Insomnia, sleep duration, and risk of anxiety: A two-sample Mendelian randomization study

Chronic Low Back Pain Causal Risk Factors Identified by Mendelian Randomization: a Cross-Sectional Cohort Analysis

Background Context

There are a number of risk factors- from biological, psychological, and social domains- for non-specific chronic low back pain (cLBP). Many cLBP treatments target risk factors on the assumption that the targeted factor is not just associated with cLBP but is also a cause (i.e, a causal risk factor). In most cases this is a strong assumption, primarily due to the possibility of confounding variables. False assumptions about the causal relationships between risk factors and cLBP likely contribute to the generally marginal results from cLBP treatments.

Purpose

The objectives of this study were to a) using rigorous confounding control compare associations between modifiable causal risk factors identified by Mendelian randomization (MR) studies with associations in a cLBP population and b) estimate the association of these risk factors with cLBP outcomes.

Study Design/Setting

Cross sectional analysis of a longitudinal, online, observational study.

Patient Sample

1,376 participants in BACKHOME, a longitudinal observational e-Cohort of U.S. adults with cLBP that is part of the NIH Back Pain Consortium (BACPAC) Research Program.

Outcome Measures

Pain, Enjoyment of Life, and General Activity (PEG) Scale.

Methods

Five risk factors were selected based on evidence from MR randomization studies: sleep disturbance, depression, BMI, alcohol use, and smoking status. Confounders were identified using the ESC-DAG approach, a rigorous method for building directed acyclic graphs based on causal criteria. Strong evidence for confounding was found for age, female sex, education, relationship status, financial strain, anxiety, fear avoidance and catastrophizing. These variables were used to determine the adjustment sets for the primary analysis. Potential confounders with weaker evidence were used for a sensitivity analysis.

Results

Participants had the following characteristics: age 54.9 ± 14.4 years, 67.4% female, 60% never smokers, 29.9% overweight, 39.5% obese, PROMIS sleep disturbance T-score 54.8 ± 8.0, PROMIS depression T-score 52.6 ± 10.1, Fear-avoidance Beliefs Questionnaire 11.6 ± 5.9, Patient Catastrophizing Scale 4.5 ± 2.6, PEG 4.4 ± 2.2. In the adjusted models alcohol use, sleep disturbance, depression, and obesity were associated with PEG, after adjusting for confounding variables identified via a DAG constructed using a rigorous protocol. The adjusted effect estimates- the expected change in the PEG outcome for every standard deviation increase or decrease in the exposure (or category shift for categorical exposures) were the largest for sleep disturbance and obesity. Each SD increase in the PROMIS sleep disturbance T-score resulted in a mean 0.77 (95% CI: 0.66, 0.88) point increase in baseline PEG score. Compared to participants with normal BMI, adjusted mean PEG score was slightly higher by 0.37 points (95% CI: 0.09, 0.65) for overweight participants, about 0.8 to 0.9 points higher for those in obesity classes I and II, and 1.39 (95% CI: 0.98, 1.80) points higher for the most obese participants. Each SD increase in the PROMIS depression T-score was associated with a mean 0.28 (95% CI: 0.17, 0.40) point increase in baseline PEG score, while each SD decrease in number of alcoholic drinks per week resulted in a mean 0.12 (95%CI: 0.01, 0.23) increase in baseline PEG score in the adjusted model.

Conclusions

Several modifiable causal risk factors for cLBP - alcohol use, sleep disturbance, depression, and obesity- are associated with PEG, after adjusting for confounding variables identified via a DAG constructed using a rigorous protocol. Convergence of our findings for sleep disturbance, depression, and obesity with the results from MR studies, which have different designs and biases, strengthens the evidence for causal relationships between these risk factors and cLBP (1). The estimated effect of change in a risk factors on change in PEG were the largest for sleep disturbance and obesity. Future analyses will evaluate these relationships with longitudinal data.

The bidirectional relationship between sleep disturbance and anxiety: Sleep disturbance is a stronger predictor of anxiety

BACKGROUND

Both sleep disturbance and anxiety are common problems that significantly affect human health, but little is known about their causal relationship. The aim of this study was to explore the causal relationship between them with a large sample of community-dwelling adults included.

