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Gyamfi J, Vieira D, Iwelunmor J, Watkins BX, Williams O, Peprah E, Ogedegbe G, Allegrante JP. Assessing descriptions of scalability for hypertension control interventions implemented in low-and middle-income countries: A systematic review. PLoS One 2022; 17:e0272071. [PMID: 35901114 PMCID: PMC9333290 DOI: 10.1371/journal.pone.0272071] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 07/12/2022] [Indexed: 11/20/2022] Open
Abstract
Background The prevalence of hypertension continues to rise in low- and middle-income- countries (LMICs) where scalable, evidence-based interventions (EBIs) that are designed to reduce morbidity and mortality attributed to hypertension have yet to be fully adopted or disseminated. We sought to evaluate evidence from published randomized controlled trials using EBIs for hypertension control implemented in LMICs, and identify the WHO/ExpandNet scale-up components that are relevant for consideration during “scale-up” implementation planning. Methods Systematic review of RCTs reporting EBIs for hypertension control implemented in LMICs that stated “scale-up” or a variation of scale-up; using the following data sources PubMed/Medline, Web of Science Biosis Citation Index (BCI), CINAHL, EMBASE, Global Health, Google Scholar, PsycINFO; the grey literature and clinicaltrials.gov from inception through June 2021 without any restrictions on publication date. Two reviewers independently assessed studies for inclusion, conducted data extraction using the WHO/ExpandNet Scale-up components as a guide and assessed the risk of bias using the Cochrane risk-of-bias tool. We provide intervention characteristics for each EBI, BP results, and other relevant scale-up descriptions. Main results Thirty-one RCTs were identified and reviewed. Studies reported clinically significant differences in BP, with 23 studies reporting statistically significant mean differences in BP (p < .05) following implementation. Only six studies provided descriptions that captured all of the nine WHO/ExpandNet components. Multi-component interventions, including drug therapy and health education, provided the most benefit to participants. The studies were yet to be scaled and we observed limited reporting on translation of the interventions into existing institutional policy (n = 11), cost-effectiveness analyses (n = 2), and sustainability measurements (n = 3). Conclusion This study highlights the limited data on intervention scalability for hypertension control in LMICs and demonstrates the need for better scale-up metrics and processes for this setting. Trial registration Registration PROSPERO (CRD42019117750).
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Affiliation(s)
- Joyce Gyamfi
- Teachers College, Columbia University, New York, NY, United States of America
- NYU School of Global Public Health, New York, NY, United States of America
- * E-mail:
| | - Dorice Vieira
- NYU School of Global Public Health, New York, NY, United States of America
- NYU Health Sciences Library, New York, NY, United States of America
- NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Juliet Iwelunmor
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, United States of America
| | | | - Olajide Williams
- Columbia University Medical Center, New York, NY, United States of America
| | - Emmanuel Peprah
- NYU School of Global Public Health, New York, NY, United States of America
| | - Gbenga Ogedegbe
- NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - John P. Allegrante
- Teachers College, Columbia University, New York, NY, United States of America
- Mailman School of Public Health, Columbia University, New York, NY, United States of America
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2
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Kharibam P, Pathania M, Naithani M, Singh Y, Bahurupi Y, Dhar M, Yadav SR, Singh N. A Comparative Study of Baseline Heart Rate Variability, Sleep Quality, and Oxidative Stress Levels in Hypertensive Versus Normotensive Subjects: A Cross-Sectional Study. Cureus 2022; 14:e25855. [PMID: 35832766 PMCID: PMC9273169 DOI: 10.7759/cureus.25855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2022] [Indexed: 01/01/2023] Open
Abstract
Objectives: To understand sleep quality, oxidative stress levels, and heart rate variability (HRV) in subjects with hypertension. This study aims to create baseline data in hypertensive subjects to research the possibility of further estimating the risk of developing cardiovascular mortality and morbidity in a patient with hypertension. Design and methods: This analytical cross-sectional study, encompassing 128 study subjects of both genders, with 64 hypertensive subjects, analyse the co-relation of sleep quality, malondialdehyde, and heart rate variability in hypertensive and normotensive subjects. The study was done in a tertiary teaching institute in northern India for 14 months. Descriptive statistics were used, and the independent t-test, Mann-Whitney U test, and Chi-square were used to find the association among the variables. Linear regression was used to estimate the effect of blood pressure on malondialdehyde levels. Results: Subjects with hypertension were found to have poor sleep quality (Global PSQI score ≥5, p=0.0001) and an increased malondialdehyde level (0.30303±0.17193 µM/L, p=0.0001). The hypertensive subjects were found to have lower parasympathetic activity as indicated by low high frequency (2.79463±473.220280; p=0.0001) and increased sympathetic activity; low frequency/high frequency (2.29823±2.792441; p=0.0001). Multivariate linear regression predicts that with one unit increase in systolic blood pressure, the malondialdehyde level increases by 0.006 units (p=0.002; 95% CI). Conclusion: Among the hypertensive group, there is significantly increased oxidative stress level, poor quality of sleep, and increased sympathetic activity, thereby predisposing the subjects to increased risk of cardiac morbidity and mortality.
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3
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Valenzuela PL, Santos-Lozano A, Torres-Barrán A, Morales JS, Castillo-García A, Ruilope LM, Ríos-Insua D, Ordovás JM, Lucia A. Poor self-reported sleep is associated with risk factors for cardiovascular disease: A cross-sectional analysis in half a million adults. Eur J Clin Invest 2022; 52:e13738. [PMID: 34958676 DOI: 10.1111/eci.13738] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/23/2021] [Accepted: 12/25/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sleep is known to affect cardiovascular health, but some controversy exists on the independent association between different sleep characteristics (duration, restfulness, difficulties falling asleep) and specific risk factors for cardiovascular disease (CVD). We aimed to assess the association between self-reported sleep characteristics and the likelihood of major CVD risk factors. METHODS Totally, 521,364 Spanish workers (32% female, 44 ± 9 years [18-64]) insured by an occupational risk prevention company participated in this nationwide cross-sectional study. Participants' sleep was considered 'poor' if they reported having ≥1 of the following conditions: excessively short (<6 h/d) or long (>9 h/d) sleep, unrestful sleep, or difficulties to fall asleep. We assessed the independent association between aforementioned sleep characteristics and the prevalence of hypertension, diabetes, hypercholesterolaemia, obesity and physical inactivity. RESULTS Poor sleep (reported by 33% of participants) was associated with a higher likelihood of presenting all CVD risk factors individually, particularly physical inactivity (which prevalence was ~3-fold higher in the poor sleep group compared with participants reporting no sleep abnormality). In separate analyses, all the different sleep characteristics were associated with the likelihood of ≥2 CVD risk factors. Participants with optimal sleep, normal sleep duration, no difficulties falling sleep and restful sleep showed a lower total CVD risk score than their peers with poor sleep, short sleep duration, difficulties falling sleep and unrestful sleep, respectively (all p < .001). CONCLUSIONS Poor sleep was associated with a higher likelihood of presenting major CVD risk factors. These findings might support the importance of monitoring and improving sleep patterns for primary CVD prevention.
