Sleep and the endocrine system

Implications of obstructive sleep apnea on reproductive health: a study on anti-Mullerian hormone levels

PURPOSE

This study aimed to explore the association between anti-mullerian hormone (AMH) levels and obstructive sleep apnea (OSA) severity.

METHODS

A cross-sectional design was employed to evaluate AMH levels in 68 premenopausal women diagnosed with OSA at Van Yüzüncü Yıl University Faculty of Medicine. OSA severity was scored according to the 2018 AASM guidelines using a 16-channel Embla device. AMH levels were measured from blood samples using a commercially available kit.

RESULTS

The study found that AMH levels in OSA patients were significantly lower than those in the healthy control group. A statistically significant negative correlation between AMH and AHI levels was observed. When stratified by OSA severity, the lowest AMH levels were found in the severe OSA group.

CONCLUSION

OSA may have potential endocrine implications, especially concerning reproductive health. Decreased AMH levels in OSA patients could indicate future risks of infertility or early menopause.

Effects of Testosterone in Mediating the Relationship Between Daytime Napping and Osteoporosis in European Populations: A Mendelian Randomization Study

We aimed to explore the causal effect of daytime napping on the risk of osteoporosis and the mediation role of testosterone in explaining this relationship. Summary data for Mendelian randomization (MR) analysis were obtained from the IEU OpenGWAS database. Univariable MR(UVMR) analysis and multiple sensitivity analyses were applied to explore the casual relationship between daytime napping and bone mineral density (BMD)/osteoporosis. We also conducted multivariable Mendelian randomization (MVMR) analysis to evaluate the correlation between testosterone-associated single-nucleotide variations and BMD/osteoporosis. Then, mediation analysis was performed to explore whether the association between daytime napping and BMD/osteoporosis was mediated via testosterone. Genetically predicted daytime napping was significantly associated with femoral neck BMD (β [95% CI]: 0.2573 [0.0487, 0.4660]; P = 0.0156), lumbar spine BMD (β [95% CI]: 0.2526 [0.0211, 0.4840]; P = 0.0324), and osteoporosis (OR [95% CI]: 0.5063 [0.2578, 0.9942]; P = 0.0481). β and 95%CIs indicate the standard deviation (SD) unit of BMD increase per category increase in daytime napping. OR and 95%CIs represent the change in the odds ratio of osteoporosis per category increase in daytime napping. We observed a potentially causal effect of more frequent daytime napping on higher BMD and a lower risk of osteoporosis. Daytime napping was causally associated with a higher level of bioavailable testosterone (β [95% CI]: 0.1397 [0.0619, 0.2175]; P = 0.0004). β and 95%CIs represent the change in the SD of testosterone per category increase in daytime napping. Furthermore, the causal effects of daytime napping on BMD/osteoporosis were partly mediated by bioavailable testosterone. Daytime napping can efficiently increase BMD and reduce the risk of osteoporosis, and testosterone plays a key mediating role in this process.

The causal relationship between sleep disturbances and the risk of frailty: a two-sample Mendelian randomization study

OBJECTIVE

Adequate sleep is closely related to people's health. However, with increasing age, the quality of sleep worsens. At the same time, among elderly individuals, frailty is also a disturbing factor, which makes elderly individuals more vulnerable to negative factors. To explore the relationship between the two, we conducted this study.

METHODS

In this paper, independent genetic variations related to insomnia, sleep duration and daytime sleepiness were selected as IVs, and related genetic tools were used to search published genome-wide association studies for a two-sample Mendelian randomization (TSMR) analysis. The inverse-variance weighted (IVW) method was used as the main Mendelian randomization analysis method. Cochran's Q test was used to test heterogeneity, MR‒Egger was used to test horizontal pleiotropy, and the MR-PRESSO test was used to remove outliers.

RESULTS

According to our research, insomnia (OR = 1.10, 95% CI 1.03-1.17, P = 2.59e-97), long sleep duration (OR = 0.66, 95% CI 0.37-1.17, P = 0.02), short sleep duration (OR = 1.30, 95% CI 1.22-1.38, P = 2.23e-17) and daytime sleepiness (OR = 1.49, 95% CI 1.25-1.77, P = 0.96e-4) had a bidirectional causal relationship with frailty.

CONCLUSIONS

Our research showed that there is a causal relationship between sleep disturbances and frailty. This result was obtained by a TSMR analysis, which involves the use of genetic variation as an IV to determine causal relationships between exposure and outcome. Future TSMR studies should include a larger sample for analysis.

Research progress on the treatment of perimenopausal insomnia with Chaihu Jia Longgu Muli decoction based on brain-intestine-bacteria axis: A review

With the progress and rapid societal development, women are confronted with multifaceted pressures in their lives, encompassing familial and other domains. Furthermore, during the perimenopausal phase, endocrine equilibrium is disrupted, leading to the emergence of psychological and physiological health challenges. Insomnia is a prevalent symptom among perimenopausal individuals. The brain-gut-bacteria axis assumes a pivotal role in the prevention, diagnosis, and management of perimenopausal insomnia. Chaihu Jia Longgu Muli decoction is a commonly prescribed remedy for addressing perimenopopausal insomnia. Consequently, this paper aims to investigate the interplay between the brain-gut-bacteria axis, intestinal microbiota, and the pathogenesis of perimenopausal insomnia. The study focuses on examining the regulatory effects of Chaihu Jia Longgu Muli decoction on the nervous system, intestinal microbiota, and the hypothalamus-pituitary-adrenal axis. Additionally, it explores the mechanisms underlying Hujia Longgu Muli decoction in mitigating perimenopausal insomnia.