METHODS

Data for this study were extracted from the baseline survey of West China Natural Population Cohort Study (WCNPCS) and follow-up in the following year. The sleep quality was assessed using Pittsburgh Sleep Quality Index (PSQI), and anxiety was screened using the Generalized Anxiety Disorder Scale (GAD-7). Age, gender, educational level, marital status, smoking status, drinking status, depressive symptoms, loneliness and chronic diseases were taken as covariant factors. Logistic regression and cross-lagged models were used for data analyses.

RESULTS

A total of 16699 participants (67.5 % females) were enrolled, with the average age of participants being 57.3 ± 12.7 years. A total of 40.50 % of participants experienced poor sleep quality at baseline and 40.52 % at follow-up. The prevalence of anxiety was 7.58 % at baseline and 4.62 % at follow-up. The results showed that the risk of developing anxiety in individuals with sleep disturbance at baseline was 1.89 times higher than those without (95%CI = 1.43-2.48). Similarly, anxiety increased the risk of developing sleep disturbance by 1.20-fold (95%CI = 1.03-1.39). These results were further supported by the cross-lagged panel models.

CONCLUSION

Sleep disturbance and anxiety are mutually causal, and the effect of poor sleep on anxiety seems to be more significant. Timely interventions targeting sleep may help to break the vicious circle between sleep disturbance and anxiety symptoms, and improve the quality of life.

The Connection between Sleep Patterns and Mental Health: Insights from Rural Chinese Students

BACKGROUND

The association between sleep patterns and young students' mental health, which is crucial for their development, remains understudied in rural China. Therefore, the relationship between sleep patterns and mental health among primary and junior high school students in rural China was examined.

METHOD

A total of 1592 primary and junior high school students from rural areas of Gansu Province were surveyed, and the Depression Anxiety and Stress Scale (DASS) was utilized to assess mental health, alongside self-reported data on their daily sleep patterns.

RESULTS

Significant sleep inadequacies were identified: 28% of students received less than 8 h of sleep on weekdays, and 19% went to bed later than recommended. On weekends, 38% of students had delayed bedtimes, though only 7.2% received less than 8 h of sleep. Notably, a "U-shaped" relationship was uncovered between sleep duration and mental health for students on weekends, with optimal mental health correlated with receiving 10-11 h of sleep, while both shorter and longer sleep durations on weekends worsened outcomes. This pattern is absent on weekdays. Additionally, adequate sleep and an earlier bedtime was linked to a 6-8% decrease in mental health risks.

CONCLUSIONS

These findings provide valuable insights for policymakers seeking to enhance student mental well-being in rural settings, emphasizing the importance of implementing measures that promote balanced sleep habits among young students.

Efficacy and safety of multiple external therapies in patients with insomnia: a systematic review and network meta-analysis

Background

The annual incidence of insomnia continues to increase owing to changes in lifestyle habits, increased work pressure, and increased environmental pollution. In recent years, an increasing number of external therapies have been proven effective in treating insomnia and have been widely used. However, the relative benefits and harms of external therapies remain uncertain, and an optimal treatment strategy has not yet been determined.

Objectives

A network meta-analysis was performed to evaluate and compare the efficacy and safety of multiple external therapies for patients with insomnia.

Methods

Eight electronic databases were comprehensively searched from their inception to June 2023 for relevant literature. We also searched the grey literature and reviewed the reference lists of related systematic reviews. Two independent reviewers performed the study selection, data extraction, and bias assessment of the included randomized controlled trials (RCTs) using the Cochrane Reviewers' Handbook, and a network meta-analysis was conducted using Stata and RevMan software.

Results

In total, 14,826 studies were identified. Of these, 83 studies, including 9 external therapies and 6,100 patients, were deemed eligible for the present network meta-analysis. Except for the SL outcome, each external therapy was better than conventional medicine and the sham intervention (SI) in improving sleep quality. In terms of improving the psychological state indices of insomnia patients, each external therapy was superior to the SI; each external therapy had a better effect on the regulation of monoamine neurotransmitters. Tuina may be the most effective intervention in improving the total effective rate, Pittsburgh sleep quality index score, and SL. Repetitive transcranial magnetic stimulation (rTMS) perhaps resulted in the best improvement in total sleep time and awakening time (surface under the cumulative ranking curve [SUCRA] = 78.3 and 75.4%, respectively); and moxibustion (MB) and hyperbaric oxygen (HBO) were the most effective in reducing Self-rating Anxiety Scale and Self-rating Depression Scale scores. In terms of improving the monoamine neurotransmitters 5-hydroxytryptamine, norepinephrine, and dopamine, the best interventions were acupoint catgut embedding, electroacupuncture, and Tuina (SUCRA = 82.0, 69.9 and 90.3%, respectively). Safety results showed that the three safest interventions were the SI, Tuina, and foot bath. No serious adverse events were reported across the studies, and the most common minor adverse events included drowsiness, pain, excessive thirst, and hematoma.

