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Von Behren J, Goldberg D, Hurley S, Clague DeHart J, Wang SS, Reynolds P. Prospective analysis of sleep characteristics, chronotype, and risk of breast cancer in the california teachers study. Cancer Causes Control 2024; 35:597-604. [PMID: 37940783 PMCID: PMC10960753 DOI: 10.1007/s10552-023-01817-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/12/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE Poor sleep quality and evening chronotype were associated with increased risk of breast cancer in a previous retrospective study in the California Teachers Study (CTS). The present analysis examines these sleep factors prospectively in the same cohort of women. METHODS From the CTS, we included 1,085 incident breast cancer cases and 38,470 cancer-free participants from 2012 through 2019. We calculated time at risk and used Cox proportional hazards regression models to estimate the hazard ratios (HRs) and control for risk factors such as age, race, body mass index, family history of breast cancer, and reproductive history. The sleep factors examined were quality, latency, duration, disturbance, and sleep medication use, based on a shortened version of the Pittsburgh Sleep Quality Index, as well as chronotype (preference for morning or evening activity). This analysis was limited to women who were post-menopausal at the time they answered these sleep-related questions. RESULTS Measures of sleep quality did not appear to be associated with subsequent breast cancer risk. The HR for evening chronotypes compared to morning chronotypes was somewhat elevated (HR 1.19, 95% CI 1.04, 1.36). CONCLUSION While the measures of sleep quality and duration were not associated with post-menopausal breast cancer risk in this prospective analysis, the modestly elevated risk observed for evening chronotypes was consistent with the prior retrospective analysis.
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Affiliation(s)
- Julie Von Behren
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
| | - Debbie Goldberg
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Susan Hurley
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Jessica Clague DeHart
- School of Community and Global Health, Claremont Graduate University, Claremont, CA, USA
| | - Sophia S Wang
- Division of Health Analytics, Department of Computational and Quantitative Medicine, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Peggy Reynolds
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
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2
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Lin SJ, Tang SCJ, Lee YC, Liu TY, Huang TC, Yu RL, Tan CH. Lack of direct association between viral hepatitis and sleep disturbances. Front Med (Lausanne) 2022; 9:951762. [DOI: 10.3389/fmed.2022.951762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/25/2022] [Indexed: 11/15/2022] Open
Abstract
BackgroundIndividuals with chronic viral hepatitis are at increased risk of experiencing poor sleep quality and sleep disturbances. However, it remains unclear whether the sleep disorders associated with viral hepatitis are secondary to the comorbidities related to viral hepatitis or the direct effect of hepatitis viruses on sleep. This study investigated the direct impact of viral hepatitis B and C on sleep quality.MethodsIndividuals with viral hepatitis B or C and their healthy counterparts were recruited for the present study, and they were evaluated with the Parkinson's Disease Sleep Scale-2, the Epworth Sleepiness Scale, and the Pittsburgh Sleep Quality Index in the absence of common comorbidities associated with viral hepatitis.ResultsNeither hepatitis B nor hepatitis C was found to cause significant differences in insomnia symptoms or excessive daytime sleepiness. However, individuals with hepatitis C, but not hepatitis B, tended to be less likely to experience restlessness of the legs or arms at night.ConclusionsThis study suggests that hepatitis viruses B and C may not cause a significant impact on sleep quality and related disorders directly. Sleep disturbances in individuals with chronic viral hepatitis may instead be attributable to hepatic decompensation or the comorbid factors associated with viral hepatitis.
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3
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Jones GS, Graubard BI, Ramirez Y, Liao LM, Huang WY, Alvarez CS, Yang W, Zhang X, Petrick JL, McGlynn KA. Sweetened beverage consumption and risk of liver cancer by diabetes status: A pooled analysis. Cancer Epidemiol 2022; 79:102201. [PMID: 35728406 DOI: 10.1016/j.canep.2022.102201] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 06/07/2022] [Accepted: 06/09/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Consumption of sweetened beverages has been linked to several risk factors for liver cancer including diabetes. Studies investigating the role of sweetened beverage consumption and liver cancer, however, are limited. As persons with diabetes are advised against consumption of sugar, the objective of this study was to examine the role of sweetened beverage consumption and liver cancer risk by diabetes status. METHODS Data from two U.S. cohorts: the NIH-AARP Diet and Health Study, and the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial were harmonized and pooled. Hazard ratios and 95%CI were estimated using Cox proportional hazard models stratified by median follow-up time. RESULTS Among persons without diabetes, there were no statistical evidence of associations between liver cancer and consumption of sweetened beverages overall, sugar sweetened beverages (SSB), or artificially sweetened beverages (ASB). Sugar sweetened (SS) soda consumption, however, was associated with liver cancer in the first follow-up interval (HR:1.18. 95%CI: 1.03, 1.35). In contrast, among persons with diabetes, there were significant associations between liver cancer and consumption of sweetened beverages overall (HR: 1.12, 95%CI 1.01, 1.24), ASBs (HR: 1.13, 95% CI: 1.02, 1.25), soda overall (HR: 1.13, 95% CI: 1.00, 1.26) and artificially sweetened (AS) soda (HR: 1.13, 95% CI: 1.01, 1.27) in the first follow-up interval. CONCLUSIONS Increased soda consumption may be associated with risk of liver cancer. The results suggest that decreasing consumption of SS soda by persons without diabetes, and AS soda by persons with diabetes, could be associated with reduced liver cancer risk.
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Affiliation(s)
- Gieira S Jones
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
| | - Barry I Graubard
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Yesenia Ramirez
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Linda M Liao
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Wen-Yi Huang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Christian S Alvarez
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Wanshui Yang
- Channing Division of Network Medicine, Department of Medicine Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Nutrition, School of Public Heath, Anhui Medical University, Hefei, China
| | - Xuehong Zhang
- Channing Division of Network Medicine, Department of Medicine Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Katherine A McGlynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
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4
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Hui Y, Wang X, Yu Z, Feng H, Li C, Mao L, Fan X, Lin L, Cui B, Chen X, Sun L, Wang B, Sun C. Relationship Between Sleep-Wake Disturbance and Risk of Malnutrition in Hospitalized Patients With Cirrhosis. Front Nutr 2021; 8:719176. [PMID: 34532336 PMCID: PMC8439378 DOI: 10.3389/fnut.2021.719176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/09/2021] [Indexed: 01/05/2023] Open
Abstract
Both sleep-wake disturbance and malnutrition are common in cirrhosis and might be associated with similar adverse outcomes, such as impaired health-related quality of life, hepatic encephalopathy, and sarcopenia, but there is no study investigating the relationship between these two. We aimed to explore the relationship between sleep-wake disturbance [estimated by the Pittsburgh Sleep Quality Index (PSQI)] and malnutrition risk [estimated by the Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT)]. About 150 patients with cirrhosis were prospectively recruited. The nutritional risk is classified as low (0 points), moderate (1 point), and high (2-7 points) according to the RFH-NPT score. A global PSQI >5 indicated poor sleepers. Furthermore, multivariate linear regression analyses were performed to determine the relationship between sleep-wake disturbance and malnutrition. The median PSQI was seven, and RFH-NPT was two in the entire cohort, with 60.67 and 56.67% rated as poor sleep quality and high malnutrition risk, respectively. Patients with cirrhosis with poor sleep quality had significantly higher RFH-NPT score (3 vs. 1, P = 0.007). Our multivariate analyses indicated that male patients (β = 0.279, P < 0.001), ascites (β = 0.210, P = 0.016), and PSQI (β = 0.262, P = 0.001) were independent predictors of malnutrition. In addition, the differences regarding PSQI score were more significant in male patients, as well as those >65 years or with Child-Turcotte-Pugh class A/B (CTP-A/B) or the median model for end-stage liver disease (MELD) <15. Taken together, the sleep-wake disturbance is strongly correlated with high malnutrition risk in patients with cirrhosis. Given sleep-wake disturbance is remediable, it is tempting to incorporate therapies to reverse poor sleep quality for improving nutritional status in patients with cirrhosis.