A Cross-Sectional Association Between Screen-Based Sedentary Behavior and Anxiety in Academic College Students: Mediating Role of Negative Emotions and Moderating Role of Emotion Regulation

Purpose

The study aims to explore the relationship and potential mechanisms between screen time and anxiety and have a clear understanding of the role of negative emotions and emotion regulation, thus providing guidance for Chinese college students to improve mental health.

Methods

We conducted a questionnaire survey by selecting 1721 academic college students from 6 colleges and universities in 5 provinces in China, and the data were analyzed through the Process program of SPSS for mediating effect and moderating effect.

Results

There is a significant positive relationship between screen time and anxiety, negative emotions play a mediating role between the two (indirect effect = 0.32, p < 0.001), mediating effect accounts for 59.88% of the total effect, and emotion regulation regulates the direct relationship between screen time and anxiety (interaction effect = 0.027, p < 0.001).

Conclusion

This study sheds light on the potential mechanisms by which screen time affects anxiety in academic college students, providing a fresh perspective on anxiety reduction. Screen time positively affects anxiety levels, where negative emotions have a mediating role and emotion regulation has a moderating role. In the future, we can control screen ++time, increase physical activities, reduce negative emotions, and improve the emotional regulation ability to relieve anxiety, so as to improve the mental health of academic college students, and expect to have a positive impact on future learning, life, and planning.

Association of long-term exposure to air pollution with chronic sleep deprivation in South Korea: A community-level longitudinal study, 2008-2018

BACKGROUND AND OBJECTIVE

Although there are many findings about the effects of fine particulate matter (PM_2.5) and sleep deprivation on health respectively, the association between PM_2.5 and chronic sleep deprivation has rarely been investigated. Thus, we aimed to investigate this association using a nationwide survey in South Korea.

METHOD

We examined the association between long-term exposure to PM_2.5 and chronic sleep deprivation using a national cross-sectional health survey covering the entire 226 districts in inland South Korea from 2008 to 2018, with a machine learning-based national air pollution prediction model with 1 km² spatial resolution.

RESULTS

Chronic sleep deprivation was positively associated with PM_2.5 in the total population (odds ratio (OR): 1.09, 95% confidence interval (CI): 1.05-1.13) and sub-population (low, middle, high population density areas with OR: 1.127, 1.09, and 1.059, respectively). The association was consistently observed in both sexes (males with OR: 1.09, females with OR: 1.09)) and was more pronounced in the elderly population (OR: 1.12) than in the middle-aged (OR: 1.07) and young (OR: 1.09) populations.

CONCLUSIONS

Our results are consistent with the hypothesis regarding the relationship between long-term PM_2.5 exposure and chronic sleep deprivation, and the study provides quantitative evidence for public health interventions to improve air quality that can affect chronic sleep conditions.

Dose-response association of polycyclic aromatic hydrocarbon with self-reported trouble sleeping in adults: evidence from the National Health and Nutrition Examination Survey

Previous epidemiological evidence from large population-based studies on the association between polycyclic aromatic hydrocarbons (PAH) exposure and the risk of sleep disorders is inadequate. To comprehensively examine the relationship between independent and combined PAHs and trouble sleeping, we analyzed data from 8194 participants from the National Health and Nutrition Survey (NHANES) cycles. Multivariate adjusted logistic regression and restricted cubic spline models were applied to assess the relationship between PAH exposure and the risk of trouble sleeping. Bayesian kernel machine regression and weighted quantile sum regression models were used to estimate the combined association of urinary PAHs with trouble sleeping. In the single-exposure analyses, compared with the lowest level, the respective adjusted odds ratios (ORs) for trouble sleeping among subjects from the highest quartile were 1.34 (95% CI, 1.15, 1.56), 1.23 (95% CI, 1.05, 1.44), 1.31 (95% CI, 1.11, 1.54), 1.35 (95% CI, 1.15, 1.58), and 1.29 (95% CI, 1.08, 1.53) for 1-hydroxynaphthalene (1-NAP), 2-hydroxynaphthalene (2-NAP), 3-hydroxyfluorene (3-FLU), 2-hydroxyfluorene(2-FLU), and 1-hydroxypyrene(1-PYR). An overall positive correlation between the PAH mixture and trouble sleeping was observed when the mixture was at the 50th percentile or higher. The current study reveals that PAH metabolites (1-NAP, 2-NAP, 3-FLU, 2-FLU, and 1-PYR) may be detrimental to trouble sleeping. PAH mixture exposure was positively associated with trouble sleeping. The results suggested the potential impacts of PAHs and expressed concerns regarding the potential impact of PAHs on health. More intensive research and monitoring of environmental pollutants in the future will contribute to preventing environmental hazards.

