Endocrine and metabolic changes during sleep

Administration of growth hormone ameliorates adverse effects of total sleep deprivation

Total sleep deprivation (TSD) causes several harmful changes including anxiety, inflammation, and increased expression of extracellular signal-regulated kinase (ERK) and tropomyosin receptor kinase B (TrkB) genes in the hippocampus. The current study was conducted to explain the possible effects of exogenous GH against the above parameters caused by TSD and the possible mechanisms involved. Male Wistar rats were divided into 1) control, 2) TSD and 3) TSD + GH groups. To induce TSD, the rats received a mild repetitive electric shock (2 mA, 3 s) to their paws every 10 min for 21 days. Rats in the third group received GH (1 ml/kg, sc) for 21 days as treatment for TSD. The motor coordination, locomotion, the level of IL-6, and expression of ERK and TrkB genes in hippocampal tissue were measured after TSD. The motor coordination (p < 0.001) and locomotion indices (p < 0.001) were impaired significantly by TSD. The concentrations of serum corticotropin-releasing hormone (CRH) (p < 0.001) and hippocampal interleukin-6 (IL-6) (p < 0.001) increased. However, there was a significant decrease in the interleukin-4 (IL-4) concentration and expression of ERK (p < 0.001) and TrkB (p < 0.001) genes in the hippocampus of rats with TSD. Treatment of TSD rats with GH improved motor balance (p < 0.001) and locomotion (p < 0.001), decreased serum CRH (p < 0.001), IL-6 (p < 0.01) but increased the IL-4 and expression of ERK (p < 0.001) and TrkB (p < 0.001) genes in the hippocampus. Results show that GH plays a key role in modulating the stress hormone, inflammation, and the expression of ERK and TrkB genes in the hippocampus following stress during TSD.

Sleep and the GH/IGF-1 axis: Consequences and countermeasures of sleep loss/disorders

This article presents an up-to-date review of the state-of-the-art knowledge regarding the effect of sleep on the anabolic growth hormone/insulin-like growth factor-1 (GH/IGF-1) axis. This axis is involved in learning and memory and neuroprotection at the central level, and in the crosstalk between sleep and the immune system, with respect to its anti-inflammatory properties. We also aim to provide insight into the consequences of sleep loss on cognitive capacities in healthy individuals and patients with obstructive sleep apnea (OSA), regarding the mechanistic association with the GH/IGF-1 axis. Finally, this review examines the inflammatory/endocrine pathways that are affected by sleep loss, and which may consequently interact with the GH/IGF-1 axis. The deleterious effects of sleep loss include fatigue, and can cause several adverse age-dependent health outcomes. It is therefore important to improve our understanding of the fundamental physiology underlying these effects in order to better apply non-pharmacological countermeasures (e.g., sleep strategies, exercise training, continuous positive airway pressure therapy) as well as pharmacological solutions, so as to limit the deleterious consequences of sleep loss/disorders.

Sleep Disturbances in Acutely Ill Patients with Cancer

Intensive care units may place acutely ill patients with cancer at additional risk for sleep loss and associated negative effects. Research suggests that communication about sleep in patients with cancer is suboptimal and sleep problems are not regularly assessed or adequately treated throughout the cancer trajectory. However, many sleep problems and fatigue can be managed effectively. This article synthesizes the current literature regarding the prevalence, cause, and risk factors that contribute to sleep disturbance in the context of acute cancer care. It describes the consequences of poor sleep and discusses appropriate assessment and treatment options.

Sleep disturbances and fatigue in critically ill patients

Sleep disturbances and fatigue are significant problems for critically ill patients. Existing sleep disorders, underlying medical/surgical conditions, environmental factors, stress, medications, and other treatments all contribute to a patient's inability to sleep. Sleep disturbance and debilitating fatigue that originate during acute illness may continue months after discharge from intensive care units (ICUs). If these issues are unrecognized, lack of treatment may contribute to chronic sleep problems, impaired quality of life, and incomplete rehabilitation. A multidisciplinary approach that incorporates assessment of sleep disturbances and fatigue, environmental controls, appropriate pharmacologic management, and educational and behavioral interventions is necessary to reduce the impact of sleep disturbances and fatigue in ICU patients. Nurses are well positioned to identify issues in their own units that prevent effective patient sleep. This article will discuss the literature related to the occurrence, etiology, and risk factors of sleep disturbance and fatigue and describe assessment and management options in critically ill adults.