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Affiliation(s)
- Yangyang Hui
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Medical University General Hospital, Tianjin Institute of Digestive Disease, Tianjin, China
| | - Xiaoyu Wang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Medical University General Hospital, Tianjin Institute of Digestive Disease, Tianjin, China
| | - Zihan Yu
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Medical University General Hospital, Tianjin Institute of Digestive Disease, Tianjin, China
| | - Hongjuan Feng
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.,Department of Nutriology, Tianjin Third Central Hospital, Tianjin, China
| | - Chaoqun Li
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.,Department of Internal Medicine, Tianjin Hexi Hospital, Tianjin, China
| | - Lihong Mao
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Medical University General Hospital, Tianjin Institute of Digestive Disease, Tianjin, China
| | - Xiaofei Fan
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Medical University General Hospital, Tianjin Institute of Digestive Disease, Tianjin, China
| | - Lin Lin
- Department of Gastroenterology, Tianjin Medical University General Hospital Airport Hospital, Tianjin, China
| | - Binxin Cui
- Department of Gastroenterology, Tianjin Medical University General Hospital Airport Hospital, Tianjin, China
| | - Xin Chen
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Medical University General Hospital, Tianjin Institute of Digestive Disease, Tianjin, China
| | - Longhao Sun
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Bangmao Wang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Medical University General Hospital, Tianjin Institute of Digestive Disease, Tianjin, China
| | - Chao Sun
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Medical University General Hospital, Tianjin Institute of Digestive Disease, Tianjin, China.,Department of Gastroenterology, Tianjin Medical University General Hospital Airport Hospital, Tianjin, China
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5
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Huang J, Song P, Hang K, Chen Z, Zhu Z, Zhang Y, Xu J, Qin J, Wang B, Qu W, Huang Z, Liang C. Sleep Deprivation Disturbs Immune Surveillance and Promotes the Progression of Hepatocellular Carcinoma. Front Immunol 2021; 12:727959. [PMID: 34539666 PMCID: PMC8446513 DOI: 10.3389/fimmu.2021.727959] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 08/12/2021] [Indexed: 12/24/2022] Open
Abstract
Sleep disturbance is common in patients with cancer and is associated with poor prognosis. However, the effects of sleep deprivation (SD) on immune surveillance during the development of hepatocellular carcinoma (HC) and the underlying mechanisms are not known. This was investigated in the present study using mouse models of SD and tumorigenesis. We determined that acute and chronic sleep deprivation (CSD) altered the relative proportions of various immune cell types in blood and peripheral organs. CSD increased tumor volume and weight, an effect that was enhanced with increasing CSD time. Expression of the cell proliferation marker Ki-67 was elevated in tumor tissues, and tumor cell infiltration into adjacent muscles was enhanced by CSD. Multicolor flow cytometry analysis revealed that CSD significantly reduced the numbers of antitumor CD3+ T cells and natural killer (NK) cells and increased that of immunosuppressive CD11b+ cells infiltrating into the tumor microenvironment from the spleen via the peripheral blood. These results indicate that CSD impairs immune surveillance mechanisms and promotes immunosuppression in the tumor microenvironment to accelerate tumor growth, underscoring the importance of alleviating sleep disturbance in HC patients in order to prevent HC progression.
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MESH Headings
- Acute Disease
- Animals
- CD11b Antigen/metabolism
- CD3 Complex/metabolism
- Carcinoma, Hepatocellular/immunology
- Carcinoma, Hepatocellular/metabolism
- Carcinoma, Hepatocellular/pathology
- Cell Line, Tumor
- Cell Movement
- Cell Proliferation
- Chronic Disease
- Disease Models, Animal
- Disease Progression
- Killer Cells, Natural/immunology
- Killer Cells, Natural/metabolism
- Liver Neoplasms/immunology
- Liver Neoplasms/metabolism
- Liver Neoplasms/pathology
- Lymph Nodes/immunology
- Lymph Nodes/metabolism
- Lymphocytes, Tumor-Infiltrating/immunology
- Lymphocytes, Tumor-Infiltrating/metabolism
- Male
- Mice, Inbred C57BL
- Sleep Deprivation/immunology
- Spleen/immunology
- Spleen/metabolism
- T-Lymphocytes/immunology
- T-Lymphocytes/metabolism
- Time Factors
- Tumor Burden
- Tumor Escape
- Tumor Microenvironment/immunology
- Mice
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Affiliation(s)
- Jing Huang
- Laboratory of Tumor Immunology, Department of Anatomy, Histology, and Embryology, School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Peiwen Song
- Department of Neurobiology, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Kaibin Hang
- Department of Radiology, Naval Medical Center of People’s Liberation Army, Shanghai, China
| | - Zeka Chen
- Department of Pharmacology, School of Basic Medical Sciences, State Key Laboratory of Medical Neurobiology and Ministry of Education (MOE) Frontiers Center for Brain Science, and Institutes of Brain Science, Fudan University, Shanghai, China
| | - Zidan Zhu
- Laboratory of Tumor Immunology, Department of Anatomy, Histology, and Embryology, School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yuye Zhang
- Laboratory of Tumor Immunology, Department of Anatomy, Histology, and Embryology, School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jietian Xu
- Laboratory of Tumor Immunology, Department of Anatomy, Histology, and Embryology, School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jie Qin
- Laboratory of Tumor Immunology, Department of Anatomy, Histology, and Embryology, School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Binghua Wang
- Laboratory of Tumor Immunology, Department of Anatomy, Histology, and Embryology, School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Weimin Qu
- Department of Pharmacology, School of Basic Medical Sciences, State Key Laboratory of Medical Neurobiology and Ministry of Education (MOE) Frontiers Center for Brain Science, and Institutes of Brain Science, Fudan University, Shanghai, China
| | - Zhili Huang
- Department of Pharmacology, School of Basic Medical Sciences, State Key Laboratory of Medical Neurobiology and Ministry of Education (MOE) Frontiers Center for Brain Science, and Institutes of Brain Science, Fudan University, Shanghai, China
| | - Chunmin Liang
- Laboratory of Tumor Immunology, Department of Anatomy, Histology, and Embryology, School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