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Affiliation(s)
- Pedro L Valenzuela
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain.,Physical Activity and Health Research Group ('PaHerg'), Research Institute of the Hospital, 12 de Octubre ('imas12'), Madrid, Spain
| | - Alejandro Santos-Lozano
- Physical Activity and Health Research Group ('PaHerg'), Research Institute of the Hospital, 12 de Octubre ('imas12'), Madrid, Spain.,i+HeALTH, European University Miguel de Cervantes, Valladolid, Spain
| | - Alberto Torres-Barrán
- Institute of Mathematical Sciences (ICMAT-CSIC), Madrid, Spain.,Komorebi AI Technologies, Madrid, Spain
| | - Javier S Morales
- MOVE-IT Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cadiz, Cadiz, Spain
| | | | - Luis M Ruilope
- Hypertension Unit and Cardiorenal Translational Laboratory, Research Institute of the Hospital, 12 de Octubre (imas12), Madrid, Spain
| | | | - José M Ordovás
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts, USA
| | - Alejandro Lucia
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain.,Physical Activity and Health Research Group ('PaHerg'), Research Institute of the Hospital, 12 de Octubre ('imas12'), Madrid, Spain
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4
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Ruilope LM, Ruiz-Hurtado G, Lucia A. Preventing and managing hypertension: do not forget the night. Hypertens Res 2021; 44:1674-1675. [PMID: 34526671 DOI: 10.1038/s41440-021-00744-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 08/13/2021] [Accepted: 08/19/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Luis M Ruilope
- Cardiorenal Translational Laboratory, Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain. .,CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, Spain. .,Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain.
| | - Gema Ruiz-Hurtado
- Cardiorenal Translational Laboratory, Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain.,CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Alejandro Lucia
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain.,Research Institute of the Hospital Universitario 12 de Octubre i+12, Madrid, Spain
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5
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Messineo L, Carter SG, Taranto-Montemurro L, Chiang A, Vakulin A, Adams RJ, Carberry JC, Eckert DJ. Addition of zolpidem to combination therapy with atomoxetine-oxybutynin increases sleep efficiency and the respiratory arousal threshold in obstructive sleep apnoea: A randomized trial. Respirology 2021; 26:878-886. [PMID: 34164887 DOI: 10.1111/resp.14110] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 05/24/2021] [Accepted: 06/15/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Atomoxetine combined with oxybutynin (Ato-Oxy) has recently been shown to reduce obstructive sleep apnoea (OSA) severity by >60%. However, Ato-Oxy also modestly reduced the respiratory arousal threshold, which may decrease sleep quality/efficiency. We sought to investigate the additional effect of zolpidem with Ato-Oxy on sleep efficiency (primary outcome), the arousal threshold, OSA severity, other standard polysomnography (PSG) parameters, next-day sleepiness and alertness (secondary outcomes). METHODS Twelve participants with OSA received 10 mg zolpidem plus Ato-Oxy (80-5 mg, respectively) or Ato-Oxy plus placebo prior to overnight in-laboratory PSG according to a double-blind, randomized, crossover design (1-week washout). Participants were fitted with an epiglottic catheter, a nasal mask and pneumotachograph to quantify arousal threshold and airflow. Next-day sleepiness and alertness were assessed via the Karolinska Sleepiness Scale and a driving simulation task. RESULTS The addition of zolpidem increased sleep efficiency by 9% ± 13% (80.9% ± 16.9% vs. 88.2% ± 8.2%, p = 0.037) and the respiratory arousal threshold by 17% ± 18% (-26.6 ± 14.5 vs. -33.8 ± 20.3 cm H2 O, p = 0.004) versus Ato-Oxy + placebo. Zolpidem did not systematically change OSA severity. Combination therapy was well tolerated, and zolpidem did not worsen next-day sleepiness. However, median steering deviation during the driving simulator task increased following the zolpidem combination. CONCLUSION Zolpidem improves sleep efficiency via an increase in the respiratory arousal threshold to counteract potential wake-promoting properties of atomoxetine in OSA. These changes occur without altering the rate of respiratory events or overnight hypoxaemia. However, while the addition of zolpidem does not increase next-day perceived sleepiness, caution is warranted given the potential impact on next-morning objective alertness.
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Affiliation(s)
- Ludovico Messineo
- Adelaide Institute for Sleep Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Sophie G Carter
- Neuroscience Research Australia (NeuRA), The University of New South Wales, Sydney, New South Wales, Australia
| | - Luigi Taranto-Montemurro
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital & Harvard Medical School, Boston, Massachusetts, USA
| | - Alan Chiang
- Neuroscience Research Australia (NeuRA), The University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew Vakulin
- Adelaide Institute for Sleep Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Robert J Adams
- Adelaide Institute for Sleep Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Jayne C Carberry
- Adelaide Institute for Sleep Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Danny J Eckert
- Adelaide Institute for Sleep Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
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Kakar E, Venema E, Jeekel J, Klimek M, van der Jagt M. Music intervention for sleep quality in critically ill and surgical patients: a meta-analysis. BMJ Open 2021; 11:e042510. [PMID: 33972331 PMCID: PMC8112429 DOI: 10.1136/bmjopen-2020-042510] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Sleep disruption occurs frequently in hospitalised patients. Given the potential of music intervention as a non-pharmacological measure to improve sleep quality, we aimed to assess and quantify current literature on the effect of recorded music interventions on sleep quality and quantity in the adult critical care and surgical populations. DESIGN Systematic review and meta-analysis. DATA SOURCES Embase, MEDLINE Ovid, Cochrane Central, Web of Science and Google Scholar. ELIGIBILITY CRITERIA FOR STUDIES Randomised controlled trials assessing the effect of music on sleep quality in critically ill and surgical patients. METHODS The electronic databases were systematically searched from 1 January 1981 to 27 January 2020. Data were screened, extracted and appraised by two independent reviewers. Primary outcomes were sleep quality and quantity, assessed with validated tools. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Random effects meta-analysis was performed, and pooled standardised mean differences (SMDs) with 95% CIs were reported. RESULTS Five studies (259 patients) were included in qualitative (risk of bias) and quantitative analysis (meta-analysis). Pooled data showed a significant effect of recorded music on subjective sleep quality in the critical care and surgical population (SMD=1.21 (95% CI 0.50 to 1.91), p<0.01, excluding one non-English study; SMD=0.87 (95% CI 0.45 to 1.29), p<0.01). The SMD of 1.21 corresponded to a 27.1% (95% CI 11.2 to 42.8) increase in subjective sleep quality using validated questionnaires. A significant increase in subjective sleep quantity of 36 min was found in one study. Objective measurements of sleep assessed in one study using polysomnography showed significant increase in deeper sleep stage in the music group. CONCLUSIONS Recorded music showed a significant improvement in subjective sleep quality in some critical care and surgical populations. Therefore, its use may be relevant to improve sleep, but given the moderate potential for bias, further research is needed. PROSPERO REGISTRATION NUMBER CRD42020167783.