Ecdysone acts through cortex glia to regulate sleep in Drosophila

Steroid hormones are attractive candidates for transmitting long-range signals to affect behavior. These lipid-soluble molecules derived from dietary cholesterol easily penetrate the brain and act through nuclear hormone receptors (NHRs) that function as transcription factors. To determine the extent to which NHRs affect sleep:wake cycles, we knocked down each of the 18 highly conserved NHRs found in Drosophila adults and report that the ecdysone receptor (EcR) and its direct downstream NHR Eip75B (E75) act in glia to regulate the rhythm and amount of sleep. Given that ecdysone synthesis genes have little to no expression in the fly brain, ecdysone appears to act as a long-distance signal and our data suggest that it enters the brain more at night. Anti-EcR staining localizes to the cortex glia in the brain and functional screening of glial subtypes revealed that EcR functions in adult cortex glia to affect sleep. Cortex glia are implicated in lipid metabolism, which appears to be relevant for actions of ecdysone as ecdysone treatment mobilizes lipid droplets (LDs), and knockdown of glial EcR results in more LDs. In addition, sleep-promoting effects of exogenous ecdysone are diminished in lsd-2 mutant flies, which are lean and deficient in lipid accumulation. We propose that ecdysone is a systemic secreted factor that modulates sleep by stimulating lipid metabolism in cortex glia.

Sleep, circadian biology and skeletal muscle interactions: Implications for metabolic health

There currently exists a modern epidemic of sleep loss, triggered by the changing demands of our 21st century lifestyle that embrace 'round-the-clock' remote working hours, access to energy-dense food, prolonged periods of inactivity, and on-line social activities. Disturbances to sleep patterns impart widespread and adverse effects on numerous cells, tissues, and organs. Insufficient sleep causes circadian misalignment in humans, including perturbed peripheral clocks, leading to disrupted skeletal muscle and liver metabolism, and whole-body energy homeostasis. Fragmented or insufficient sleep also perturbs the hormonal milieu, shifting it towards a catabolic state, resulting in reduced rates of skeletal muscle protein synthesis. The interaction between disrupted sleep and skeletal muscle metabolic health is complex, with the mechanisms underpinning sleep-related disturbances on this tissue often multifaceted. Strategies to promote sufficient sleep duration combined with the appropriate timing of meals and physical activity to maintain circadian rhythmicity are important to mitigate the adverse effects of inadequate sleep on whole-body and skeletal muscle metabolic health. This review summarises the complex relationship between sleep, circadian biology, and skeletal muscle, and discusses the effectiveness of several strategies to mitigate the negative effects of disturbed sleep or circadian rhythms on skeletal muscle health.

Associations between organophosphate esters metabolites and sleep disorder and trouble sleeping in adults: a machine-learning approach

Organophosphate esters (OPEs) are used widely as flame retardants and plasticizers. However, the associations between OPEs metabolites and sleep outcomes (sleep disorder and trouble sleeping) remain unknown. Data utilized in this cross-sectional study was from the National Health and Nutrition Examination Survey 2013-2014, including 1393 adults aged ≥ 20 years. We conducted weighted logistic regression and Bayesian kernel machine regression (BKMR) models to analyze the associations between OPEs metabolites and sleep outcomes. We included data from 2011 to 2012 cycle in our sensitivity analysis to explore the association further. Logistic regression model presented a significant positive association between diphenyl phosphate (DPHP) and sleep disorder in all participants (odds ratio (95% confidence interval) for the second quartile was 2.46 (1.85, 3.28)). We observed positive associations between OPEs metabolites and sleep outcomes in males. Among females, no significant association was observed in the logistic model. BKMR presented that dibutyl phosphate (DBUP) was the relatively important exposure. There was a positive association between OPEs metabolites mixture and trouble sleeping. Univariable exposure-response functions demonstrated U-shaped associations between DBUP and sleep outcomes, while bis(2-chloroethyl) phosphate (BCEP) was associated with sleep disorder negatively in females. No substantial changes appeared in the results after including the data from 2011 to 2012 cycle. This current study indicated that OPEs metabolites might be associated with sleep disorder and trouble sleeping, and the associations seemed to be sex-dependent.

Improvement of several stress response and sleep quality hormones in men and women after sleeping in a bed that protects against electromagnetic fields

BACKGROUND

The electromagnetic fields (EMFs) emitted by the technologies affect the homeostatic systems (nervous, endocrine, and immune systems) and consequently the health. In a previous work, we observed that men and women, after 2 months of using a bed with a registered HOGO system, that prevents and drain EMFs, improved their immunity, redox and inflammatory states and rejuvenated their rate of aging or biological age. Since, EMFs can act as a chronic stressor stimulus, and affect the sleep quality. The objective of this work was to study in men and women (23-73 years old) the effect of sleeping for 2 months on that bed in the blood concentrations of several hormones related to stress response and sleep quality as well as to corroborate the rejuvenation of their biological age.

METHODS

In 18 men and women, plasma concentration of cortisol, dehydroepiandrosterone (DHEA), catecholamines (epinephrine, norepinephrine and dopamine), serotonin, oxytocin and melatonin were analyzed before and after 2 months of using the HOGO beds. A group of 10 people was used as placebo control. In another cohort of 25 men (20 experimental and 5 placebo), the effects of rest on the HOGO system on the concentration of cortisol and testosterone in plasma were studied. In all these volunteers, the biological age was analyzed using the Immunity Clock model.

RESULTS

There is a significant increase in plasma concentration of DHEA, norepinephrine, serotonin, oxytocin, and melatonin as well as in testosterone, after resting for 2 months in that bed with the EMFs avoiding system. In addition, decreases in Cortisol/DHEA and Testosterone/cortisol ratio and plasma dopamine concentration were observed. No differences were found in placebo groups. In all participants that slept on HOGO beds, the biological age was reduced.