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6
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Zhao J, Liu M, Ungvari GS, Ng CH, Chow IHI, Wang T, Chen Y, Duan Z, Xiang YT, Zheng SJ. Prevalence and clinical correlates of insomnia symptoms and their association with quality of life in Chinese patients with HBV-related liver disease. PeerJ 2021; 9:e10956. [PMID: 33717693 PMCID: PMC7937339 DOI: 10.7717/peerj.10956] [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: 11/23/2020] [Accepted: 01/27/2021] [Indexed: 12/30/2022] Open
Abstract
Objective This study aimed to describe the one-month prevalence of insomnia symptoms (insomnia hereafter) and the demographic and clinical correlates, and its association with quality of life (QOL) in Chinese patients with HBV-related liver disease. Method A total of 689 patients with HBV-related liver disease in Beijing, China formed the study sample. Three forms of insomnia including difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS) and early morning awakening (EMA) were assessed using standardized questions. QOL was measured using the Medical Outcomes Study Short Form 12 (SF-12). Results The one-month prevalence of at least one type of insomnia was 69.5%, while DIS, DMS and EMA were 60.4%, 54.7% and 50.9%, respectively. Only 4.8% of patients suffering from insomnia received treatment. Multiple logistic regression analyses revealed that pre-existing medical conditions were positively associated with DIS and EMA; patients with more severe depressive symptoms were more likely to have DIS, DMS and EMA; local residents were less likely to have DIS; and those who were married and older were more likely to have DMS. Insomnia was not independently associated with QOL. Conclusions Insomnia is common in Chinese patients with HBV-related liver disease with a very low rate of treatment. Greater attention should be given to identify and treat insomnia in this patient population.
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Affiliation(s)
- Jing Zhao
- Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | - Mei Liu
- Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | - Gabor S Ungvari
- University of Notre Dame Australia, Fremantle, Australia.,Division of Psychiatry, School of Medicine, University of Western Australia / Graylands Hospital, Perth, Australia
| | - Chee H Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, Victoria, Australia
| | - Ines Hang Iao Chow
- Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China
| | - Ting Wang
- Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | - Yu Chen
- Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | - Zhongping Duan
- Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | - Yu-Tao Xiang
- Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China.,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China
| | - Su-Jun Zheng
- Beijing YouAn Hospital, Capital Medical University, Beijing, China
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7
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Shah NM, Malhotra AM, Kaltsakas G. Sleep disorder in patients with chronic liver disease: a narrative review. J Thorac Dis 2020; 12:S248-S260. [PMID: 33214928 PMCID: PMC7642630 DOI: 10.21037/jtd-cus-2020-012] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Sleep disturbance is a common feature of chronic liver disease (CLD) with impact on health-related quality of life; 60-80% of patients with CLD report subjective poor sleep; frequent presentations of sleep disturbance include insomnia, reduced sleep efficiency, increased sleep latency, reduced time in rapid eye movement (REM) sleep, restless leg syndrome and excessive daytime sleepiness (EDS). Key contributors to sleep disturbance include hepatic encephalopathy (HE) and circadian rhythm imbalance due to altered melatonin metabolism. Specific conditions causing CLD, such as non-alcoholic fatty liver disease (NAFLD), chronic viral hepatitis and primary biliary cholangitis (PBC) result in different types of sleep disturbance, and the treatment of these conditions can often also lead to sleep disturbance. There are currently limited management options for sleep disturbance in CLD. Obstructive sleep apnoea (OSA) is a common condition that causes chronic intermittent hypoxia due to airway collapse during sleep. This chronic intermittent hypoxia appears to contribute to the development of NAFLD. The presence of reactive oxygen species and the overexpression of hypoxia inducible factor 1-alpha secondary to hypoxia may be responsible for the second 'hit' of the 'two-hit' hypothesis of NAFLD. Treatment of the intermittent hypoxia with continuous positive airway pressure therapy has limited efficacy against liver dysfunction. There remain many outstanding areas of investigation in the management of sleep disturbance in CLD, and of liver dysfunction in OSA.
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Affiliation(s)
- Neeraj Mukesh Shah
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
| | - Akanksha Mimi Malhotra
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Georgios Kaltsakas
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
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Abstract
Circadian rhythms govern a large array of physiological and metabolic functions. Perturbations of the daily cycle have been linked to elevated risk of developing cancer as well as poor prognosis in patients with cancer. Also, expression of core clock genes or proteins is remarkably attenuated particularly in tumours of a higher stage or that are more aggressive, possibly linking the circadian clock to cellular differentiation. Emerging evidence indicates that metabolic control by the circadian clock underpins specific hallmarks of cancer metabolism. Indeed, to support cell proliferation and biomass production, the clock may direct metabolic processes of cancer cells in concert with non-clock transcription factors to control how nutrients and metabolites are utilized in a time-specific manner. We hypothesize that the metabolic switch between differentiation or stemness of cancer may be coupled to the molecular clockwork. Moreover, circadian rhythms of host organisms appear to dictate tumour growth and proliferation. This Review outlines recent discoveries of the interplay between circadian rhythms, proliferative metabolism and cancer, highlighting potential opportunities in the development of future therapeutic strategies.
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Affiliation(s)
- Kenichiro Kinouchi
- Center for Epigenetics and Metabolism, U1233 INSERM, Department of Biological Chemistry, University of California, Irvine, CA, USA.
- Department of Endocrinology, Metabolism, and Nephrology, School of Medicine, Keio University, Tokyo, Japan.
| | - Paolo Sassone-Corsi
- Center for Epigenetics and Metabolism, U1233 INSERM, Department of Biological Chemistry, University of California, Irvine, CA, USA.
