San Diego, CA
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26
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Coombe AH, Hayat MJ, Faulkner MS, Rogers AE, Lee J, Clark PC. Preliminary evidence of insulin resistance in young adults with impaired sleep. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:1724-1730. [PMID: 33048647 DOI: 10.1080/07448481.2020.1819290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 08/01/2020] [Accepted: 08/28/2020] [Indexed: 06/11/2023]
Abstract
Objective: Impaired sleep is associated with insulin resistance (IR), a precursor to type 2 diabetes mellitus (T2DM), but is poorly understood in young adults. This cross-sectional study examined sleep characteristics, risk factors for T2DM, and IR in college students. Participants: Thirty-two college students (18-25 years) with either short sleep or poor quality sleep were assessed. Methods: Participants completed self-report measures of sleep and T2DM risk factors. One week of objective sleep was measured with wrist actigraphy. IR was calculated from fasting serum glucose and insulin concentrations. Results: The sample slept on average 6.6 hours/night, and over half had IR. Of those with IR, 44.4% had normal body mass index (BMI), 72% had normal fasting glucose concentrations, and all but one had T2DM risk test score indicating they were not at risk. Conclusions: IR was found in over half of participants; however, many typical T2DM risk factors were not present in those with IR.
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Affiliation(s)
- Ashley Helvig Coombe
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Matthew J Hayat
- Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta, Georgia, USA
| | | | - Ann E Rogers
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Jiwon Lee
- Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta, Georgia, USA
| | - Patricia C Clark
- Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta, Georgia, USA
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27
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Nicolì F, Prete A, Citro F, Bertolotto A, Battini L, de Gennaro G, Del Prato S, Bianchi C. Short sleep duration and risk of gestational diabetes. Gynecol Endocrinol 2022; 38:672-675. [PMID: 35723586 DOI: 10.1080/09513590.2022.2089105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
ObjectiveSleep disturbances and short sleep duration are common in pregnancy and might contribute to the development of hyperglycemia. Therefore, we evaluated the association of sleep disturbances and gestational diabetes (GDM) in a cohort of women.MethodsWe collected data of 386 women consecutively screened for GDM in 2019 by 75 gr OGTT, according with IDPSG criteria. Pittsburgh Sleep Quality Index (PSQI) questionnaire was used to assess self-reported poor sleep quality (PSQI score >5) and short nocturnal sleep duration (<6 h).ResultsOf 386 women, 148 (38.3%) had poor sleep quality and 87 (22.5%) short sleep duration. GDM prevalence was 26.9%. There was no difference in GDM prevalence between women with poor or good sleep quality (26% vs. 28%; n.s.), while GDM was more frequent in women with short sleep duration (35.6% vs. 24.4%; p = 0.038). On univariate logistic regression analysis, short sleep duration (OR 1.71; 95%CI: 1.03-2.86; p = 0.039), previous GDM (OR 3.52; 95%CI: 1.83-6.76; p < 0.0001), family history of diabetes (OR 1.96; 95%CI: 1.21-3.91; p = 0.007), pre-pregnancy overweight (OR 1.85; 95%CI: 1.06-3.23; p = 0.031) or obesity (OR 2.56; 95%CI: 1.40-4.70; p = 0.002) were associated to GDM. However, after adjustment for confounders, short sleep duration did not persist as an independent risk factor for GDM (OR: 1.55; 95%CI: 0.91-2.65; ns).ConclusionsSleep disturbances are relative common among pregnant women. Although GDM seems more common among women with short sleep duration, this sleep disturbance does not seem to be an independent risk factor for GDM in women at high risk.
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Affiliation(s)
- Francesca Nicolì
- Section of Diabetes, Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandro Prete
- Section of Diabetes, Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
| | - Fabrizia Citro
- Section of Diabetes, Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Lorella Battini
- Maternal-Infant Department, University Hospital of Pisa, Italy
| | - Giovanni de Gennaro
- Section of Diabetes, Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
| | - Stefano Del Prato
- Section of Diabetes, Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
| | - Cristina Bianchi
- Section of Diabetes, Azienda-Ospedaliero Universitaria Pisana, Pisa, Italy
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28
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AL-Musharaf S, AlAjllan L, Aljuraiban G, AlSuhaibani M, Alafif N, Hussain SD. Nutritional Biomarkers and Factors Correlated with Poor Sleep Status among Young Females: A Case-Control Study. Nutrients 2022; 14:nu14142898. [PMID: 35889857 PMCID: PMC9320813 DOI: 10.3390/nu14142898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 12/14/2022] Open
Abstract
Poor sleep status is associated with several health problems. Nutritional biomarkers and factors related to poor sleep are understudied. This study aimed to identify nutrition biomarkers and factors related to sleep status in healthy young Saudi females. The study included 92 normal-weight and obese Saudi females aged 19−25. Fasting blood glucose, insulin, and lipid profiles were measured. Insulin resistance was calculated on the basis of the homeostasis model assessment of insulin resistance (HOMA-IR) method. Anthropometric, stress, physical activity, and dietary data were collected. Data on the polyphenol content in foods were retrieved from the Phenol-Explorer database. The sleep status was assessed using the Pittsburgh sleep quality index (PSQI). Associations between variables were assessed using the multiple logistic regression model. Around 76% of the participants had poor sleep status (PSQI > 5). Multiple logistic regression reported high polyphenol intake as a protective factor against poor sleep (OR 0.24; 95% CI 0.07−0.83; p = 0.03) and HOMA-IR as an independent risk for poor sleep (OR 4.97; 95% CI 1.11−22.31; p = 0.04). Other nutritional biomarkers and factors, such as BMI, lipid profile, and vitamins, revealed a trend but were not significant. In conclusion, poor sleep status is associated with insulin resistance and low polyphenol intake among women of reproductive age.
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Affiliation(s)
- Sara AL-Musharaf
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia; (L.A.); (G.A.); (M.A.); (N.A.)
- Correspondence: ; Tel.: +966-554243033
| | - Lama AlAjllan
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia; (L.A.); (G.A.); (M.A.); (N.A.)
| | - Ghadeer Aljuraiban
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia; (L.A.); (G.A.); (M.A.); (N.A.)
| | - Munirah AlSuhaibani
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia; (L.A.); (G.A.); (M.A.); (N.A.)
| | - Noura Alafif
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia; (L.A.); (G.A.); (M.A.); (N.A.)
| | - Syed Danish Hussain
- Riyadh Biochemistry Department, College of Science, King Saud University, Riyadh 11451, Saudi Arabia;
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Mantantzis K, Campos V, Darimont C, Martin FP. Effects of Dietary Carbohydrate Profile on Nocturnal Metabolism, Sleep, and Wellbeing: A Review. Front Public Health 2022; 10:931781. [PMID: 35910892 PMCID: PMC9326315 DOI: 10.3389/fpubh.2022.931781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/13/2022] [Indexed: 11/22/2022] Open
Abstract
Sleep is a crucial biological function and a well-established driver of health and wellbeing across the lifespan. In this review, we describe how sleep in humans is associated with specific circadian metabolic and physiological changes, and how the organization of sleep-wake states is related to regulation of nocturnal metabolism during fasting. Among the modifiable factors that can contribute to sleep-related benefits, emerging evidence suggests that diet and nocturnal changes in glucose regulation are strong determinants of sleep quality. Here, we review studies that have explored the importance of quantity and quality of dietary carbohydrates and proteins in modulation of sleep and sleep-related health benefits. Future research may guide the creation of nutritional solutions to improve sleep, which could lead to positive changes in health, wellbeing, and overall quality of life.
