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Lim DC, Najafi A, Afifi L, Bassetti CLA, Buysse DJ, Han F, Högl B, Melaku YA, Morin CM, Pack AI, Poyares D, Somers VK, Eastwood PR, Zee PC, Jackson CL. The need to promote sleep health in public health agendas across the globe. Lancet Public Health 2023; 8:e820-e826. [PMID: 37777291 PMCID: PMC10664020 DOI: 10.1016/s2468-2667(23)00182-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 10/02/2023]
Abstract
Healthy sleep is essential for physical and mental health, and social wellbeing; however, across the globe, and particularly in developing countries, national public health agendas rarely consider sleep health. Sleep should be promoted as an essential pillar of health, equivalent to nutrition and physical activity. To improve sleep health across the globe, a focus on education and awareness, research, and targeted public health policies are needed. We recommend developing sleep health educational programmes and awareness campaigns; increasing, standardising, and centralising data on sleep quantity and quality in every country across the globe; and developing and implementing sleep health policies across sectors of society. Efforts are needed to ensure equity and inclusivity for all people, particularly those who are most socially and economically vulnerable, and historically excluded.
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Affiliation(s)
- Diane C Lim
- Miami Veterans Affairs Healthcare System, Miami, FL, USA; Division of Pulmonary, Critical Care and Sleep Medicine, University of Miami, Miami, FL, USA
| | - Arezu Najafi
- Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran; Sleep Breathing Disorders Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Lamia Afifi
- Clinical Neurophysiology Unit, School of Medicine, Cairo University Hospitals, Cairo, Egypt
| | | | - Daniel J Buysse
- Center for Sleep and Circadian Science, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Fang Han
- Department of Sleep Medicine, Peking University People's Hospital, Beijing, China
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Yohannes Adama Melaku
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Charles M Morin
- Department of Psychology, and CERVO Brain Research Center, Université Laval, Quebec City, QC, Canada
| | - Allan I Pack
- Sleep Division, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dalva Poyares
- Psychobiology Department, Sleep Medicine Division, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Virend K Somers
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Peter R Eastwood
- Health Futures Institute, Murdoch University, Perth, WA, Australia
| | - Phyllis C Zee
- Division of Sleep Medicine, Center for Circadian and Sleep Medicine, Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Chandra L Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, US Department of Health and Human Services, Research Triangle Park, NC, USA; Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, USA.
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Liu X, Lan H, Bai X, Li Q, Wen Y, Feng M, Tang X. Sleep quality and its associated factors among patients with tuberculosis: A cross-sectional study. Front Public Health 2023; 10:1047425. [PMID: 36684994 PMCID: PMC9847579 DOI: 10.3389/fpubh.2022.1047425] [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: 09/18/2022] [Accepted: 11/29/2022] [Indexed: 01/06/2023] Open
Abstract
Background Tuberculosis (TB) patients commonly suffer from sleep issues owing to various adverse drug reactions (ADRs), disease symptoms, and the contagious nature of their disease. These sleep issues negatively affect the treatment outcome and quality of life. However, the prevalence of sleep disturbance and its associated factors among TB patients have rarely been reported. Methods A total of 497 inpatients with TB from three hospitals in China were enrolled in this cross-sectional study to investigate their sleep quality using the Pittsburgh sleep quality index (PSQI). Clinical data, including demographic information, TB-related stigma, perceived stress, and nutrition- and immunity-related indicators, were also collected to explore the factors associated with sleep disturbance among the recruited patients. Results Approximately 70% of the recruited patients reported a sleep disturbance to varying degrees, presenting poorer global and subjective sleep qualities, longer sleep latency, shorter sleep duration, lower sleep efficiency, more frequent sleep disturbances, greater use of sleeping medication, and more severe daytime dysfunction. Furthermore, the body mass index (BMI), hemoglobin levels, albumin levels, and T lymphocyte count of the patients in the poor sleep quality group were significantly lower than those in the good sleep quality group (p < 0.05). Increasing age, higher income, drug resistance, higher stigma or stress perception, lower albumin levels, and lower CD4 levels were significantly associated with sleep disturbance among TB patients (p < 0.05). Conclusion Three-quarters of the participants were found to suffer from a probable sleep disturbance. And sleep problems are linked to biological traits that interact with psychological, cultural, and social factors in complex ways. It is therefore important to pay attention to the sleep quality of TB patients, especially those with the identified risk factors. Besides, taking care of these risk factors may prove to be an effective sleep management strategy.