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9
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Huang TW, Cheung DST, Xu X, Loh EW, Lai JH, Su WW, Wu SS, Lin CC. Relationship Between Diurnal Cortisol Profile and Sleep Quality in Patients With Hepatocellular Carcinoma. Biol Res Nurs 2019; 22:139-147. [DOI: 10.1177/1099800419881195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Purpose:Hepatocellular carcinoma (HCC) is the second leading cause of cancer mortality worldwide. Sleep problems are common in HCC patients and may be attributable to disturbances in the circadian rhythm. Research into the role of circadian rhythms in sleep quality among HCC patients is lacking, however. This study investigated the relationship between the diurnal cortisol profile and sleep quality among HCC patients. We aimed to identify alterations in the diurnal cortisol profile in patients with HCC compared to healthy controls and investigate whether they were associated with poor sleep quality among HCC patients.Methods:Participants comprised 75 HCC patients and 33 healthy individuals. The Taiwanese version of the Pittsburgh Sleep Quality Index (PSQI-T) was administered to assess sleep quality. Saliva samples were collected on 3 consecutive days at five time points daily to measure diurnal cortisol levels.Results:In the HCC group, 89.3% of individuals were poor sleepers (PSQI-T > 5), whereas among healthy individuals, 30.3% were poor sleepers. While the healthy participants’ diurnal cortisol profile followed a typical pattern that peaked 30 min after waking and declined gradually throughout the day, the cortisol level in the HCC patients rebounded at bedtime. Higher cortisol levels were marginally correlated with poor sleep quality ( OR = 1.00007, p < .05).Conclusions:Our study suggests a potential association between disturbed circadian rhythm and poor sleep quality in HCC patients. Further investigation of the causal relationship between sleep and circadian rhythm is warranted.
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Affiliation(s)
- Tsai-Wei Huang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
| | - Denise Shuk Ting Cheung
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Xinyi Xu
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - El-Wui Loh
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
- Center for Evidence-Based Health Care, Department of Medical Research, Taipei Medical University Shuang Ho Hospital, Zhonghe District, New Taipei City, Taiwan
- Shared Decision Making Resource Center, Department of Medical Research, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jun-Hung Lai
- Department of Internal Medicine, Erlin Christian Hospital, Changhua, Taiwan
| | - Wei-Wen Su
- Department of Gastroenterology, Changhua Christian Medical Center, Changhua, Taiwan
| | - Shun-Sheng Wu
- Department of Gastroenterology, Changhua Christian Medical Center, Changhua, Taiwan
| | - Chia-Chin Lin
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
- Alice Ho Miu Ling Nethersole Charity Foundation Professor in Nursing, Pok Fu Lam, Hong Kong
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10
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Jia Y, Zhang W, You S, Li M, Lei L, Chen L. A nomogram for predicting depression in patients with hepatocellular carcinoma: an observational cross-sectional study. Int J Psychiatry Clin Pract 2019; 23:273-280. [PMID: 31124729 DOI: 10.1080/13651501.2019.1619777] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Objectives: Depression is common in hepatocellular carcinoma patients. Predicting depression is critical for managing hepatocellular carcinoma patients. The aim of this study was to establish a comprehensive visual predictive nomogram for calculating a probabilistic estimate of depression in hepatocellular carcinoma patients.Methods: Two-hundred and sixty-nine patients diagnosed with hepatocellular carcinoma were included. The demographic and clinical information was collected from medical records. A nomogram was constructed based on the results of a multivariate regression analysis. Discrimination and calibration were used to assess its performance. A decision curve analysis was used to assess its clinical utility.Results: One hundred and thirty-four (49.82%) hepatocellular carcinoma patients with depression were identified. The education level, social support, pain intensity, disclosure of the cancer diagnosis to the patient and Child-Pugh class were included in the nomogram. The AUC was 0.828, indicating good discrimination. The nomogram demonstrated calibration curves with slight deviation from the ideal predictions and a high net benefit in the decision curve analysis.Conclusions: We proposed a nomogram for the individualised prediction of depression in hepatocellular carcinoma patients with satisfactory performance and clinical utility.Key points/highlightsA visual, comprehensive and convenient nomogram was established for the prediction of depression in patients with hepatocellular carcinoma.The proposed nomogram showed satisfactory validity, discrimination and clinical utility, indicating good performance for predicting depression.The variables found to be sufficiently informative and predictive to warrant inclusion in the nomogram were the patient education level, pain intensity, social support, disclosure of the hepatocellular carcinoma diagnosis to the patient and Child-Pugh class.
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Affiliation(s)
- Yong Jia
- School of Nursing, Jilin University, Changchun, China
| | - Wenlei Zhang
- Invasive Technology Department, The First Hospital Jilin University, Changchun, China
| | - Simiao You
- Department of Nursing Welfare, College of Health and Welfare, College of Humanities and Sciences of Northeast, Normal University, Changchun, China
| | - Min Li
- Invasive Technology Department, The First Hospital Jilin University, Changchun, China
| | - Lin Lei
- Pediatric Department, The Second Hospital Jilin University, Changchun, China
| | - Li Chen
- School of Nursing, Jilin University, Changchun, China.,Department of Pharmacology, College of Basic Medical Sciences, Jilin University, Changchun, China
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Lan QY, Liao GC, Zhou RF, Chen PY, Wang XY, Chen MS, Chen YM, Zhu HL. Dietary patterns and primary liver cancer in Chinese adults: a case-control study. Oncotarget 2018; 9:27872-27881. [PMID: 29963244 PMCID: PMC6021235 DOI: 10.18632/oncotarget.23910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 10/30/2017] [Indexed: 12/13/2022] Open
Abstract
Introduction Healthy dietary patterns may prevent many chronic diseases, and is emphasized by 2015 US dietary guideline, but it remains unclear which dietary patterns may be benefit to prevention of primary liver cancer (PLC). Materials and Methods We recruited 782 PLC cases and 1:1 age- and sex-matched controls in Guangzhou, China. Habitual dietary intake was assessed by face-to-face interview using a 79-item food frequency questionnaire, and used to explore dietary patterns by factor analysis. Results Three dietary patterns were identified: 1) an urban prudent dietary pattern (UPDP) characterized by high in dairy products, eggs, mushrooms, nuts and soy foods, but low in refined grains; 2) a traditional Cantonese dietary pattern (TCDP) consisting of a high intake of fruit and vegetables, fish, Cantonese soup, and Chinese herb tea; and 3) a high meat and preserved food pattern (MPFP). Multivariable analyses showed favorable associations for the first two dietary patterns, but unfavorable association for the last one (all p-trend < 0.01). Odds ratios (95% CI) of PLC for the highest (vs. lowest) quartile of pattern scores of the three patterns were 0.25 (0.18–0.35), 0.61 (0.46–0.82), and 1.98 (1.46–2.69), respectively. Conclusions Our findings suggest that the UPDP and TCDP were associated with lower, whereas the MPFP with higher, risk of PLC.
