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Tran NM, McKay T, Gonzales G, Dusetzina SB, Fry C. Aging in isolation: Sexual orientation differences in navigating cognitive decline. SSM Popul Health 2024; 27:101699. [PMID: 39139827 PMCID: PMC11320599 DOI: 10.1016/j.ssmph.2024.101699] [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: 11/17/2023] [Revised: 05/30/2024] [Accepted: 07/10/2024] [Indexed: 08/15/2024] Open
Abstract
Introduction Subjective cognitive decline is a self-reported measure of worsening memory and day-to-day decision making. Cognitive decline may impair an individual's ability to complete instrumental activities of daily living (IADL) such as preparing meals or taking medication, ultimately limiting one's ability to live independently. People with IADL impairments typically rely on informal care from spouses or children. Interpersonal and structural discrimination towards sexual minority (SM, including lesbian, gay, bisexual, and other queer identified) populations may contribute to disparities in cognitive decline and informal care outcomes. Objective Estimate differences in prevalence, severity, and receipt of social support for subjective cognitive decline stratified by sex and SM status. Methods Cross-sectional study design using a probability sample (n = 172,047) from the Behavioral Risk Factor Surveillance System 2015-2019. Prevalence estimates and multivariable Poisson regression models were used to compare outcomes by sex and sexual identity. Results Compared to heterosexual peers, SM men and women were more likely to experience cognitive decline (15% of SM men, 11% of heterosexual men, 17% of SM women, 11% of heterosexual women). In adjusted models, SM women were 22% more likely (95%CI:3%-44%, p < .05) to report IADL impairments due to cognitive decline but were 17% less likely (95%CI:1%-31%, p < .05) to receive any social support with IADL impairments compared to heterosexual women. In adjusted models, SM men were 25% more likely (95%CI: 0%-56%, p < .05) to report IADL impairments due to cognitive decline but reported no significant difference in receiving social support with IADL impairments compared to heterosexual men. Discussion We identified significant unmet need for social supports for IADL impairments, with highest unmet need among SM women. Comprehensive strategies such as LGBTQ + affirming assisted living and home and community-based services are needed to ensure equity in receipt of long-term supports and services for SM populations.
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Affiliation(s)
- Nathaniel M. Tran
- Department of Health Policy, Vanderbilt University, United States
- LGBTQ+ Policy Lab, Vanderbilt University, United States
- Division of Health Policy & Administration, University of Illinois Chicago, United States
| | - Tara McKay
- Department of Health Policy, Vanderbilt University, United States
- LGBTQ+ Policy Lab, Vanderbilt University, United States
- Department of Medicine, Health, and Society, Vanderbilt University, United States
| | - Gilbert Gonzales
- Department of Health Policy, Vanderbilt University, United States
- LGBTQ+ Policy Lab, Vanderbilt University, United States
- Department of Medicine, Health, and Society, Vanderbilt University, United States
| | | | - Carrie Fry
- Department of Health Policy, Vanderbilt University, United States
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Wang L, Liu H, Qin L, Li L. Cytokine Storm: The Novel Mechanism for Sleep Deprivation-induced Multiple Organ Dysfunction Syndrome. Neurosci Bull 2024; 40:1031-1033. [PMID: 38702450 PMCID: PMC11250721 DOI: 10.1007/s12264-024-01210-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 02/23/2024] [Indexed: 05/06/2024] Open
Affiliation(s)
- Liwen Wang
- Institute of Pharmacy and Pharmacology, University of South China, Hengyang, 421001, China
| | - Huimei Liu
- Hengyang Medical School, University of South China, Hengyang, 421001, China
| | - Li Qin
- Institute of Pharmacy and Pharmacology, University of South China, Hengyang, 421001, China
| | - Lanfang Li
- Institute of Pharmacy and Pharmacology, University of South China, Hengyang, 421001, China.
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Li N, Yang K, Deng L, Zeng Y, Cao S, Chen D. Mendelian randomization study supports positive bidirectional causal relationships between genetically predicted insomnia symptom and liability to benign prostatic hyperplasia. BMC Urol 2024; 24:91. [PMID: 38643096 PMCID: PMC11031934 DOI: 10.1186/s12894-024-01474-z] [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: 02/16/2024] [Accepted: 04/02/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Sleep quality may be related to benign prostatic hyperplasia (BPH), however causal associations have not been established. This study aimed to evaluate causal relationships between six sleep traits ([i] day time napping, [ii] daytime sleepiness, [iii] insomnia, [iv] long sleep duration, [v] short sleep duration, and [vi] sleep duration per hour) and BPH through a bidirectional Mendelian randomization (MR) study. METHODS Genome-wide association summary statistics of sleep traits and BPH were downloaded from public databases. Inverse variance weighting (IVW) was used as the main approach for causal inference. For causal estimates identified by IVW, various sensitivity analyses were performed to assess the reliability of the results: (i) four additional MR methods to complement IVW; (ii) Cochran's Q test to assess heterogeneity; (iii) MR-Egger intercept test and MR-PRESSO global test to assess horizontal pleiotropy; and (iv) leave-one-out method to assess stability. RESULTS Forward MR analyses indicated that genetically predicted insomnia symptom significantly increased BPH risk (OR = 1.267, 95% CI: 1.003-1.601, P = 0.048), while reverse MR analyses identified that genetically predicted liability to BPH significantly increased the incidence of insomnia (OR = 1.026, 95% CI: 1.000-1.052, P = 0.048). In a replicate MR analysis based on summary statistics including exclusively male participants, the finding of increased risk of BPH due to genetically predicted insomnia symptom was further validated (OR = 1.488, 95% CI: 1.096-2.022, P = 0.011). No further causal links were identified. In addition, sensitivity tests demonstrated the reliability of the MR results. CONCLUSION This study identified that a higher prevalence of genetically predicted insomnia symptoms may significantly increase the risk of BPH, while genetically predicted liability to BPH may in turn increase the incidence of insomnia symptom. Therefore, improving sleep quality and reducing the risk of insomnia could be a crucial approach for the prevention of BPH.
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Affiliation(s)
- Nannan Li
- The First Hospital of Changsha, Changsha, 410005, China
- The Affiliated Changsha Hospital of Xiangya School of Medicine, Central South University, Changsha, 410008, China
| | - Ke Yang
- The First Hospital of Changsha, Changsha, 410005, China
- The Affiliated Changsha Hospital of Xiangya School of Medicine, Central South University, Changsha, 410008, China
| | - Liang Deng
- The First Hospital of Changsha, Changsha, 410005, China
- The Affiliated Changsha Hospital of Xiangya School of Medicine, Central South University, Changsha, 410008, China
| | - Youjie Zeng
- Department of Anesthesiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, China
| | - Si Cao
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-XIANGYA, Changsha, Hunan, 410205, China
| | - Dong Chen
- The First Hospital of Changsha, Changsha, 410005, China.
- The Affiliated Changsha Hospital of Xiangya School of Medicine, Central South University, Changsha, 410008, China.
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Visallini TS, Parameswari RP. Retrospective Case Study on the Evaluation of Inflammatory Markers, Macrophage Inhibitory Protein-1α and Interferon-γ in Sleep Deprivation Condition. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S1326-S1329. [PMID: 38882737 PMCID: PMC11174169 DOI: 10.4103/jpbs.jpbs_607_23] [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: 08/13/2023] [Revised: 11/02/2023] [Accepted: 11/17/2023] [Indexed: 06/18/2024] Open
Abstract
Background and Aim Sleep is an important physiological process that is necessary for the normal functioning of the body. Sleep greatly affects all aspects of our body, including the immune pathways or immune response system of our body, which plays a determinant role in the development and progression of chronic inflammatory diseases. In this study, we worked to find the relation between sleep deprivation and levels of pro-inflammatory markers macrophage inflammatory protein 1-alpha (MIP-1α) and interferon gamma (IFN-γ). To find the relation between sleep deprivation and levels of pro-inflammatory markers MIP-1α and IFN-γ. Objective To find the relation between sleep deprivation and levels of pro-inflammatory markers MIP-1α and IFN-γ. Materials and Methods The study was conducted with 40 individuals as participants, of which 20 were sleep-deprived (SD), and 20 had adequate amounts of sleep. The sleep duration details of the individuals were obtained by questionnaire. Blood was withdrawn from all the subjects after due consent from them. Plasma was separated and was used to evaluate their MIP-1α levels and IFN-γ levels. Results The MIP-1α levels and levels of IFN-γ were found to be significantly elevated in the SD individuals than that of individuals who had adequate sleep. Conclusion Sleep loss and sleep deprivation are associated with altered expressions of key regulatory factors and upregulation of pro-inflammatory cytokines production. Thus, sleep deprivation can be considered to be one of the major contributors to the development and progression of various chronic inflammatory diseases.
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Affiliation(s)
- T S Visallini
- Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Thandalam, Chennai, Tamil Nadu, India
| | - R P Parameswari
- Department of Pharmacology, Centre for Transdisciplinary Research, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
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Howell SN, Griesbach GS. Sex Differences in Sleep Architecture After Traumatic Brain Injury: Potential Implications on Short-Term Episodic Memory and Recovery. Neurotrauma Rep 2024; 5:3-12. [PMID: 38249321 PMCID: PMC10797171 DOI: 10.1089/neur.2023.0093] [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] [Indexed: 01/23/2024] Open
Abstract
Sleep-wake disturbances (SWDs) are common after TBI and often extend into the chronic phase of recovery. Such disturbances in sleep can lead to deficits in executive functioning, attention, and memory consolidation, which may ultimately impact the recovery process. We examined whether SWDs post-TBI were associated with morbidity during the post-acute period. Particular attention was placed on the impact of sleep architecture on learning and memory. Because women are more likely to report SWDs, we examined sex as a biological variable. We also examined subjective quality of life, depression, and disability levels. Data were retrospectively analyzed for 57 TBI patients who underwent an overnight polysomnography. Medical records were reviewed to determine cognitive and functional status during the period of the sleep evaluation. Consideration was given to medications, owing to the fact that a high number of these are likely to have secondary influences on sleep characteristics. Women showed higher levels of disability and reported more depression and lower quality of life. A sex-dependent disruption in sleep architecture was observed, with women having lower percent time in REM sleep. An association between percent time in REM and better episodic memory scores was found. Melatonin utilization had a positive impact on REM duration. Improvements in understanding the impact of sleep-wake disturbances on post-TBI outcome will aid in defining targeted interventions for this population. Findings from this study support the hypothesis that decreases in REM sleep may contribute to chronic disability and underlie the importance of considering sex differences when addressing sleep.
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Affiliation(s)
| | - Grace S. Griesbach
- Centre for Neuro Skills, Bakersfield, California, USA
- Department of Neurosurgery, David Geffen School of Medicine at the University of California, Los Angeles, California, USA
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Lin J, Yao H, Li J, Tian S, Li X, Hou Q. Associations of sleep quality and exercise frequency and the risk of coronary heart disease in Chinese urban elderly: a secondary analysis of cross-sectional data. BMC Public Health 2023; 23:2199. [PMID: 37940903 PMCID: PMC10631020 DOI: 10.1186/s12889-023-17077-6] [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: 05/15/2022] [Accepted: 10/26/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Sleep quality and exercise frequency are closely associated with coronary heart disease (CHD). Few studies focused on the joint effect of initiating sleep, sleep disorders, and exercise frequency on the risk of CHD in the elderly. We used a secondary data analysis based on Boshan Elderly cross-sectional study. We explored the sleep quality, exercise frequency, and their joint effects on the risk of CHD. METHODS We collected 678 participants whose age ≥ 60 years old from Boshan District Hospital. We used the Pittsburgh Sleep Quality Index to evaluate the sleep quality and obtained physical examination information from the hospital. RESULTS Compared with the non-CHD group, patients with CHD spent more time in initiating sleep (time ≥ 60 min, 34.59% vs. 22.93%, P = 0.025) and less time exercising (exercise frequency < 1 times/week, 23.90% vs. 17.15%, P = 0.024). In multiple logistic regression analysis, sleep latency ≥ 60 min was associated with CHD risk (adjusted OR = 1.83; 95% CI: 1.11, 2.99; P-trend = 0.008). The adjusted OR (95% CI) of CHD was 2.24 (1.16, 4.34) for sleep duration < 5 h versus 5-9 h. Compared with exercise frequency < 1 times/week, the adjusted OR for exercise frequency ≥ 1 times/week was 0.46 (95% CI: 0.26, 0.83; P = 0.010). In addition, the joint effects of long sleep latency (≥ 60 min) and sleep disorders were associated with CHD (adjusted OR = 3.36; 95% CI: 1.41, 8.02). The joint effect of exercise frequency ≥ 1 times/week and sleep onset latency within normal limits (< 30 min) was also associated with CHD, and the adjusted OR (95% CI) was 0.42 (0.21, 0.87). CONCLUSIONS Long sleep latency, high frequency of initiating sleep difficulty, sleep disorders, and short sleep duration were positively associated with CHD. In addition, the joint effects of long sleep latency and sleep disorders were positively correlated with CHD incidence. However, the joint effects of exercise frequency ≥ 1 times/week and normal sleep onset latency were negatively associated CHD.