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Affiliation(s)
- Xiangmin Liu
- Department of Respiratory and Critical Care Medicine, West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Huizhen Lan
- Ward 3, Department of Tuberculosis, The Fourth People Hospital of Nanning, Nanning, China
| | - Xinyu Bai
- Department of Respiratory and Critical Care Medicine, West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Qian Li
- Department of Respiratory and Critical Care Medicine, West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Wen
- Department of Respiratory and Critical Care Medicine, West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Mei Feng
- Department of Respiratory and Critical Care Medicine, West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Xiangdong Tang
- Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, West China Hospital, Chengdu, China
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Jiménez-Jiménez FJ, Alonso-Navarro H, García-Martín E, Agúndez JAG. Inflammatory factors and restless legs syndrome: A systematic review and meta-analysis. Sleep Med Rev 2022; 68:101744. [PMID: 36634410 DOI: 10.1016/j.smrv.2022.101744] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/15/2022] [Accepted: 12/25/2022] [Indexed: 01/01/2023]
Abstract
The possible role of inflammatory factors in the pathogenesis of restless legs syndrome (RLS) is not well understood. Because several inflammatory diseases have shown an association with the risk for RLS, the measurement of serum/plasma levels of inflammatory factors has been a matter of a scarce number of studies. We performed a systematic review and a meta-analysis to assess the possible association of serum/plasma levels of inflammatory markers with the risk for RLS. Our results showed a significant trend towards higher serum/plasma C reactive protein (CRP) levels and higher neutrophil-to-lymphocyte (NLR) ratio in patients diagnosed with RLS than in controls, although statistical significance disappeared after applying the random-effects model. Further studies are needed to confirm the suggested possible role of inflammatory factors in the pathogenesis of RLS.
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Affiliation(s)
| | | | - Elena García-Martín
- Universidad de Extremadura, University Institute of Molecular Pathology Biomarkers. ARADyAL Instituto de Salud Carlos III, Cáceres, Spain
| | - José A G Agúndez
- Universidad de Extremadura, University Institute of Molecular Pathology Biomarkers. ARADyAL Instituto de Salud Carlos III, Cáceres, Spain
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Zhang H, Li A, Jiang Y, Chen W, Wang J, Zhang P, Deng G, Wang W, Chen J, Lin Y. Sleep quality and influencing factors and correlation with T-lymphocyte subpopulation counts in patients with pulmonary tuberculosis: a cross-sectional study. BMC Infect Dis 2022; 22:956. [PMID: 36550493 PMCID: PMC9773432 DOI: 10.1186/s12879-022-07946-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Patients diagnosed with pulmonary tuberculosis (TB) have poor sleep quality due to multiple factors. We aimed to assess the sleep status and related factors of TB patients in Shenzhen, China. METHODS A questionnaire survey was conducted on 461 TB patients hospitalized at Shenzhen Third People's Hospital from March 2021 to January 2022, and sleep quality was assessed using the Pittsburgh sleep quality index (PSQI). RESULTS A total of 459 valid questionnaires were collected, and 238 of the 459 TB patients had general or poor sleep quality (PSQI > 5). Patients' gender, marriage, nutritional screening score, family atmosphere, fear of discrimination, fear of interactions, and the impact of the disease on their work life had significant effects on sleep quality (P < 0.05); PSQI scores of TB patients were negatively correlated with lymphocyte counts (r = - 0.296, P < 0.01), T-lymphocyte counts (r = - 0.293, P < 0.01), helper T lymphocyte counts (r = - 0.283, P < 0.01), killer T lymphocyte counts (r = - 0.182, P < 0.05), and were positively correlated with depression scores (r = 0.424, P < 0.01). Multivariable logistic regression analysis showed that male (OR = 1.64,95% CI 1.11-2.42, P < 0.05), unmarried (OR = 1.57, 95% CI 1.02-2.42, P < 0.05), NRS score grade 3(OR = 5.35, 95% CI 2.08-15.73, P < 0.01), general family atmosphere (OR = 2.23, 95% CI 1.07-4.93, P < 0.05), and the disease affecting work (OR = 1.66, 95% CI 1.11-2.50, P < 0.05) were factors influencing poor sleep quality. CONCLUSION Most TB patients had varying degrees of sleep disturbance, which may be affected by their gender, marriage, family atmosphere, nutritional status, the effect of the disease on work life, and, depression, as well as lower absolute T-lymphocyte subpopulation counts. Appropriate interventions should be implemented to improve their sleep quality, when treating or caring for such patients.