Conclusion

Both Tuina and rTMS have significant effects on improving sleep quality, but the safety of rTMS is low. Therefore, Tuina can be recommended as the first line of treatment to improve sleep quality. If a patient's anxiety and depression symptoms are evident, MB or HBO can be selected for treatment based on the actual situation. External therapy to improve sleep quality may be related to the regulation of monoamine neurotransmitters, which may be a potential mechanism of action.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=440882.

Effects of Ward Noise Management on Mental Health and Hip Function in Elderly Patients Undergoing Total Hip Arthroplasty

OBJECTIVE

The aim of this study was to explore the influence of ward noise management on the mental health and hip joint function of elderly patients post-total hip arthroplasty.

METHODS

The retrospective analysis involved the medical records of 160 elderly patients who underwent total hip arthroplasty at Nanchang First Hospital from March 2021 to January 2023. The observation group received ward noise management (n = 75) and the control group received perioperative routine management (n = 85). The noise level, Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS), the Generic Quality of Life Inventory-74 (GQOLI-74), Harris Hip Score (HHS) system, and satisfaction scale were used to evaluate patients. T test and chi-square tests were used for statistical analysis.

RESULTS

The observation group exhibited a significantly lower noise level compared to the control group (P < 0.05). No significant differences were observed in the general information and preoperative SDS, SAS, HHS, and GQOLI-74 scores between the two groups (P > 0.05). No significant differences were observed in the SDS and HHS between the two groups 7 days after the operation (P > 0.05). The observation group presented a significantly lower SAS score than the control group 7 days after the operation (P < 0.05). The score of the observation group 7 days after the operation was lower than that before the operation (P < 0.05). At 7 days after the operation, the observation group showed a higher score in the "social function" dimension of GQOLI-74 compared to the control group (P < 0.05), and the satisfaction of the observation group was significantly higher than that of the control group (94.67 vs. 77.65%, P < 0.05).

CONCLUSIONS

Ward noise management can help reduce anxiety among elderly patients after total hip arthroplasty, improve their quality of life and social function, and obtain higher satisfaction.

The brain in chronic insomnia and anxiety disorder: a combined structural and functional fMRI study

Background

Chronic insomnia disorder (CID) is usually associated with Generalized Anxiety Disorder (GAD), which may change brain structure and function. However, the possible brain markers, imaging characteristics, and pathophysiology are unknown.

Objective

To look at the probable brain markers, imaging characteristics, and pathogenesis of CID in combination with GAD.

Methods

A total of 57 patients with CID concomitant GAD and 57 healthy controls (HC) were enrolled. Voxel-based morphometry (VBM) and functional connectivity (FC) were utilized to measure gray matter volume (GMV) and functional changes. Correlation analysis was utilized to identify relationships between brain changes and clinical characteristics.

Results

Patients had decreased GMV in the left cerebellum, right cerebellar peduncle, and left insula; increased FC between the left cerebellum and right angular gyrus, as well as between the left insula and anterior left cingulate gyrus; and decreased FC in several areas, including the left cerebellum with the middle left cingulate gyrus and the left insula with the left superior postcentral gyrus. These brain changes related to CID and GAD. These data could be used to identify relevant brain markers, imaging features, and to better understand the etiology.

Conclusion

The intensity of insomnia in patients was strongly related to the severity of anxiety. The lower GMV in the cerebellum could be interpreted as an imaging characteristic of CID. Reduced GMV in the insula, as well as aberrant function in the cingulate gyrus and prefrontal lobe, may contribute to the pathophysiology of CID and GAD. Abnormal function in the postcentral gyrus and angular gyrus may be associated with patients' clinical complaints.

Relationship between dietary diversity and sleep quality: a Chinese community-based study

OBJECTIVES

The objective of this study was to examine the association between dietary diversity and sleep quality among Chinese middle-aged and older adults.