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Affiliation(s)
- Jiujing Lin
- School of Public Health and Health Management, Shandong First Medical University and Shandong Academy of Medical Sciences, 6699 Qingdao Rd, Jinan, 250117, Shandong, China
- Medical Science and Technology Innovation Center, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Huichen Yao
- Cardiology Department, The Third Affiliated Hospital of Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Jia Li
- School of Public Health and Health Management, Shandong First Medical University and Shandong Academy of Medical Sciences, 6699 Qingdao Rd, Jinan, 250117, Shandong, China
- Medical Science and Technology Innovation Center, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Shoufeng Tian
- Disease Control and Prevention Center of Jinan Shi Zhong District, Jinan, Shandong, China
| | - Xiaoliang Li
- School of Public Health and Health Management, Shandong First Medical University and Shandong Academy of Medical Sciences, 6699 Qingdao Rd, Jinan, 250117, Shandong, China
| | - Qingzhi Hou
- School of Public Health and Health Management, Shandong First Medical University and Shandong Academy of Medical Sciences, 6699 Qingdao Rd, Jinan, 250117, Shandong, China.
- Medical Science and Technology Innovation Center, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China.
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Wang S, Zhao Y, Hu X. Exploring the mechanism of Suanzaoren decoction in treatment of insomnia based on network pharmacology and molecular docking. Front Pharmacol 2023; 14:1145532. [PMID: 37670944 PMCID: PMC10475534 DOI: 10.3389/fphar.2023.1145532] [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: 01/16/2023] [Accepted: 08/08/2023] [Indexed: 09/07/2023] Open
Abstract
Objective: To explore the functional mechanisms of Suanzaoren decoction (SZRD) for treating insomnia using network pharmacology and molecular docking. Methods: The active ingredients and corresponding targets of SZRD were obtained from the Traditional Chinese Medicine Systems Pharmacology database, and then, the names of the target proteins were standardized using the UniProt database. The insomnia-related targets were obtained from the GeneCards, DisGeNET, and DrugBank databases. Next, a Venn diagram comprising the drug and disease targets was created, and the intersecting targets were used to draw the active ingredient-target network diagram using Cytoscape software. Next, the STRING database was used to build a protein-protein interaction network, followed by cluster analysis using the MCODE plug-in. The Database for Annotation, Visualization, Integrated Discovery (i.e., DAVID), and the Metascape database were used for Gene Ontology (GO) enrichment and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses. AutoDock Vina and Pymol software were used for molecular docking. Results: SZRD contained 138 active ingredients, corresponding to 239 targets. We also identified 2,062 insomnia-related targets, among which, 95 drug and disease targets intersected. The GO analysis identified 490, 62, and 114 genes related to biological processes, cellular components, and molecular functions, respectively. Lipid and atherosclerosis, chemical carcinogen-receptor activation, and neuroactive ligand-receptor interaction were the most common pathways in the KEGG analysis. Molecular docking demonstrated that the primary active components of SZRD for insomnia had good binding capabilities with the core proteins in PPI network. Conclusion: Insomnia treatment with SZRD involves multiple targets and signaling pathways, which may improve insomnia by reducing inflammation, regulating neurotransmitters.
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Affiliation(s)
- Shuxiao Wang
- Internal Encephalopathy of Traditonal Chinese Medicine, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
| | - Yan Zhao
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Xingang Hu
- Internal Encephalopathy of Traditonal Chinese Medicine, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China
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Jung E, Ryu HH, Kim SW, Lee JH, Song KJ, Ro YS, Cha KC, Hwang SO. Interaction effects between insomnia and depression on risk of out-of-hospital cardiac arrest: Multi-center study. PLoS One 2023; 18:e0287915. [PMID: 37594944 PMCID: PMC10437782 DOI: 10.1371/journal.pone.0287915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 06/15/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Insomnia and depression have been known to be risk factors of several diseases, including coronary heart disease. We hypothesized that insomnia affects the out-of-hospital cardiac arrest (OHCA) incidence, and these effects may vary depending on whether it is accompanied by depression. This study aimed to determine the association between insomnia and OHCA incidence and whether the effect of insomnia is influenced by depression. METHODS This prospective multicenter case-control study was performed using Phase II Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiology Surveillance (CAPTURES-II) project database for OHCA cases and community-based controls in Korea. The main exposure was history of insomnia. We conducted conditional logistic regression analysis to estimate the effect of insomnia on the risk of OHCA incidence and performed interaction analysis between insomnia and depression. Finally, subgroup analysis was conducted in the patients with insomnia. RESULTS Insomnia was not associated with increased OHCA risk (0.95 [0.64-1.40]). In the interaction analysis, insomnia interacted with depression on OHCA incidence in the young population. Insomnia was associated with significantly higher odds of OHCA incidence (3.65 [1.29-10.33]) in patients with depression than in those without depression (0.84 [0.59-1.17]). In the subgroup analysis, depression increased OHCA incidence only in patients who were not taking insomnia medication (3.66 [1.15-11.66]). CONCLUSION Insomnia with depression is a risk factor for OHCA in the young population. This trend was maintained only in the population not consuming insomnia medication. Early and active medical intervention for patients with insomnia may contribute to lowering the risk of OHCA.
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Affiliation(s)
- Eujene Jung
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hyun Ho Ryu
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea
- Medicine, Chonnam National University, Gwangju, Korea
| | - Sung Wan Kim
- Department of Psychiartry, Chonnam National University Medical School, Gwangju, Korea
| | - Jung Ho Lee
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Kyoung Jun Song
- Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Young Sun Ro
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kyoung Chul Cha
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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Carroll JE, Olmstead R, Cole SW, Breen EC, Arevalo JM, Irwin MR. Remission of insomnia in older adults treated with cognitive behavioral therapy for insomnia (CBT-I) reduces p16 INK4a gene expression in peripheral blood: secondary outcome analysis from a randomized clinical trial. GeroScience 2023; 45:2325-2335. [PMID: 36849678 PMCID: PMC10651570 DOI: 10.1007/s11357-023-00741-5] [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: 12/06/2022] [Accepted: 01/23/2023] [Indexed: 03/01/2023] Open
Abstract
Late life insomnia may increase risk for accelerated biological aging. Intervening to treat insomnia may provide protection from biological aging by reducing the prevalence of senescent cells in the immune system, as indicated by gene expression of a marker of cellular senescence, p16INK4a. In the present study, we determine whether treatment of insomnia in older adults with cognitive behavioral therapy for insomnia (CBT-I) would reduce p16INK4a gene expression in peripheral blood mononuclear cells (PBMC), compared to a sleep education therapy (SET), an active comparator condition. Secondly, we investigate the relationship between sustained insomnia remission and reduced expression of p16INK4a. Participants 60 + years old with insomnia were enrolled in a randomized controlled trial and assigned to CBT-I or SET. Analyses of 231 older adults (CBT-I = 119; SET = 112) examine baseline, post (2 months), and 24 months gene expression of p16INK4a. Compared to baseline, expression of p16INK4a increased in the SET group over 24 months (P = 0.03), but showed no change in the CBT-I group. Those who received CBT-I and experienced sustained remission of insomnia had a significant decline in p16INK4a expression by 24 months compared to baseline (P = 0.02). Individuals not sustaining remission of insomnia exhibited overall increase expression of p16INK4a by 24 months (P = 0.03). In older adults with insomnia, p16INK4a increases over 24 months, while CBT-I treatment of insomnia mitigates the increase in p16INK4a. Further, sustained remission of insomnia using CBT-I leads to a decrease in p16INK4a. These results suggest that behavioral interventions that are effective at treating insomnia might reduce the population of senescent cells in circulating blood.
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Affiliation(s)
- Judith E Carroll
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA.
- Jane & Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, University of California, 300 UCLA Medical Plaza, Suite 3330, Los Angeles, CA, 90095, USA.
| | - Richard Olmstead
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA
- Jane & Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, University of California, 300 UCLA Medical Plaza, Suite 3330, Los Angeles, CA, 90095, USA
| | - Steve W Cole
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA
- Jane & Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, University of California, 300 UCLA Medical Plaza, Suite 3330, Los Angeles, CA, 90095, USA
| | - Elizabeth C Breen
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA
- Jane & Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, University of California, 300 UCLA Medical Plaza, Suite 3330, Los Angeles, CA, 90095, USA
| | - Jesusa M Arevalo
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA
- Jane & Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, University of California, 300 UCLA Medical Plaza, Suite 3330, Los Angeles, CA, 90095, USA
| | - Michael R Irwin
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA
- Jane & Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, University of California, 300 UCLA Medical Plaza, Suite 3330, Los Angeles, CA, 90095, USA
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10
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Poindexter M, Stokes A, Mellman TA. Neighborhood Stress Predicts Fear of Sleep Independently of Posttraumatic Stress Disorder. Behav Sleep Med 2023; 21:185-192. [PMID: 35471154 PMCID: PMC10292665 DOI: 10.1080/15402002.2022.2067162] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Chronic insufficient sleep is linked to a variety of adverse health outcomes, and African Americans have been found to have poorer sleep than their non-Hispanic White counterparts. African Americans disproportionately live in low-income disordered neighborhoods which increases their risk of trauma exposure and adversely affects their sleep. Fear of sleep is a construct linked to posttraumatic stress disorder (PTSD). We have reported a relationship between fear of sleep and insomnia in urban residing African Americans. Our objective is to report the relative contributions of neighborhood stress along with PTSD to fear of sleep. METHODS The present study features a nonclinical sample of 117 African Americans (ages 18-35) who reside in DC. RESULTS After controlling for gender, hierarchical linear regression analyses revealed that PTSD severity and perceptions of the neighborhood environment accounted for approximately 32% of the variance in sleep-related fears (∆R2 = .320, p < .001). Regression coefficients suggest that perceptions of the neighborhood (β = .360) predict sleep-related fears to a similar degree as PTSD severity (β = .368). CONCLUSION Results from this study have implications for interventions to help African Americans to cope with their neighborhood environments effect on their sleep.
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11
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Meaklim H, Junge MF, Varma P, Finck WA, Jackson ML. Beyond Stress: Altered Sleep-Wake Patterns are a Key Behavioral Risk Factor for Acute Insomnia During Times of Crisis. Behav Sleep Med 2023; 21:208-225. [PMID: 35604338 DOI: 10.1080/15402002.2022.2074996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Stress is a common precipitant of acute insomnia; however, reducing stress during times of crisis is challenging. This study aimed to determine which modifiable factors, beyond stress, were associated with acute insomnia during a major crisis, the COVID-19 pandemic. PARTICIPANTS/METHODS A global online survey assessed sleep/circadian, stress, mental health, and lifestyle factors between April-May 2020. Logistic regression models analyzed data from 1319 participants (578 acute insomnia, 731 good sleepers), adjusted for demographic differences. RESULTS Perceived stress was a significant predictor of acute insomnia during the pandemic (OR 1.23, 95% CI1.19-1.27). After adjusting for stress, individuals who altered their sleep-wake patterns (OR 3.36, CI 2.00-5.67) or increased technology use before bed (OR 3.13, CI 1.13-8.65) were at increased risk of acute insomnia. Other sleep factors associated with acute insomnia included changes in dreams/nightmares (OR 2.08, CI 1.32-3.27), increased sleep effort (OR 1.99, CI1.71-2.31) and cognitive pre-sleep arousal (OR 1.18, CI 1.11-1.24). For pandemic factors, worry about contracting COVID-19 (OR 3.08, CI 1.18-8.07) and stringent government COVID-19 restrictions (OR 1.12, CI =1.07-1.18) were associated with acute insomnia. Anxiety (OR 1.02, CI 1.01-1.05) and depressive (OR 1.29, CI 1.22-1.37) symptoms were also risk factors. A final hierarchical regression model revealed that after accounting for stress, altered sleep-wake patterns were a key behavioral predictor of acute insomnia (OR 2.60, CI 1.68-5.81). CONCLUSION Beyond stress, altered sleep-wake patterns are a key risk factor for acute insomnia. Modifiable behaviors such as maintaining regular sleep-wake patterns appear vital for sleeping well in times of crisis.