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Affiliation(s)
- Qiu-Ye Lan
- School of Public Health, Sun Yat-Sen University, Guangzhou 510080, People's Republic of China
| | - Gong-Cheng Liao
- School of Public Health, Sun Yat-Sen University, Guangzhou 510080, People's Republic of China
| | - Rui-Fen Zhou
- School of Public Health, Sun Yat-Sen University, Guangzhou 510080, People's Republic of China
| | - Pei-Yan Chen
- School of Public Health, Sun Yat-Sen University, Guangzhou 510080, People's Republic of China
| | - Xiao-Yan Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou 510080, People's Republic of China
| | - Min-Shan Chen
- Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, People's Republic of China
| | - Yu-Ming Chen
- School of Public Health, Sun Yat-Sen University, Guangzhou 510080, People's Republic of China
| | - Hui-Lian Zhu
- School of Public Health, Sun Yat-Sen University, Guangzhou 510080, People's Republic of China
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Royse KE, El-Serag HB, Chen L, White DL, Hale L, Sangi-Haghpeykar H, Jiao L. Sleep Duration and Risk of Liver Cancer in Postmenopausal Women: The Women's Health Initiative Study. J Womens Health (Larchmt) 2017; 26:1270-1277. [PMID: 28933583 PMCID: PMC6037184 DOI: 10.1089/jwh.2017.6412] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Sleep duration has been associated with nonalcoholic fatty liver disease, but its association with liver cancer remains unknown. MATERIAL AND METHODS In the prospective Women's Health Initiative Study, 139,368 postmenopausal women reported sleep habits at baseline (1993-1998). We ascertained 175 incident liver cancer cases during an average 13.8 years of follow-up through August 2014. We used multivariable Cox proportional hazard regression models to estimate a hazard ratio (HR) and its 95% confidence interval (95% CI) for risk of liver cancer in association with nocturnal sleep duration. RESULTS Compared to women reporting 6-8 hours of sleep, the HR for liver cancer was 1.94 (95% CI 1.07-3.53) for women reporting ≥9 hours of sleep. Among the obese women, the HR associated with ≥9 hours of sleep was 3.18 (95% CI 1.84-8.60). The HR was 0.93 (95% CI 0.34-2.53) among nonobese women (p value for interaction = 0.18). Short sleep duration (≤5 hours) was not associated with liver cancer risk. CONCLUSION Long sleep duration was associated with a moderate increase in liver cancer risk in obese postmenopausal women in the United States. Larger study is needed to confirm our observation on effect modification by adiposity status.
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Affiliation(s)
- Kathryn E. Royse
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas
- Center for Innovations in Quality, Effectiveness and Safety (iQuEST), Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Hashem B. El-Serag
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas
- Center for Innovations in Quality, Effectiveness and Safety (iQuEST), Michael E. DeBakey VA Medical Center, Houston, Texas
- Texas Medical Center Digestive Disease Center, Houston, Texas
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Liang Chen
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas
- Center for Innovations in Quality, Effectiveness and Safety (iQuEST), Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Donna L. White
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas
- Center for Innovations in Quality, Effectiveness and Safety (iQuEST), Michael E. DeBakey VA Medical Center, Houston, Texas
- Texas Medical Center Digestive Disease Center, Houston, Texas
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
- Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Lauren Hale
- Program in Public Health, School of Medicine, Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, New York
| | | | - Li Jiao
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas
- Center for Innovations in Quality, Effectiveness and Safety (iQuEST), Michael E. DeBakey VA Medical Center, Houston, Texas
- Texas Medical Center Digestive Disease Center, Houston, Texas
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
- Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, Texas
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Li M, Tse LA, Chan WC, Kwok CH, Leung SL, Wu C, Yu WC, Lee PMY, Tsang KH, Law SH, Vermeulen R, Gu F, Caporaso NE, Yu ITS, Wang F, Yang XR. Nighttime eating and breast cancer among Chinese women in Hong Kong. Breast Cancer Res 2017; 19:31. [PMID: 28302140 PMCID: PMC5356318 DOI: 10.1186/s13058-017-0821-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 03/01/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND A novel line of research suggests that eating at nighttime may have several metabolic consequences that are highly relevant to breast cancer. We investigated the association between nighttime eating habits after 10 p.m. and breast cancer in Hong Kong women. METHODS A hospital-based case-control study was conducted during 2012-2015. A total of 922 patients with incident breast cancer (cases) and 913 hospital controls were recruited and interviewed using a standard questionnaire including information on eating behavior during both daytime and nighttime. We collected the timing, duration, types and frequencies of food intake of eating at nighttime. Odds ratios (ORs) for the risk of breast cancer in relation to nighttime eating-related variables were calculated by unconditional multivariable logistic regression. RESULTS Eating at night after 10 pm was significantly associated with breast cancer with an adjusted OR of 1.50 (95% confidence interval (CI) 1.06-2.12, P = 0.02), and the associations were stronger in women who had the longest duration of nighttime eating (≥20 years) (adjusted OR = 2.28 (95% CI 1.13-4.61, P = 0.02) and who ate late (midnight to 2 a.m.) (adjusted OR = 2.73, 95% CI 1.01-6.99, P = 0.04). Interestingly, nighttime eating was only associated with breast cancer among women who consumed staple foods (OR = 2.16, 95% CI 1.42-3.29, P < 0.001) but not those who ate vegetables or fruits as nighttime meals. The significant association between nighttime eating and breast cancer was observed among women with body mass index (BMI) <25 (OR = 2.29, 95% CI 1.48-3.52, P < 0.001) but not among women with BMI ≥25. CONCLUSIONS Results from this study suggest a possible association between nighttime eating behavior and breast cancer. These findings need to be confirmed by independent large studies.
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Affiliation(s)
- Mengjie Li
- JC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Lap Ah Tse
- JC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Wing-Cheong Chan
- Department of Surgery, North District Hospital, Hong Kong SAR, China
| | - Chi-Hei Kwok
- Department of Oncology, Princess Margaret Hospital, Hong Kong SAR, China
| | - Siu-Lan Leung
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| | - Cherry Wu
- Department of Pathology, North District Hospital, Hong Kong SAR, China
| | - Wai-Cho Yu
- Department of Medicine, Princess Margaret Hospital, Hong Kong SAR, China
| | - Priscilla Ming-Yi Lee
- JC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Koon-Ho Tsang
- Department of Pathology, Yan Chai Hospital, Hong Kong SAR, China
| | - Sze-Hong Law
- Department of Surgery, Yan Chai Hospital, Hong Kong SAR, China
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | - Fangyi Gu
- Genetic Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Neil E Caporaso
- Genetic Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Ignatius Tak-Sun Yu
- JC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Feng Wang
- JC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xiaohong Rose Yang
- Genetic Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, USA
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Zeitzer JM, Nouriani B, Rissling MB, Sledge GW, Kaplan KA, Aasly L, Palesh O, Jo B, Neri E, Dhabhar FS, Spiegel D. Aberrant nocturnal cortisol and disease progression in women with breast cancer. Breast Cancer Res Treat 2016; 158:43-50. [PMID: 27314577 PMCID: PMC4938753 DOI: 10.1007/s10549-016-3864-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 06/09/2016] [Indexed: 02/07/2023]
Abstract
While a relationship between disruption of circadian rhythms and the progression of cancer has been hypothesized in field and epidemiologic studies, it has never been unequivocally demonstrated. We determined the circadian rhythm of cortisol and sleep in women with advanced breast cancer (ABC) under the conditions necessary to allow for the precise measurement of these variables. Women with ABC (n = 97) and age-matched controls (n = 24) took part in a 24-h intensive physiological monitoring study involving polysomnographic sleep measures and high-density plasma sampling. Sleep was scored using both standard clinical metrics and power spectral analysis. Three-harmonic regression analysis and functional data analysis were used to assess the 24-h and sleep-associated patterns of plasma cortisol, respectively. The circadian pattern of plasma cortisol as described by its timing, timing relative to sleep, or amplitude was indistinguishable between women with ABC and age-matched controls (p's > 0.11, t-tests). There was, however, an aberrant spike of cortisol during the sleep of a subset of women, during which there was an eightfold increase in the amount of objectively measured wake time (p < 0.004, Wilcoxon Signed-Rank). This cortisol aberration was associated with cancer progression such that the larger the aberration, the shorter the disease-free interval (time from initial diagnosis to metastasis; r = -0.30, p = 0.004; linear regression). The same aberrant spike was present in a similar percent of women without ABC and associated with concomitant sleep disruption. A greater understanding of this sleep-related cortisol abnormality, possibly a vulnerability trait, is likely important in our understanding of individual variation in the progression of cancer.