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Affiliation(s)
- Ellaha Kakar
- Department of Surgery and Intensive Care Unit, Erasmus MC, Rotterdam, The Netherlands
| | - Esmée Venema
- Maastricht University, Maastricht, The Netherlands
| | - Johannes Jeekel
- Department of Surgery and Neuroscience, Erasmus MC, Rotterdam, The Netherlands
| | - Markus Klimek
- Department of Anaesthesiology, Erasmus MC, Rotterdam, The Netherlands
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7
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Yang F, Zhang Y, Qiu R, Tao N. Association of sleep duration and sleep quality with hypertension in oil workers in Xinjiang. PeerJ 2021; 9:e11318. [PMID: 33987006 PMCID: PMC8101473 DOI: 10.7717/peerj.11318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 03/30/2021] [Indexed: 11/20/2022] Open
Abstract
Objective The aim of this study is to explore sleep status and hypertension among oil workers in Xinjiang, China. It may provide new ideas and basis for the precise prevention and treatment of hypertension in occupational population. Methods Sleep status and hypertension were investigated in 3,040 workers by a multi-stage cluster sampling method in six oil field bases in Karamay City, Xinjiang. The Pittsburgh Sleep Quality Index was used to evaluate the sleep status of workers. Logistic regression was used to analyze the relationship between sleep duration and sleep quality, and hypertension. Stratified analysis was also performed. Results Our results show: 1. Insufficient sleep duration (OR = 1.51, 95% CI [1.19–1.90]) and poor sleep quality (OR = 1.78, 95% CI [1.33–2.38] were positively associated with hypertension. 2. Stratified analysis indicated insufficient sleep duration was associated with increased risk of hypertension in females (OR = 1.54, 95% CI [1.16–2.04]) than males (OR = 1.49, 95% CI [1.00–2.23]), and the risk of hypertension in the group <30 years old (OR = 9.03, 95% CI [2.32–35.15]) was higher than that in the group of 30–45 years old (OR = 1.59, 95% CI [1.14–2.20]). However, in the group > 45 years old, sleeping > 8 h was associated with increased risk of hypertension (OR = 3.36, 95% CI [1.42–7.91]). Oil workers doing shift work had a higher risk of hypertension (OR = 1.55, 95% CI [1.16–2.07]) to no shift work (OR = 1.48, 95% CI [1.02–2.15]). The risk of hypertension in the group with < 10 years of service (OR = 4.08, 95% CI [1.92–8.83]) was higher than that in the group with length of service of 10–20 years (OR = 2.79, 95% CI [1.59–4.86]). Poor sleep quality was associated with risk for hypertension in females (OR = 1.78, 95% CI [1.26–2.49]), those doing shift work (OR = 1.70, 95% CI [1.17–2.47]), those with length of service of > 20 years (OR = 1.64, 95% CI [1.18–2.27]). The risk of hypertension in the group 30–45 years old is higher than that in the group > 45 years old (OR30–45 years old = 1.71, 95% CI [1.10–2.66]; OR > 45 years old = 1.60, 95% CI [1.09–2.34]). Conclusion Insufficient sleep duration and poor sleep quality are the potential factors affecting hypertension in Xinjiang oil workers.
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Affiliation(s)
- Fen Yang
- School of Public Health, Xinjiang Medical University, Xinjiang, China
| | - Yuanyue Zhang
- School of Public Health, Xinjiang Medical University, Xinjiang, China
| | - Ruiying Qiu
- School of Public Health, Xinjiang Medical University, Xinjiang, China
| | - Ning Tao
- School of Public Health, Xinjiang Medical University, Xinjiang, China.,Clinical Postdoctoral Mobile Station, Xinjiang Medical University, Xinjiang, China
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8
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Shahrokhi M, Ghaeli P, Arya P, Shakiba A, Noormandi A, Soleimani M, Esfandbod M. Comparing the Effects of Melatonin and Zolpidem on Sleep Quality, Depression, and Anxiety in PatientsWithColorectalCancerUndergoingChemotherapy. Basic Clin Neurosci 2021; 12:105-114. [PMID: 33995933 PMCID: PMC8114863 DOI: 10.32598/bcn.12.1.1650.2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/25/2019] [Accepted: 11/21/2020] [Indexed: 12/25/2022] Open
Abstract
Introduction: Patients with cancer may have many complications involving their psychosomatic systems, such as sleep disturbance, depression, and anxiety. Thus, many research studies were conducted to reduce these complications. Zolpidem, as a short-term non-benzodiazepine treatment of insomnia, and melatonin as a chronobiological functionregulatory hormone, are commonly used for improving sleep quality. This randomized clinical trial aims to compare the effects of zolpidem and melatonin on sleep quality, depression, and anxiety in patients with colorectal cancer. Methods: In this single-blinded trial, 90 patients with colorectal cancer undergoing chemotherapy who had obtained a score of 5 or higher on the Pittsburgh Sleep Quality Index (PSQI) were randomly divided into two groups (n=45). One group was treated with 10 mg zolpidem at bedtime, and the other group received 6 mg melatonin at bedtime for 30 days. PSQI on weeks 0, 4, 8, Groningen sleep quality scale, Hamilton rating scale for depression, and Hamilton anxiety rating scale questionnaires were performed to assess patients on weeks 0, 4, and 8. The outcome was then analyzed, and P≤0.05 was considered statistically significant. Results: Both zolpidem and melatonin had significant impacts on sleep quality in week 4 (P<0.05). After stopping the treatments, the conditions were noticeably reversed on week 8 (P<0.05). Zolpidem and melatonin were relatively similar in affecting sleep duration, latency, efficiency, and disturbance. None of the two study medications had any considerable influence on anxiety and depression. Conclusion: Melatonin and zolpidem are promising agents for treating sleep complications and, to some extent, depression, and anxiety in cancer patients, according to the present study. However, further clinical trials are recommended to confirm the results of this study.