CONCLUSIONS

Sleeping in a bed that isolates from EMFs and drain them can be a possible strategy to improve the secretion of hormones related to a better response to stress and sleep quality, which means a better endocrine system, and consequently better homeostasis and maintenance of health. This fact was confirmed with the slowdown in the rate of aging checked with a rejuvenation of the biological age.

Epidemiological studies of sleep disorder in educational community of Pakistani population, its major risk factors and associated diseases

Sleep is one of the most important functions of the life. The disturbance in sleep or quality of sleep leads to several dysfunctions of the human body. This study aimed to investigate the prevalence of sleep disorders, their possible risk factors and their association with other health problems. The data was collected from the educational community of the Pakistani population. The Insomnia Severity Index (ISI) was used to evaluate the insomnia and the sleep apnea was evaluated through a simple questionnaire method. The blood samples were collected to perform significant blood tests for clinical investigations. Current research revealed that the individuals in the educational community had poor sleep quality. A total of 1998 individuals from the educational community were surveyed, 1584 (79.28%) of whom had a sleep disorders, including insomnia (45.20%) and sleep apnea (34.08%). The measured onset of age for males and females was 30.35 years and 31.07 years respectively. The Clinical investigations showed that the sleep had significant impact on the hematology of the patients. Higher levels of serum uric acid and blood sugar were recorded with a sleep disorder. The individuals of the educational community were using the sleeping pills. The other associated diseases were mild tension, headaches, migraines, depression, diabetes, obesity, and myopia. The use of beverage, bad mood, medical condition, mental stress, disturbed circadian rhythms, workload and extra use of smartphone were major risk factors of sleep disorders. It was concluded that the insomnia was more prevalent than the sleep apnea. Furthermore, life changes events were directly linked with disturbance of sleep. Tension, depression, headaches, and migraine were more associated with sleep disorders than all other health issues.

Adherence to a healthy sleep pattern is associated with lower risks of all-cause, cardiovascular and cancer-specific mortality

BACKGROUND

Individual unhealthy sleep behaviours have been associated with increased risks of all-cause mortality and deaths due to cardiovascular disease (CVD) or cancer. The evidence regarding the association of sleep patterns with these risks is limited.

OBJECTIVE

To examine the associations of sleep patterns with all-cause, CVD and cancer mortality in a large prospective cohort.

METHODS

This prospective cohort study included 283,443 adults from UK Biobank without CVD and cancer at baseline. We created a healthy sleep score and sleep patterns combining five individual sleep behaviours.

RESULTS

During a mean (standard deviation) of 8.9 (1.1) years (2.5 million person-years) of follow up, a total of 7936 all-cause deaths, 762 CVD-caused deaths, and 4540 cancer-caused deaths occurred during follow up. One point increase of the healthy sleep score was associated with a 4-11% lower risk of all-cause mortality (Hazard Ratio [HR], 0.94; 95% CI, 0.92-0.96), CVD mortality (HR, 0.89; 95% CI, 0.83-0.95) and cancer mortality (HR, 0.96; 95% CI, 0.93-0.99), with adjustment for age, sex, assessment centres, smoking status, alcohol intake status, socioeconomic status and physical activity. Compared with participants with an unfavourable sleep pattern, those with a favourable sleep pattern had 24-42% lower risks of all-cause and CVD mortality. The association with all-cause mortality tended to be stronger among underweight participants and those with insufficient physical activity.

CONCLUSIONS

A healthy sleep pattern was associated with lower risks of all-cause mortality and mortality from CVD and cancer. Our findings highlight the importance of improving overall sleep behaviours in lowering mortality.

Maternal exposure of mice to sodium p-perfluorous nonenoxybenzene sulfonate causes endocrine disruption in both dams and offspring

The toxicity of certain novel perfluoroalkyl substances (PFCs) has attracted increasing attention. However, the toxic effects of sodium p-perfluorous nonenoxybenzene sulfonate (OBS) on the endocrine system have not been elucidated. In this study, OBS was added to the drinking water during the pregnancy and lactation of the healthy female mice at dietary levels of 0.0 mg/L (CON), 0.5 mg/L (OBS-L), and 5.0 mg/L (OBS-H). OBS exposure during the pregnancy and lactation resulted in the presence of OBS residues in the placenta and fetus. We also analyzed physiological and biochemical parameters and gene expression levels in mice of the F0 and F1 generations after maternal OBS exposure. The total serum cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels were significantly increased in female mice of the F0 generation. The androgen levels in the serum and the ovarian mRNA levels of androgen receptor (AR) also tended to increase after maternal OBS exposure in the F0 generation mice. Moreover, maternal OBS exposure altered the mRNA expression of endocrine-related genes in male mice of F1 generation. Notably, the serum TC and LDL-C levels were significantly increased in 8-weeks-old male mice of the F1 generation, and the serum high-density lipoprotein cholesterol (HDL-C) levels were decreased in 24-week-old male mice of the F1 generation. These results indicated that maternal OBS exposure can interfere with endocrine homeostasis in the F0 and F1 generations. Therefore, exposure to OBS during pregnancy and lactation has the potential toxic effects on the dams and male offspring, which cannot be overlooked.