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Affiliation(s)
- Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA.
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, 3801 Miranda Avenue (151Y), Palo Alto, CA, 94304, USA.
| | - Bita Nouriani
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Michelle B Rissling
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, 3801 Miranda Avenue (151Y), Palo Alto, CA, 94304, USA
- Durham VA Medical Center, Durham, NC, 27705, USA
| | - George W Sledge
- Department of Medicine/Oncology, Stanford University, Stanford, CA, 94305, USA
| | - Katherine A Kaplan
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Linn Aasly
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
- Columbia University, New York, NY, 10027, USA
| | - Oxana Palesh
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Booil Jo
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Eric Neri
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Firdaus S Dhabhar
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
| | - David Spiegel
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
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Erren T, Morfeld P, Foster R, Reiter R, Groß J, Westermann I. Sleep and cancer: Synthesis of experimental data and meta-analyses of cancer incidence among some 1,500,000 study individuals in 13 countries. Chronobiol Int 2016; 33:325-50. [DOI: 10.3109/07420528.2016.1149486] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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16
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Fang HF, Miao NF, Chen CD, Sithole T, Chung MH. Risk of Cancer in Patients with Insomnia, Parasomnia, and Obstructive Sleep Apnea: A Nationwide Nested Case-Control Study. J Cancer 2015; 6:1140-7. [PMID: 26516362 PMCID: PMC4615350 DOI: 10.7150/jca.12490] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 07/30/2015] [Indexed: 01/13/2023] Open
Abstract
Purpose: Insomnia, parasomnia, and obstructive sleep apnea have been associated with a number of disease pathologies, but little is known about the relationship of these sleep disorders and cancer. The study explored the risk of sleep disorder (SD)-induced cancer using nationwide population data. Two million data from the National Health Insurance system of Taiwan was used to assess for the relationship. Patients and Methods: Patients with cancer as our cases and patients without cancer as our control group in 2001-20011. The study patients were traced back to seek the exposure risk factor of sleep disorders, which was divided into three categories: insomnia, obstructive sleep apnea (OSA) and parasomnia. Patients were selected excluding patients who had cancer prior to presenting with the sleep disorder and the person-year is less than 2 years. Each case was randomly matched with two cases with the same age, gender, and index year. Results: There were significantly increased risks of breast cancer in the patients with insomnia (AHR=1.73; 95% CI: 1.57-1.90), patients with parasomnia (AHR=2.76; 95% CI: 1.53-5.00), and patients with OSA (AHR=2.10; 95% CI: 1.16-3.80). Moreover, patients with parasomnia had significantly higher risk of developing oral cancer (AHR=2.71; 95% CI: 1.02-7.24) compared with patients without parasomnia. The risk of suffering from nasal cancer (AHR=5.96, 95% CI: 2.96-11.99) and prostate cancer (AHR=3.69, 95% CI: 1.98- 6.89) in patients with OSA was significantly higher than that of patients without OSA. Conclusions: Our findings provided the evidence that people diagnosed with insomnia, parasomnia and OSA are at a higher risk of developing cancers to remind people to improve sleep quality.
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Affiliation(s)
- Hui-Feng Fang
- 1. Deputy Director, Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Nae-Fang Miao
- 2. Assistant Professor, School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Chi-Dan Chen
- 3. Assistant, Graduate Institute of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Trevor Sithole
- 4. Nurse, Maternity Department, Emkhuzweni Health Center, Swaziland ; 5. Nurse, Customer Care Officer, Emkhuzweni Health Center, Swaziland
| | - Min-Huey Chung
- 6. Associate Professor, School of Nursing, Graduate Institute of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
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Yang YW, Hsieh TF, Yu CH, Huang YS, Lee CC, Tsai TH. Zolpidem and the risk of Parkinson's disease: a nationwide population-based study. J Psychiatr Res 2014; 58:84-8. [PMID: 25124550 DOI: 10.1016/j.jpsychires.2014.07.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 06/30/2014] [Accepted: 07/04/2014] [Indexed: 01/18/2023]
Abstract
BACKGROUND This nationwide population-based study investigated the risk of Parkinson's disease (PD) after zolpidem use in patients with sleep disturbance using the National Health Insurance Research Database (NHIRD) in Taiwan. MATERIAL AND METHODS In total, 59,548 adult patients newly diagnosed with sleep disturbance and who used zolpidem were recruited as the study cohort, along with 42,171 subjects who did not use zolpidem as a comparison cohort from 2002 to 2009. Each patient was monitored for 5 years, and those who subsequently had PD were identified. A Cox proportional hazards model was used to compare the risk of PD between the study and comparison cohorts after adjusting for possible confounding risk factors. RESULTS The patients who received zolpidem had a higher cumulative rate of PD than those who did not receive zolpidem during the 5-year follow-up period (1.2% vs. 0.5%, P < 0.001). The adjusted hazard ratios were 1.10 (95% CI, 0.88-1.37), 1.41 (95% CI, 1.17-1.72), and 1.27 (95% CI, 1.05-1.55) for zolpidem use with 28-90, 91-365, and more than 365 cumulative defined daily doses (cDDDs), respectively, compared to those who did not use zolpidem. CONCLUSIONS Among the patients with sleep disturbance, zolpidem use increased the risk of PD after 5 years of follow-up. Further mechanistic research of zolpidem effect in PD is needed.