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Affiliation(s)
- Maryam Shahrokhi
- Department of clinical pharmacy, Faculty of Pharmacy, Guilan University of Medical Sciences, Rasht, Iran
| | - Padideh Ghaeli
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Pantea Arya
- Department of Psychiatry, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alia Shakiba
- Psychiatry and Psychoogy Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Afsaneh Noormandi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Soleimani
- Department of Psychiatry, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Esfandbod
- Hematology-Oncology and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
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9
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Izumida T, Nakamura Y, Sato Y, Ishikawa S. The Association between Sleeping Pill Use and Metabolic Syndrome in an Apparently Healthy Population in Japan: JMS-II Cohort Study. J Epidemiol 2020; 32:145-150. [PMID: 33162423 PMCID: PMC8824657 DOI: 10.2188/jea.je20200361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Sleeping pills are widely used for sleep disorders and insomnia. This population-based study aimed to evaluate the association between the use of sleeping pills and metabolic syndrome (MetS) and metabolic components in an apparently healthy Japanese cohort. Methods We examined baseline cross-sectional data from the JMS-II Cohort Study. The criteria for MetS and its components were based on The National Cholesterol Education Program Adult Treatment Panel III. Sleep habits including the sleep duration of the subjects and the frequency of sleeping pill use were obtained using The Pittsburgh Sleep Quality Index questionnaire. For different sleep durations, the association between sleeping pill use and MetS was assessed. Odds ratios (ORs) and their 95% confidence intervals (CIs) were estimated using multiple logistic regression models to quantify this association. Results Our study included 6,153 individuals (mean age, 63.8 [standard deviation 11.2] years), and 3,348 (54.4%) among them were women. The association between sleep duration and MetS was an inverted J-shaped curve among sleeping pill users and a J-shaped curve among non-users. After adjustment for various confounders, less than 6 h of sleep among sleeping pill users was associated with increased rates of MetS (<6 h, OR 3.08; 95% CI, 1.29–7.34]). The frequency of sleeping pill use in individuals with short sleep duration showed a positive association with the prevalence of MetS and its components. Conclusions Sleeping pill users with a short sleep duration had a 3-fold higher chance of having MetS than non-users with a short sleep duration.
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Affiliation(s)
- Toshihide Izumida
- Division of Community Medicine, Kanawaza Medical University Himi Municipal Hospital
| | - Yosikazu Nakamura
- Division of Public Health, Center for Community Medicine, Jichi Medical University
| | | | - Shizukiyo Ishikawa
- Division of Public Health, Center for Community Medicine, Jichi Medical University
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10
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Maiolino G, Bisogni V, Silvani A, Pengo MF, Lombardi C, Parati G. Treating sleep disorders to improve blood pressure control and cardiovascular prevention: a dream come true?-a narrative review. J Thorac Dis 2020; 12:S225-S234. [PMID: 33214926 PMCID: PMC7642627 DOI: 10.21037/jtd-cus-2020-014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Hypertension is one of the primary risk factors for heart disease and stroke, the leading causes of death worldwide. Current evidence supports the treatment of high blood pressure (BP) values in order to obtain a substantial reduction of cardiovascular burden. Sleep plays an important role in maintaining nocturnal BP control and nocturnal hypertension which, in turn, can be affected by the presence of sleep disorders. Whilst respiratory disturbances have been extensively studied and their causal role in the development of nocturnal hypertension has been demonstrated in both cross sectional and prospective studies, less is known about the impact of other sleep disorders such as insomnia. In this review, we aim to describe the role of sleep disorders in the development of nocturnal and diurnal hypertension. Furthermore, we aim to discuss the potential impact of the treatment of such sleep disorders on BP values as an adjunct treatment for patients with hypertension.
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Affiliation(s)
- Giuseppe Maiolino
- Clinica Medica 3, Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Valeria Bisogni
- Unit of Internal Medicine, Terni University Hospital, Terni, Italy
| | - Alessandro Silvani
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Martino Francesco Pengo
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, Milan, Italy
| | - Carolina Lombardi
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, Milan, Italy.,Faculty of Medicine, University of Milan-Bicocca, Milan, Italy
| | - Gianfranco Parati
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, Milan, Italy.,Faculty of Medicine, University of Milan-Bicocca, Milan, Italy
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11
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Circadian rhythms of blood pressure and rate pressure product in children with postural tachycardia syndrome. Auton Neurosci 2020; 228:102715. [PMID: 32846397 DOI: 10.1016/j.autneu.2020.102715] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 08/03/2020] [Accepted: 08/07/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To investigate circadian rhythms of blood pressure (BP) and rate pressure product (RPP) in children with postural tachycardia syndrome (POTS) by performing 24-hour ambulatory blood pressure monitoring (24-h ABPM). METHODS 103 POTS children and 84 age- and gender-matched healthy children were enrolled and they got 24-h ABPM under usual routine of diurnal activity and nocturnal sleep. RESULTS Although the mean awake systolic BP (SBP), 24-h diastolic BP (DBP), awake DBP, asleep heart rate (HR) did not differ between two groups (P > 0.05), the mean 24-h and asleep SBP, asleep DBP, 24-h and awake HR, 24-h, awake and asleep RPP were significantly higher in POTS children (P < 0.01). Non-dipping BP was more prevalent in POTS children (67.0% vs. 46%, P < 0.001). The RPP of POTS and control children showed 24-h circadian variations with peak roughly occurring approximately 2 h after waking from nocturnal sleep. Compared with controls, the RPP values of POTS children were significantly higher during 2 h before and 3 h after waking (P < 0.05). For the RPP value of 1 h after waking, a cutoff value of 8995.6 bpm·mmHg yielded a sensitivity of 75.8% and a specificity of 65.4% for predicting POTS. CONCLUSIONS Abnormal circadian BP regulation is prevalent in POTS children. POTS children present with daily sympathetic hyperactivity, especially during nocturnal sleep and within 3 h after waking. And the excessive morning surge in RPP parallels with the morning surge of orthostatic HR increments and OI symptoms.