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Affiliation(s)
- Hailey Meaklim
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Moira F Junge
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.,The Sleep Health Foundation, Blacktown, New South Wales, Australia
| | - Prerna Varma
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Wendy A Finck
- Faculty of Education, Monash University, Clayton, Victoria, Australia
| | - Melinda L Jackson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
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12
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Sabot D, Lovegrove R, Stapleton P. The association between sleep quality and telomere length: A systematic literature review. Brain Behav Immun Health 2023; 28:100577. [PMID: 36691437 PMCID: PMC9860369 DOI: 10.1016/j.bbih.2022.100577] [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: 09/21/2022] [Accepted: 12/20/2022] [Indexed: 01/10/2023] Open
Abstract
Several sleep parameters present an elevated risk for processes that contribute to cellular aging. Short sleep duration, sleep apnoea, and insomnia are significantly associated with shorter telomeres, a biological marker of cellular aging. However, there has been no review or analysis of studies that have examined the association between the psychological construct of sleep quality and telomere length. The present study aimed to provide a systematic review of the association between sleep quality and telomere length. A systematic review of English articles was conducted using MEDLINE/PubMed, PsycINFO, Google Scholar, and Web of Science electronic databases, with the final search conducted on 3rd September 2021. Search terms included sleep quality, poor sleep, insomnia, sleep difficulties, sleep issue*, non-restorative sleep, telomere*, cellular aging, and immune cell telomere length. Study eligibility criteria included human participants aged 18 years or older and a reproducible methodology. Study appraisal and synthesis were completed using a systematic search in line with a PICOS approach (P = Patient, problem, or population; I = Intervention, prognostic factor, exposure; C = Comparison, control, or comparator; O = Outcomes; S = Study designs). Twenty-two studies met review inclusion criteria. Qualitative synthesis of the literature indicated insufficient evidence overall to support a significant association between sleep quality and telomere length. Limitations across studies were addressed, such as the assessment of examined constructs. Findings highlight important targets for future research, including the standardised operationalisation of the sleep quality construct and experimental study designs. Research in this area has clinical significance by identifying possible mechanisms that increase the risk for age-related disease and mortality. PROSPERO Registration No.: CRD 42021233139.
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Affiliation(s)
- Debbie Sabot
- School of Psychology, Faculty of Society and Design, Bond University, Australia
| | - Rhianna Lovegrove
- School of Psychology, Faculty of Society and Design, Bond University, Australia
| | - Peta Stapleton
- School of Psychology, Faculty of Society and Design, Bond University, Australia
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13
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Brooks Holliday S, Dong L, Haas A, Ghosh-Dastidar MB, Dubowitz T, Buysse DJ, Hale L, Troxel WM. Longitudinal associations between sleep and BMI in a low-income, predominantly Black American sample. Sleep Health 2023; 9:11-17. [PMID: 36456450 PMCID: PMC9992091 DOI: 10.1016/j.sleh.2022.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/04/2022] [Accepted: 10/27/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Black individuals and those experiencing socioeconomic disadvantage are at increased risk for sleep problems and obesity. This study adds to the limited extant literature examining longitudinal associations between objectively measured sleep and changes in body mass index (BMI) in Black Americans. DESIGN We focused on individuals with at least 1 observation of sleep and BMI at 1 of 3 study time points (2013, 2016, and 2018). We modeled longitudinal trends in BMI as a function of time, average of each sleep variable across assessments, and within-person deviations in each sleep variable over time. SETTING Data were collected via interviewer-administered at-home surveys and actigraphy in Pittsburgh, PA. PARTICIPANTS Our sample comprised 1115 low-income, primarily Black adults, including 862 women and 253 men. MEASUREMENTS Sleep measures included actigraphy-measured total sleep time, sleep efficiency, and wakefulness after sleep onset, as well as self-reported sleep quality. We also included objectively measured BMI. RESULTS In models adjusted for age, gender, and other sociodemographic covariates (eg, income, marital status), there were no significant longitudinal associations between total sleep time, sleep efficiency, wakefulness after sleep onset, or subjective sleep quality and changes in BMI. CONCLUSIONS This study provides further evidence that, among a sample of low-income Black adults, sleep problems are not longitudinally predictive of BMI. Although ample cross-sectional evidence demonstrates that sleep problems and obesity commonly co-occur, longitudinal evidence is mixed. Better understanding the overlap of sleep and obesity over time may contribute to prevention and intervention efforts.
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Affiliation(s)
| | - Lu Dong
- RAND Corporation, Santa Monica, California, USA
| | - Ann Haas
- RAND Corporation, Pittsburgh, Pennsylvania, USA
| | | | | | | | - Lauren Hale
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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14
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Rezapour M, Moosazadeh M, Hessami A, Khademloo M, Hosseini SH. Association between blood pressure and parameters related to sleep disorders in Tabari cohort population. Clin Hypertens 2022; 28:33. [PMCID: PMC9664700 DOI: 10.1186/s40885-022-00216-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 06/17/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
Insomnia and other sleep disorders can cause an increase in blood pressure, thereby resulting in premature death. Regarding this, the present study was conducted to investigate the relationship between hypertension and parameters related to sleep disorders in Tabari cohort population.
Methods
In this cross-sectional study, the data from the enrollment phase of the Tabari cohort study were adopted. Tabari cohort is a part of the PERSIAN (Prospective Epidemiological Research Studies in Iran) cohort study. Data analysis was performed using descriptive and inferential statistics.
Results
Out of 10,255 patients enrolled in the Tabari cohort, 2,281 patients (22.2%) had hypertension. According to the results of univariable logistic regression test, the odds ratio of high blood pressure in patients with insomnia and hypersomnia is 1.22 (95% confidence interval [CI], 1.06–1.40) and 1.22 (95% CI, 1.01–1.47) times higher than normal sleep. This odds ratio was not significant after adjusting the effect of sex, age, body mass index, waist circumference, area residence, high-density lipoprotein cholesterol, triglyceride, and total cholesterol variables with multivariable logistic regression. Frequency of routine hypnotic medication usage (14.6% vs. 5.7%, P < 0.001), involuntary napping (25.3% vs. 19%, P < 0.001), and leg restlessness during sleep (14.8% vs. 11.7%, P < 0.001) was higher in hypertensive individuals than in nonhypertensive cases.
Conclusions
This study showed that sleep disorders prevalence are higher in hypertensive patients than nonhypertensive patients. Also, routine use of hypnotics was significantly higher medication in patients with hypertension compared to that in the nonhypertensive patients.
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15
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Sur B, Lee B. Myricetin prevents sleep deprivation-induced cognitive impairment and neuroinflammation in rat brain via regulation of brain-derived neurotropic factor. THE KOREAN JOURNAL OF PHYSIOLOGY & PHARMACOLOGY : OFFICIAL JOURNAL OF THE KOREAN PHYSIOLOGICAL SOCIETY AND THE KOREAN SOCIETY OF PHARMACOLOGY 2022; 26:415-425. [PMID: 36302617 PMCID: PMC9614391 DOI: 10.4196/kjpp.2022.26.6.415] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 09/15/2022] [Accepted: 09/15/2022] [Indexed: 11/07/2022]
Abstract
Memory formation in the hippocampus is formed and maintained by circadian clock genes during sleep. Sleep deprivation (SD) can lead to memory impairment and neuroinflammation, and there remains no effective pharmacological treatment for these effects. Myricetin (MYR) is a common natural flavonoid that has various pharmacological activities. In this study, we investigated the effects of MYR on memory impairment, neuroinflammation, and neurotrophic factors in sleep-deprived rats. We analyzed SD-induced cognitive and spatial memory, as well as pro-inflammatory cytokine levels during SD. SD model rats were intraperitoneally injected with 10 and 20 mg/kg/day MYR for 14 days. MYR administration significantly ameliorated SD-induced cognitive and spatial memory deficits; it also attenuated the SD-induced inflammatory response associated with nuclear factor kappa B activation in the hippocampus. In addition, MYR enhanced the mRNA expression of brain-derived neurotropic factor (BDNF) in the hippocampus. Our results showed that MYR improved memory impairment by means of anti-inflammatory activity and appropriate regulation of BDNF expression. Our findings suggest that MYR is a potential functional ingredient that protects cognitive function from SD.
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Affiliation(s)
- Bongjun Sur
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul 02447, Korea
| | - Bombi Lee
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul 02447, Korea,Center for Converging Humanities, Kyung Hee University, Seoul 02447, Korea,Correspondence Bombi Lee, E-mail:
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16
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Rowe RK, Griesbach GS. Immune-endocrine interactions in the pathophysiology of sleep-wake disturbances following traumatic brain injury: A narrative review. Brain Res Bull 2022; 185:117-128. [DOI: 10.1016/j.brainresbull.2022.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 04/26/2022] [Accepted: 04/30/2022] [Indexed: 12/16/2022]
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17
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Park SH, Shin NR, Yang M, Bose S, Kwon O, Nam DH, Lee JH, Song EJ, Nam YD, Kim H. A Clinical Study on the Relationship Among Insomnia, Tongue Diagnosis, and Oral Microbiome. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2022; 50:773-797. [PMID: 35380093 DOI: 10.1142/s0192415x2250032x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Currently, there is a lack of adequate methods to assess insomnia objectively. This study addresses the usefulness of tongue features and oral microbial profile as a potential diagnostic biomarker of insomnia. One hundred insomniac patients and 20 healthy control subjects were selected. Their demographic and clinical characteristics, as well as the tongue diagnostic indices and oral microbial profile, were examined. Compared to the control group, insomniac patients showed a higher abnormal low-frequency/high-frequency (LF/HF) ratio. In tongue diagnosis, the indices related to lightness of tongue body and tongue coating were higher in the insomniac group vs. the control group. Furthermore, linear discriminant analysis (LDA) of oral microbial population revealed that the relative abundances of Clostridia, Veillonella, Bacillus and Lachnospiraceae were significantly higher in the insomniac patients than the control group. Additionally, the tongue features of the insomniac group exhibited that the non-coating group had a poor sleep condition compared to the thick-coating group, although the difference was insignificant. On the other hand, the oral microbial communities of the insomniac patients revealed greater alpha and beta diversities in the non-coating group vs. the thick-coating group. The alpha and beta diversities were higher in orotype1 than orotype2. Collectively, this study highlighted that the lightness of tongue body and tongue coating as well as oral microbial profiles of SR1, Actinobacteria, Clostridia and Lachnospiraceae_unclassified could be considered potential biomarkers of insomnia.
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Affiliation(s)
- Seo-Hyun Park
- Department of Rehabilitation Medicine of Korean Medicine, Dongguk University Goyang, Republic of Korea
| | - Na Rae Shin
- Department of Rehabilitation Medicine of Korean Medicine, Dongguk University Goyang, Republic of Korea
| | - Meng Yang
- Department of Rehabilitation Medicine of Korean Medicine, Dongguk University Goyang, Republic of Korea
| | - Shambhunath Bose
- Department of Life Science, Sri Sathya Sai University for Human Excellence Navanihal, Okali Post, Kamalapur, Kalaburagi, Karnataka 585313, India
| | - Ojin Kwon
- Division of Clinical Medicine, Korea Institute of Oriental Medicine, Republic of Korea
| | - Dong-Hyun Nam
- Department of Biofunctional Medicine and Diagnosis, College of Korean Medicine Sangji University, Wonju 26382, Republic of Korea
| | - Jun-Hwan Lee
- Division of Clinical Medicine, Korea Institute of Oriental Medicine, Republic of Korea
| | - Eun-Ji Song
- Research Group of Healthcare, Korea Food Research Institute, Wanju-gun 55365, Republic of Korea
- Department of Food Biotechnology, Korea University of Science and Technology, Daejeon 34113, Republic of Korea
| | - Young-Do Nam
- Research Group of Healthcare, Korea Food Research Institute, Wanju-gun 55365, Republic of Korea
- Department of Food Biotechnology, Korea University of Science and Technology, Daejeon 34113, Republic of Korea
| | - Hojun Kim
- Department of Rehabilitation Medicine of Korean Medicine, Dongguk University Goyang, Republic of Korea
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18
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Oh H, DeVylder JE, Koyanagi A. Psychotic experiences as a health indicator: A provisional framework. Int J Soc Psychiatry 2022; 68:244-252. [PMID: 33554709 DOI: 10.1177/0020764021992809] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hans Oh
- Suzanne Dworak Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Jordan E DeVylder
- Graduate School of Social Service, Fordham University, New York, NY, USA
| | - Ai Koyanagi
- Parc Sanitari Sant Joan de Deu, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM)
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19
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Naja F, Hasan H, Khadem SH, Buanq MA, Al-Mulla HK, Aljassmi AK, Faris ME. Adherence to the Mediterranean Diet and Its Association With Sleep Quality and Chronotype Among Youth: A Cross-Sectional Study. Front Nutr 2022; 8:805955. [PMID: 35127790 PMCID: PMC8808718 DOI: 10.3389/fnut.2021.805955] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 12/10/2021] [Indexed: 12/17/2022] Open
Abstract
Background Evidence indicates that many university students have poor adherence to a healthy diet accompanied by unhealthy lifestyle behaviors. Chrono-nutrition is an emerging field of research that examines the pattern of optimum daily activity in relation to the human's dietary patterns, and their reflections of variable health indicators such as sleep quality. However, there is a scarcity of research that examines the relationship between adherence to the healthy eating pattern, like the Mediterranean diet (MD), with sleep quality and chronotype among university students. Methods A cross-sectional study was conducted, and convenience sampling was used. Participants were assessed for adherence to the MD using the Mediterranean Diet Quality Index (KIDMED), for sleep quality using the Pittsburgh Sleep Quality Index (PSQI), and for chronotype using the Morningness-Eveningness questionnaire (MEQ). Results The study included 503 university students, most of them (81.5%) were females. Only 15.1 and 16.9% reported morningness chronotype and good sleep quality, respectively. About half of the students showed medium and high adherence to the KIMED. In-depth analysis revealed that students with good adherence to the MD were more likely to have a good sleep quality (OR = 0.35; 95%CI: 0.21–0.59; P < 0.001) even after adjustment for age and sex (OR = 0.36; 95%CI: 0.21–0.62; P < 0.001). The regression analysis also showed that those with good adherence to the MD had a significant association with better subjective sleep quality, less sleep latency, sleep disturbance, and daytime dysfunction even after adjustment for age and sex. Those with morningness chronotype had about a six-fold higher chance to have good adherence to the MD (OR = 5.67; 95%CI: 2.86–11.26; P < 0.001, respectively). Conclusions Good adherence to the healthy diet presented in the MD among university students is associated with morningness chronotype and with improved overall sleep quality and sleep components. Long-term, controlled intervention research works are warranted for more elaboration on the impact of chronotype and dietary habits on sleep quality and other important aspects such as mental health and academic achievement.