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Affiliation(s)
- Yu-Wan Yang
- Department of Neurology, China Medical University Hospital and School of Medicine, China Medical University, Taichung, Taiwan
| | - Teng-Fu Hsieh
- Department of Urology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan; School of Medicine, Tzu Chi University, Hualian, Taiwan
| | - Chia-Hui Yu
- Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Ming-Sheng Road, Dalin Town, Chiayi 622, Taiwan, ROC
| | - Yung-Sung Huang
- Division of Neurology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Ming-Sheng Road, Dalin Town, Chiayi 622, Taiwan, ROC.
| | - Ching-Chih Lee
- School of Medicine, Tzu Chi University, Hualian, Taiwan; Department of Otolaryngology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Ming-Sheng Road, Dalin Town, Chiayi 622, Taiwan, ROC; Department of Education, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Ming-Sheng Road, Dalin Town, Chiayi 622, Taiwan, ROC.
| | - Tsung-Huang Tsai
- Department of Psychiatry, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Ming-Sheng Road, Dalin Town, Chiayi 622, Taiwan, ROC.
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Yen CM, Kuo CL, Lin MC, Lee CF, Lin KY, Lin CL, Chang SN, Sung FC, Kao CH. Sleep disorders increase the risk of osteoporosis: a nationwide population-based cohort study. Sleep Med 2014; 15:1339-44. [PMID: 25224072 DOI: 10.1016/j.sleep.2014.07.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 06/23/2014] [Accepted: 07/03/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND This study evaluated the relationship between sleep disorders (SDs) and osteoporosis risk in Taiwan. METHODS From the Taiwan National Health Insurance data, we identified 44,690 newly diagnosed SD patients (846 with apnea and 43,844 without) from 1998 to 2001 and 89,380 comparisons without SD in the same period frequency matched by sex, age and diagnosis year. Incident osteoporosis was measured by the end of 2010. RESULT Patients with apnea-SD and nonapnea SD exhibited a higher osteoporosis incidence rate than did the comparisons (9.97 and 13.3 vs. 6.77 per 1000 person-years, respectively). The Cox method estimated adjusted hazard ratio (HR) of osteoporosis was 2.98 (95% confidence interval [CI] = 2.36-3.74) in apnea-SD patients, compared with 2.76 (95% CI = 2.64-2.88) in nonapnea-SD patients after controlling for sex, age, comorbidities, and treatment. Greater HRs of osteoporosis were observed for female patients (4.00, 95% CI = 3.72-4.29) and those aged >64 years (42.0, 95% CI = 33.5-52.7) in the apnea SD sub-cohort. Apnea SD was associated with the highest risk of osteoporosis without fracture compared with both the nonapnea SD sub-cohort and comparisons. CONCLUSION Patients with sleep disorders have an elevated risk of osteoporosis, especially for women and the elderly.
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Affiliation(s)
- Chia-Ming Yen
- Department of Anesthesiology, Buddhist Tzu Chi General Hospital, Taichung Branch, Taichung, Taiwan
| | - Chi-Ling Kuo
- Department of Nuclear Medicine, New Taipei City Hospital, Sanchong Branch, Taipei, Taiwan
| | - Ming-Chia Lin
- Department of Nuclear Medicine, E-DA Hospital, Kaohsiung, Taiwan
| | - Chun-Feng Lee
- Department of Oral and Maxillofacial Surgery, Buddhist Tzu Chi General Hospital, Taichung Branch, Taichung, Taiwan
| | - Kuan-Yu Lin
- Department of Nursing, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Ni Chang
- Department of Medical Research, Taichung Veterans General Hospital, Taiwan
| | - Fung-Chang Sung
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.
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Chen JC, Hwang JH. Sleep apnea increased incidence of primary central nervous system cancers: a nationwide cohort study. Sleep Med 2014; 15:749-54. [PMID: 24891080 DOI: 10.1016/j.sleep.2013.11.782] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 11/02/2013] [Accepted: 11/06/2013] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) was associated with increased incidence of all cancers. We aimed to determine the risk for primary central nervous system (CNS) cancers in patients with sleep apnea syndrome. METHODS A total of 23,055 incident cases of newly diagnosed sleep apnea syndrome (sleep apnea group) were identified between 2000 and 2003 in the medical claims database of Taiwan's National Health Institute (NHI) program and were matched by age and gender to patients without OSA (comparison group) in the same period. The occurrence of primary malignant CNS cancers was measured 2 years after the index date over a 10-year period. RESULTS The incidence density of primary CNS cancers (per 10,000 individual-years) was 2.14 and 1.28, respectively, for the OSA and comparison groups. The overall risk for developing primary CNS cancers was significantly higher in the OSA group (adjusted hazard ratio [HR], 1.54; P=0.046) after adjusting for age, gender, and obesity, among other variables. Subgroup analysis revealed a significantly higher risk for primary brain cancers but not primary spinal cord cancers in the OSA subgroup (adjusted HR, 1.71; P=0.027). The analysis also revealed a significantly higher risk for primary CNS cancers in the insomnia with OSA subgroup (adjusted HR, 2.20; P=0.001) and in the OSA without surgical treatment subgroup (adjusted HR, 1.831; P=0.003). CONCLUSIONS OSA, especially with insomnia, may increase the risk for primary CNS cancer development, though surgical treatment may reduce this risk in participants with OSA.
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Affiliation(s)
- Jin-Cherng Chen
- Department of Neurosurgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Juen-Haur Hwang
- School of Medicine, Tzu Chi University, Hualien, Taiwan; Department of Otolaryngology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; Department of Sleep Center, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.
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Chao CT, Wang CY, Lai CF, Huang TM, Chen YY, Kao TW, Chu TS, Chang CH, Wu VC, Ko WJ, Chen L, Wu KD. Dialysis-requiring acute kidney injury increases risk of long-term malignancy: a population-based study. J Cancer Res Clin Oncol 2014; 140:613-21. [PMID: 24519490 DOI: 10.1007/s00432-014-1600-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 01/30/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is gaining worldwide attention recently, emerging as a major public health threat. However, the association between the development of AKI and subsequent malignancy has not been studied before. METHODS We conducted a population study based on the Taiwan National Health Insurance database, using 1,000,000 representative database during 2000-2008. All patients' survival to discharge from index hospitalization with recovery from dialysis-requiring AKI were identified (recovery group), and matched with those without recovery and those without AKI, at a 1:1:1 ratio. RESULTS We identified 625 individuals more than 18 years old [352 male (56.5%); mean age, 63.3 years] in recovery group and matched 625 individuals in each group. During a mean followed-up of 3.7 years, the incidences of new-onset malignancy were 4.2, 2.9, and 2.6 per 100 person-year among the non-recovery, the recovery, and the non-AKI group, respectively. After adjustment, the recovery group was more likely to develop long-term de novo malignancy than those without AKI [hazard ratio (HR) 1.44, 95% confidence interval (CI) 1.02-2.03; p = 0.04], while less likely than those who did not recover (HR 0.66, 95% CI 0.45-0.98; p = 0.04). CONCLUSIONS Dialysis-requiring AKI can post a long-term risk of de novo malignancy for those who survive from the initial insult. Even patients who have recovered from dialysis still carry a significantly higher possibility of developing malignancy than those without AKI episode.