Understanding insomnia as systemic disease

Sleep plays a critical role in homeostasis of the body and mind. Insomnia is a disease that causes disturbances in the initiation and maintenance of sleep. Insomnia is known to affect not only the sleep process itself but also an individual’s cognitive function and emotional regulation during the daytime. It increases the risk of various neuropsychiatric diseases such as depression, anxiety disorder, and dementia. Although it might appear that insomnia only affects the nervous system, it is also a systemic disease that affects several aspects of the body, such as the cardiovascular, endocrine, and immune systems; therefore, it increases the risk of various diseases such as hypertension, diabetes mellitus, and infection. Insomnia has a wide range of effects on our bodies because sleep is a complex and active process. However, a high proportion of patients with insomnia do not seek treatment, which results in high direct and indirect costs. This is attributed to the disregard of many of the negative effects of insomnia. Therefore, we expect that understanding insomnia as a systemic disease will provide an opportunity to understand the condition better and help prevent secondary impairment due to insomnia.

The Longitudinal Association between Sleep Duration and Suicidal Behavior among Chinese Adolescents: The Role of Nonmedical Use of Prescription Drug

OBJECTIVE/BACKGROUND

Abnormal sleep and nonmedical use of prescription drugs are known to be factors associated with suicidal behavior, but the nature of the association between weekday sleep duration and suicidal behavior has not been elucidated. Nonmedical use of prescription drugs may play a mediator role in the association mentioned above.

PARTICIPANTS

There were a total of 3,273 high school students interviewed at baseline with a response rate of 96.8% and followed up at one year (retention rate, 96.1%). The mean (SD) age of the students was 13.7 (1.0) years.

METHODS

Data were drawn from the longitudinal data of the School-based Chinese Adolescents Health Survey. A total of 12 high schools were selected in Guangzhou. Suicidal behavior, weekday sleep duration, and nonmedical use of prescription drugs were measured.

RESULTS

Sleeping < 7 hours/day at time 0 was positively associated with suicidal ideation (Adjusted odds ratio [AOR] = 1.51, 95% CI = 1.21-1.89) and suicide attempts (AOR = 2.35, 95% CI = 1.02-5.38) at time 1. The mediation analyses showed that baseline opioids misuse or sedatives misuse partially mediated the associations of baseline short weekday sleep duration with suicidal ideation and suicide attempts at one-year follow-up.

CONCLUSIONS

Baseline short weekday sleep duration was positively associated with subsequent suicidal ideation and suicide attempts, and nonmedical use of opioids or sedatives partially mediated the associations mentioned above. Suicidal behavior can be prevented, short weekday sleep duration and nonmedical use of prescription drugs may be risk factors for suicidal behavior, and the respective roles of these factors are needed to be better understood.

Sleeping patterns and childhood obesity: an epidemiological study in 1,728 children in Greece

STUDY OBJECTIVES

Sleep is an essential normal function for children's growth and development, but over the years, lifestyle changes have resulted in insufficient sleep, a factor that may be associated with increased childhood obesity. The aim of this study was to evaluate the association between sleep duration and sleep patterns separately on weekdays and weekends regarding children's weight status.

METHODS

This study was conducted among Greek students (55.1% girls) in 2014-2016. Children's weight status was classified according to the International Obesity Task Force tables and guidelines. Sleep duration was determined based on the sleep and wake time that children reported, separately for weekdays and weekends. Classification and regression tree analysis was used to derive sleep patterns and evaluate their relation to children's weight status.

RESULTS

Multiadjusted analysis revealed an inverse association between average duration of sleep on weekdays and weekends with the likelihood of being overweight/obese (odds ratio per 1 hour 0.82; 95% confidence interval, 0.73-0.92). This was more prominent on weekends than on weekdays. Children who had lower duration on weekdays, but catch-up sleep duration on weekends, were 2% (95% confidence interval, 0.97-0.99) less likely to be overweight/obese compared to those children having both less or increased sleep duration on weekdays and weekends.

CONCLUSIONS

Sleep duration and sleep patterns seem to be associated with childhood weight status. Interventions should be developed to educate parents on the importance of an adequate sleep duration and healthy sleep patterns for their children's healthy development.

Intensive Care Unit Environment and Sleep

Patients undergoing treatment in intensive care unit are in an extremely vulnerable state and require a complex multidisciplinary approach. Adequate sleep is required to maintain physiologic functions of the human body. Good sleep quality plays a vital role in the process of recovery. Sleep disruption in intensive care settings is a well-known fact. The consequences of sleep deprivation can cause numerous complications including delayed mechanical ventilation wean, neurocognitive dysfunction, decreased immune function and increased mortality rates. This review describes how the intensive care unit environment impacts sleep architecture.

Adequate sleep duration among children and adolescents: a review of the Brazil's Report Card

abstract – This study aimed to summarize existing research examining the prevalence of adequate sleep duration or meeting sleep recommendations among Brazilian children and adolescents. A systematic review was conducted on eight databases. The criteria for inclusion were original research, samples including Brazilian children and adolescents (age 0–18), studies that reported variables regarding sleep duration using both objective or subjective measures, school- or population-based surveys with random sampling, and cross-sectional or cohort studies. Of the 54 articles included, only 27 used data from different studies. Most of the studies were conducted in the southern region (n = 17) with only two studies having a nationally representative sample. Two studies included children below age five, and the age group most investigated was adolescents (>10 years old). A majority of the studies used a self-reported questionnaire and showed variability in the cutoff point applied for adequate sleep duration with the most reported being ≥8 hours. The proportion of adolescents who met recommendations or had adequate sleep duration ranged from 15% to 89%. Among children, the prevalence ranged from 17% to 95%. The least variability was observed among toddlers, ranging from 93% to 95%. No consistent gender differences were observed among the gender-stratified groups of children and adolescents across the studies. It can be observed that, because of the wide range of results and the lack of data with national representativeness, the prevalence of sufficient sleep among young people aged below 18 remains undefined in Brazil.