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20
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Combined alcohol use and weight status effects on mortality risk among adults: Analysis of the National Health Interview Survey linked mortality files, 2001-2015. Drug Alcohol Depend 2022; 230:109206. [PMID: 34890926 PMCID: PMC8717405 DOI: 10.1016/j.drugalcdep.2021.109206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 11/17/2021] [Accepted: 11/19/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Both alcohol use and weight status have been linked to increased mortality risk, but evidence of their joint effect is limited. The goal of this study was to examine the combined effects of alcohol and weight status (BMI classes: underweight, normal, overweight, obesity) on mortality using nationally representative data. METHODS Using data from public-use National Health Interview Survey-Linked Mortality Files (NHIS-LMF), 2001-2011, linked to prospective mortality follow-up through December 2015, we used age-period-cohort Cox proportional hazards models to examine all-cause and cause-specific mortality associated with the joint effects of alcohol use and BMI on 209,317 individuals aged 35-85. RESULTS Individuals with an underweight BMI status had higher all-cause and cause-specific mortality risks than those with a normal BMI status and light/moderate alcohol intake. All-cause mortality risks were 148% (hazard ratio [HR] 2.48, 95% CI 1.60-3.83) higher in underweight heavy drinkers than light/moderate drinkers with normal BMI status. Obese heavy drinkers had a 16% higher chance of dying from all-cause mortality (HR 1.16, 95% CI 1.00-1.35). Individuals in the unknown alcohol and BMI category have a higher chance of death from all-cause (HR 1.35, 95% CI 1.14-1.59) or cause-specific (CVD HR 1.75, 95% CI 1.14-2.69 and Cancer HR 1.33, 95% CI 1.01-1.76). CONCLUSIONS Alcohol drinking levels result in heightened all-cause and cause-specific mortality risks; the risks are compounded among underweight, obese, and unknown BMI individuals across all or cause-specific mortality.
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21
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Are periodontal diseases associated with sleep duration or sleep quality? A systematic review. Arch Oral Biol 2021; 129:105184. [PMID: 34118748 DOI: 10.1016/j.archoralbio.2021.105184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 05/26/2021] [Accepted: 05/29/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVES This study aimed to systematically review the associations between periodontal diseases/tooth loss and sleep duration/quality. MATERIAL AND METHODS PubMed, Scopus, and Embase databases were searched (up to May 2021) to identify studies that assessed the association between periodontal diseases or number of teeth with sleep quality and sleep duration. Two researchers independently selected the studies and extracted the data. Considering the high heterogeneity among the included studies, meta-analysis was deemed unviable. Results are presented descriptively for sleep quality (studies that have used PSQI), self-reported sleep hours, and other tools that assessed sleep patterns. RESULTS Twenty studies (16 cross-sectional, two case-control, and two cohort) were included. Eight studies used the Pittsburgh Sleep Quality Index (PSQI) to assess quality of sleep. Six of these studies demonstrated that individuals with worse periodontal conditions demonstrated poorer sleep quality. However, most of the included studies that performed adjusted analysis showed no statistically significant association between self-reported hours of sleep and periodontitis. The mean number of present teeth was assessed in four studies; three of them demonstrated lower numbers of present teeth in individuals with inadequate sleep. CONCLUSION The literature shows conflicting results for the association between sleep hours and periodontitis. However, inadequate sleep may be associated with lower number of present teeth and periodontal diseases. Further studies are necessary in order to confirm these results.
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22
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Carroll JE, Ross KM, Horvath S, Okun M, Hobel C, Rentscher KE, Coussons-Read M, Schetter CD. Postpartum sleep loss and accelerated epigenetic aging. Sleep Health 2021; 7:362-367. [PMID: 33903077 PMCID: PMC10027398 DOI: 10.1016/j.sleh.2021.02.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Insufficient sleep has been linked to accelerated biological aging in adults, providing a possible mechanism through which sleep may influence disease risk. In the current paper, we test the hypothesis that short sleep in postpartum would predict older biological age in women one year post birth, as indicated by accelerated epigenetic aging. METHODS As part of a larger study of pregnancy and postpartum health (Healthy Babies Before Birth, HB3), 33 mothers provided blood samples for epigenetic aging clock estimates. intrinsic epigenetic age acceleration (IEAA), extrinsic apigenetic age acceleration, phenotypic epigenetic age acceleration (PEAA), GrimAge, DNAmPAI-1, and DNAm telomere length (TL) were calculated using established protocols. Sleep duration was categorized as insufficient sleep (<7 hours per night) or healthy sleep duration (7+ hours per night). Sleep quality was determined using the Pittsburgh Sleep Quality Index (Global score >5). RESULTS Maternal postpartum sleep duration at 6 months, but not 12 months, following a birth was predictive of older 12-month IEAA, B (SE) = 3.0 (1.2), P = .02, PEAA, B (SE) = 7.3 (2.0), P = .002, and DNAmTL, B (SE) = -0.18 (0.07), P = .01, but not other indices, all P> .127. Self-reported poor sleep quality at 6 and 12 months was not significantly related to epigenetic age. CONCLUSIONS These findings suggest that insufficient sleep duration during the early postpartum period is associated with accelerated biological aging. As the sample size is small, additional research is warranted with a larger sample size to replicate these findings.
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Affiliation(s)
- Judith E Carroll
- Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, USA.
| | - Kharah M Ross
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA
| | - Steve Horvath
- Department of Biostatistics, University of California, Los Angeles, Los Angeles, California, USA
| | - Michele Okun
- Department of Psychology, University of Colorado, Colorado Springs, Colorado Springs, Colorado, USA
| | - Calvin Hobel
- Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Kelly E Rentscher
- Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, USA
| | - Mary Coussons-Read
- Department of Psychology, University of Colorado, Colorado Springs, Colorado Springs, Colorado, USA
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23
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John-Henderson NA, Oosterhoff B, Kampf TD, Hall B, Johnson LR, Laframboise ME, Malatare M, Salois E, Carter JR, Adams AK. Historical Loss: Implications for Health of American Indians in the Blackfeet Community. Ann Behav Med 2021; 56:193-204. [PMID: 33969868 DOI: 10.1093/abm/kaab032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Historical loss in American Indians (AIs) is believed to contribute to high incidence of mental health disorders, yet less is known about the associations between historical loss and physical health. PURPOSE To investigate whether frequency of thought about historical loss predicts risk factors for chronic physical health conditions in an AI community. METHODS Using Community Based Participatory research (CBPR) and Ecological Momentary Assessment (EMA), we measured frequency of thoughts about historical loss in 100 AI adults residing on the Blackfeet reservation. Participants completed a 1-week monitoring period, during which ambulatory blood pressure and daily levels of psychological stress were measured. At the end of the week, we collected a dried blood spot sample for measurement of C-reactive protein (CRP). RESULTS In hierarchical linear regression models controlling for demographics and relevant covariates, greater frequency of thoughts about historical loss predicted higher average daily psychological stress (B = .55, t = 6.47, p < .001, ΔR2 = .30) and higher levels of CRP (B = .33, t = 3.93, p < .001, ΔR2 = .10). Using linear mixed modeling with relevant covariates, we found that greater thoughts about historical loss were associated with higher systolic ambulatory blood pressure (B = .32, 95% CI = .22-.42, t = 6.48, p < .001, ΔR2 = .25; Fig. 1c) and greater diastolic ambulatory blood pressure (B = .19, 95% CI = .11-.27, t = 4.73, p < .001, ΔR2 = .19). CONCLUSIONS The data suggest that frequency of thought about historical loss may contribute to increased subclinical risk for cardiovascular disease in the Blackfeet community.
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Affiliation(s)
- Neha A John-Henderson
- Montana State University, Department of Psychology, 319 Traphagen Hall, Bozeman, MT, USA
| | - Benjamin Oosterhoff
- Montana State University, Department of Psychology, 319 Traphagen Hall, Bozeman, MT, USA
| | - Taylor D Kampf
- Montana State University, Department of Psychology, 319 Traphagen Hall, Bozeman, MT, USA
| | - Brad Hall
- University of Montana, Missoula, MT, USA
| | | | | | | | - Emily Salois
- Montana State University, Center for American Indian and Rural Health Equity, Bozeman, MT, USA
| | - Jason R Carter
- Montana State University, Department of Psychology, 319 Traphagen Hall, Bozeman, MT, USA.,Montana State University, Department of Health and Human Development, Bozeman, MT, USA
| | - Alexandra K Adams
- Montana State University, Center for American Indian and Rural Health Equity, Bozeman, MT, USA
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24
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Kostin A, Alam MA, McGinty D, Alam MN. Adult hypothalamic neurogenesis and sleep-wake dysfunction in aging. Sleep 2021; 44:5986548. [PMID: 33202015 DOI: 10.1093/sleep/zsaa173] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/22/2020] [Indexed: 12/21/2022] Open
Abstract
In the mammalian brain, adult neurogenesis has been extensively studied in the hippocampal sub-granular zone and the sub-ventricular zone of the anterolateral ventricles. However, growing evidence suggests that new cells are not only "born" constitutively in the adult hypothalamus, but many of these cells also differentiate into neurons and glia and serve specific functions. The preoptic-hypothalamic area plays a central role in the regulation of many critical functions, including sleep-wakefulness and circadian rhythms. While a role for adult hippocampal neurogenesis in regulating hippocampus-dependent functions, including cognition, has been extensively studied, adult hypothalamic neurogenic process and its contributions to various hypothalamic functions, including sleep-wake regulation are just beginning to unravel. This review is aimed at providing the current understanding of the hypothalamic adult neurogenic processes and the extent to which it affects hypothalamic functions, including sleep-wake regulation. We propose that hypothalamic neurogenic processes are vital for maintaining the proper functioning of the hypothalamic sleep-wake and circadian systems in the face of regulatory challenges. Sleep-wake disturbance is a frequent and challenging problem of aging and age-related neurodegenerative diseases. Aging is also associated with a decline in the neurogenic process. We discuss a hypothesis that a decrease in the hypothalamic neurogenic process underlies the aging of its sleep-wake and circadian systems and associated sleep-wake disturbance. We further discuss whether neuro-regenerative approaches, including pharmacological and non-pharmacological stimulation of endogenous neural stem and progenitor cells in hypothalamic neurogenic niches, can be used for mitigating sleep-wake and other hypothalamic dysfunctions in aging.