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Abstract
Sleep loss has negative impacts on quality of life, mood, cognitive function and heath. Insomnia or difficulty sleeping is also a prevalent issue, affecting up to 35% of the population at some point in their lives. Insomnia is linked to poor mood, increased use of health care resources, and decreased quality of life as well as possible links to cardiovascular risk factors and disease. Studies have shown an increase in cortisol levels, decreased immunity, and increased markers of sympathetic activity in sleep-deprived healthy subjects and those with chronic insomnia. The literature also shows that subjective complaints consistent with chronic insomnia and shortened sleep time, both independently and in combination, can be associated with the development of diabetes, hypertension, and cardiovascular disease. In this article, we will explore the relationship and strength of association between insufficient sleep and insomnia with these health conditions.
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Affiliation(s)
- Meena S Khan
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA; Department of Neurology, The Ohio State University, Columbus, OH, USA.
| | - Rita Aouad
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
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Li CI, Lin CC, Liu CS, Lin CH, Yang SY, Li TC. Sleep duration predicts subsequent long-term mortality in patients with type 2 diabetes: a large single-center cohort study. Cardiovasc Diabetol 2022; 21:60. [PMID: 35477572 PMCID: PMC9045470 DOI: 10.1186/s12933-022-01500-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/12/2022] [Indexed: 12/17/2022] Open
Abstract
Background Sleep duration is associated with mortality. However, prior studies exploring whether sleep duration predicts subsequent long-term mortality in patients with diabetes are limited. This study aims to examine whether metabolic factors affect the associations between baseline sleep duration and subsequent risks of all-cause, expanded, and non-expanded cardiovascular disease (CVD) mortalities among patients with type 2 diabetes (T2D). Methods A total of 12,526 T2D patients aged 30 years and older, with a follow-up period ≥ 3 years, were identified from the Diabetes Case Management Program of a medical center in Taiwan. Sleep duration was measured using computerized questionnaires by case managers, and the time frame for this question was 1 month prior to the interview date. Sleep duration in relation to subsequent mortality from all causes, expanded CVD, and non-expanded CVD was examined using Cox proportional hazard models. Results Within 10 years of follow-up, 2918 deaths (1328 CVD deaths and 1590 non-CVD deaths) were recorded. A J-shaped association was observed for all-cause, expanded CVD, and non-expanded CVD mortalities, and the lowest risks were observed for patients with 5–7 h of sleep. The significant joint effects included sleep duration of more or less than 7 h with age ≥ 65 years [adjusted HRs: 4.00 (3.49–4.60)], diabetes duration ≥ 5 years [1.60 (1.40–1.84)], age at diabetes diagnosis ≤ 45 years [1.69 (1.38–2.07)], insulin use [1.76 (1.54–2.03)], systolic blood pressure/diastolic blood pressure > 130/85 mmHg [1.24 (1.07–1.43)], triglyceride ≥ 150 mg/dL [1.38 (1.22–1.56)], HbA1c ≥ 7% [1.31 (1.13–1.52)], and body mass index < 27 kg/m2 [1.31 (1.17–1.45)] for all-cause mortality. Conclusion A J-shaped association was observed between sleep duration and all-cause and expanded CVD mortality, and a sleep duration of 5–7 h had the lowest mortality risk. Sleep duration also showed significant synergistic interactions with diabetes duration but shared an antagonistic interaction with age and obesity. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01500-0.
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Affiliation(s)
- Chia-Ing Li
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Chieh Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.,Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chiu-Shong Liu
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.,Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Hsueh Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Shing-Yu Yang
- Department of Public Health, College of Public Health, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist., Taichung, 406040, Taiwan
| | - Tsai-Chung Li
- Department of Public Health, College of Public Health, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist., Taichung, 406040, Taiwan. .,Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.
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Kim JS, Dashti HS, Huang T, Cade BE, Podolanczuk AJ, O’Hearn DJ, Hoffman EA, Wang H, Blaikley J, Barr RG, Redline S. Associations of sleep duration and sleep-wake rhythm with lung parenchymal abnormalities on computed tomography: The MESA study. J Sleep Res 2022; 31:e13475. [PMID: 34498326 PMCID: PMC8891036 DOI: 10.1111/jsr.13475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/22/2021] [Accepted: 08/16/2021] [Indexed: 11/29/2022]
Abstract
Impairment of the circadian rhythm promotes lung inflammation and fibrosis in pre-clinical models. We aimed to examine whether short and/or long sleep duration and other markers of sleep-wake patterns are associated with a greater burden of lung parenchymal abnormalities on computed tomography among adults. We cross-sectionally examined associations of sleep duration captured by actigraphy with interstitial lung abnormalities (n = 1111) and high attenuation areas (n = 1416) on computed tomography scan in the Multi-Ethnic Study of Atherosclerosis at Exam 5 (2010-2013). We adjusted for potential confounders in logistic and linear regression models for interstitial lung abnormalities and high attenuation area, respectively. High attenuation area models were also adjusted for study site, lung volume imaged, radiation dose and stratified by body mass index. Secondary exposures were self-reported sleep duration, sleep fragmentation index, sleep midpoint and chronotype. The mean age of those with longer sleep duration (≥ 8 hr) was 70 years and the prevalence of interstitial lung abnormalities was 14%. Increasing actigraphy-based sleep duration among participants with ≥ 8 hr of sleep was associated with a higher adjusted odds of interstitial lung abnormalities (odds ratio of 2.66 per 1-hr increment, 95% confidence interval 1.42-4.99). Longer sleep duration and higher sleep fragmentation index were associated with greater high attenuation area on computed tomography among participants with a body mass index < 25 kg m-2 (p-value for interaction < 0.02). Self-reported sleep duration, later sleep midpoint and evening chronotype were not associated with outcomes. Actigraphy-based longer sleep duration and sleep fragmentation were associated with a greater burden of lung abnormalities on computed tomography scan.