Association between household fuel use and sleep quality in the oldest-old: Evidence from a propensity-score matched case-control study in Hainan, China

STUDY OBJECTIVES

Emerging evidence has documented that poor sleep quality associated with adverse effects with physical, psychological and neurological disorders, which impeded healthy aging. There is limited knowledge regarding the association of household air pollution (HAP) from solid fuel use with sleep quality, particularly among the population at advanced ages. The aim of this study is to investigate this association in oldest-old (≥80 years) populations.

METHODS

China Hainan Centenarian Cohort Study was conducted in the 18 cities and counties of Hainan Province from 2015 to 2017. A total of 1725 individuals aged 80 years and older were included in the study. We used the Pittsburgh sleep quality index (PSQI) to measure individuals' sleep quality with a score of PSQI >8 indicating poor sleep quality. Solid fuel users were defined as those who primarily use coal, biomass charcoal, wood or straw for cooking in their daily life. The propensity score matching (PSM) was adopted and logistic regressions were performed based on the matched sample to estimate the association between the two factors. We adjusted for a wide range of covariates, including demographic, socioeconomic, health-related, and environmental factors.

RESULTS

After matching, a total of 1616 participants (mean [SD] age, 94.5 [9.5] years; 72.5% women) were included in the final analysis. About 50.9% of the participants used solid fuel for cooking. The average global PSQI score was 8.26 (SD = 3.3), 49.0% of them were detected as poor sleep quality with a global PSQI score >8. We found significantly higher risk of having poor sleep quality among those who were currently solid fuel users than among clean fuel users, with an odds ratio (OR) of 1.43 (95% CI: 1.14-1.80), adjusting for a wide range of confounders. The associations were more pronounced in those who did not use any ventilation (compared to those who used either mechanical or natural cooking ventilation; 1.79 [1.30-2.47] vs. 1.27 [1.01-1.53], P for interaction = 0.016) and in those who were frequent cooking at home (compared to those who never cooked; 1.65 [1.21-2.26] vs. 1.18 [0.93-1.40], P for interaction = 0.025).

CONCLUSIONS

Exposure to HAP from solid fuel combustion increases the risk of poor sleep quality at oldest-old ages. Our findings point to the need of reducing HAP from polluted fuel combustion and implementing cooking ventilation as a public health priority for healthy aging initiatives.

Concussive head injury exacerbates neuropathology of sleep deprivation: Superior neuroprotection by co-administration of TiO2-nanowired cerebrolysin, alpha-melanocyte-stimulating hormone, and mesenchymal stem cells

Sleep deprivation (SD) is common in military personnel engaged in combat operations leading to brain dysfunction. Military personnel during acute or chronic SD often prone to traumatic brain injury (TBI) indicating the possibility of further exacerbating brain pathology. Several lines of evidence suggest that in both TBI and SD alpha-melanocyte-stimulating hormone (α-MSH) and brain-derived neurotrophic factor (BDNF) levels decreases in plasma and brain. Thus, a possibility exists that exogenous supplement of α-MSH and/or BDNF induces neuroprotection in SD compounded with TBI. In addition, mesenchymal stem cells (MSCs) are very portent in inducing neuroprotection in TBI. We examined the effects of concussive head injury (CHI) in SD on brain pathology. Furthermore, possible neuroprotective effects of α-MSH, MSCs and neurotrophic factors treatment were explored in a rat model of SD and CHI. Rats subjected to 48h SD with CHI exhibited higher leakage of BBB to Evans blue and radioiodine compared to identical SD or CHI alone. Brain pathology was also exacerbated in SD with CHI group as compared to SD or CHI alone together with a significant reduction in α-MSH and BDNF levels in plasma and brain and enhanced level of tumor necrosis factor-alpha (TNF-α). Exogenous administration of α-MSH (250μg/kg) together with MSCs (1×10⁶) and cerebrolysin (a balanced composition of several neurotrophic factors and active peptide fragments) (5mL/kg) significantly induced neuroprotection in SD with CHI. Interestingly, TiO₂ nanowired delivery of α-MSH (100μg), MSCs, and cerebrolysin (2.5mL/kg) induced enhanced neuroprotection with higher levels of α-MSH and BDNF and decreased the TNF-α in SD with CHI. These observations are the first to show that TiO₂ nanowired administration of α-MSH, MSCs and cerebrolysin induces superior neuroprotection following SD in CHI, not reported earlier. The clinical significance of our findings in light of the current literature is discussed.

Is Sleep Associated with the S-Klotho Anti-Aging Protein in Sedentary Middle-Aged Adults? The FIT-AGEING Study

Sleep and Klotho have both been closely related to the ageing process, both playing a substantial role in the endocrine and immune systems and, thereby, in oxidative stress and chronic inflammation. However, there are no studies elucidating the relationship between sleep and Klotho. Therefore, this study investigated the association of sleep quantity and quality with the shed form of the α-Klotho gene (S-Klotho plasma levels) in sedentary middle-aged adults. A total of 74 volunteers (52.7% women; aged 53.7 ± 5.1) were recruited for the present study. Objective sleep quality parameters (total sleep time (TST), wake after sleep onset (WASO), and sleep efficiency (SE)) were determined using a wrist-worn accelerometer over seven consecutive days, and the subjective sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI; higher scores indicate worse sleep quality). The S-Klotho plasma levels were measured in the ethylenediaminetetraacetic acid plasma using a solid-phase sandwich enzyme-linked immunosorbent assay. Objective sleep parameters were associated with the S-Klotho plasma levels only after including the age, fat mass percentage, and lean mass index as covariates. A direct relationship was observed between the subjective sleep quality (inverse of PSQI scores) and the S-Klotho plasma levels in sedentary middle-aged adults. Improving sleep quantity and quality could be considered an anti-aging therapeutic approach for the prevention, slowing, and even reversal of the physiological decline and degenerative pathologies that are certainly related to the aging process.