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Affiliation(s)
- Andrey Kostin
- Research Service (151A3), Veterans Affairs Greater Los Angeles Healthcare System, Sepulveda, CA
| | - Md Aftab Alam
- Research Service (151A3), Veterans Affairs Greater Los Angeles Healthcare System, Sepulveda, CA.,Department of Psychiatry, University of California, Los Angeles, CA
| | - Dennis McGinty
- Research Service (151A3), Veterans Affairs Greater Los Angeles Healthcare System, Sepulveda, CA.,Department of Psychology, University of California, Los Angeles, CA
| | - Md Noor Alam
- Research Service (151A3), Veterans Affairs Greater Los Angeles Healthcare System, Sepulveda, CA.,Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA
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25
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Ibatov AD. [Features of emotional status and autonomic regulation in patients with ischemic heart disease with sleep disorders]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:21-25. [PMID: 33580756 DOI: 10.17116/jnevro202112101121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To study the features of the emotional status and autonomic regulation in patients with coronary heart disease and sleep disorders. MATERIAL AND METHODS Patients with angina pectoris of II-IV functional class (n=244), aged 36 to 72 years (average age 56.9±0.5 years), were examined. Emotional status was assessed by the Hospital Anxiety and Depression Scale (HADS), the Beck Depression Inventory, the State-Trait Anxiety Inventory. The vegetative status was studied by heart rate variability based on 5-minute recordings of cardiointervalogram and D.J. Ewing cardiovascular tests and a vegetative disorders questionnaire. Patients were divided into 2 groups depending on the severity of sleep disorders. RESULTS Sixty-two patients (25.4%) had no sleep disorders (≥22 points on the sleep quality questionnaire), they were included in the 2nd group; 113 patients (46.3%) had severe sleep disorders (≤18 points on the sleep quality questionnaire), these patients were included in the 1st group, 69 patients (28.3%) had sleep disorders assessed as insignificant (from 19 to 21 points on the sleep quality questionnaire). The HADS scores for anxiety and depression were 9.2±0.4 and 7.7±0.4, respectively, in the 1st group; in the 2nd group the levels of anxiety and depression were 5.9±0.4 and 3.9±0.4 points (p<0.001). Clinically expressed autonomic disorders were observed in 100% of patients in the 1st group and in 75.8% in the 2nd group (p<0.001). The average score on the questionnaire of autonomic disorders was 41.8±1.2 in the 1st group, and 25.6±1.6 points in the 2nd group (p<0.001). CONCLUSION In patients with sleep disorders, a higher level of anxiety, depression, autonomic disorders and lower heart rate variability were detected, which is an unfavourable prognostic sign that should be considered in treatment and rehabilitation of these patients.
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Affiliation(s)
- A D Ibatov
- Sechenov First Moscow State Medical University, Moscow, Russia
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Polanka BM, Kundu S, So-Armah KA, Freiberg MS, Gupta SK, Zapolski TCB, Hirsh AT, Bedimo RJ, Budoff MJ, Butt AA, Chang CCH, Gottlieb SS, Marconi VC, Womack JA, Stewart JC. Insomnia symptoms and biomarkers of monocyte activation, systemic inflammation, and coagulation in HIV: Veterans Aging Cohort Study. PLoS One 2021; 16:e0246073. [PMID: 33561176 PMCID: PMC7872271 DOI: 10.1371/journal.pone.0246073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/12/2021] [Indexed: 12/11/2022] Open
Abstract
Background Insomnia may be a risk factor for cardiovascular disease in HIV (HIV-CVD); however, mechanisms have yet to be elucidated. Methods We examined cross-sectional associations of insomnia symptoms with biological mechanisms of HIV-CVD (immune activation, systemic inflammation, and coagulation) among 1,542 people with HIV from the Veterans Aging Cohort Study (VACS) Biomarker Cohort. Past-month insomnia symptoms were assessed by the item, “Difficulty falling or staying asleep?,” with the following response options: “I do not have this symptom” or “I have this symptom and…” “it doesn’t bother me,” “it bothers me a little,” “it bothers me,” “it bothers me a lot.” Circulating levels of the monocyte activation marker soluble CD14 (sCD14), inflammatory marker interleukin-6 (IL-6), and coagulation marker D-dimer were determined from blood specimens. Demographic- and fully-adjusted (CVD risk factors, potential confounders, HIV-related factors) regression models were constructed, with log-transformed biomarker variables as the outcomes. We present the exponentiated regression coefficient (exp[b]) and its 95% confidence interval (CI). Results We observed no significant associations between insomnia symptoms and sCD14 or IL-6. For D-dimer, veterans in the “Bothers a Lot” group had, on average, 17% higher D-dimer than veterans in the “No Difficulty Falling or Staying Asleep” group in the demographic-adjusted model (exp[b] = 1.17, 95%CI = 1.01–1.37, p = .04). This association was nonsignificant in the fully-adjusted model (exp[b] = 1.09, 95%CI = 0.94–1.26, p = .27). Conclusion We observed little evidence of relationships between insomnia symptoms and markers of biological mechanisms of HIV-CVD. Other mechanisms may be responsible for the insomnia-CVD relationship in HIV; however, future studies with comprehensive assessments of insomnia symptoms are warranted.
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Affiliation(s)
- Brittanny M Polanka
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Suman Kundu
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Kaku A So-Armah
- Division of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Matthew S Freiberg
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Samir K Gupta
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Tamika C B Zapolski
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, Indiana, United States of America
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, Indiana, United States of America
| | - Roger J Bedimo
- Division of Infectious Diseases, VA North Texas Healthcare System, Dallas, Texas, United States of America
| | - Matthew J Budoff
- Lundquist Institute, Torrance, California, United States of America
| | - Adeel A Butt
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States of America
- Weill Cornell Medical College, Doha, Qatar, and New York City, New York, United States of America
- Hamad Medical Corp, Doha, Qatar
| | - Chung-Chou H Chang
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Stephen S Gottlieb
- Department of Medicine, University of Maryland School of Medicine and Baltimore VAMC, Baltimore, Maryland, United States of America
| | - Vincent C Marconi
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Atlanta VA Medical Center, Atlanta, Georgia, United States of America
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, Unites States of America
| | - Julie A Womack
- VA Connecticut Healthcare System, West Haven, Connecticut, United States of America
- Yale University School of Nursing, West Haven, Connecticut, United States of America
| | - Jesse C Stewart
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, Indiana, United States of America
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Ramos-Lopez O, Milagro FI, Riezu-Boj JI, Martinez JA. Epigenetic signatures underlying inflammation: an interplay of nutrition, physical activity, metabolic diseases, and environmental factors for personalized nutrition. Inflamm Res 2021; 70:29-49. [PMID: 33231704 PMCID: PMC7684853 DOI: 10.1007/s00011-020-01425-y] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/26/2020] [Accepted: 11/12/2020] [Indexed: 12/12/2022] Open
Abstract
AIM AND OBJECTIVE Emerging translational evidence suggests that epigenetic alterations (DNA methylation, miRNA expression, and histone modifications) occur after external stimuli and may contribute to exacerbated inflammation and the risk of suffering several diseases including diabetes, cardiovascular diseases, cancer, and neurological disorders. This review summarizes the current knowledge about the harmful effects of high-fat/high-sugar diets, micronutrient deficiencies (folate, manganese, and carotenoids), obesity and associated complications, bacterial/viral infections, smoking, excessive alcohol consumption, sleep deprivation, chronic stress, air pollution, and chemical exposure on inflammation through epigenetic mechanisms. Additionally, the epigenetic phenomena underlying the anti-inflammatory potential of caloric restriction, n-3 PUFA, Mediterranean diet, vitamin D, zinc, polyphenols (i.e., resveratrol, gallic acid, epicatechin, luteolin, curcumin), and the role of systematic exercise are discussed. METHODS Original and review articles encompassing epigenetics and inflammation were screened from major databases (including PubMed, Medline, Science Direct, Scopus, etc.) and analyzed for the writing of the review paper. CONCLUSION Although caution should be exercised, research on epigenetic mechanisms is contributing to understand pathological processes involving inflammatory responses, the prediction of disease risk based on the epigenotype, as well as the putative design of therapeutic interventions targeting the epigenome.
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Affiliation(s)
- Omar Ramos-Lopez
- Medicine and Psychology School, Autonomous University of Baja California, Tijuana, Baja California, Mexico
| | - Fermin I Milagro
- Department of Nutrition, Food Science and Physiology, Center for Nutrition Research, University of Navarra, 1 Irunlarrea Street, 31008, Pamplona, Spain.
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.
- CIBERobn, Fisiopatología de la Obesidad y la Nutrición, Carlos III Health Institute, Madrid, Spain.
| | - Jose I Riezu-Boj
- Department of Nutrition, Food Science and Physiology, Center for Nutrition Research, University of Navarra, 1 Irunlarrea Street, 31008, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - J Alfredo Martinez
- Department of Nutrition, Food Science and Physiology, Center for Nutrition Research, University of Navarra, 1 Irunlarrea Street, 31008, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
- CIBERobn, Fisiopatología de la Obesidad y la Nutrición, Carlos III Health Institute, Madrid, Spain
- Precision Nutrition and Cardiometabolic Health, IMDEA-Food Institute (Madrid Institute for Advanced Studies), Madrid, Spain
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Morris G, Puri BK, Olive L, Carvalho A, Berk M, Walder K, Gustad LT, Maes M. Endothelial dysfunction in neuroprogressive disorders-causes and suggested treatments. BMC Med 2020; 18:305. [PMID: 33070778 PMCID: PMC7570030 DOI: 10.1186/s12916-020-01749-w] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/16/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Potential routes whereby systemic inflammation, oxidative stress and mitochondrial dysfunction may drive the development of endothelial dysfunction and atherosclerosis, even in an environment of low cholesterol, are examined. MAIN TEXT Key molecular players involved in the regulation of endothelial cell function are described, including PECAM-1, VE-cadherin, VEGFRs, SFK, Rho GEF TRIO, RAC-1, ITAM, SHP-2, MAPK/ERK, STAT-3, NF-κB, PI3K/AKT, eNOS, nitric oxide, miRNAs, KLF-4 and KLF-2. The key roles of platelet activation, xanthene oxidase and myeloperoxidase in the genesis of endothelial cell dysfunction and activation are detailed. The following roles of circulating reactive oxygen species (ROS), reactive nitrogen species and pro-inflammatory cytokines in the development of endothelial cell dysfunction are then described: paracrine signalling by circulating hydrogen peroxide, inhibition of eNOS and increased levels of mitochondrial ROS, including compromised mitochondrial dynamics, loss of calcium ion homeostasis and inactivation of SIRT-1-mediated signalling pathways. Next, loss of cellular redox homeostasis is considered, including further aspects of the roles of hydrogen peroxide signalling, the pathological consequences of elevated NF-κB, compromised S-nitrosylation and the development of hypernitrosylation and increased transcription of atherogenic miRNAs. These molecular aspects are then applied to neuroprogressive disorders by considering the following potential generators of endothelial dysfunction and activation in major depressive disorder, bipolar disorder and schizophrenia: NF-κB; platelet activation; atherogenic miRs; myeloperoxidase; xanthene oxidase and uric acid; and inflammation, oxidative stress, nitrosative stress and mitochondrial dysfunction. CONCLUSIONS Finally, on the basis of the above molecular mechanisms, details are given of potential treatment options for mitigating endothelial cell dysfunction and activation in neuroprogressive disorders.
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Affiliation(s)
- Gerwyn Morris
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
| | | | - Lisa Olive
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
- School of Psychology, Faculty of Health, Deakin University, Geelong, Australia
| | - Andre Carvalho
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Michael Berk
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia.
- Orygen, The National Centre of Excellence in Youth Mental Health, the Department of Psychiatry and the Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia.
| | - Ken Walder
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
| | - Lise Tuset Gustad
- Department of Circulation and medical imaging, Norwegian University of Technology and Science (NTNU), Trondheim, Norway
- Nord-Trøndelag Hospital Trust, Levanger Hospital, Levanger, Norway
| | - Michael Maes
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
- Department of Psychiatry, King Chulalongkorn University Hospital, Bangkok, Thailand
- Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria
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Shih YC, Han SH, Burr JA. Are Spouses' Sleep Problems a Mechanism Through Which Health is Compromised? Evidence Regarding Insomnia and Heart Disease. Ann Behav Med 2020; 53:345-357. [PMID: 29947733 DOI: 10.1093/abm/kay048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Symptoms of insomnia have been widely identified as risk factors for health, including heart disease. Despite the expansive and growing literature on health concordance among coupled individuals, few studies have examined insomnia as a shared risk factor for heart disease among middle-aged and older couples. PURPOSE This study examined the association between insomnia and incident heart disease among couples. A dyadic modeling approach was employed to investigate the relationships between one's own insomnia and partners' insomnia for the risk of incident heart disease for each partner. METHODS Data from the 2010, 2012, and 2014 Health and Retirement Study were utilized in a prospective research design (N = 3,221 couples). Actor-partner interdependence models were employed to estimate actor and partner effects of insomnia symptoms for incident heart disease over the 4 year observation period. RESULTS Insomnia symptoms measured at baseline were related to an increased risk for heart disease for husbands, whereas for wives the association was attenuated after other health measures were controlled. Wives' insomnia was related to an increased risk of incident heart disease for husbands but husbands' insomnia was not related to wives' risk of heart disease. CONCLUSIONS This study showed how subjective insomnia symptoms among middle-aged and older adults in intimate partnerships are associated with their heart disease risk. Further research is needed to verify the results with objective measures of sleep problems and heart disease.