METHODS

The Lifestyle and Healthy Aging of Chinese Square Dancer Study is a prospective, community-based cohort study that enrolled participants aged 45 years and above from 2020 to 2021. Using the semiquantitative food frequency questionnaire to investigate the diets of study participants, and using the Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality. Dietary diversity was assessed using two scoring methods covering ten food groups and 66 food items, respectively: the dietary diversity score (DDS) and the food variety score (FVS). The higher scores of DDS and FVS indicated greater dietary diversity and higher dietary quality. Logistic regression analysis explored the associations between these scores and sleep quality.

RESULTS

A total of 2409 individuals with completed information on PSQI and FFQ were included in this study, of whom 767 (31.8%) had poor sleep quality. Participants with higher DDS were associated with an 18% lower odds of poor sleep quality compared to those with low DDS (OR = 0.82, 95% CI, 0.68-0.98). Participants in the highest quartile of the FVS had a 32% lower odds of poor sleep quality than those in the lowest quartile (OR = 0.68, 95% CI, 0.52-0.89).

CONCLUSIONS

There was a positive correlation between higher FVS and DDS with better sleep quality. Therefore, ensuring a diverse diet may be beneficial for maintaining good sleep quality among middle-aged and older adults.

Sleep quality and mental health among Chinese nurses after the COVID-19 pandemic: A moderated model

INTRODUCTION AND AIMS

In the specialized nursing setting, nurses are susceptible to developing negative mental health issues. Such conditions among nurses can potentially result in unfavorable medical outcomes. Consequently, this study aims to explore the role of social support in regulating between sleep and mental health in nurses.

METHODS

A cross-sectional study was carried out in September 2022 on 1219 nurses in Quanzhou. The study comprised general demographic information and utilized various questionnaires, namely the Social Support Rate Scale (SSRS), Pittsburgh Sleep Quality Index Questionnaire (PSQI), Generalized Anxiety Disorder Questionnaire (GAD-7), and Patient Health Questionnaire-9 (PHQ-9). The data analysis was performed using t-tests, ANOVAs, Pearsons correlations and hierarchical regression analyses in SPSS software.

RESULTS

Results show that significant associations of sleep quality and social support with anxiety and depression. Simple slope analysis shows that under low levels of social support, sleep quality has a positive impact on anxiety(β = 0.598) and depression(β = 0.851), and the impact is significant. Under high levels of social support, sleep quality also has a positive impact on anxiety(β = 0.462) and depression(β = 0.578), but the impact is smaller. This indicates that as the level of social support increases, the positive predictive effect of sleep quality on anxiety and depression gradually diminishes.

CONCLUSIONS

Social support has the potential to alter the impact of sleep quality on anxiety and depression. Therefore, healthcare policymakers need to focus on enhancing the level of social support and mitigating the impact of poor sleep on anxiety and depression.

Casual associations between blood metabolites and colon cancer

BACKGROUND

Limited knowledge exists regarding the casual associations linking blood metabolites and the risk of developing colorectal cancer.

AIM

To investigate causal associations between blood metabolites and colon cancer.

METHODS

The study utilized a two-sample Mendelian randomization (MR) analysis to investigate the causal impact of 486 blood metabolites on colorectal cancer. The primary method of analysis used was the inverse variance weighted model. To further validate the results several sensitivity analyses were performed, including Cochran's Q test, MR-Egger intercept test, and MR robust adjusted profile score. These additional analyses were conducted to ensure the reliability and robustness of the findings.

RESULTS

After rigorous selection for genetic variation, 486 blood metabolites were included in the MR analysis. We found Mannose [odds ratio (OR) = 2.09 (1.10-3.97), P = 0.024], N-acetylglycine [OR = 3.14 (1.78-5.53), P = 7.54 × 10-8], X-11593-O-methylascorbate [OR = 1.68 (1.04-2.72), P = 0.034], 1-arachidonoylglycerophosphocholine [OR = 4.23 (2.51-7.12), P = 6.35 × 10-8] and 1-arachidonoylglycerophosphoethanolamine 4 [OR = 3.99 (1.17-13.54), P = 0.027] were positively causally associated with colorectal cancer, and we also found a negative causal relationship between Tyrosine [OR = 0.08 (0.01-0.63), P = 0.014], Urate [OR = 0.25 (0.10-0.62), P = 0.003], N-acetylglycine [0.73 (0.54-0.98), P = 0.033], X-12092 [OR = 0.89 (0.81-0.99), P = 0.028], Succinylcarnitine [OR = 0.48 (0.27-0.84), P = 0.09] with colorectal cancer. A series of sensitivity analyses were performed to confirm the rigidity of the results.