Associations of sleep durations and sleep-related parameters with metabolic syndrome among older Chinese adults

PURPOSE

There is a lack of data on the role of sleep in the development of metabolic syndrome (MetS) in older adults. We aimed to examine the associations of sleep durations at night and other sleep-related parameters with the presence of MetS in older Chinese adults.

METHODS

Data of 4579 individuals aged 60 years or older from the Weitang Geriatric Disease Study were analyzed. MetS was diagnosed based on the Adult Treatment Panel III (ATP III) criteria. Information regarding sleep durations and other sleep-related parameters was collected by questionnaires.

RESULTS

Compared with those with daytime napping, individuals without daytime napping were at an increased risk of MetS (odds ratio [OR] = 1.23; 95% confidence interval [CI] = 1.03-1.47). Each hour increase in daytime napping increased the risk of MetS by 33% (OR = 1.33; 95% CI = 1.15-1.52). After adjusting for the effect of age and gender, a J-shaped association between sleep durations at night and the presence of MetS was observed. The risk of MetS was lowest among those who slept 7-8 h at night. Gender-stratified analysis indicated that the J-shaped relationship between sleep durations at night and MetS remained significant in men but not in women.

CONCLUSIONS

In older Chinese adults, sleep durations at night might have a dual effect on the risk of MetS and this effect was particularly pronounced in men. The results indicated that circadian rhythm might play an important role in the development of MetS in older populations.

Psychometric properties and cultural adaptation of sleep disturbance measures in Arabic-speaking populations: A systematic review

The aim of this review was to evaluate the psychometric properties and cross-cultural adaptation of sleep disturbance scales that have been translated into Arabic or originally developed in Arabic, and to identify appropriate scales that can be used in research and clinical practice intended for Arabic-speaking participants. The following databases were searched: CINAHL (2003-2019), MEDLINE (1946-2019), EMBASE (1980-2019), PsycINFO (1806-2019) and Cochrane Library (1806-2019). This review was conducted following PRISMA guidelines. Terwee et al. (J. Clin. Epidemiol., 60, 2007, 34) quality assessment was used to evaluate the psychometric properties of the studies, and cross-cultural adaptation was assessed using criteria from Guillemin, Bombardier, and Beaton (J. Clin. Epidemiol., 46, 1993, 1417). Seven studies met the inclusion criteria, which included four scales: the Epworth Sleepiness Scale, Insomnia Severity Index, Pittsburgh Sleep Quality Index, and Arabic Scale of Insomnia. Cross-cultural adaptations scored between good and poor; psychometric properties information was missing for most scales. The review suggested that Pittsburgh Sleep Quality Index may be a useful scale to measure sleep disturbance, as the scale showed good cultural adaptation and acceptable psychometric properties in an Arabic population. Furthermore, the scales measure seven different aspects of sleep quality. This review provides options to help researchers and clinicians select the most appropriate instrument for their practice. Further psychometric testing and cultural adaptation is required for sleep scales used in Arabic clinical populations to ensure validity and reliability in outcome measurement for research studies.

Morbi-Mortality of the Victims of Internal Conflict and Poor Population in the Risaralda Province, Colombia

This work studies the health status of two populations similar in most social and environmental interactions but one: the individuals from one population are victims of an internal armed conflict. Both populations are located in the Risaralda province, Colombia and the data for this study results from a combination of administrative records from the health system, between 2011 and 2016. We implemented a methodology based on graph theory that defines the system as a set of heterogeneous social actors, including individuals as well as organizations, embedded in a biological environment. The model of analysis uses the diagnoses in medical records to detect morbidity and mortality patterns for each individual (ego-networks), and assumes that these patterns contain relevant information about the effects of the actions of social actors, in a given environment, on the status of health. The analysis of the diagnoses and causes of specific mortality, following the Social Network Analysis framework, shows similar morbidity and mortality rates for both populations. However, the diagnoses' patterns show that victims portray broader interactions between diagnoses, including mental and behavioral disorders, due to the hardships of this population.

Factors associated with Obesity among Korean Adolescents based on the Seventh Korea National Health and Nutrition Examination Survey (2016)

Purpose

This study was conducted to examine factors associated with obesity among Korean adolescents.

Methods

The participants were 436 Korean adolescents aged 12~18 years who took part in the seventh Korea National Health and Nutrition Examination Survey (2016). The data were analyzed by descriptive statistics, the x² test, one-way analysis of variance, and multinomial logistic regression using complex sample analysis.

Results

Among the participants, 9.7% were classified as being obese, and 11.9% as being overweight. Several health parameters, including systolic blood pressure, diastolic blood pressure, waist circumference, and triglyceride, fasting blood sugar, and alanine aminotransferase levels, varied according to obesity. Distorted perceptions of body shape showed a significant negative association with overweight, and carbohydrate intake was negatively associated with obesity.