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12
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Ostroumova TM, Parfenov VA, Ostroumova OD, Kochetkov AI. [Hypertension and insomnia]. TERAPEVT ARKH 2020; 92:69-75. [PMID: 32598666 DOI: 10.26442/00403660.2020.01.000319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 11/22/2022]
Abstract
Insomnia is frequently detected in patients with arterial hypertension (AH): from 19% to 47.9% of all cases according to epidemiological studies. On the other hand, the frequency of hypertension in patients with insomnia ranges from 21.4% to 50.2%, whereas in patients without insomnia, from 11.0% to 41.8%. In single studies in which patients with insomnia underwent ambulatory blood pressure monitoring (ABPM), these patients showed higher nocturnal blood pressure levels. Recent data suggests that insomnia is also a risk factor for hypertension. Among the pathogenetic mechanisms explaining the relationship between hypertension and insomnia, an increase in the activity of the main neuroendocrine stress systems, sympatho - adrenal and hypothalamic - pituitary - adrenal, and the frequent presence of concomitant anxiety disorders are discussed. To determine the sleep quality in patients with insomnia, the Pittsburgh Sleep Quality Index (PSQI) is most often used, patients with hypertension in a number of studies had higher total PSQI score compared to individuals with normal blood pressure. PSQI score correlates with systolic and diastolic blood pressure level, as well as with the presence of non - dipper blood pressure profile. Both hypertension and insomnia are associated with impaired cognitive functions. However, the relationship between cognitive impairment and insomnia is rather contradictory, which is most associated with the methodology for assessing cognitive functions and differences in the initial clinical and demographic characteristics of the examined patient population.
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Affiliation(s)
- T M Ostroumova
- Sechenov First Moscow State Medical University (Sechenov University)
| | - V A Parfenov
- Sechenov First Moscow State Medical University (Sechenov University)
| | - O D Ostroumova
- Sechenov First Moscow State Medical University (Sechenov University).,Pirogov Russian National Research Medical University - Russian Clinical and Research Center of Gerontology
| | - A I Kochetkov
- Pirogov Russian National Research Medical University - Russian Clinical and Research Center of Gerontology
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Stavropoulos K, Imprialos KP, Doumas M, Karagiannis A, Papademetriou V. Insomnia and hypertension: A misty landscape. J Clin Hypertens (Greenwich) 2019; 21:835-837. [DOI: 10.1111/jch.13519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Konstantinos Stavropoulos
- Second Propedeutic Department of Internal Medicine Aristotle University of Thessaloniki Thessaloniki Greece
- Veterans Affairs Medical Center Georgetown University Washington District of Columbia
| | - Konstantinos P. Imprialos
- Second Propedeutic Department of Internal Medicine Aristotle University of Thessaloniki Thessaloniki Greece
| | - Michael Doumas
- Second Propedeutic Department of Internal Medicine Aristotle University of Thessaloniki Thessaloniki Greece
- Veterans Affairs Medical Center George Washington University Washington District of Columbia
| | - Asterios Karagiannis
- Second Propedeutic Department of Internal Medicine Aristotle University of Thessaloniki Thessaloniki Greece
| | - Vasilios Papademetriou
- Veterans Affairs Medical Center Georgetown University Washington District of Columbia
- Faculty of Medicine Aristotle University of Thessaloniki Thessaloniki Greece
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Kario K, Yamasaki K, Yagi K, Tsukamoto M, Yamazaki S, Okawara Y, Tomitani N, Kanegae H. Effect of suvorexant on nighttime blood pressure in hypertensive patients with insomnia: The SUPER‐1 study. J Clin Hypertens (Greenwich) 2019; 21:896-903. [DOI: 10.1111/jch.13505] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/26/2018] [Accepted: 12/28/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Kazuomi Kario
- Jichi Medical University School of Medicine Tochigi Japan
| | | | | | | | - Shoji Yamazaki
- Jichi Medical University School of Medicine Tochigi Japan
| | - Yukie Okawara
- Jichi Medical University School of Medicine Tochigi Japan
| | - Naoko Tomitani
- Jichi Medical University School of Medicine Tochigi Japan
| | - Hiroshi Kanegae
- Jichi Medical University School of Medicine Tochigi Japan
- Genki Plaza Medical Center for Health Care Tokyo Japan
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Shitara J, Kasai T, Akihiro S, Yatsu S, Matsumoto H, Suda S, Ogita M, Yanagisawa N, Fujibayashi K, Nojiri S, Nishizaki Y, Ono N, Suwa S, Daida H. Effects of suvorexant on sleep apnea in patients with heart failure: A protocol of crossover pilot trial. J Cardiol 2019; 74:90-94. [PMID: 30737183 DOI: 10.1016/j.jjcc.2018.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 12/23/2018] [Accepted: 12/30/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Suvorexant, an orexin receptor antagonist, is known as a safe and effective sleep medication. Many patients with heart failure (HF) have sleep-disordered breathing (SDB) and are short sleepers, and it is unknown whether suvorexant is effective in HF patients and can improve insomnia safely. The aim of this study is to examine the effect of suvorexant on SDB in patients with HF. METHODS The Heart Failure with Insomnia and Suvorexant trial of Juntendo University Hospital and Juntendo Shizuoka Hospital (J-FLAVOR trial) is a multicenter trial with a randomized double crossover design. We will enroll a total of 30 HF patients treated in the Juntendo University Hospital and Juntendo Shizuoka Hospital. Eligible patients will undergo portable sleep monitoring twice with or without oral administration of suvorexant in a randomly assigned order. Before the study night, patients in the suvorexant first group will receive suvorexant for 4 consecutive days. There are at least 3 wash-out days between the study nights with and without suvorexant. Primary outcome measures of the non-inferiority trial of suvorexant include the apnea-hypopnea index and the severity of SDB, and the results will be compared between the study nights with and without suvorexant. CONCLUSION The present study can determine whether suvorexant can be used in HF patients without affecting their SDB. This is a pilot study to primarily assess whether suvorexant affects the severity of SDB in patients with HF. Therefore, further study is warranted to investigate whether suvorexant alters short- and long-term clinical outcomes by providing longer and better sleep in patients with HF.