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Affiliation(s)
- Yao-Chi Shih
- Department of Social Welfare, National Chung Cheng University, Minxiong, Chiayi, Taiwan
| | - Sae Hwang Han
- Department of Gerontology, University of Massachusetts Boston, Boston, MA
| | - Jeffrey A Burr
- Department of Gerontology, University of Massachusetts Boston, Boston, MA
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Sleep Disturbance in Early Pregnancy, but Not Inflammatory Cytokines, May Increase Risk for Adverse Pregnancy Outcomes. Int J Behav Med 2020; 28:48-63. [PMID: 32372169 DOI: 10.1007/s12529-020-09880-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND It is unclear whether subjective or objective measures of sleep during pregnancy are more pertinent to pregnancy outcomes. Moreover, it is unclear as to whether subjective indices (i.e., those likely influenced by psychological thoughts and emotions) are more likely than objective measures to modify inflammatory cytokines. METHOD Subjective and objective measures of sleep were collected from 166 pregnant women. Sleep data, both aggregate and variability measures, from diary and actigraphy, were ascertained for three 2-week periods during early gestation (10-20 weeks). A fasting morning blood sample was assayed for the cytokines (IL-6, IFN-γ, and TNF-α). Sleep, stress, and depression questionnaires were also collected. Repeated measures ANOVAs, regression models, and independent t tests were used to analyze the data. RESULTS Diary-assessed total sleep time (p < .05) and actigraphy-assessed sleep latency (p = .05) were negatively associated with gestational age. Variability in actigraphy-assessed sleep latency (p < .01) was negatively associated with infant weight. None of the cytokines was associated with any of the outcomes. t tests revealed that those with a complication were older (p < .05) and had higher pre-pregnancy BMI (p < .05), higher self-reported stress (p < .05), and lower IFN-γ (p < .05). CONCLUSION Findings suggest that longer and more variable sleep latency, as well as shorter sleep duration, is associated with shorter gestational age or a lower birth weight infant. Overall, the findings suggest that among a low-risk, healthy sample of pregnant women, sleep disturbance does not pose a substantial risk for adverse delivery outcomes.
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31
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Miller BJ, Parker CB, Rapaport MH, Buckley PF, McCall WV. Insomnia and suicidal ideation in nonaffective psychosis. Sleep 2020; 42:5165662. [PMID: 30407600 DOI: 10.1093/sleep/zsy215] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Indexed: 12/20/2022] Open
Abstract
Study Objectives Insomnia is a common symptom in the clinical course of schizophrenia. There is a robust association between insomnia and suicidality in other psychiatric disorders. Two previous studies found associations between insomnia and suicide attempt or completed suicide in patients with schizophrenia. We hypothesized that greater insomnia would be associated with greater levels of suicidal ideation in patients with schizophrenia and other nonaffective psychoses. Methods We recruited 108 inpatients and outpatients age 18-65 between July 2010 and July 2016 with DSM-IV nonaffective psychosis (schizophrenia, schizoaffective disorder, or schizophreniform disorder). We investigated relationships between current insomnia (Insomnia Severity Index [ISI]), suicidal ideation over the past week, and lifetime history of suicide attempt (Beck Scale for Suicide Ideation [BSS]) in regression analyses. Results After controlling for potential confounders, insomnia was a significant indicator of suicidal ideation (β = 0.27, p = 0.032). Insomnia was also a significant indicator of a high BSS score (≥16; OR = 1.14, 95% CI: 1.01-1.28, p = 0.029). Furthermore, participants with severe insomnia were almost 15 times more likely to have a lifetime history suicide attempt than participants without current insomnia (OR = 14.8, 95% CI: 1.4-157, p = 0.025). Insomnia was also an indicator of greater PANSS total (β = 0.33, p = 0.001), positive subscale (β = 0.32, p = 0.002), and general subscale (β = 0.40, p < 0.001) scores. Conclusions Insomnia is associated with suicidal ideation, lifetime suicide attempt, and greater psychopathology in patients with schizophrenia. Our findings suggest that formal assessment of insomnia may be germane to the clinical care of patients with schizophrenia as a marker of suicide risk and symptom severity.
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Affiliation(s)
- Brian J Miller
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA
| | - Carmen B Parker
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Mark H Rapaport
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA
| | - Peter F Buckley
- School of Medicine, Virginia Commonwealth University, Richmond, VA
| | - William V McCall
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA
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Davidson KW, Alcántara C, Miller GE. Selected psychological comorbidities in coronary heart disease: Challenges and grand opportunities. ACTA ACUST UNITED AC 2019; 73:1019-1030. [PMID: 30394780 DOI: 10.1037/amp0000239] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Evidence of popular interest in the interrelationships between mind, body, and heart disease dates to Ancient Grecian times and paved the way for modern-day scientific inquiry into the relationships between psychological comorbidities in coronary heart disease. Although the systematic evidence has suggested an association of poor medical prognosis and lower quality of life among patients with coronary heart disease with comorbid psychological conditions, the mechanisms are less well understood. In this selective review article, the epidemiology, mechanisms, screening, and treatment recommendations for 4 common psychological conditions (depression, anxiety, stress, and insomnia) comorbid with coronary heart disease are presented. We focus on the grand challenges and unprecedented opportunities for research in this area considering the methodological and technological innovations of the 21st century. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
- Karina W Davidson
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center
| | - Carmela Alcántara
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center
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Havekes R, Heckman PRA, Wams EJ, Stasiukonyte N, Meerlo P, Eisel ULM. Alzheimer's disease pathogenesis: The role of disturbed sleep in attenuated brain plasticity and neurodegenerative processes. Cell Signal 2019; 64:109420. [PMID: 31536750 DOI: 10.1016/j.cellsig.2019.109420] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 09/15/2019] [Indexed: 01/07/2023]
Abstract
Alzheimer's disease (AD) is a neurodegenerative disorder characterized by cognitive impairments. The classical symptoms of the disease include gradual deterioration of memory and language. Epidemiological studies indicate that around 25-40% of AD patients have sleep-wake cycle disturbances. Importantly, a series of studies suggested that the relationship between AD and sleep disturbance may be complex and bidirectional. Indeed, accumulation of the extracellular neuronal protein amyloid-beta (Aβ) leads to altered sleep-wake behavior in both mice and humans. At the same time, disturbances of the normal sleep-wake cycle may facilitate AD pathogenesis. This paper will review the mechanisms underlying this potential interrelated connection including locus coeruleus damage, reductions in orexin neurotransmission, alterations in melatonin levels, and elevated cytokine levels. In addition, we will also highlight how both the development of AD and sleep disturbances lead to changes in intracellular signaling pathways involved in regulating neuronal plasticity and connectivity, particularly extremes in cofilin phosphorylation. Finally, current pharmacological and nonpharmacological therapeutic approaches will be discussed.
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Affiliation(s)
- Robbert Havekes
- Neurobiology expertise group, Groningen Institute for Evolutionary Life Sciences (GELIFES), University of Groningen, Groningen, the Netherlands.
| | - Pim R A Heckman
- Neurobiology expertise group, Groningen Institute for Evolutionary Life Sciences (GELIFES), University of Groningen, Groningen, the Netherlands
| | - Emma J Wams
- Neurobiology expertise group, Groningen Institute for Evolutionary Life Sciences (GELIFES), University of Groningen, Groningen, the Netherlands
| | - Neringa Stasiukonyte
- Neurobiology expertise group, Groningen Institute for Evolutionary Life Sciences (GELIFES), University of Groningen, Groningen, the Netherlands
| | - Peter Meerlo
- Neurobiology expertise group, Groningen Institute for Evolutionary Life Sciences (GELIFES), University of Groningen, Groningen, the Netherlands
| | - Ulrich L M Eisel
- Neurobiology expertise group, Groningen Institute for Evolutionary Life Sciences (GELIFES), University of Groningen, Groningen, the Netherlands.
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McIntosh R, Antoni M, Seay J, Fletcher MA, Ironson G, Klimas N, Kumar M, Schneiderman N. Associations Among Trajectories of Sleep Disturbance, Depressive Symptomology and 24-Hour Urinary Cortisol in HIV+ Women Following a Stress Management Intervention. Behav Sleep Med 2019; 17:605-620. [PMID: 29461096 DOI: 10.1080/15402002.2018.1435545] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective: The burden of sleep disturbance and depressive symptomology is high for persons living with HIV and particularly so for women. While cognitive behavioral stress management (CBSM) is shown to reduce symptoms of depression and 24-hr urinary free cortisol output (CORT) in HIV+ men, less is known about the effects of CBSM on mood and concomitant sleep disturbance in HIV+ women. The study aim is to model longitudinal change in sleep disturbance, depressive symptomology, and CORT for HIV+ women exposed to a 12-week CBSM intervention or control condition. Methods: Self-reported sleep quality and depressive symptomology, along with CORT, was collected from surveys at baseline and approximately every three months thereafter for nine months from 130 HIV+ women (Mage = 38.44, SD = 7.73). The data was used to specify a parallel process latent growth model with CORT as a time-varying covariate. Results: The model showed acceptable fit. There was a linear decline in sleep disturbance (β = -0.32, p < .05) and logarithmic decline in depressive symptomology (β = -0.33, p < .05) for those receiving the intervention. Decline in sleep disturbance predicted lower CORT at nine months. Furthermore, having less depressive symptoms at baseline was associated with lower initial levels of sleep disturbance and greater improvement in sleep quality over time. There was no discernible association between sleep and mood disturbance in the control group. Across groups, there was a consistent association between older age and greater sleep disturbance (r = 0.34, p < .01). Conclusion: Sleep disturbance appears to be a behavioral target for CBSM in HIV+ women although older age, preintervention levels of depressive mood, and time-varying levels of CORT output may limit improvement in sleep quality over time.
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Affiliation(s)
- Roger McIntosh
- a Department of Psychology, University of Miami , Coral Gables , Florida , USA
| | - Michael Antoni
- a Department of Psychology, University of Miami , Coral Gables , Florida , USA.,b Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami , Miami , Florida , USA.,e Departments of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine , Miami , Florida , USA
| | - Julia Seay
- b Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami , Miami , Florida , USA
| | - Mary Ann Fletcher
- c Miami Veterans Affairs Medical Center , Miami , Florida , USA.,d Institute for Neuro-immune Medicine, Nova Southeastern University , Davie , Florida , USA
| | - Gail Ironson
- a Department of Psychology, University of Miami , Coral Gables , Florida , USA
| | - Nancy Klimas
- c Miami Veterans Affairs Medical Center , Miami , Florida , USA.,d Institute for Neuro-immune Medicine, Nova Southeastern University , Davie , Florida , USA
| | - Mahendra Kumar
- e Departments of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine , Miami , Florida , USA
| | - Neil Schneiderman
- a Department of Psychology, University of Miami , Coral Gables , Florida , USA.,c Miami Veterans Affairs Medical Center , Miami , Florida , USA.,f Behavioral Medicine Research Center, Miller School of Medicine, University of Miami , Miami , Florida , USA
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Carroll JE, Irwin MR, Seeman TE, Diez-Roux AV, Prather AA, Olmstead R, Epel E, Lin J, Redline S. Obstructive sleep apnea, nighttime arousals, and leukocyte telomere length: the Multi-Ethnic Study of Atherosclerosis. Sleep 2019; 42:zsz089. [PMID: 30994174 PMCID: PMC6612669 DOI: 10.1093/sleep/zsz089] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 02/28/2019] [Indexed: 02/07/2023] Open
Abstract
STUDY OBJECTIVES Sleep disturbances and sleep apnea are associated with increased vulnerability to age-related disease, altering molecular pathways affecting biological aging. Telomere length captures one component of biological aging. We evaluated whether objectively assessed sleep and sleep apnea relate to leukocyte telomere length (LTL) in the Multi-Ethnic Study of Atherosclerosis (MESA). METHODS Men and women aged 44-84 years (n = 672) from the MESA Stress and MESA Sleep studies underwent polysomnography and 7 day actigraphy (at Exam 5) and assessment of LTL (at baseline [Exam 1] and about 10 years later [Exam 5]). RESULTS General linear models adjusting for age, sex, race/ethnicity, BMI, physical activity, and smoking found that severe obstructive sleep apnea (OSA; apnea-hypopnea index > 30) was cross-sectionally associated with shorter LTL (p = 0.007). Modest associations of shorter LTL with less rapid eye movement sleep, more stage 1 sleep, wake after sleep onset >30 min, and long sleep duration were found, but these effects were diminished after adjusting for lifestyle and OSA. Exploratory analyses found that higher arousal index at Exam 5 was associated with greater LTL decline over the prior 10 years (p = 0.004). CONCLUSIONS OSA was associated with shorter LTL. Individuals with high-arousal frequency had greater leukocyte telomere attrition over the prior decade. These findings suggest that sleep apnea and sleep fragmentation are associated with accelerated biological aging.