Conclusion

These findings indicate that obesity in Korean adolescents was associated with lifestyle and health parameters. Therefore, intervention programs for obese or overweight adolescents should focus on preventing them from developing health problems.

Neuroendocrine Control of Sleep

Sleep is a phenomenon in animal behavior as enigmatic as it is ubiquitous, and one deeply tied to endocrine function. Though there are still many unanswered questions about the neurochemical basis of sleep and its functions, extensive interactions have been identified between sleep and the endocrine system, in both the endocrine system's effect on sleep and sleep's effect on the endocrine system. Unfortunately, until recent years, much research on sleep behavior largely disregarded its connections with the endocrine system. Use of both clinical studies and rodent models to investigate interactions between neuroendocrine function, including biological sex, and sleep therefore presents a promising area of further exploration. Further investigation of the neurobiological and neuroendocrine basis of sleep could have wide impact on a number of clinical and basic science fields. In this review, we summarize the state of basic sleep biology and its connections to the field of neuroendocrine biology, as well as suggest key future directions for the neuroendocrine regulation of sleep that may significantly impact new therapies for sleep disorders in women and men.

Monitoring healthy and disturbed sleep through smartphone applications: a review of experimental evidence

Smartphone applications are considered as the prime candidate for the purposes of large-scale, low-cost and long-term sleep monitoring. How reliable and scientifically grounded is smartphone-based assessment of healthy and disturbed sleep remains a key issue in this direction. Here we offer a review of validation studies of sleep applications to the aim of providing some guidance in terms of their reliability to assess sleep in healthy and clinical populations, and stimulating further examination of their potential for clinical use and improved sleep hygiene. Electronic literature review was conducted on Pubmed. Eleven validation studies published since 2012 were identified, evaluating smartphone applications' performance compared to standard methods of sleep assessment in healthy and clinical samples. Studies with healthy populations show that most sleep applications meet or exceed accuracy levels of wrist-based actigraphy in sleep-wake cycle discrimination, whereas performance levels drop in individuals with low sleep efficiency (SE) and in clinical populations, mirroring actigraphy results. Poor correlation with polysomnography (PSG) sleep sub-stages is reported by most accelerometer-based apps. However, multiple parameter-based applications (i.e., EarlySense, SleepAp) showed good capability in detection of sleep-wake stages and sleep-related breathing disorders (SRBD) like obstructive sleep apnea (OSA) respectively with values similar to PSG. While the reviewed evidence suggests a potential role of smartphone sleep applications in pre-screening of SRBD, more experimental studies are warranted to assess their reliability in sleep-wake detection particularly. Apps' utility in post treatment follow-up at home or as an adjunct to the sleep diary in clinical setting is also stressed.

Simultaneous determination of selected hormones, endocrine disruptor compounds, and pesticides in water medium at trace levels by GC-MS after dispersive liquid-liquid microextraction

The need to enhance food safety has led to major advancements in pesticide productions, and though many benefits have been gained, environmental contamination has also risen from these chemicals that tend to persist in the environment. Some pesticides, together with other chemicals commonly called endocrine disruptor compounds, block the receptor sites of hormones or mimic displaced hormones, leading to imbalanced hormonal levels that result in health disorders and diseases. These chemicals occur at trace levels and are not directly detected by conventional analytical methods. A dispersive liquid-liquid microextraction method was therefore developed for preconcentration of 12 analytes including hormones, endocrine disruptor compounds, and pesticides, to be analyzed by gas chromatography mass spectrometry. This was achieved by optimizing parameters such as extractor solvent type and amount, dispersive solvent type and amount, pH, and salt effect that affect extraction output. The limits of detection and quantification of the developed method were between 0.09 and 3.36 and 0.31 and 11.19 ng mL^-1, respectively. The calibration plots of the analytes also showed good linearity and low percent relative standard deviations. Recovery studies were performed for tap water and wastewater samples, and the percent recoveries recorded were between 84 and 109%.

Association between sleep duration, suicidal ideation, and suicidal attempts among Chinese adolescents: The moderating role of depressive symptoms

BACKGROUND

Suicidal ideation and attempts are still currently serious problems among adolescents worldwide, and there is evidence that sleep problem may be associated with increased rates of mental disorder. This study aimed to examine the associations between sleep duration and suicidal ideation and attempts among adolescents and to test whether depressive symptoms have moderating effects on the associations.

METHODS

A 3-stage, stratified cluster, random sampling method was used to collect data from 20,130 high school students in southeast China.

RESULTS

The weighted prevalence of short sleep among Chinese adolescents was 5.6% (95% CI, 5.3-6.0%), and the weighted prevalence of long sleep was 2.7% (95% CI, 2.5-3.0%). The final results demonstrated that short sleep was positively associated with suicidal ideation (AOR=2.28, 95% CI=1.96-2.66) and suicidal attempts (AOR=3.20, 95% CI=2.46-4.16), and long sleep was only significantly associated with suicidal attempts (AOR=2.47, 95% CI=1.70-3.58). Stratification analyses conducted separately for students with and without depressive symptoms demonstrated that depressive symptoms may have moderating effects on the associations between sleep duration and suicidality.

LIMITATIONS

Our study sample only included school students, and causal inference could not be examined due to the cross-sectional design.

CONCLUSIONS

Sleep duration was associated with suicidal ideation and attempts, and the association between sleep duration and suicidal attempts was U-shaped. These findings support that proper treatments services with the potential to restore adolescent normal sleep would be helpful in preventing suicidality among adolescents.