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Affiliation(s)
- Jun Shitara
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Sleep and Sleep Disordered Breathing Center, Juntendo University Hospital, Tokyo, Japan.
| | - Sato Akihiro
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shoichiro Yatsu
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroki Matsumoto
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shoko Suda
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Manabu Ogita
- Department of Cardiology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Naotake Yanagisawa
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan; Clinical Research and Trial Center, Juntendo University Hospital, Tokyo, Japan
| | - Kazutoshi Fujibayashi
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan; Clinical Research and Trial Center, Juntendo University Hospital, Tokyo, Japan
| | - Shuko Nojiri
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan; Clinical Research and Trial Center, Juntendo University Hospital, Tokyo, Japan
| | - Yuji Nishizaki
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan; Clinical Research and Trial Center, Juntendo University Hospital, Tokyo, Japan
| | - Naoko Ono
- Faculty of International Liberal Arts, Juntendo University, Tokyo, Japan
| | - Satoru Suwa
- Department of Cardiology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Abstract
PURPOSE OF REVIEW Given the emerging knowledge that circadian rhythmicity exists in every cell and all organ systems, there is increasing interest in the possible benefits of chronotherapy for many diseases. There is a well-documented 24-h pattern of blood pressure with a morning surge that may contribute to the observed morning increase in adverse cardiovascular events. Historically, antihypertensive therapy involves morning doses, usually aimed at reducing daytime blood pressure surges, but an absence of nocturnal dipping blood pressure is also associated with increased cardiovascular risk. RECENT FINDINGS To more effectively reduce nocturnal blood pressure and still counteract the morning surge in blood pressure, a number of studies have examined moving one or more antihypertensives from morning to bedtime dosing. More recently, such studies of chronotherapy have studied comorbid populations including obstructive sleep apnea, chronic kidney disease, or diabetes. Here, we summarize major findings from recent research in this area (2013-2017). In general, nighttime administration of antihypertensives improved overall 24-h blood pressure profiles regardless of disease comorbidity. However, inconsistencies between studies suggest a need for more prospective randomized controlled trials with sufficient statistical power. In addition, experimental studies to ascertain mechanisms by which chronotherapy is beneficial could aid drug design and guidelines for timed administration.
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Sasaki N, Fujiwara S, Ozono R, Yamashita H, Kihara Y. Lower blood pressure and smaller pulse pressure in sleeping pill users: A large-scale cross-sectional analysis. Medicine (Baltimore) 2017; 96:e8272. [PMID: 29049222 PMCID: PMC5662388 DOI: 10.1097/md.0000000000008272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aimed to investigate the association between sleeping pill use and hypertension or blood pressure (BP) via a cross-sectional analysis.A total of 11,225 subjects (5875 men and 5350 women) underwent health examinations. We compared the proportion of sleeping pill users among hypertension (n = 5099) and normotensive (n = 6126) participants. We analyzed participants with no intake of antihypertensive medication (n = 7788), comparing the proportions with high systolic BP (SBP) ≥140, high diastolic BP (DBP) ≥90, and high pulse pressure (PP) ≥50 mm Hg across 3 subgroups. These groups were classified according to the sleeping pill use [nonuse group (n = 6869); low-frequency-use group, defined as taking sleeping pills ≤2 days per week (n = 344); and high-frequency-use group, defined as taking sleeping pills ≥3 days per week (n = 575)].In the multivariable-adjusted model, odds of sleeping pill use (odds ratio (OR), 1.14; P < .05) was significantly higher in the hypertensive group compared with the normotensive group. In participants with no intake of antihypertensive medication, odds of high SBP (OR, 0.65; P < .0005), high DBP (OR, 0.58; P < .005), and high PP (OR, 0.77; P < .01) were significantly lower in the high-frequency-use group compared with the nonuse group. Odds of high DBP (OR, 0.59; P < .05) was significantly lower in the low-frequency-use group.Sleeping pills were more frequently required in hypertensive participants than in the normotensive ones. Sleeping pill use may decrease BP and assist in the treatment of high BP in patients with sleep disturbances.
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Affiliation(s)
- Nobuo Sasaki
- Health Management and Promotion Center, Hiroshima Atomic Bomb Casualty Council
| | - Saeko Fujiwara
- Health Management and Promotion Center, Hiroshima Atomic Bomb Casualty Council
| | | | | | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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Thomas RJ, Shin C, Bianchi MT, Kushida C, Yun CH. Distinct polysomnographic and ECG-spectrographic phenotypes embedded within obstructive sleep apnea. SLEEP SCIENCE AND PRACTICE 2017. [DOI: 10.1186/s41606-017-0012-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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19
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Li Y, Yang Y, Li Q, Yang X, Wang Y, Ku WL, Li H. The impact of the improvement of insomnia on blood pressure in hypertensive patients. J Sleep Res 2016; 26:105-114. [PMID: 27095167 DOI: 10.1111/jsr.12411] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 02/07/2016] [Indexed: 12/23/2022]
Affiliation(s)
- Yuan Li
- Department of Cell Biology and Molecular Genetics; University of Maryland; College Park MD USA
| | - Yiling Yang
- Department of Diagnostics of TCM; School of Preclinical Medicine; Beijing University of Chinese Medicine; Beijing China
| | - Qiubing Li
- Department of Geriatrics; China-Japan Friendship Hospital; Beijing China
| | - Xueqing Yang
- Department of Geriatrics; China-Japan Friendship Hospital; Beijing China
| | - Yan Wang
- Department of Geriatrics; China-Japan Friendship Hospital; Beijing China
| | - Wai Lim Ku
- Systems Biology Center; Division of Intramural Research; National Heart, Lung, and Blood Institute; National Institutes of Health; Bethesda Maryland 20892 USA
| | - Haicong Li
- Department of Geriatrics; China-Japan Friendship Hospital; Beijing China
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Lan TY, Zeng YF, Tang GJ, Kao HC, Chiu HJ, Lan TH, Ho HF. The Use of Hypnotics and Mortality--A Population-Based Retrospective Cohort Study. PLoS One 2015; 10:e0145271. [PMID: 26709926 PMCID: PMC4692546 DOI: 10.1371/journal.pone.0145271] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 12/02/2015] [Indexed: 12/03/2022] Open
Abstract
Background Sleep disorders, especially chronic insomnia, have become major health problem worldwide and, as a result, the use of hypnotics is steadily increasing. However, few studies with a large sample size and long-term observation have been conducted to investigate the relationship between specific hypnotics and mortality. Methods We conducted this retrospective cohort study using data from the National Health Insurance Research Database in Taiwan. Information from claims data including basic characteristics, the use of hypnotics, and survival from 2000 to 2009 for 1,320,322 individuals were included. The use of hypnotics was divided into groups using the defined daily dose and the cumulative length of use. Hazard ratios (HRs) were calculated from a Cox proportional hazards model, with two different matching techniques to examine the associations. Results Compared to the non-users, both users of benzodiazepines (HR = 1.81; 95% confidence interval [CI] = 1.78–1.85) and mixed users (HR = 1.44; 95% CI = 1.42–1.47) had a higher risk of death, whereas the users of other non-benzodiazepines users showed no differences. Zolpidem users (HR = 0.73; 95% CI = 0.71–0.75) exhibited a lower risk of mortality in the adjusted models. This pattern remained similar in both matching techniques. Secondary analysis indicated that zolpidem users had a reduced risk of major cause-specific mortality except cancer, and that this protective effect was dose-responsive, with those using for more than 1 year having the lowest risk. Conclusions The effects of different types of hypnotics on mortality were diverse in this large cohort with long-term follow-up based on representative claims data in Taiwan. The use of zolpidem was associated with a reduced risk of mortality.