CONCLUSION

This study showed a causal relationship between 10 blood metabolites and colorectal cancer, of which 5 blood metabolites were found to be causal for the development of colorectal cancer and were confirmed as risk factors. The other five blood metabolites are protective factors.

Obstructive Sleep Apnea in Pregnancy: A Comprehensive Review of Maternal and Fetal Implications

Obstructive sleep apnea (OSA) is a prevalent yet underdiagnosed condition in pregnancy, associated with various maternal and fetal complications. This review synthesizes the current evidence on the epidemiology, pathophysiology, and neurological consequences of OSA in pregnancy, along with the potential management strategies. Articles were sourced from the PubMed, EMBASE, and Cochrane databases until 2023. Our comprehensive review highlights that the incidence of OSA increases during pregnancy due to physiological changes such as weight gain and hormonal fluctuations. OSA in pregnancy is linked with gestational hypertension, pre-eclampsia, gestational diabetes, and potential adverse fetal outcomes such as intrauterine growth restriction and preterm birth. Continuous positive airway pressure (CPAP) therapy remains the most effective management strategy for pregnant women with OSA. However, adherence to CPAP therapy is often suboptimal. This comprehensive review underscores the importance of the early recognition, timely diagnosis, and effective management of OSA in pregnancy to improve both maternal and fetal outcomes. Future research should focus on enhancing screening strategies and improving adherence to CPAP therapy in this population.

Assessment and management of chronic insomnia disorder: an algorithm for primary care physicians

BACKGROUND

Primary care physicians often lack resources and training to correctly diagnose and manage chronic insomnia disorder. Tools supporting chronic insomnia diagnosis and management could fill this critical gap. A survey was conducted to understand insomnia disorder diagnosis and treatment practices among primary care physicians, and to evaluate a diagnosis and treatment algorithm on its use, to identify ways to optimize it specifically for these providers.

METHODS

A panel of experts developed an algorithm for diagnosing and treating chronic insomnia disorder, based on current guidelines and experience in clinical practice. An online survey was conducted with primary care physicians from France, Germany, Italy, Spain, and the United Kingdom, who treat chronic insomnia patients, between January and February 2023. A sub-sample of participants provided open-ended feedback on the algorithm and gave suggestions for improvements.

RESULTS

Overall, 106 primary care physicians completed the survey. Half (52%, 55/106) reported they did not regularly screen for insomnia and half (51%, 54/106) felt they did not have enough time to address patients' needs in relation to insomnia or trouble sleeping. The majority (87%,92/106) agreed the algorithm would help diagnose chronic insomnia patients and 82% (87/106) agreed the algorithm would help improve their clinical practice in relation to managing chronic insomnia. Suggestions for improvements were making the algorithm easier to read and use.

CONCLUSION

The algorithm developed for, and tested by, primary care physicians to diagnose and treat chronic insomnia disorder may offer significant benefits to providers and their patients through ensuring standardization of insomnia diagnosis and management.

Prevalence and correlates of sleep disturbance among adolescents in the eastern seaboard of China

BACKGROUND

Sleep disturbances are serious public health issues that warrant increased attention, especially in adolescents. The aim of this study was to investigate the prevalence and factors associated with sleep disorders among urban adolescents in China.

METHODS

This study utilized an online survey to assess the demographic characteristics and mental health status of secondary school students in Lianyungang City. The Patient Health Questionnaire-9 (PHQ-9) was used to evaluate sleep disturbances in adolescents. The seven-item Generalized Anxiety Disorder (GAD-7) assessed anxiety symptoms, and the Perceived Social Support Scale (PSSS) was used to measure perceived social support.

RESULTS

Among 3443 adolescents, the prevalence of sleep disorders were 10.8%, with significantly higher proportions of sleep disorders (13.7% VS 8.3%, P < 0.001) among female adolescents when compared to males. Binary regression analysis revealed that anxiety symptoms (OR = 1.305, 95% CI: 1.269-1.342, P < 0.001) was risk factor for sleep disturbances, and significant other support (OR = 0.944, 95% CI: 0.896-0.994, P = 0.028) and good annual household income (OR = 0.616, 95% CI: 0.394-0.963, P = 0.034) were protective factors. Furthermore, multinomial logistic regression analysis showed that age, sex, and anxiety symptoms were associated with an elevated risk of experiencing more frequent sleep disturbances (all P < 0.05).