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Affiliation(s)
- Hailin Zhang
- grid.410741.7Department of Pulmonary Medicine and Tuberculosis, The Third People’s Hospital of Shenzhen, Shenzhen, People’s Republic of China
| | - Ao Li
- grid.412017.10000 0001 0266 8918Hengyang Medical School, School of Nursing, University of South China, Hengyang, People’s Republic of China
| | - Youli Jiang
- grid.412017.10000 0001 0266 8918Hengyang Medical School, School of Nursing, University of South China, Hengyang, People’s Republic of China
| | - Wenqiu Chen
- grid.410741.7Department of Pulmonary Medicine and Tuberculosis, The Third People’s Hospital of Shenzhen, Shenzhen, People’s Republic of China
| | - Jin Wang
- grid.410741.7Department of Pulmonary Medicine and Tuberculosis, The Third People’s Hospital of Shenzhen, Shenzhen, People’s Republic of China
| | - Peize Zhang
- grid.410741.7Department of Pulmonary Medicine and Tuberculosis, The Third People’s Hospital of Shenzhen, Shenzhen, People’s Republic of China
| | - Guofang Deng
- grid.410741.7Department of Pulmonary Medicine and Tuberculosis, The Third People’s Hospital of Shenzhen, Shenzhen, People’s Republic of China
| | - Weiyu Wang
- grid.410741.7Department of Pulmonary Medicine and Tuberculosis, The Third People’s Hospital of Shenzhen, Shenzhen, People’s Republic of China
| | - Jingfang Chen
- grid.410741.7Department of Pulmonary Medicine and Tuberculosis, The Third People’s Hospital of Shenzhen, Shenzhen, People’s Republic of China ,grid.412017.10000 0001 0266 8918Hengyang Medical School, School of Nursing, University of South China, Hengyang, People’s Republic of China
| | - Yi Lin
- grid.410741.7Department of Pulmonary Medicine and Tuberculosis, The Third People’s Hospital of Shenzhen, Shenzhen, People’s Republic of China
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Zhang S, Zhang W, Feng Y, Wan S, Ge J, Qu Z, Li X. Causal relationship between insomnia and tuberculosis: A bi-directional Mendelian randomization analysis. Medicine (Baltimore) 2022; 101:e30509. [PMID: 36123897 PMCID: PMC10662851 DOI: 10.1097/md.0000000000030509] [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] [Received: 11/25/2021] [Accepted: 08/05/2022] [Indexed: 10/14/2022] Open
Abstract
Previous observational studies appear to have established a bi-directional association between sleep disorders and tuberculosis. However, their conclusions are prone to be biased by confounding effects and reverse causation due to the nature of observational studies. Mendelian randomization (MR) approach provides unconfounded estimates of causal effects and overcomes the limitations of observational studies. We performed a bi-directional MR analysis to clarify whether there existed a causal effect of insomnia on tuberculosis, or tuberculosis on insomnia. In forward-direction MR, we chose genome-wide significant (P < .5 × 10-8) and independent (r2 < 0.001) single-nucleotide polymorphisms (SNPs) as instrumental variants (IVs), then extracted effect estimates of these IVs in tuberculosis genome-wide association study (GWAS) dataset to explore causal effect of genetically proxied insomnia on tuberculosis using inverse variance-weighted (IVW), MR-Egger, and weighted median methods. Additionally, we examined robustness and pleiotropy of effect estimates by heterogeneity and sensitivity analysis. Similarly, we investigated causal effect of genetically proxied tuberculosis on insomnia in reverse-direction MR. We revealed no causal relationship between genetically proxied insomnia and tuberculosis using 15 SNPs in forward-direction MR (IVW OR 5.305 [0.100-281.341], P = .410) and reverse-direction MR analysis (ORs and P values were not applicable due to no eligible SNPs in GWAS), with insignificant heterogeneity (Q = 22.6, I2 < 0.001, P = .066) and pleiotropy (intercept = 0.032, SE = 0.057, P = .592) in effect estimates. Our bi-directional MR analysis affirms no causal effect of insomnia on tuberculosis, or tuberculosis on insomnia.