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Affiliation(s)
- Judith E Carroll
- Department of Psychiatry and Biobehavioral Sciences, Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA
| | - Michael R Irwin
- Department of Psychiatry and Biobehavioral Sciences, Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA
| | - Teresa E Seeman
- Department of Medicine, Division of Geriatrics, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Ana V Diez-Roux
- Department of Epidemiology, School of Public Health, Drexel University, Philadelphia, PA
| | - Aric A Prather
- Department of Psychiatry, Univeristy of California, San Francisco, CA
| | - Richard Olmstead
- Department of Psychiatry and Biobehavioral Sciences, Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA
| | - Elissa Epel
- Department of Psychiatry, Univeristy of California, San Francisco, CA
| | - Jue Lin
- Department of Biochemistry and Biophysics, University of California, San Francisco, CA
| | - Susan Redline
- Department of Medicine, Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Hitzler M, Karabatsiakis A, Kolassa IT. Biomolekulare Vulnerabilitätsfaktoren psychischer Erkrankungen. PSYCHOTHERAPEUT 2019. [DOI: 10.1007/s00278-019-0366-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Rajalingam D, Jacobsen DP, Nielsen MB, Einarsen SV, Gjerstad J. Exposure to Workplace Bullying, Distress, and Insomnia: The Moderating Role of the miR-146a Genotype. Front Psychol 2019; 10:1204. [PMID: 31178808 PMCID: PMC6542980 DOI: 10.3389/fpsyg.2019.01204] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 05/07/2019] [Indexed: 12/29/2022] Open
Abstract
Several lines of evidence show that systematic exposure to negative social acts at the workplace i.e., workplace bullying, results in symptoms of depression and anxiety among those targeted. However, little is known about the association between bullying, inflammatory genes and sleep problems. In the present study, we examined the indirect association between exposure to negative social acts and sleep through distress, as moderated by the miR-146a genotype. The study was based on a nationally representative survey of 1179 Norwegian employees drawn from the Norwegian Central Employee Register by Statistics Norway. Exposure to workplace bullying was measured with the 9-item version of Negative Acts Questionnaire - Revised (NAQ-R) inventory. Seventeen items from Hopkins Symptom Checklist (HSCL-25) was used to measure distress. Insomnia was assessed with three items reflecting problems with sleep onset, maintenance of sleep and early morning awakening. Genotyping with regard to miR-146a rs2910164, previously linked to inflammatory processes, was carried out using Taqman assay. The data revealed that individuals systematically exposed to negative social acts at the workplace reported higher levels of sleep problems than non-exposed individuals. Moreover, the relationship between distress induced by exposure to negative social acts and insomnia was significantly stronger for individuals with the miR-146a GG genotype. Thus, the miR-146a genotype moderated the association between distress and insomnia among individuals exposed to negative social acts. The present report support the hypothesis that inflammation could play a role in stress-induced insomnia among individuals exposed to workplace bullying.
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Affiliation(s)
| | | | - Morten Birkeland Nielsen
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
- National Institute of Occupational Health, Oslo, Norway
| | | | - Johannes Gjerstad
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
- National Institute of Occupational Health, Oslo, Norway
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Preoperative Sleep Disturbance Exaggerates Surgery-Induced Neuroinflammation and Neuronal Damage in Aged Mice. Mediators Inflamm 2019; 2019:8301725. [PMID: 31011286 PMCID: PMC6442479 DOI: 10.1155/2019/8301725] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 12/23/2018] [Indexed: 12/20/2022] Open
Abstract
Postoperative cognitive dysfunction (POCD) is defined as new cognitive impairment (memory impairment and impaired performance) after surgery, especially in aged patients. Sleep disturbance is a common phenomenon before surgery that has been increasingly thought to affect patient recovery. However, little is known about the functional impact of preoperative sleep disturbance on POCD. Here, we showed that tibial fracture surgery induced cognitive deficit and production of proinflammatory cytokines interleukin-6 (IL-6) and IL-1β, along with microglia and astrocyte activation, neuronal damage, and blood-brain barrier (BBB) disruption. Preoperative sleep disturbance enhanced the surgery-induced neuroinflammation, neuronal damage, BBB disruption, and memory impairment 24 h after surgery. Taken together, these results demonstrated that preoperative sleep disturbance aggravated postoperative cognitive function in aged mice and the mechanism may be related to central nervous system (CNS) inflammation and neuronal damage.
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Cooper LN, Mishra I, Ashley NT. Short-Term Sleep Loss Alters Cytokine Gene Expression in Brain and Peripheral Tissues and Increases Plasma Corticosterone of Zebra Finch (Taeniopygia guttata). Physiol Biochem Zool 2019; 92:80-91. [DOI: 10.1086/701170] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
OBJECTIVE Spousal bereavement is linked to increased mortality and morbidity from inflammatory conditions. It also has a significant impact on sleep disturbances. Evidence from experimental studies indicates that chronic stress may prime individuals to have an exaggerated inflammatory response to acute stress. In this study, we examined the association between self-reported sleep disturbances and inflammation after adjusting for depressive symptoms and determined whether this association varies by bereavement status (bereaved individuals versus controls). METHODS Participants included 54 bereaved individuals and 47 controls with a M (SD) age of 67.12 (12.11) years. Inflammation was measured using C-reactive protein. Self-reported sleep disturbances were measured using the Pittsburgh Sleep Quality Index. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale. RESULTS Sleep disturbances were not associated with elevated levels of C-reactive protein in the overall group (B = 0.030, standardized β = 0.122, 95% confidence interval [CI] = -0.027 to 0.087, p = .299) after adjusting for depressive symptoms. Results indicated, however, that bereavement moderated the association between inflammation and sleep disturbances (B = 0.104, β = 0.517, 95% CI = 0.009 to 0.198, p = .032). Stratified analyses demonstrated that these associations differed across groups. Associations were significant among bereaved individuals (B = 0.104, β = 0.406, 95% CI = 0.013 to 0.196, p = .026) and not controls (B = -0.016, β = -0.066, 95% CI = -0.096 to 0.065, p = .690). CONCLUSIONS These findings provide preliminary evidence that bereavement moderates the association between self-reported sleep disturbances and inflammation. Future studies should examine the course of sleep disturbances after bereavement and establish whether objective sleep has differential associations with inflammation among bereaved adults.
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von Känel R, Princip M, Schmid JP, Barth J, Znoj H, Schnyder U, Meister-Langraf RE. Association of sleep problems with neuroendocrine hormones and coagulation factors in patients with acute myocardial infarction. BMC Cardiovasc Disord 2018; 18:213. [PMID: 30463526 PMCID: PMC6249741 DOI: 10.1186/s12872-018-0947-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 11/01/2018] [Indexed: 12/14/2022] Open
Abstract
Background Obstructive sleep apnea (OSA) and insomnia are frequent sleep problems that are associated with poor prognosis in patients with coronary heart disease. The mechanisms linking poor sleep with an increased cardiovascular risk are incompletely understood. We examined whether a high risk of OSA as well as insomnia symptoms are associated with neuroendocrine hormones and coagulation factors in patients admitted with acute myocardial infarction. Methods We assessed 190 patients (mean age 60 years, 83% men) in terms of OSA risk (STOP screening tool for the assessment of high vs. low OSA risk) and severity of insomnia symptoms (Jenkins Sleep Scale for the assessment of subjective sleep difficulties) within 48 h of an acute coronary intervention. Circulating concentrations of epinephrine, norepinephrine, cortisol, fibrinogen, D-dimer, and von Willebrand factor were measured the next morning. The association of OSA risk and insomnia symptoms with neuroendocrine hormones and coagulation factors was computed using multivariate models adjusting for demographic factors, health behaviors, somatic and psychiatric comorbidities, cardiac disease-related variables, and OSA risk in the model for insomnia symptoms, respectively, for insomnia symptoms in the model for OSA risk. Results High OSA risk was identified in 41% of patients and clinically relevant insomnia symptoms were reported by 27% of patients. Compared to those with low OSA risk, patients with high OSA risk had lower levels of epinephrine (p = 0.015), norepinephrine (p = 0.049) and cortisol (p = 0.001). More severe insomnia symptoms were associated with higher levels of fibrinogen (p = 0.037), driven by difficulties initiating sleep, and with lower levels of norepinephrine (p = 0.024), driven by difficulties maintaining sleep. Conclusions In patients with acute myocardial infarction, sleep problems are associated with neuroendocrine hormones and coagulation activity. The pattern of these relationships is not uniform for patients with a high risk of OSA and those with insomnia symptoms, and whether they contribute to adverse cardiovascular outcomes needs to be established. Trial registration ClinicalTrials.gov NCT01781247.
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Affiliation(s)
- Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Culmannstrasse 8, CH-8091, Zurich, Switzerland.
| | - Mary Princip
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Culmannstrasse 8, CH-8091, Zurich, Switzerland
| | - Jean-Paul Schmid
- Department of Cardiology, Clinic Barmelweid, Barmelweid, Switzerland
| | - Jürgen Barth
- Complementary and Integrative Medicine, University of Zurich, Zurich, Switzerland
| | - Hansjörg Znoj
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
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Harvey AG, Hein K, Dolsen EA, Dong L, Rabe-Hesketh S, Gumport NB, Kanady J, Wyatt JK, Hinshaw SP, Silk JS, Smith RL, Thompson MA, Zannone N, Blum DJ. Modifying the Impact of Eveningness Chronotype ("Night-Owls") in Youth: A Randomized Controlled Trial. J Am Acad Child Adolesc Psychiatry 2018; 57:742-754. [PMID: 30274649 PMCID: PMC6923796 DOI: 10.1016/j.jaac.2018.04.020] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 03/31/2018] [Accepted: 06/20/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To determine whether an intervention to reduce eveningness chronotype improves sleep, circadian, and health (emotional, cognitive, behavioral, social, physical) outcomes. METHOD Youth aged 10 to 18 years with an evening chronotype and who were "at risk" in 1 of 5 health domains were randomized to: (a) Transdiagnostic Sleep and Circadian Intervention for Youth (TranS-C; n = 89) or (b) Psychoeducation (PE; n = 87) at a university-based clinic. Treatments were 6 individual, weekly 50-minute sessions during the school year. TranS-C addresses sleep and circadian problems experienced by youth by integrating evidence-based treatments derived from basic research. PE provides education on the interrelationship between sleep, stress, diet, and health. RESULTS Relative to PE, TranS-C was not associated with greater pre-post change for total sleep time (TST) or bed time (BT) on weeknights but was associated with greater reduction in evening circadian preference (pre-post increase of 3.89 points, 95% CI = 2.94-4.85, for TranS-C, and 2.01 points, 95% CI = 1.05-2.97 for PE, p = 0.006), earlier endogenous circadian phase, less weeknight-weekend discrepancy in TST and wakeup time, less daytime sleepiness, and better self-reported sleep via youth and parent report. In terms of functioning in the five health domains, relative to PE, TranS-C was not associated with greater pre-post change on the primary outcome. However, there were significant interactions favoring TranS-C on the Parent-Reported Composite Risk Scores for cognitive health. CONCLUSION For at-risk youth, the evidence supports the use of TranS-C over PE for improving sleep and circadian functioning, and improving health on selected outcomes. CLINICAL TRIAL REGISTRATION INFORMATION Triple Vulnerability? Circadian Tendency, Sleep Deprivation and Adolescence. https://clinicaltrials.gov; NCT01828320.
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Affiliation(s)
| | | | | | - Lu Dong
- University of California, Berkeley
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Vožeh F. Immunity - a significant pathogenic factor as well as an integral part of the psychoneuroendocrine-immune regulations. Physiol Res 2018; 67:165-173. [PMID: 29303607 DOI: 10.33549/physiolres.933656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Immunity plays an important role in the reactivity of the organism and, in this context, is an essential factor in the pathogenesis of many diseases. Basically, there is no system or organ in the body, whose dysfunction is not related to immunity consequences. In addition, there are also multisystem diseases simultaneously involving multiple body systems. They are not always caused by weak immunity, but also often by modified immune reactions known as overshooting. The essence of all these diseases is a change in the reactivity of the organism where immunity plays an important role. The immunity as such is then part of the systems of neuroendocrine-immune regulation, which have common mediators and receptors. The establishment of psychoneuroimmunology, a relatively new discipline in neuroscience, contributed to a detailed understanding of these mechanisms between central and peripheral nervous system, the endocrine system and the immune system. This research enabled the uncovering of the nature of stress-diseases and impact of other regulatory disturbances on the function of various body organs and systems of the organism as a whole. The aim of this short review is to show complex interconnections of these relationships to better understand the human health and disease.