CONCLUSIONS

We have found that 10.8% of adolescents experience sleep disorders, and it is evident that various factors can influence healthy sleeping. These results underscore the significance of addressing these factors to enhance sleep health among this population.

THE RELATIONSHIP BETWEEN CIRCULATING IMMUNE CELL PHENOTYPES AND SEPSIS: A MENDELIAN RANDOMIZATION STUDY

ABSTRACT

Objective: The role of immune cells in sepsis remains unclear, and there is some controversy. Here, we aim to systematically assess whether distinct immune cell phenotypes impact the susceptibility to sepsis. Methods: In this study, we harnessed publicly available summary-level data from genome-wide association studies (GWASs). The selection of genetic variations strongly associated with 731 phenotypes of circulating immune cells served as instrumental variables (IVs). Using a two-sample Mendelian randomization (MR) analysis, we investigated the relationships between different immunophenotypes and the occurrence of sepsis, as well as the 28-day mortality. The MR study utilized the inverse variance weighting (IVW) method as the main analytical approach. In addition, we incorporated four other MR methods for supplementary causal inference, including weighted median (WME), MR-Egger regression, simple mode, and weighted mode. Furthermore, the robustness of the results was affirmed through multiple sensitivity analyses. Results: The results of the IVW method indicated that a total of 36 immunophenotypes are associated with the risk of sepsis. We also identified 34 immunophenotypes with a causal association with the 28-day mortality. Interestingly, before multiple testing corrections, 11 immunophenotypes were determined to have consistent causal relationships with both the occurrence of sepsis and the 28-day mortality. Notably, after false discovery rate (FDR) correction, four immunophenotypes were found to be significantly correlated with susceptibility to sepsis: CD45RA- CD4+ %CD4+ (odds ratio [OR], 1.355; 95% confidence interval [CI], 1.139~1.611; P < 0.001, PFDR = 0.192), HLA DR on HLA DR+ NK (OR, 0.818; 95% CI, 0.726~0.922; P = 0.001, PFDR = 0.192), IgD+ CD24+ %B cell (OR, 0.626; 95% CI, 0.473~0.828; P = 0.001, PFDR = 0.192), and TD DN (CD4- CD8-) AC (OR, 0.655; 95% CI, 0.510~0.840; P < 0.001, PFDR = 0.192). Following FDR correction, only one immunophenotype was confirmed to be negatively correlated with the 28-day mortality: CD39 on CD39+ CD8br (OR, 0.820; 95% CI, 0.737~0.912; P < 0.001, PFDR = 0.184). Conclusion: This study, for the first time, has uncovered indicative evidence of a causal relationship between circulating immune cell phenotypes and varying degrees of sepsis through genetic means. These findings underscore the significance of immune cells in the pathogenesis of sepsis.

Temporal network of experience sampling methodology identifies sleep disturbance as a central symptom in generalized anxiety disorder

BACKGROUND

A temporal network of generalized anxiety disorder (GAD) symptoms could provide valuable understanding of the occurrence and maintenance of GAD. We aim to obtain an exploratory conceptualization of temporal GAD network and identify the central symptom.

METHODS

A sample of participants (n = 115) with elevated GAD-7 scores (Generalized Anxiety Disorder 7-Item Questionnaire [GAD-7] ≥ 10) participated in an online daily diary study in which they reported their GAD symptoms based on DSM-5 diagnostic criteria (eight symptoms in total) for 50 consecutive days. We used a multilevel VAR model to obtain the temporal network.

RESULTS

In temporal network, a lot of lagged relationships exist among GAD symptoms and these lagged relationships are all positive. All symptoms have autocorrelations and there are also some interesting feedback loops in temporal network. Sleep disturbance has the highest Out-strength centrality.

CONCLUSIONS

This study indicates how GAD symptoms interact with each other and strengthen themselves over time, and particularly highlights the relationships between sleep disturbance and other GAD symptoms. Sleep disturbance may play an important role in the dynamic development and maintenance process of GAD. The present study may develop the knowledge of the theoretical model, diagnosis, prevention and intervention of GAD from a temporal symptoms network perspective.