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Affiliation(s)
- John S. Kim
- Department of Medicine, University of Virginia School of
Medicine, Charlottesville, VA, USA
- Department of Medicine, Columbia University Irving Medical
Center, New York, NY, USA
| | - Hassan S. Dashti
- Center for Genomic Medicine and Department of Anesthesia,
Critical Care, and Pain Medicine, Center for Genomic Medicine, Massachusetts General
Hospital and Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics, Broad
Institute, Cambridge, MA, USA
| | - Tianyi Huang
- Channing Division of Network Medicine, Brigham and
Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston,
MA, USA
| | - Brian E. Cade
- Program in Medical and Population Genetics, Broad
Institute, Cambridge, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston,
MA, USA
- Division of Sleep and Circadian Disorders, Brigham and
Women’s Hospital, Boston, MA, USA
| | - Anna J. Podolanczuk
- Division of Pulmonary and Critical Care Medicine, Weill
Cornell Medical Center, New York, NY, USA
| | - Daniel J. O’Hearn
- Department of Medicine, University of Virginia School of
Medicine, Charlottesville, VA, USA
| | - Eric A. Hoffman
- Departments of Radiology, Medicine, and Biomedical
Engineering, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Heming Wang
- Program in Medical and Population Genetics, Broad
Institute, Cambridge, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston,
MA, USA
- Division of Sleep and Circadian Disorders, Brigham and
Women’s Hospital, Boston, MA, USA
| | - John Blaikley
- Faculty of Biology, Medicine and Health, The University
of Manchester, Manchester, United Kingdom
- Manchester University National Health Service Foundation
Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - R. Graham Barr
- Department of Medicine, Columbia University Irving Medical
Center, New York, NY, USA
- Department of Epidemiology, Mailman School of Public
Health, New York, NY, USA
| | - Susan Redline
- Channing Division of Network Medicine, Brigham and
Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston,
MA, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine,
Beth Israel Deaconess Medical Center, Boston, MA, USA
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Wang L, Zhang S, Yu M, Yuan J. Association between insomnia and subclinical atherosclerosis among Chinese steelworkers: a cross-sectional survey. Arch Public Health 2022; 80:80. [PMID: 35287740 PMCID: PMC8919587 DOI: 10.1186/s13690-022-00834-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Insomnia is a common prevalent sleep disorder. Difficulty maintaining sleep or poor in quality in insomnia caused by disrupted or misaligned circadian rhythms may play an important role in the development of atherosclerosis. This study aimed to examine the association between insomnia and subclinical atherosclerosis in Chinese steelworkers. Methods A total of 3240 subjects from a large enterprise located in northern China were included in this study. The Athens Insomnia Scale (AIS) was used to assess the status of insomnia. Subclinical atherosclerosis was evaluated using ultrasonographic measurements of carotid plaque. Multivariable logistic regression was used to identify association between insomnia and carotid atherosclerosis. Results The overall prevalence of insomnia and carotid plaque were 35.3 and 31.7% in the study population. Compared with non-insomnia workers, significantly increased odds of carotid plaque were observed among insomnia workers after adjusting for potential confounders, odds ratio (OR) = 1.38, 95% confidence interval (CI): 1.17 to 1.63. Exposure to current shift work and insomnia simultaneously can significantly elevated the odds of carotid plaque. Conclusion Insomnia is associated with elevated odds of carotid atherosclerosis in male steelworkers. Insomnia problems of workers should receive further attention in occupational worker health interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-022-00834-1.
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Affiliation(s)
- Lihua Wang
- Department of Epidemiology and Health Statistics, School of Public Health. North China University of Science and Technology, Tangshan, Hebei Province, China
| | - Shengkui Zhang
- Department of Epidemiology and Health Statistics, School of Public Health. North China University of Science and Technology, Tangshan, Hebei Province, China
| | - Miao Yu
- Department of Epidemiology and Health Statistics, School of Public Health. North China University of Science and Technology, Tangshan, Hebei Province, China
| | - Juxiang Yuan
- Department of Epidemiology and Health Statistics, School of Public Health. North China University of Science and Technology, Tangshan, Hebei Province, China.
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Hilow HJ, Whibley D, Kratz AL, Ghanbari H. A focus group study to inform design of a symptom management intervention for adults with atrial fibrillation. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2022; 2:246-255. [PMID: 35265916 PMCID: PMC8890334 DOI: 10.1016/j.cvdhj.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Current symptom management approaches for patients with atrial fibrillation (AF) focus on addressing heart rhythm and do not include management of behavioral or emotional contributors to symptom manifestation or severity. Objective To inform content development of a digitally delivered AF symptom self-management program by exploring patients’ experiences of the impact of AF symptoms and their perspectives on behavioral approaches to symptom management. Methods This was a qualitative study of 3 focus groups composed of adults living with symptomatic AF. Group transcripts underwent thematic content analysis to identify themes and subthemes. Themes were matched to available self-management strategies that could be adapted for use in a digitally delivered AF symptom self-management program. Results Six major themes (with subthemes) were identified: symptoms (anxiety, fatigue, stress/other negative emotions, AF-specific symptoms, heart rhythm); social aspects (social impact, social support); AF treatments (medication, procedures); health behaviors (sleep, physical activity, hydration, breathing/mindfulness/relaxation); positive emotions; and AF education and information gathering. Symptom self-management strategies were identified that could be used to address these symptom-related themes. Conclusion Patients with AF reported a wide range of emotional, physical, and social impacts of the condition. They endorsed attempts to self-manage symptoms and an interest in learning more about how to effectively self-manage. Findings indicate the potential for a digital self-management program to address existing gaps in AF symptom–related care.
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Affiliation(s)
- Henry J. Hilow
- Section of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Daniel Whibley
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan
| | - Anna L. Kratz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan
| | - Hamid Ghanbari
- Section of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
- Address reprint requests and correspondence: Dr Hamid Ghanbari, Department of Internal Medicine, Section of Cardiology, University of Michigan, 1425 E Ann St, Ann Arbor, MI 48109.
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35
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Imes CC, Bizhanova Z, Sereika SM, Korytkowski MT, Atwood CW, Burke LE, Kariuki J, Morris JL, Stansbury R, Strollo PJ, Chasens ER. Metabolic outcomes in adults with type 2 diabetes and sleep disorders. Sleep Breath 2022; 26:339-346. [PMID: 34105104 PMCID: PMC8655315 DOI: 10.1007/s11325-021-02408-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/13/2021] [Accepted: 05/18/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Insomnia is frequently co-morbid with obstructive sleep apnea (OSA); the effect of insomnia or co-morbid insomnia and OSA (OSA + I) on associated metabolic outcomes in adults with type 2 diabetes (T2D) remains unclear. This study in adults with T2D compared metabolic outcomes among persons with OSA, insomnia, or OSA + I. METHODS This study analyzed baseline data from the Diabetes Sleep Treatment Trial of persons recruited for symptoms of OSA or poor sleep quality. Home sleep studies determined OSA presence and severity. Insomnia was evaluated using the Insomnia Severity Index. Height and weight to calculate body mass index (BMI) and blood for laboratory values were obtained. Multivariate general linear models were used to examine the impact of the type of sleep disorder and sociodemographic, lifestyle, and sleep risk factors on metabolic outcomes. RESULTS Participants (N = 253) were middle-aged (56.3 ± 10.5 years), white (60.5%), obese (mean BMI of 35.3 ± 7.1 kg/m2), and male (51.4%) with poor glucose control (mean HbA1c of 8.0 ± 1.8%). Most participants had OSA + I (42.7%) or insomnia only (41.0%). HbA1c and BMI differed among the sleep disorder groups. In addition, in the adjusted models, having insomnia only, compared to OSA only, was associated on average with higher HbA1c levels (b = 1.08 ± 0.40, p < 0.007) and lower BMI (b = - 7.03 ± 1.43, p < 0.001). CONCLUSIONS Findings suggest that insomnia frequently co-exists with OSA, is independently associated with metabolic outcomes in adults with T2D, and should be considered in investigations of the effects of OSA in persons with T2D. TRIAL REGISTRATION Diabetes-Obstructive Sleep Apnea Treatment Trial (NCT01901055), https: Clinicaltrials.gov/ct2/show/NCT01901055; Registration date: July 17, 2013.