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Affiliation(s)
- Tzuo-Yun Lan
- Institute of Hospital & Health Care Administration, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
| | - Ya-Fang Zeng
- Institute of Hospital & Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Gau-Jun Tang
- Institute of Hospital & Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Hui-Chuan Kao
- Department of Public Health, Tzu Chi University, Hualien, Taiwan
| | | | - Tsuo-Hung Lan
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hsiao-Feng Ho
- National Health Insurance Administration, Ministry of Health and Welfare, Taipei, Taiwan
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Kara B, Tenekeci EG. Sleep Quality and Associated Factors in Older Turkish Adults With Hypertension: A Pilot Study. J Transcult Nurs 2015; 28:296-305. [PMID: 26711885 DOI: 10.1177/1043659615623330] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate sleep quality and to explore its associations with participant characteristics, anemia, excessive daytime sleepiness, and physical activity in older Turkish adults with hypertension. METHOD This cross-sectional study included 128 adults aged 60 years or older with hypertension. Data were collected by using a personal information form, the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, and the International Physical Activity Questionnaire. Anemia was assessed by hemoglobin levels. RESULTS Eighty-one patients (63.3%) reported poor sleep quality. Anemia was present in 35.2% of the patients (defined as hemoglobin <13 g/dL for males and <12 g/dL for females). Female gender, the presence of anemia, and low levels of physical activity were associated with poor sleep quality. Conclusion/Implication: The majority of the participants had poor sleep quality. Better understanding of risk factors associated with poor sleep quality may contribute to more effective interventions to improve health and well-being.
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Miyata A, Iwamoto K, Kawano N, Kohmura K, Yamamoto M, Aleksic B, Ebe K, Noda A, Noda Y, Iritani S, Ozaki N. The effects of acute treatment with ramelteon, triazolam, and placebo on driving performance, cognitive function, and equilibrium function in healthy volunteers. Psychopharmacology (Berl) 2015; 232:2127-37. [PMID: 25533998 DOI: 10.1007/s00213-014-3843-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 12/08/2014] [Indexed: 12/21/2022]
Abstract
RATIONALE Hypnotics are widely used to treat insomnia but adverse effects of different hypnotics, especially benzodiazepine receptor agonists, are getting more attention lately. The effects of novel hypnotics have not been fully examined. OBJECTIVE This study aims to assess the effects of two hypnotics, ramelteon and triazolam, on driving performance, cognitive function, and equilibrium function. METHODS In this double-blinded, three-way crossover trial, 17 healthy males received acute doses of 8 mg ramelteon, 0.125 mg triazolam, and placebo. The subjects were administered three driving tasks-road-tracking, car-following, and harsh-braking-using a driving simulator and three cognitive tasks-Continuous Performance Test, N-back Test, and Trail-Making Test-at baseline and at 1 and 4 h post-dosing. The Stanford Sleepiness Scale scores and computerized posturography were also assessed. RESULTS In the driving simulations, ramelteon and triazolam increased the number of subjects who slid off the road. Triazolam increased the standard deviation of lateral position compared to ramelteon and placebo at 1 h post-dosing. Ramelteon and triazolam significantly increased the time to complete of Trail-Making Test part A and the environmental area in posturography compared to placebo at 1 and 4 h post-dosing. Ramelteon and triazolam significantly increased subjective sleepiness compared to placebo at 1 h post-dosing. CONCLUSIONS Ramelteon may affect road-tracking performance, visual attention and/or psychomotor speed measured by Trail-Making Test part A, and body balance in acute dosing. Lower dose of triazolam also impaired performance worse than ramelteon. Physicians should consider risks and benefits when prescribing both drugs, especially in the initial period of administration.
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Affiliation(s)
- Akemi Miyata
- Department of Psychiatry, Nagoya University, Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan
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Huang YC, Lin CY, Lan CC, Wu YK, Lim CS, Huang CY, Huang HL, Yeh KH, Liu YC, Yang MC. Comparison of cardiovascular co-morbidities and CPAP use in patients with positional and non-positional mild obstructive sleep apnea. BMC Pulm Med 2014; 14:153. [PMID: 25257571 PMCID: PMC4189203 DOI: 10.1186/1471-2466-14-153] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 09/23/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This retrospective cohort study aimed to determine if there are differences in cardiovascular co-morbidities, blood pressure (BP) and continuous positive airway pressure (CPAP) use between patients with positional-dependent and nonpositional-dependent obstructive sleep apnea (OSA). METHODS Patients who were referred for overnight polysomnography for suspected OSA between 2007 and 2011 were screened. A total of 371 patients with OSA were included for analysis and divided into six groups according to positional-dependency and severity of OSA: positional mild (n = 52), positional moderate (n = 29), positional severe (n = 24), non-positional mild (n = 18), non-positional moderate (n = 70) and non-positional severe group (n = 178). The six groups were compared for anthropometric and polysomnographic variables, presence of cardiovascular co-morbidities, morning and evening BP and the changes between evening and morning BP, and CPAP device usage patterns. RESULTS Demographic and anthropometric variables showed non-positional severe OSA had poor sleep quality and higher morning blood pressures. Positional mild OSA had the lowest cardiovascular co-morbidities. Overall CPAP acceptance was 45.6%. Mild OSA patients had the lowest CPAP acceptance rate (10%), followed by moderate group (37.37%) and severe group (61.88%, P < 0.001). However, the significant difference in CPAP acceptance across OSA severity disappeared when the data was stratified by positional dependency. CONCLUSIONS This study found that positional mild OSA had less cardiovascular co-morbidities compared with subjects with positional severe OSA. Independent of posture, CPAP acceptance in patients with mild OSA was low, but CPAP compliance was similar in CPAP acceptors regardless of posture dependency of OSA. Since there are increasing evidences of greater cardiovascular risk for untreated mild OSA, improving CPAP acceptance among mild OSA patients may be clinically important regardless of posture dependency.