Relationship of Sleep Disorder with Neurodegenerative and Psychiatric Diseases: An Updated Review

Sleep disorders affect many people worldwide and can accompany neurodegenerative and psychiatric diseases. Sleep may be altered before the clinical manifestations of some of these diseases appear. Moreover, some sleep disorders affect the physiological organization and function of the brain by influencing gene expression, accelerating the accumulation of abnormal proteins, interfering with the clearance of abnormal proteins, or altering the levels of related hormones and neurotransmitters, which can cause or may be associated with the development of neurodegenerative and psychiatric diseases. However, the detailed mechanisms of these effects are unclear. This review mainly focuses on the relationship between and mechanisms of action of sleep in Alzheimer's disease, depression, and anxiety, as well as the relationships between sleep and Parkinson's disease, Huntington's disease, and amyotrophic lateral sclerosis. This summary of current research hotspots may provide researchers with better clues and ideas to develop treatment solutions for neurodegenerative and psychiatric diseases associated with sleep disorders.

Prevalence of insomnia and associations with depression, anxiety among adults in guangdong, China: A large-scale cross-sectional study

OBJECTIVE

Insomnia is a common sleep disorder, often associated with some mental disorders or mental health concerns, especially when accompanied by depression or anxiety, but very limited research has been reported in China. The purpose of this study was to investigate the prevalence of insomnia and associations with depression, anxiety in Chinese adults.

METHODS

We conducted this large-sample cross-sectional study (51774 adults) in Guangdong province from October to December 2022. We used multistage stratified equal-volume random sampling under a complex sampling design to select the sample and standardized structured questionnaires to collect the necessary information. Descriptive analysis and logistic regression model were used for statistical analysis.

RESULTS

The weighted prevalence of insomnia was 24.8 %. Insomnia was significantly associated with depression (OR:11.29, 95 %CI: 9.58-13.29), and anxiety (OR:10.98, 95 %CI: 8.78-13.72). Risk factors as being associated with insomnia were female, higher years of education, suffering from chronic diseases, previous drinking and current drinking, while protective factors were living in a rural area, married or cohabited, divorce or separation and being older. Risk factors as being associated with depression in the insomnia group included 10-16 years of education and suffering from chronic diseases, while protective factors were being older, married or cohabited, and normal BMI. Risk factors associated with anxiety in the insomnia group included 7-12 years of education and suffering from chronic diseases, while protective factors were being older, married or cohabited, and having a normal BMI.

CONCLUSIONS

Insomnia is associated with the development of depression and anxiety. Women and unhealthy lifestyle were at high risk for insomnia, had chronic diseases is an important factor, and insomnia with depression or anxiety.

Associations of a multidimensional polygenic sleep health score and a sleep lifestyle index on health outcomes and their interaction in a clinical biobank

Sleep is a complex behavior regulated by genetic and environmental factors, and is known to influence health outcomes. However, the effect of multidimensional sleep encompassing several sleep dimensions on diseases has yet to be fully elucidated. Using the Mass General Brigham Biobank, we aimed to examine the association of multidimensional sleep with health outcomes and investigate whether sleep behaviors modulate genetic predisposition to unfavorable sleep on mental health outcomes. First, we generated a Polygenic Sleep Health Score using previously identified single nucleotide polymorphisms for sleep health and constructed a Sleep Lifestyle Index using data from self-reported sleep questions and electronic health records; second, we performed phenome-wide association analyses between these indexes and clinical phenotypes; and third, we analyzed the interaction between the indexes on prevalent mental health outcomes. Fifteen thousand eight hundred and eighty-four participants were included in the analysis (mean age 54.4; 58.6% female). The Polygenic Sleep Health Score was associated with the Sleep Lifestyle Index (β=0.050, 95%CI=0.032, 0.068) and with 114 disease outcomes spanning 12 disease groups, including obesity, sleep, and substance use disease outcomes (p<3.3×10-5). The Sleep Lifestyle Index was associated with 458 disease outcomes spanning 17 groups, including sleep, mood, and anxiety disease outcomes (p<5.1×10-5). No interactions were found between the indexes on prevalent mental health outcomes. These findings suggest that favorable sleep behaviors and genetic predisposition to healthy sleep may independently be protective of disease outcomes. This work provides novel insights into the role of multidimensional sleep on population health and highlights the need to develop prevention strategies focused on healthy sleep habits.