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Affiliation(s)
| | - Zhadyra Bizhanova
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Susan M. Sereika
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA,Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Charles W. Atwood
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lora E. Burke
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA,Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jacob Kariuki
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jonna L. Morris
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert Stansbury
- School of Medicine, West Virginia University, Morgantown, WV, USA
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36
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Diabetes and anxiety were associated with insomnia among Japanese male truck drivers. Sleep Med 2022; 90:102-108. [DOI: 10.1016/j.sleep.2022.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 11/17/2022]
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Liu X, Li C, Sun X, Yu Y, Si S, Hou L, Yan R, Yu Y, Li M, Li H, Xue F. Genetically Predicted Insomnia in Relation to 14 Cardiovascular Conditions and 17 Cardiometabolic Risk Factors: A Mendelian Randomization Study. J Am Heart Assoc 2021; 10:e020187. [PMID: 34315237 PMCID: PMC8475657 DOI: 10.1161/jaha.120.020187] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background This Mendelian randomization study aims to investigate causal associations between genetically predicted insomnia and 14 cardiovascular diseases (CVDs) as well as the potential mediator role of 17 cardiometabolic risk factors. Methods and Results Using genetic association estimates from large genome‐wide association studies and UK Biobank, we performed a 2‐sample Mendelian randomization analysis to estimate the associations of insomnia with 14 CVD conditions in the primary analysis. Then mediation analysis was conducted to explore the potential mediator role of 17 cardiometabolic risk factors using a network Mendelian randomization design. After correcting for multiple testing, genetically predicted insomnia was consistent significantly positively associated with 9 of 14 CVDs, those odds ratios ranged from 1.13 (95% CI, 1.08–1.18) for atrial fibrillation to 1.24 (95% CI, 1.16–1.32) for heart failure. Moreover, genetically predicted insomnia was consistently associated with higher body mass index, triglycerides, and lower high‐density lipoprotein cholesterol, each of which may act as a mediator in the causal pathway from insomnia to several CVD outcomes. Additionally, we found very little evidence to support a causal link between insomnia with abdominal aortic aneurysm, thoracic aortic aneurysm, total cholesterol, low‐density lipoprotein cholesterol, glycemic traits, renal function, and heart rate increase during exercise. Finally, we found no evidence of causal associations of genetically predicted body mass index, high‐density lipoprotein cholesterol, or triglycerides on insomnia. Conclusions This study provides evidence that insomnia is associated with 9 of 14 CVD outcomes, some of which may be partially mediated by 1 or more of higher body mass index, triglycerides, and lower high‐density lipoprotein cholesterol.
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Affiliation(s)
- Xinhui Liu
- Department of Biostatistics School of Public Health Cheeloo College of MedicineShandong University Jinan Shandong China.,Institute for Medical Dataology Cheeloo College of MedicineShandong University Jinan Shandong China
| | - Chuanbao Li
- Department of Emergency and Chest Pain Center Qilu HospitalCheeloo College of MedicineShandong University Jinan Shandong China
| | - Xiaoru Sun
- Department of Biostatistics School of Public Health Cheeloo College of MedicineShandong University Jinan Shandong China.,Institute for Medical Dataology Cheeloo College of MedicineShandong University Jinan Shandong China
| | - Yuanyuan Yu
- Department of Biostatistics School of Public Health Cheeloo College of MedicineShandong University Jinan Shandong China.,Institute for Medical Dataology Cheeloo College of MedicineShandong University Jinan Shandong China
| | - Shucheng Si
- Department of Biostatistics School of Public Health Cheeloo College of MedicineShandong University Jinan Shandong China.,Institute for Medical Dataology Cheeloo College of MedicineShandong University Jinan Shandong China
| | - Lei Hou
- Department of Biostatistics School of Public Health Cheeloo College of MedicineShandong University Jinan Shandong China.,Institute for Medical Dataology Cheeloo College of MedicineShandong University Jinan Shandong China
| | - Ran Yan
- Department of Biostatistics School of Public Health Cheeloo College of MedicineShandong University Jinan Shandong China.,Institute for Medical Dataology Cheeloo College of MedicineShandong University Jinan Shandong China
| | - Yifan Yu
- Department of Biostatistics School of Public Health Cheeloo College of MedicineShandong University Jinan Shandong China.,Institute for Medical Dataology Cheeloo College of MedicineShandong University Jinan Shandong China
| | - Mingzhuo Li
- Center for Big Data Research in Health and Medicine Shandong Qianfoshan HospitalCheeloo College of MedicineShandong University Jinan Shandong China
| | - Hongkai Li
- Department of Biostatistics School of Public Health Cheeloo College of MedicineShandong University Jinan Shandong China.,Institute for Medical Dataology Cheeloo College of MedicineShandong University Jinan Shandong China
| | - Fuzhong Xue
- Department of Biostatistics School of Public Health Cheeloo College of MedicineShandong University Jinan Shandong China.,Institute for Medical Dataology Cheeloo College of MedicineShandong University Jinan Shandong China
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Grimaldi D, Reid KJ, Papalambros NA, Braun RI, Malkani RG, Abbott SM, Ong JC, Zee PC. Autonomic dysregulation and sleep homeostasis in insomnia. Sleep 2021; 44:6029088. [PMID: 33295989 DOI: 10.1093/sleep/zsaa274] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 11/24/2020] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES Insomnia is common in older adults, and is associated with poor health, including cognitive impairment and cardio-metabolic disease. Although the mechanisms linking insomnia with these comorbidities remain unclear, age-related changes in sleep and autonomic nervous system (ANS) regulation might represent a shared mechanistic pathway. In this study, we assessed the relationship between ANS activity with indices of objective and subjective sleep quality in older adults with insomnia. METHODS Forty-three adults with chronic insomnia and 16 age-matched healthy sleeper controls were studied. Subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), objective sleep quality by electroencephalogram spectral components derived from polysomnography, and ANS activity by measuring 24-h plasma cortisol and norepinephrine (NE). RESULTS Sleep cycle analysis displayed lower slow oscillatory (SO: 0.5-1.25 Hz) activity in the first cycle in insomnia compared to controls. In insomnia, 24-h cortisol levels were higher and 24-h NE levels were lower than controls. In controls, but not in insomnia, there was a significant interaction between NE level during wake and SO activity levels across the sleep cycles, such that in controls but not in insomnia, NE level during wake was positively associated with the amount of SO activity in the first cycle. In insomnia, lower 24-h NE level and SO activity in the first sleep cycle were associated with poorer subjective sleep quality. CONCLUSION Dysregulation of autonomic activity may be an underlying mechanism that links objective and subjective measures of sleep quality in older adults with insomnia, and potentially contribute to adverse health outcomes.