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Affiliation(s)
- Yi-Chih Huang
- />Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzuchi Hospital, the Buddhist Tzuchi Medical Foundation, Xindian Dist, New Taipei City, Taiwan
| | - Chun-Yao Lin
- />Divisions of Pulmonary, Critical Care and Sleep Medicine, Chang Gung Memorial Hospital at Keelung, Keelung City, Taiwan
| | - Chou-Chin Lan
- />Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzuchi Hospital, the Buddhist Tzuchi Medical Foundation, Xindian Dist, New Taipei City, Taiwan
- />School of Medicine, Tzu-Chi University, Hualien, Taiwan
| | - Yao-Kuang Wu
- />Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzuchi Hospital, the Buddhist Tzuchi Medical Foundation, Xindian Dist, New Taipei City, Taiwan
- />School of Medicine, Tzu-Chi University, Hualien, Taiwan
| | - Chor-Shen Lim
- />Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzuchi Hospital, the Buddhist Tzuchi Medical Foundation, Xindian Dist, New Taipei City, Taiwan
| | - Chun-Yao Huang
- />Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzuchi Hospital, the Buddhist Tzuchi Medical Foundation, Xindian Dist, New Taipei City, Taiwan
| | - Hsuan-Li Huang
- />School of Medicine, Tzu-Chi University, Hualien, Taiwan
- />Division of Cardiology, Department of Internal Medicine, Taipei Tzuchi Hospital, the Buddhist Tzuchi Medical Foundation, Xindian Dist, New Taipei City, Taiwan
| | - Kuan-Hung Yeh
- />School of Medicine, Tzu-Chi University, Hualien, Taiwan
- />Division of Cardiology, Department of Internal Medicine, Taipei Tzuchi Hospital, the Buddhist Tzuchi Medical Foundation, Xindian Dist, New Taipei City, Taiwan
| | - Yu-Chih Liu
- />Divisions of Pulmonary, Critical Care and Sleep Medicine, Chang Gung Memorial Hospital at Keelung, Keelung City, Taiwan
| | - Mei-Chen Yang
- />Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzuchi Hospital, the Buddhist Tzuchi Medical Foundation, Xindian Dist, New Taipei City, Taiwan
- />School of Medicine, Tzu-Chi University, Hualien, Taiwan
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Bonnet MH, Burton GG, Arand DL. Physiological and medical findings in insomnia: Implications for diagnosis and care. Sleep Med Rev 2014; 18:111-22. [DOI: 10.1016/j.smrv.2013.02.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 01/29/2013] [Accepted: 02/16/2013] [Indexed: 12/28/2022]
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Gramaglia E, Ramella Gigliardi V, Olivetti I, Tomelini M, Belcastro S, Calvi E, Dotta A, Ghigo E, Benso A, Broglio F. Impact of short-term treatment with benzodiazepines and imidazopyridines on glucose metabolism in healthy subjects. J Endocrinol Invest 2014; 37:203-6. [PMID: 24497220 DOI: 10.1007/s40618-013-0016-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 11/16/2013] [Indexed: 11/29/2022]
Abstract
AIM In the last years there has been a progressive reduction of the average duration of sleep and an increase in the incidence of sleep disturbances. At the same time, an increase of the incidence of the metabolic syndrome has been described, partly attributable to the progressive worsening of dietary habits and the increase in sedentary lifestyle. Recent studies suggest that adequate sleep is essential to maintain good glucose metabolism and sleep disturbances may contribute to the manifestation of the metabolic syndrome. Benzodiazepines (BZ), such as brotizolam, and imidazopyridines, such as zolpidem, are frequently used as hypnotics but their potential impact on glucose metabolism has never been evaluated so far. METHODS In 12 healthy volunteers [age (mean ± SEM) 38.3 ± 8.1 years; body mass index (BMI) 21.9 ± 0.8 kg/m²] we studied glucose and insulin responses to oral glucose tolerance test (OGTT, 75 g) before and after 15 days treatment with brotizolam 0.25 mg/day or zolpidem 10 mg/day. RESULTS Brotizolam increased glucose delta area under curve response to the OGTT by 122 % (p < 0.01) and zolpidem by 86 % (p < 0.01) without significant variations of insulin levels, suggesting an impact on insulin sensitivity and/or insulin secretion. CONCLUSIONS This study suggests that BZ and imidazopyridines have a rapid glucometabolic effect that is detectable as early as after 15 days treatment.
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Affiliation(s)
- E Gramaglia
- Division of Endocrinology, Diabetology and Metabolism, Department of Internal Medicine, A.O. Città Della Salute e Della Scienza, San Giovanni Battista, Molinette Hospital, University of Turin, Corso Dogliotti, 14, 10126, Turin, Italy
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Ulmer CS, Calhoun PS, Bosworth HB, Dennis MF, Beckham JC. Nocturnal blood pressure non-dipping, posttraumatic stress disorder, and sleep quality in women. Behav Med 2013; 39:111-21. [PMID: 24236808 PMCID: PMC3964784 DOI: 10.1080/08964289.2013.813434] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Women with posttraumatic stress disorder (PTSD) have poor sleep quality and increased risk of cardiovascular disease (CVD). Non-dipping of nocturnal blood pressure may be an explanatory factor for the relationship between sleep and CVD found in previous research. The current study was designed to determine if non-dipping nocturnal blood pressure was associated with trauma exposure, PTSD diagnosis, PTSD symptoms, and sleep quality in a sample of women. Participants completed 24 hours of ABPM and self-report questionnaires. Non-dipping was defined as less than 10% reduction in blood pressure during sleep. The frequency of non-dippers did not differ by diagnostic status (d = .15). However, non-dippers endorsed more traumatic event categories (d = .53), more PTSD hyperarousal symptoms (d = .53), poorer overall sleep quality (d = .59), more frequent use of sleep medication (d = .62), greater sleep-related daytime dysfunction (d = .58), and longer sleep onset latencies (d = .55) than dippers. Increased attention to nocturnal blood pressure variation may be needed to improve blood pressure control in trauma-exposed women.
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Affiliation(s)
- Christi S Ulmer
- a Durham Veterans Affairs Medical Center and Duke University Medical Center
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Huang Y, Mai W, Hu Y. Relationship between sleep quality and the level and pattern of BP. Nat Rev Cardiol 2012; 9:429; author reply 429. [PMID: 22614620 DOI: 10.1038/nrcardio.2011.202-c1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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