Anxiety and depression among women with newly diagnosed vulvar cancer - A nationwide longitudinal study

INTRODUCTION

Our objective was to investigate the trajectories of anxiety, depression, emotional and social functioning in women with newly diagnosed vulvar cancer from the time of diagnosis to 12 months after treatment. A further aim was to identify risk factors for high levels of anxiety.

MATERIAL AND METHODS

PROVE (PROspective Vulvar Cancer Evaluation) is a nationwide longitudinal cohort study investigating quality of life in women with newly diagnosed vulvar cancer by the following validated patient-reported outcome measures at diagnosis, and 3 and 12 months after treatment: The Hospital Anxiety and Depression Scale, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Vulvar module VU34. Mean scores, changes over time and associations were analyzed by generalized estimated equations and log-linear regression models, adjusted for possible confounders.

RESULTS

Between 2019 and 2021, 105 (69%) women completed the questionnaires at all three time points. At diagnosis, 42% of the women reported elevated anxiety levels, decreasing significantly to 30% during the first 12 months. Insomnia, persisting vulvar symptoms and high information needs were significantly associated with a high level of anxiety (relative risk [RR] 2.1, 95% CI 1.2-3.7 for insomnia; RR 2.8, 95% CI 1.7-4.6 for vulvar symptoms, RR 2.7, 95% CI 1.5-4.9 for information needs). We found a trend towards a higher level of anxiety in younger women (<65 years: RR 1.5, 95% CI 1.0-2.5). Participants reported a low and stable prevalence of depression (14%) and high social functioning throughout the study period.

CONCLUSIONS

Women with newly diagnosed vulvar cancer report a high level of anxiety at diagnosis. Despite a significant improvement, anxiety remains widely prevalent during the first year of follow-up. Targeting insomnia, vulvar symptoms and unmet needs may decrease anxiety during surveillance.

Potential genetic and epigenetic mechanisms in insomnia: A systematic review

Insomnia is a stress-related sleep disorder conceptualised within a diathesis-stress framework, which it is thought to result from predisposing factors interacting with precipitating stressful events that trigger the development of insomnia. Among predisposing factors genetics and epigenetics may play a role. A systematic review of the current evidence for the genetic and epigenetic basis of insomnia was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) system. A total of 24 studies were collected for twins and family heritability, 55 for genome-wide association studies, 26 about candidate genes for insomnia, and eight for epigenetics. Data showed that insomnia is a complex polygenic stress-related disorder, and it is likely to be caused by a synergy of genetic and environmental factors, with stress-related sleep reactivity being the important trait. Even if few studies have been conducted to date on insomnia, epigenetics may be the framework to understand long-lasting consequences of the interaction between genetic and environmental factors and effects of stress on the brain in insomnia. Interestingly, polygenic risk for insomnia has been causally linked to different mental and medical disorders. Probably, by treating insomnia it would be possible to intervene on the effect of stress on the brain and prevent some medical and mental conditions.

Effects of outdoor artificial light at night on human health and behavior: A literature review

The quality of life of human beings has improved tremendously through improved productivity, convenience, safety, and livability due to nighttime lights that illuminate outdoor work, leisure, and mobility. Recently, however, concerns have been growing over outdoor artificial light at night (ALAN) and its effects on human beings as well as ecosystems including animals and plants. This literature review aims to deliver a critical overview of the findings and the areas for future research on the effects of outdoor ALAN on human health and behaviors. Through a narrative literature review, we found that scientific research crucially lacks studies on the effects of outdoor ALAN on human behaviors and health, including social interaction, which may be more widespread compared to what is recognized so far. This review also highlights the importance of investigating the causal and complex relationships between outdoor ALAN, health, and behaviors with sleep as a key mediating factor. We elucidate that outdoor ALAN has both positive and negative effects on human life. Therefore, it is important for societies to be able to access facts and evidence about these effects to plan, agree to, and realize the optimal usage of nighttime lighting that balances its merits and demerits. Researchers in related areas of study must investigate and deliver the science of outdoor ALAN to various stakeholders, such as citizens, policymakers, urban and landscape planners, relevant practitioners, and industries. We believe that our review improves the understanding of outdoor ALAN in relation to human life and contributes to sustainable and thriving societies.