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Affiliation(s)
- Daniela Grimaldi
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Kathryn J Reid
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Nelly A Papalambros
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Rosemary I Braun
- Biostatistics Division, Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.,Department of Engineering Sciences and Applied Mathematics, Northwestern University, Evanston, IL, USA.,Department of Physics and Astronomy, Northwestern University, Evanston, IL, USA
| | - Roneil G Malkani
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Sabra M Abbott
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Jason C Ong
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Phyllis C Zee
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
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von Schantz M, Ong JC, Knutson KL. Associations between sleep disturbances, diabetes and mortality in the UK Biobank cohort: A prospective population-based study. J Sleep Res 2021; 30:e13392. [PMID: 34101927 PMCID: PMC8612946 DOI: 10.1111/jsr.13392] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 04/15/2021] [Accepted: 04/29/2021] [Indexed: 11/29/2022]
Abstract
Non-communicable diseases, including diabetes, are partly responsible for the deceleration of improvements of life expectancy in many countries. Diabetes is also associated with sleep disturbances. Our aim was to determine whether sleep disturbances, particularly in people with diabetes, were associated with increased mortality risk. Data from the UK Biobank were analysed (n = 487,728, mean follow-up time = 8.9 years). The primary exposure was sleep disturbances, assessed through the question: Do you have trouble falling asleep at night or do you wake up in the middle of the night? The primary outcome was mortality. We also dichotomized sleep disturbances into "never/sometimes" versus "usually" (frequently), and combined with the presence/absence of diabetes: 24.2% of participants reported "never/rarely" experiencing sleep disturbances, 47.8% "sometimes" and 28.0% "usually". In age- and sex-adjusted models, frequent sleep disturbances were associated with an increased risk of all-cause mortality (hazard ratio [HR], 1.31; 95% confidence interval [CI], 1.26-1.37), which remained significant in the fully adjusted model (HR 1.13, 95% CI 1.09-1.18). The presence of both diabetes and frequent sleep disturbances was associated with greater risk of all-cause mortality than either condition alone. In the fully adjusted model, the hazard ratio for all-cause mortality was 1.11 (95% CI, 1.07-1.15) for frequent sleep disturbances alone, 1.67 (95% CI, 1.57-1.76) for diabetes alone and 1.87 for both (95% CI, 1.75-2.01). Frequent sleep disturbances (experienced by more than one quarter of the sample) were associated with increased risk of all-cause mortality. Mortality risk was highest in those with both diabetes and frequent sleep disturbances. Complaints of difficulty falling or staying asleep merit attention by physicians.
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Affiliation(s)
| | - Jason C Ong
- Department of Neurology, Center for Circadian and Sleep Medicine, Northwestern University, Chicago, IL, USA
| | - Kristen L Knutson
- Department of Neurology, Center for Circadian and Sleep Medicine, Northwestern University, Chicago, IL, USA
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Wang W, Meng H, Liu Y, Yin W, Li Z, Wan M, Zou L, Zhang D. Effects of sleep duration and sleep quality in early pregnancy and their interaction on gestational diabetes mellitus. Sleep Breath 2021; 26:489-496. [PMID: 33929688 DOI: 10.1007/s11325-021-02391-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 04/06/2021] [Accepted: 04/23/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To examine the association of sleep duration and quality in early pregnancy with gestational diabetes mellitus (GDM), and explore their interaction effect on GDM. METHODS Participants from 2 hospitals were enrolled in this case-control study between April 2018 and November 2020. Sleep duration and quality were measured using the Pittsburg Sleep Quality Index (PSQI). RESULTS A total of 1300 participants (396 GDM and 904 controls) were included. After adjusting for potential confounders, higher global PSQI scores or poor sleep quality were associated with GDM with odds ratios of 1.13 (95% CI 1.07, 1.19, p < 0.001) and 1.75 (95% CI 1.29, 2.38, p < 0.001), respectively; sleep duration < 7 h, 9-9.9 h and ≥ 10 h were all associated with increased GDM with odds ratios of 4.28 (95% CI 2.51, 7.31, p < 0.001), 1.69 (95% CI 1.20, 2.39, p = 0.003), and 4.42 (95% CI 3.01, 6.50, p < 0.001), respectively. In the stratified analysis based on sleep duration, the effect of poor sleep quality on GDM in the < 7 h group (OR 5.47, 95% CI 2.57, 11.64, p < 0.001) was much stronger than that in the 7-8.9 h group (OR 1.24, 95% CI 0.81, 1.91, p = 0.327), and the p value of the interaction was 0.011. CONCLUSIONS Poor sleep quality and short or long sleep duration in early pregnancy were all associated with GDM, and an interaction effect between short sleep duration and poor sleep quality on GDM was noted.
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Affiliation(s)
- Weiye Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Qingdao University, 38 Dengzhou Road, Qingdao, Shandong, 266021, People's Republic of China
- Department of Public Health and Preventive Medicine, School of Medicine, Jinggangshan University, 28 Xueyuan Road, Ji'an, Jiangxi, 343009, People's Republic of China
| | - Haozhe Meng
- Department of Biomedical Engineering, School of Mechanical and Electrical Engineering, Jinggangshan University, 28 Xueyuan Road, Ji'an, Jiangxi, 343009, People's Republic of China
| | - Yiwa Liu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinggangshan University, 28 Xueyuan Road, Ji'an, Jiangxi, 343009, People's Republic of China
| | - Wei Yin
- Department of Public Health and Preventive Medicine, School of Medicine, Jinggangshan University, 28 Xueyuan Road, Ji'an, Jiangxi, 343009, People's Republic of China
| | - Zetong Li
- Department of Public Health and Preventive Medicine, School of Medicine, Jinggangshan University, 28 Xueyuan Road, Ji'an, Jiangxi, 343009, People's Republic of China
| | - Mengting Wan
- Department of Public Health and Preventive Medicine, School of Medicine, Jinggangshan University, 28 Xueyuan Road, Ji'an, Jiangxi, 343009, People's Republic of China
| | - Linbing Zou
- Department of Obstetrics, Anhui Women and Children Health Hospital, 15 Yimin Road, Hefei, Anhui, 230001, People's Republic of China
| | - Dongfeng Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Qingdao University, 38 Dengzhou Road, Qingdao, Shandong, 266021, People's Republic of China.