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Affiliation(s)
- Shaobin Zhang
- Department of Surgery, Wuhan Jinyintan Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Wei Zhang
- Department of Critical Care Medicine, Wuhan Jinyintan Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Yan Feng
- Department of Tuberculosis, Wuhan Jinyintan Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Shiqian Wan
- Department of Infectious Diseases, Wuhan Jinyintan Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Jing Ge
- Department of Critical Care Medicine, Wuhan Jinyintan Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Zhaohui Qu
- Department of Critical Care Medicine, Wuhan Jinyintan Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Xin Li
- Department of Surgery, Wuhan Jinyintan Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
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Bellur S, Thota SS, Raj JP, Kallarakal TK, Nadig R. Prevalence And Predictors of Restless Leg Syndrome in Adolescent and Young Adults in Bengaluru City, India - a Cross Sectional Study. Neuroepidemiology 2022; 56:298-305. [PMID: 35671733 DOI: 10.1159/000525336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 05/31/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Restless leg syndrome (RLS) is a sensorimotor disease characterized by an urge to move the legs, often caused by uncomfortable and unpleasant sensations in the legs. It affects the quality of sleep which in turn affects scholastic performance in children and predisposes them to cardiovascular diseases in the long run. Hence, the primary aim of this study was to assess the prevalence and predictors of RLS, poor sleep quality and excessive daytime sleepiness (EDS) Methods: This was a cross sectional observational study conducted between September 2017 and March 2020 in Bengaluru, India including all consenting Pre - university college, Degree college, and Higher secondary school students. After parental consent and assent (if applicable) was obtained, a semi-structured standardized pilot tested questionnaire consisting of the RLS diagnostic criteria, Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale (ESS) and questions on sleep hygiene was administered. The prevalence was expressed as proportions and 95% confidence intervals (95% CI). Regression analysis was done to determine the predictors. RESULTS The overall prevalence (95CI; frequency) of students with RLS, poor sleep quality and EDS in our study population was 8.36% (7.54, 9.24; n=1544/4211), 36.67% (35.21, 38.14; n=1544/4211) and 39.87% (38.39, 41.37; n=1679/4211), respectively. PSQI and Epworth score were the significant predictors of RLS. Age, Epworth score, knowledge score and the number of unacceptable sleep habits were the significant predictors of sleep quality. Female gender, PSQI, RLS, knowledge score and the number of unacceptable sleep habits were the significant predictors of EDS. CONCLUSIONS The prevalence of RLS, those with poor sleep quality and EDS among adolescents and young adults was higher when compared to the historical data of general population in the same city.
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Affiliation(s)
| | | | - Jeffrey Pradeep Raj
- Department of Pharmacology, St. John's Medical College Hospital, Bengaluru, India
| | - Tomy K Kallarakal
- School of Commerce, Finance and Accountancy, Christ University, Bengaluru, India
| | - Raghunandan Nadig
- Department of Neurology, St. John's Medical College Hospital, Bengaluru, India
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Itagi ABH, Dipankar SP, Krishna Veni D, Yunus GY. Evaluation of Spirometric Measures and Quality of Sleep in Tuberculosis Patients and Their Non-Tuberculosis Family Caregivers. Cureus 2021; 13:e17788. [PMID: 34659999 PMCID: PMC8496126 DOI: 10.7759/cureus.17788] [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] [Accepted: 09/07/2021] [Indexed: 12/05/2022] Open
Abstract
Background and Aim Tuberculosis (TB) patients may present with depression and poor sleep as co-morbidities. This presents great challenges including the stigma of increased risk of developing TB while taking care of such patients. This study aims to determine the lung functions, quality of sleep in tuberculosis patients in comparison with non-tuberculosis (non-TB) family caregivers. Methods TB patients and their family caregivers (60 each) visiting the Directly Observed Therapy Short-course (DOTS) clinic at a tertiary care hospital were assessed for spirometric parameters and quality of sleep. Spirometry measurements were performed using a portable, computerized, pre-calibrated, electronic, dry type of machine. Pulmonary function impairment pattern and severity were assessed from spirometry results using a percentage of the predicted values of Forced Vital Capacity (FVC) and Forced Expiratory Volume in one second (FEV1). Descriptive statistics and t-tests were applied using SPSS version 19.0. p≤0.05 was considered significant. Results TB patients had a significantly more (p=0.000) sleep disturbance, daytime dysfunction, and higher mean global Pittsburgh Sleep Quality Index (PSQI) score (9.56±3.97) compared to their non-TB family caregivers (4.36±2.07). The spirometric measures were reduced in TB patients and showed significant differences in actual measures of all parameters except FVC (actual). The % predicted measures of FEV1, FEF 25%-75%, PEFR, and MVV showed significant differences in comparison to their non-TB family caregivers. Conclusions The present study shows that TB patients have a poor quality of sleep and pulmonary functions compared to their non-TB family caregivers. Health care workers need to develop systematic strategies to screen the symptoms of mental disorders in tuberculosis patients and their family caregivers to enable better management of this population.
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Affiliation(s)
| | | | - D Krishna Veni
- Physiology, Nimra Institute of Medical Sciences, Vijayawada, IND
| | - G Y Yunus
- Public Health Dentistry, ESIC Dental College, Kalaburagi, IND
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