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Affiliation(s)
- F Vožeh
- Department of Pathophysiology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.
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Type D personality and coronary atherosclerotic plaque vulnerability: The potential mediating effect of health behavior. J Psychosom Res 2018; 108:54-60. [PMID: 29602326 DOI: 10.1016/j.jpsychores.2018.02.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 02/12/2018] [Accepted: 02/17/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The association between type D personality and coronary plaque vulnerability has been suggested. The objective of the study was to evaluate the potential mediating effects of health behavior on the association between type D personality and plaque vulnerability in coronary artery disease (CAD) patients. METHODS A total of 319 CAD patients were assessed for type D personality and health behavior via self-administered questionnaires. The plaque vulnerability, evaluated according to characteristics, accompaniment, and outcomes of plaque, was assessed by optical coherence tomography. RESULTS Regression analysis showed that type D personality was independently associated with lipid plaque (odds ratio [OR] = 2.387, p = 0.001), thin cap fibroatheroma (TCFA) (OR = 2.366, p = 0.001), rupture (OR = 2.153, p = 0.002), and lipid arc (β = -0.291, p < 0.001). Mediation analyses showed that aspects of health behavior were significant mediators of the relationship between type D personality and plaque vulnerability. Psychological stress mediated the relationship between type D and lipid plaque (p = 0.030), TCFA (p = 0.034), and rupture (p = 0.013). Living habits significantly mediated the relationship between type D and lipid plaque (p = 0.028), TCFA (p = 0.036), but not rupture (p = 0.066). Participating in activities was not a significant mediator of the relationship between type D personality and lipid plaque (p = 0.115), TCFA (p = 0.115), or rupture (p = 0.077). CONCLUSIONS Health behaviors (psychological stress and living habits) may be mediators of the association between type D personality and plaque vulnerability.
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Poole L, Jackowska M. The Epidemiology of Depressive Symptoms and Poor Sleep: Findings from the English Longitudinal Study of Ageing (ELSA). Int J Behav Med 2018; 25:151-161. [PMID: 29204805 PMCID: PMC5852187 DOI: 10.1007/s12529-017-9703-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE The reasons for the comorbidity between depressed mood and poor sleep are not well understood. METHOD Participants were 5172 adults aged 50 years and older from the English Longitudinal Study of Ageing. Sleep was measured via self-report and depressive symptoms using the Centre for Epidemiological Studies Depression scale. RESULTS Greater depressive symptoms and sleep complaints were associated with female sex, non-cohabitation, relative poverty, smoking, infrequent physical activity, infrequent alcohol consumption, higher body mass index (BMI), diagnosis of hypertension, coronary heart disease, diabetes/high blood glucose, pulmonary disease, arthritis, and higher levels of fibrinogen and C-reactive protein (all p < 0.05). At a 4-year follow-up, depressive symptoms and sleep complaints were both predicted by baseline depressive symptoms and sleep complaints, relative poverty, smoking, physical inactivity, BMI, and arthritis (all p < 0.05). CONCLUSION Depressive symptoms and sleep complaints share a range of correlates cross-sectionally and prospectively. These findings highlight the common comorbidity between depressive symptoms and sleep complaints underscoring the need for further research to understand their combined detrimental effect on long-term health and wellbeing.
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Affiliation(s)
- Lydia Poole
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 6BT UK
| | - Marta Jackowska
- Department of Psychology, Whitelands College, University of Roehampton, Holybourne Avenue, London, SW15 4JD UK
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Basnet S, Merikanto I, Lahti T, Männistö S, Laatikainen T, Vartiainen E, Partonen T. Seasonality, morningness-eveningness, and sleep in common non - communicable medical conditions and chronic diseases in a population. Sleep Sci 2018; 11:85-91. [PMID: 30083295 PMCID: PMC6056070 DOI: 10.5935/1984-0063.20180017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 03/25/2018] [Indexed: 01/08/2023] Open
Abstract
The seasonal pattern for mood and behaviour, the behavioural trait of morningness-eveningness, and sleep are interconnected features, that may serve as etiological factors in the development or exacerbation of medical conditions. Methods: The study was based on a random sample of inhabitants aged 25 to 74 years living in Finland. As part of the national FINRISK 2012 study participants were invited (n=9905) and asked whether the doctor had diagnosed or treated them during the past 12 months for chronic diseases. Results: A total of 6424 participants filled in the first set of questionnaires and 5826 attended the physical health status examination, after which the second set of questionnaires were filled. Regression models were built in which each condition was explained by the seasonal, diurnal and sleep features, after controlling for a range of background factors. Of the chronic diseases, depressive disorder was associated with longer total sleep duration (p<.0001) and poor sleep quality (p<.0001). Of the measurements for health status assessment, none associated with sleep features, but systolic blood pressure yielded significant (p<.0001) associations with both seasonal and diurnal features at large. Conclusion: Sleep quality was the most sensitive probe in yielding associations with chronic diseases in this population-based study. The seasonal variations in mood and social activity, and the ease in getting up and tiredness in the morning were the most sensitive probes in yielding associations with blood pressure and waist circumference. Assessment of sleep quality, seasonal and diurnal features provides thus added value for health surveys of the general population.
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Affiliation(s)
- Syaron Basnet
- National Institute for Health and Welfare (THL), Department of
Public Health Solutions - Helsinki - Finlândia
- University of Helsinki, Department of Public Health, - Helsinki -
Finland
| | - Ilona Merikanto
- National Institute for Health and Welfare (THL), Department of
Public Health Solutions - Helsinki - Finlândia
- University of Helsinki, Department of Psychology, - Helsinki -
Finland
| | - Tuuli Lahti
- National Institute for Health and Welfare (THL), Department of
Public Health Solutions - Helsinki - Finlândia
- University of Helsinki, Department of Psychology, - Helsinki -
Finland
| | - Satu Männistö
- National Institute for Health and Welfare (THL), Department of
Public Health Solutions - Helsinki - Finlândia
| | - Tiina Laatikainen
- National Institute for Health and Welfare (THL), Department of
Public Health Solutions - Helsinki - Finlândia
- University of Eastern Finland,, Institute of Public Health and
Clinical Nutrition, - Kuopio - Finland
- Hospital District of North Karelia, - Joensuu - Finland
| | - Erkki Vartiainen
- National Institute for Health and Welfare (THL), Department of
Public Health Solutions - Helsinki - Finlândia
| | - Timo Partonen
- National Institute for Health and Welfare (THL), Department of
Public Health Solutions - Helsinki - Finlândia
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Griesbach GS, Masel BE, Helvie RE, Ashley MJ. The Impact of Traumatic Brain Injury on Later Life: Effects on Normal Aging and Neurodegenerative Diseases. J Neurotrauma 2017; 35:17-24. [PMID: 28920532 DOI: 10.1089/neu.2017.5103] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The acute and chronic effects of traumatic brain injury (TBI) have been widely described; however, there is limited knowledge on how a TBI sustained during early adulthood or mid-adulthood will influence aging. Epidemiological studies have explored whether TBI poses a risk for dementia and other neurodegenerative diseases associated with aging. We will discuss the influence of TBI and resulting medical comorbidities such as endocrine, sleep, and inflammatory disturbances on age-related gray and white matter changes and cognitive decline. Post mortem studies examining amyloid, tau, and other proteins will be discussed within the context of neurodegenerative diseases and chronic traumatic encephalopathy. The data support the suggestion that pathological changes triggered by an earlier TBI will have an influence on normal aging processes and will interact with neurodegenerative disease processes rather than the development of a specific disease, such as Alzheimer's or Parkinson's. Chronic neurophysiologic change after TBI may have detrimental effects on neurodegenerative disease.
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Affiliation(s)
- Grace S Griesbach
- 1 Centre for Neuro Skills Clinical Research and Education Foundation , Bakersfield, California.,2 Department of Neurosurgery, David Geffen School of Medicine at the University of California , Los Angeles, California
| | - Brent E Masel
- 1 Centre for Neuro Skills Clinical Research and Education Foundation , Bakersfield, California.,3 University of Texas Medical Branch , Galveston, Texas
| | - Richard E Helvie
- 1 Centre for Neuro Skills Clinical Research and Education Foundation , Bakersfield, California
| | - Mark J Ashley
- 1 Centre for Neuro Skills Clinical Research and Education Foundation , Bakersfield, California
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Han X, Yang Y, Chen Y, Gao L, Yin X, Li H, Qiu J, Wang Y, Zhou Y, Xia Y. Association between insomnia and atrial fibrillation in a Chinese population: A cross-sectional study. Clin Cardiol 2017; 40:765-769. [PMID: 28561943 DOI: 10.1002/clc.22731] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 04/24/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Insomnia is the most prevalent sleep disorder; however, little research has explored the link between insomnia and atrial fibrillation (AF). HYPOTHESIS Insomnia is associated with increased risk of AF in a Chinese population. METHODS A total of 8371 Chinese participants (4314 males; mean age, 42.4 ± 13.1 years) were enrolled in this cross-sectional study to investigate the association between insomnia and AF. AF was assessed in a standard supine resting position with a 10-s 12-lead electrocardiograph (ECG) or by self-reported history. Insomnia was assessed using the Athens Insomnia Scale (AIS), and a score of ≥6 was regarded as having insomnia. The association between insomnia and AF was determined by logistic regression analysis. RESULTS Among the 8371 subjects, 1074 (12.8%) had different degrees of insomnia, and AF was observed in 50 subjects (0.60%). After adjusting for potential confounders, individuals with insomnia had moderately increased likelihood of suffering from AF compared with those without insomnia (odds ratio [OR]: 1.92, 95% confidence interval [CI]: 1.00-3.70, P = 0.05). After stratifying data by age, a significant positive association was found in those age <40 years (OR: 6.52, 95% CI: 1.64-25.83, P = 0.01), and a similar trend existed in males after stratifying by sex, although this relationship was not statistically significant (OR: 2.11, 95% CI: 0.92-4.83, P = 0.08). CONCLUSIONS Individuals with insomnia may have a higher risk of AF in the particular Chinese population assessed in this study. Age (<40 years) is a significant factor in the association between insomnia and AF.
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Affiliation(s)
- Xu Han
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yiheng Yang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yue Chen
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lianjun Gao
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiaomeng Yin
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Huihua Li
- Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jing Qiu
- Human Resource, Wuhan Hospital of Traditional Chinese Medicine, Wuhan, China
| | - Youxin Wang
- Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Yong Zhou
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yunlong Xia
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
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Epigenetic Aging and Immune Senescence in Women With Insomnia Symptoms: Findings From the Women's Health Initiative Study. Biol Psychiatry 2017; 81:136-144. [PMID: 27702440 PMCID: PMC5536960 DOI: 10.1016/j.biopsych.2016.07.008] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 06/11/2016] [Accepted: 07/10/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Insomnia symptoms are associated with vulnerability to age-related morbidity and mortality. Cross-sectional data suggest that accelerated biological aging may be a mechanism through which sleep influences risk. A novel method for determining age acceleration using epigenetic methylation to DNA has demonstrated predictive utility as an epigenetic clock and prognostic of age-related morbidity and mortality. METHODS We examined the association of epigenetic age and immune cell aging with sleep in the Women's Health Initiative study (N = 2078; mean 64.5 ± 7.1 years of age) with assessment of insomnia symptoms (restlessness, difficulty falling asleep, waking at night, trouble getting back to sleep, and early awakenings), sleep duration (short sleep 5 hours or less; long sleep greater than 8 hours), epigenetic age, naive T cell (CD8+CD45RA+CCR7+), and late differentiated T cells (CD8+CD28-CD45RA-). RESULTS Insomnia symptoms were related to advanced epigenetic age (β ± SE = 1.02 ± 0.37, p = .005) after adjustments for covariates. Insomnia symptoms were also associated with more late differentiated T cells (β ± SE = 0.59 ± 0.21, p = .006), but not with naive T cells. Self-reported short and long sleep duration were unrelated to epigenetic age. Short sleep, but not long sleep, was associated with fewer naive T cells (p < .005) and neither was related to late differentiated T cells. CONCLUSIONS Symptoms of insomnia were associated with increased epigenetic age of blood tissue and were associated with higher counts of late differentiated CD8+ T cells. Short sleep was unrelated to epigenetic age and late differentiated cell counts, but was related to a decline in naive T cells. In this large population-based study of women in the United States, insomnia symptoms are implicated in accelerated aging.
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