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Abdelmaksoud AA, Salah NY, Ali ZM, Rashed HR, Abido AY. Disturbed sleep quality and architecture in adolescents with type 1 diabetes mellitus: Relation to glycemic control, vascular complications and insulin sensitivity. Diabetes Res Clin Pract 2021; 174:108774. [PMID: 33745994 DOI: 10.1016/j.diabres.2021.108774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/15/2021] [Accepted: 03/15/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Insufficient sleep duration and poor sleep quality have been linked to insulin resistance and impaired glucose metabolism. However, the relation between sleep disruption and type1 diabetes (T1D) hasn't been thoroughly explored. AIM To study the association between sleep parameters and glycemic control, insulin resistance and micro-vascular complications among adolescent with T1D. METHODOLOGY Sixty adolescents with T1D were compared to 60 matched controls. Diabetes-duration, insulin-therapy, fundus, Epworth Sleepiness Scale-Child Adolescent and the neuropathy disability score were assessed. Fasting lipids, fraction-C of glycosylated hemoglobin(HbA1c) and urinary albumin-excretion were measured with calculation of the insulin sensitivity score(ISS). Overnight polysomnography(PSG) was done. RESULTS Adolescents with T1D had significantly lower sleep efficiency and rapid eye movement(REM) sleep than controls with significantly higher sleep onset latency, non-REM sleep and arousal index(P < 0.001). Although ISS was negatively correlated to total sleep time(P = 0.002); it was positively correlated to sleep efficiency(P < 0.001). HbA1C was negatively correlated to sleep efficiency(<0.001) and REM sleep(P = 0.003) and positively correlated to sleep onset latency(P = 0.005). T1D adolescents with micro-vascular complications had significantly lower sleep efficiency and REM sleep than those without micro-vascular complications. CONCLUSION Poor sleep quality and architecture among adolescents with T1D are associated with impaired glycemic control, insulin resistance and micro-vascular complications.
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Affiliation(s)
- Abeer A Abdelmaksoud
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Nouran Y Salah
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Zeinab M Ali
- Department of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hebatallah R Rashed
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Amal Y Abido
- Department of Pediatrics, Health Insurance Hospital, 6(th) of October, Giza, Egypt
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Zhang HZ, Zhang P, Chang GQ, Xiang QY, Cao H, Zhou JY, Dong ZM, Qiao C, Xu CR, Qin Y, Lou PA. Effectiveness of cognitive behavior therapy for sleep disturbance and glycemic control in persons with type 2 diabetes mellitus: A community-based randomized controlled trial in China. World J Diabetes 2021; 12:292-305. [PMID: 33758648 PMCID: PMC7958479 DOI: 10.4239/wjd.v12.i3.292] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/09/2020] [Accepted: 12/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Poor sleep quality is a common clinical feature in patients with type 2 diabetes mellitus (T2DM), and often negatively related with glycemic control. Cognitive behavioral therapy (CBT) may improve sleep quality and reduce blood sugar levels in patients with T2DM. However, it is not entirely clear whether CBT delivered by general practitioners is effective for poor sleep quality in T2DM patients in community settings.
AIM To test the effect of CBT delivered by general practitioners in improving sleep quality and reducing glycemic levels in patients with T2DM in community.
METHODS A cluster randomized controlled trial was conducted from September 2018 to October 2019 in communities of China. Overall 1033 persons with T2DM and poor sleep quality received CBT plus usual care or usual care. Glycosylated hemoglobin A1c (HbAlc) and sleep quality [Pittsburgh Sleep Quality Index (PSQI)] were assessed. Repeated measures analysis of variance and generalized linear mixed effects models were used to estimate the intervention effects on hemoglobin A1c and sleep quality.
RESULTS The CBT group had 0.64, 0.50, and 0.9 lower PSQI scores than the control group at 2 mo, 6 mo, and 12 mo, respectively. The CBT group showed 0.17 and 0.43 lower HbAlc values than the control group at 6 mo and 12 mo. The intervention on mean ΔHbAlc values was significant at 12 mo (t = 3.68, P < 0.01) and that mean ΔPSQI scores were closely related to ΔHbAlc values (t = 7.02, P < 0.01). Intention-to-treat analysis for primary and secondary outcomes showed identical results with completed samples. No adverse events were reported.
CONCLUSION CBT delivered by general practitioners, as an effective and practical method, could reduce glycemic levels and improve sleep quality for patients with T2DM in community.
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Affiliation(s)
- Huai-Zhong Zhang
- Department of Psychiatry, Xuzhou Third People’s Hospital, Xuzhou 221000, Jiangsu Province, China
| | - Pan Zhang
- Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, Xuzhou 221006, Jiangsu Province, China
| | - Gui-Qiu Chang
- Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, Xuzhou 221006, Jiangsu Province, China
| | - Quan-Yong Xiang
- Department of Control and Prevention of Chronic Non-communicable Diseases, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, Jiangsu Province, China
| | - Huan Cao
- Department of Psychiatry, Xuzhou Third People’s Hospital, Xuzhou 221000, Jiangsu Province, China
| | - Jin-Yi Zhou
- Department of Control and Prevention of Chronic Non-communicable Diseases, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, Jiangsu Province, China
| | - Zong-Mei Dong
- Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, Xuzhou 221006, Jiangsu Province, China
| | - Cheng Qiao
- Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, Xuzhou 221006, Jiangsu Province, China
| | - Chun-Rong Xu
- Department of Psychiatry, Xuzhou Third People’s Hospital, Xuzhou 221000, Jiangsu Province, China
| | - Yu Qin
- Department of Control and Prevention of Chronic Non-communicable Diseases, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, Jiangsu Province, China
| | - Pei-An Lou
- Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, Xuzhou 221006, Jiangsu Province, China
- Department of Epidemiology and Health Statistics, Xuzhou Medical University, Xuzhou 221006, Jiangsu Province, China
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Dietary variety is associated with sleep efficiency in urban-dwelling older adults: A longitudinal study. Clin Nutr ESPEN 2021; 41:391-397. [PMID: 33487295 DOI: 10.1016/j.clnesp.2020.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 10/19/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND & AIMS Improving sleep quality is important for an aging society. However, no study has been conducted on the association between dietary variety and sleep efficiency among older Japanese adults using longitudinal data. The current study is a longitudinal study that aimed to elucidate the association between dietary variety and sleep efficiency in older Japanese adults. METHODS This study was conducted among older adults (≥70 years old in 2016) in the metropolitan area of Tokyo, Japan, between 2016 and 2018. Dietary variety score (DVS) and sleep efficiency were determined for all participants and were used to assess dietary habits and sleep quality, respectively. A cross-lagged panel analysis was used to consider the prospective associations between DVS and sleep efficiency, and this analysis was performed before and after adjusting for possible covariates in the 2016 data. RESULTS After adjusting for age, sex, body mass index, current drinking status, current smoking status, exercise habits, living (alone or with others) style, the Japanese version of the Geriatric Depression Scale (Short Form), sleep duration and retiring time the DVS in 2016 predicted the sleep efficiency in 2018 (β = 0.130, p < 0.05). CONCLUSION The possibility that DVS can predict sleep efficiency 2 years later was demonstrated.
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Ma CC, Gu JK, Andrew ME, Fekedulegn D, Violanti JM, Klein B, Tinney-Zara C, Charles LE. Associations of Sleep Measures with Retinal Microvascular Diameters among Police Officers. Ophthalmic Epidemiol 2020; 27:487-497. [PMID: 32576060 PMCID: PMC7572729 DOI: 10.1080/09286586.2020.1783688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 04/01/2020] [Accepted: 05/28/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE We examined cross-sectional associations of sleep measures with central retinal artery equivalent (CRAE) and central retinal vein equivalent (CRVE) and investigated whether sex and race/ethnicity modified these associations. METHODS Participants (N = 202; 78% white; 71% men) were enrolled in the Buffalo Cardio-metabolic Occupational Police Stress study (2011-2014). Wrist actigraphy was used to assess sleep measures including sleep duration, sleep efficiency, sleep onset latency, wake after sleep onset, number of awakenings, and longest wake episode. CRAE and CRVE were obtained from fundus photography of retina and were averaged from both eyes per officer. RESULTS We observed significant associations between sleep efficiency and CRVE (β = -2.81 µm; P= .046), and between longest wake episode and CRVE (β = 3.24 µm; P= .021). Adjustments for demographics, lifestyles, and physical and psychological factors attenuated these associations. Sex modified the independent associations of sleep onset latency and longest wake episode with CRVE. One standard deviation (SD) increase in sleep onset latency was associated with 4.81 µm larger CRVE (P= .028) (P-interaction = 0.098), and one SD increase in longest wake episode was associated with 4.62 µm larger CRVE (P= .032) (P-interaction = 0.115) among men. Race/ethnicity also modified the association between longest wake episode and CRVE (P-interaction = 0.088). A significant association was observed only among white officers (β = 4.96 µm; P= .025). CONCLUSIONS We found that poor sleep quality, measured by longest wake episode, was positively and independently associated with retinal venular diameter among white and male officers. Longitudinal studies are warranted to assess whether poor sleep quality is a risk factor for retinal diameter changes.
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Affiliation(s)
- Claudia C Ma
- Health Effects Laboratory Division, Bioanalytics Branch, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, USA
| | - Ja K Gu
- Health Effects Laboratory Division, Bioanalytics Branch, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, USA
| | - Michael E Andrew
- Health Effects Laboratory Division, Bioanalytics Branch, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, USA
| | - Desta Fekedulegn
- Health Effects Laboratory Division, Bioanalytics Branch, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, USA
| | - John M Violanti
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, The State University of New York at Buffalo, Buffalo, New York, USA
| | - Barbara Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin, USA
| | - Cathy Tinney-Zara
- Health Effects Laboratory Division, Bioanalytics Branch, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, USA
| | - Luenda E Charles
- Health Effects Laboratory Division, Bioanalytics Branch, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, USA
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Farooque R, Herekar F, Iftikhar S, Patel MJ. The Frequency of Poor Sleep Quality in Patients With Diabetes Mellitus and Its Association With Glycemic Control. Cureus 2020; 12:e11608. [PMID: 33364126 PMCID: PMC7752787 DOI: 10.7759/cureus.11608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and objective Emerging evidence suggests that sleep problems are more common among individuals with diabetes mellitus (DM) than in the general population; these sleep issues are associated with poor glycemic control and they negatively affect the overall prognosis of the disease by increasing cardiometabolic risk. Our study aimed to determine the frequency of poor sleep quality and its association with glycemic control among Pakistani adult patients with DM. Methods This prospective cross-sectional study was conducted at the outpatient department (OPD) of The Indus Hospital (TIH), Karachi, and included 329 participants. To be eligible, participants had to be 14 years or older, should have been visiting the OPD at TIH for six months or more to seek treatment for DM, and had to give informed consent. Participants were assessed for poor sleep quality using the Pittsburgh Sleep Quality Index (PSQI) score and glycemic control using HbA1C levels ascertained through electronic health record review, with higher HbA1C levels reflecting poorer glycemic control. Results Two-thirds of the participants were females (n=212; 64.4%), and approximately 90% of the participants were married (n=292; 88.8%); 57% (n=188) of the participants were found to have poor sleep quality (PSQI of >5) and 233 (70.82%) had poor glycemic control (HbA1C of >7). Interestingly, no significant difference was observed in the PSQI scores between participants with controlled diabetes and those with uncontrolled diabetes. Conclusion Based on our findings, there is a high prevalence of sleep disturbance among Pakistani adults with DM, and we believe this necessitates the fostering of sleep-promoting interventional research in the country, as it might be highly rewarding and would positively affect the overall prognosis for diabetes by improving cardiometabolic risks. However, our results did not indicate any significant association between sleep quality and glycemic control. Further research should be conducted to explore the association between sleep disturbance and DM in Pakistani adults, by employing objective measures of sleep quality and involving a larger sample of individuals with DM to determine if these results hold true.
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Affiliation(s)
- Rabia Farooque
- Internal Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Fivzia Herekar
- Internal Medicine and Infectious Diseases, The Indus Hospital, Karachi, PAK
| | - Sundus Iftikhar
- Maternal and Child Health Program, Interactive Research and Development, Karachi, PAK
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Abstract
To examine the relationship between self-reported sleep duration and arterial stiffness in a large Chinese population from Kailuan.From July 2010 to December 2015, a total of 17,018 participants aged 18 to 98 years were enrolled after excluding those with a history of cerebrovascular events and coronary artery disease. Participants were divided into 5 categories according to self-reported night sleep duration: ≤5.0, 6.0, 7 (ref), 8, and ≥9.0 hours. A brachial-ankle pulse wave velocity ≥1400 cm/s was considered to represent arterial stiffness. Multivariate logistic regression models were used to calculate the odds ratio (OR) and confidence interval (CI) for arterial stiffness according to the sleep duration.Using 7 hours of sleep as the reference group, the multivariable adjusted ORs (95% CI) for arterial stiffness were 1.00 (0.87-1.16), 1.00 (0.90-1.11), 1.0 (ref), 1.03 (0.93-1.14), and 1.48 (1.05-2.08) from the lowest to highest category of sleep duration, respectively. Secondary analysis showed no evidence of interactions between sleep duration and age/sex on the risk of arterial stiffness (P-interaction = .390/.198).A long night sleep duration was associated with increased arterial stiffness.
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Affiliation(s)
- Xiaoxue Liu
- Department of Cardiology, Tangshan People's Hospital
| | - Qiaofeng Song
- Department of Cardiology, Tangshan People's Hospital
| | - Shouling Wu
- Department of Cardiology, North China University of Science and Technology, Tangshan, China
| | - Xizhu Wang
- Department of Cardiology, Tangshan People's Hospital
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Brindle RC, Yu L, Buysse DJ, Hall MH. Empirical derivation of cutoff values for the sleep health metric and its relationship to cardiometabolic morbidity: results from the Midlife in the United States (MIDUS) study. Sleep 2020; 42:5488780. [PMID: 31083710 DOI: 10.1093/sleep/zsz116] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 03/15/2019] [Indexed: 12/27/2022] Open
Abstract
STUDY OBJECTIVES Emerging evidence supports a multidimensional perspective of sleep in the context of health. The sleep health model, and composite sleep health score, are increasingly used in research. However, specific cutoff values that differentiate "good" from "poor" sleep, have not been empirically derived and its relationship to cardiometabolic health is less-well understood. We empirically derived cutoff values for sleep health dimensions and examined the relationship between sleep health and cardiometabolic morbidity. METHODS Participants from two independent Biomarker Studies in the MIDUS II (N = 432, 39.8% male, age = 56.92 ± 11.45) and MIDUS Refresher (N = 268, 43.7% male, age = 51.68 ± 12.70) cohorts completed a 1-week study where sleep was assessed with daily diaries and wrist actigraphy. Self-reported physician diagnoses, medication use, and blood values were used to calculate total cardiometabolic morbidity. Receiver operating characteristic (ROC) curves were generated in the MIDUS II cohort for each sleep health dimension to determine cutoff values. Using derived cutoff values, logistic regression was used to examine the relationship between sleep health scores and cardiometabolic morbidity in the MIDUS Refresher cohort, controlling for traditional risk factors. RESULTS Empirically derived sleep health cutoff values aligned reasonably well to cutoff values previously published in the sleep health literature and remained robust across physical and mental health outcomes. Better sleep health was significantly associated with a lower odds of cardiometabolic morbidity (OR [95% CI] = 0.901 [0.814-0.997], p = .044). CONCLUSIONS These results contribute to the ongoing development of the sleep health model and add to the emerging research supporting a multidimensional perspective of sleep and health.
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Affiliation(s)
- Ryan C Brindle
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.,Department of Psychology and Neuroscience Program, Washington and Lee University, Lexington, VA
| | - Lan Yu
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Martica H Hall
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Campbell LM, Tang B, Watson CWM, Higgins M, Cherner M, Henry BL, Moore RC. Cannabis use is associated with greater total sleep time in middle-aged and older adults with and without HIV: A preliminary report utilizing digital health technologies. ACTA ACUST UNITED AC 2020; 3:180-189. [PMID: 32905460 DOI: 10.26828/cannabis.2020.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Current literature on the effect of cannabis use on sleep quality is mixed, and few studies have used objectively-measured sleep measures or real-time sampling of cannabis use to examine this relationship. The prevalence of cannabis use among older adults and persons living with HIV has increased in recent years, and poor sleep quality is elevated in these populations as well. However, research examining cannabis-sleep relationships in these populations is lacking. Thus, we aimed to examine the relationship between daily cannabis use and subsequent objectively-measured sleep quality in middle-aged and older adults with and without HIV. In this pilot study, seventeen (11 HIV+, 6 HIV-) adults aged 50-70 who consumed cannabis completed four daily smartphone-based surveys for 14 days, in which they reported their cannabis use (yes/no) since the last survey. Participants also wore actigraphy watches during the 14-day period to objectively assess sleep quality (i.e., efficiency, total sleep time, and sleep fragmentation). In linear mixed-effects models, cannabis use was significantly associated with greater subsequent total sleep time (β=0.56; p=0.046). Cannabis use was not related to a change in sleep efficiency (β=1.50; p=0.46) nor sleep fragmentation (β=0.846, p=0.756) on days with cannabis use versus days without cannabis use. These preliminary results indicate cannabis use may have a positive effect on sleep duration in middle-aged and older adults. However, future studies with larger sample sizes that assess cannabis use in more detail (e.g., route of administration, dose, reason for use) are needed to further understand this relationship.
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Affiliation(s)
- Laura M Campbell
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA.,Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Bin Tang
- Department of Psychiatry, University of California San Diego, San Diego, CA
| | - C Wei-Ming Watson
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA.,Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Michael Higgins
- Exercise and Physical Activity Resource Center, University of California, San Diego
| | - Mariana Cherner
- Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Brook L Henry
- Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Raeanne C Moore
- Department of Psychiatry, University of California San Diego, San Diego, CA
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Kakutani-Hatayama M, Kadoya M, Morimoto A, Miyoshi A, Kosaka-Hamamoto K, Kusunoki Y, Shoji T, Koyama H. Associations of sleep quality, sleep apnea and autonomic function with insulin secretion and sensitivity: HSCAA study. Metabol Open 2020; 6:100033. [PMID: 32812920 PMCID: PMC7424809 DOI: 10.1016/j.metop.2020.100033] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/13/2020] [Accepted: 03/15/2020] [Indexed: 01/23/2023] Open
Abstract
RATIONALE AND PURPOSE Although sleep disorders are shown to be involved in occurrence of diabetes, impacts of several quantitative parameters related to sleep on insulin secretion and sensitivity is yet to be elucidated. We cross-sectionally examined relationships among quantitative sleep quality, sleep apnea, and autonomic function with insulin secretion and sensitivity in 399 patients without previous diagnosed diabetes who underwent 75-g oral glucose tolerance test (75gOGTT). METHOD Poor sleep quality (PSQ) was defined as an activity index ≥50 by actigraphy. Sleep apnea was measured by apnomonitor, while standard deviation of all normal-to-normal R-R intervals (SDNN) was measured by active tracer. Parameters of insulin secretion and sensitivity were measured by 75gOGTT. RESULTS Patients with PSQ exhibited significantly lower insulinogenic index (r = 0.155, p < 0.01), a parameter of insulin secretion, with the association independent of other clinical factors including apnea and SDNN (β = -0.156, p < 0.01). In contrast, presence of sleep apnea (r = -0.143, p < 0.05) and the lower SDNN (r = -0.150, p < 0.01) were significantly and inversely associated with BIGTT-S, an insulin sensitivity parameter, with the association of SDNN with BIGTT-S remaining significant even after adjustments for PSQ and sleep apnea (β = -0.111, p < 0.05). CONCLUSION Poor sleep quality is an independent predictor of pancreatic β-cell function, which could be involved in occurrence of type 2 diabetes.
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Affiliation(s)
- Miki Kakutani-Hatayama
- Division of Diabetes, Endocrinology and Clinical Immunology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, 663-8501, Japan
| | - Manabu Kadoya
- Division of Diabetes, Endocrinology and Clinical Immunology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, 663-8501, Japan
| | - Akiko Morimoto
- Division of Diabetes, Endocrinology and Clinical Immunology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, 663-8501, Japan
| | - Akio Miyoshi
- Division of Diabetes, Endocrinology and Clinical Immunology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, 663-8501, Japan
| | - Kae Kosaka-Hamamoto
- Division of Diabetes, Endocrinology and Clinical Immunology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yoshiki Kusunoki
- Division of Diabetes, Endocrinology and Clinical Immunology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, 663-8501, Japan
| | - Takuhito Shoji
- Division of Diabetes, Endocrinology and Clinical Immunology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, 663-8501, Japan
| | - Hidenori Koyama
- Division of Diabetes, Endocrinology and Clinical Immunology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, 663-8501, Japan
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Liao LZ, Li WD, Liu Y, Li JP, Zhuang XD, Liao XX. Causal assessment of sleep on coronary heart disease. Sleep Med 2020; 67:232-236. [DOI: 10.1016/j.sleep.2019.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 06/19/2019] [Accepted: 08/05/2019] [Indexed: 12/23/2022]
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