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Affiliation(s)
- Chia-Ter Chao
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Zhong-Zheng District, Taipei, 100, Taiwan
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Hakim F, Wang Y, Zhang SXL, Zheng J, Yolcu ES, Carreras A, Khalyfa A, Shirwan H, Almendros I, Gozal D. Fragmented sleep accelerates tumor growth and progression through recruitment of tumor-associated macrophages and TLR4 signaling. Cancer Res 2014; 74:1329-37. [PMID: 24448240 DOI: 10.1158/0008-5472.can-13-3014] [Citation(s) in RCA: 128] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Sleep fragmentation (SF) is a highly prevalent condition and a hallmark of sleep apnea, a condition that has been associated with increased cancer incidence and mortality. In this study, we examined the hypothesis that sleep fragmentation promotes tumor growth and progression through proinflammatory TLR4 signaling. In the design, we compared mice that were exposed to sleep fragmentation one week before engraftment of syngeneic TC1 or LL3 tumor cells and tumor analysis four weeks later. We also compared host contributions through the use of mice genetically deficient in TLR4 or its effector molecules MYD88 or TRIF. We found that sleep fragmentation enhanced tumor size and weight compared with control mice. Increased invasiveness was apparent in sleep fragmentation tumors, which penetrated the tumor capsule into surrounding tissues, including adjacent muscle. Tumor-associated macrophages (TAM) were more numerous in sleep fragmentation tumors, where they were distributed in a relatively closer proximity to the tumor capsule compared with control mice. Although tumors were generally smaller in both MYD88(-/-) and TRIF(-/-) hosts, the more aggressive features produced by sleep fragmentation persisted. In contrast, these more aggressive features produced by sleep fragmentation were abolished completely in TLR4(-/-) mice. Our findings offer mechanistic insights into how sleep perturbations can accelerate tumor growth and invasiveness through TAM recruitment and TLR4 signaling pathways.
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Affiliation(s)
- Fahed Hakim
- Authors' Affiliations: Pediatric Sleep Medicine, Department of Pediatrics, Comer Children's Hospital, The University of Chicago, Chicago, Illinois; and Department of Microbiology and Immunology, The University of Louisville, Louisville, Kentucky
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22
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Hu LY, Chen PM, Hu YW, Shen CC, Perng CL, Su TP, Yen SH, Tzeng CH, Chiou TJ, Yeh CM, Chen TJ, Wang WS, Liu CJ. The risk of cancer among patients with sleep disturbance: a nationwide retrospective study in Taiwan. Ann Epidemiol 2013; 23:757-61. [DOI: 10.1016/j.annepidem.2013.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sun LM, Lin CL, Chang YJ, Liang JA, Liu SH, Sung FC, Kao CH. Urinary tract stone raises subsequent risk for urinary tract cancer: a population-based cohort study. BJU Int 2013; 112:1150-5. [PMID: 24053541 DOI: 10.1111/bju.12402] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Li-Min Sun
- Department of Radiation Oncology; Zuoying Branch of Kaohsiung Armed Forces General Hospital; Kaohsiung Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data; China Medical University Hospital; Taichung Taiwan
- Institute of Public Health; College of Public Health; China Medical University; Taichung Taiwan
| | - Yen-Jung Chang
- Management Office for Health Data; China Medical University Hospital; Taichung Taiwan
- Institute of Public Health; College of Public Health; China Medical University; Taichung Taiwan
| | - Ji-An Liang
- Department of Radiation Oncology; China Medical University Hospital; Taichung Taiwan
- Graduate Institute of Clinical Medical Science and School of Medicine; College of Medicine; Taichung Taiwan
| | - Shu-Hui Liu
- Institute of Public Health; College of Public Health; China Medical University; Taichung Taiwan
- Department of Health Care and Social Work; Yu Da University; Miaoli Taiwan
| | - Fung-Chang Sung
- Institute of Public Health; College of Public Health; China Medical University; Taichung Taiwan
| | - Chia-Hung Kao
- Department of Nuclear Medicine and PET Center; China Medical University Hospital; Taichung Taiwan
- Graduate Institute of Clinical Medical Science and School of Medicine; College of Medicine; Taichung Taiwan
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Sun LM, Lin MC, Liang JA, Chang YJ, Chang SN, Sung FC, Muo CH, Kao CH. Does use of tetracyclic antidepressant-mirtazapine reduce cancer risk in depression patients? Pharmacoepidemiol Drug Saf 2013; 22:1292-7. [PMID: 24115340 DOI: 10.1002/pds.3523] [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: 09/19/2012] [Revised: 07/09/2013] [Accepted: 08/25/2013] [Indexed: 11/12/2022]
Abstract
PURPOSE We conducted a nested case-control study to evaluate the association between risk of cancer and mirtazapine use in depression patients in Taiwan. METHODS We obtained data from the Taiwan National Health Insurance Research Database to conduct a population-based nested case-control study. The study cohort included 16 897 patients diagnosed with depression between January 1, 2000 and December 31, 2008. We identified 530 cancer patients as the study group and matched 4 non-cancer subjects with each cancer patient by incident density, age, and sex. Odds ratios and 95% confidence intervals were estimated using multivariate conditional logistic regression analysis. RESULTS Use of mirtazapine for depression did not have significant effect on overall cancer incidence (odds ratio: 1.03, 95% confidence interval: 0.72-1.48). Further analysis of annual mirtazapine dosages and the duration of mirtazapine use revealed no significant effect on cancer risk. CONCLUSION The findings of this population-based nested case-control study suggest that mirtazapine use may not provide a tumor suppression effect in humans such as that seen in the animal model. Future large-scale and in-depth investigations in this area are warranted.
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Affiliation(s)
- Li-Min Sun
- Department of Radiation Oncology, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
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Quantitative exposure metrics for sleep disturbance and their association with breast cancer risk. Cancer Causes Control 2013; 24:919-28. [PMID: 23404350 DOI: 10.1007/s10552-013-0168-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 02/04/2013] [Indexed: 01/30/2023]
Abstract
PURPOSE It has been acknowledged by those in the field of sleep epidemiology that the current measures of sleep used in many epidemiological studies do not adequately capture the complexity and variability of sleep. A number of ways to improve the measurement of sleep have been proposed. This study aimed to assess the relationship between novel 'sleep disturbance' metrics, as expanded measures of sleep, and breast cancer risk. METHODS Data for this study were derived from a population-based case-control study conducted in Western Australia between 2009 and 2011. Participants completed a self-administered questionnaire that included questions about demographic, reproductive, and lifestyle factors in addition to questions on sleep. Four metrics of exposure to sleep disturbance (cumulative, average, duration, and peak) were developed. Unconditional logistic regression was used to examine the association between metrics of sleep disturbance and breast cancer risk. RESULTS There was no evidence to support an association between any of the sleep disturbance metrics and breast cancer risk. Compared with the reference group of unexposed women, the fully adjusted ORs for cumulative sleep disturbance (harm) metric were as follows: 1st tertile 0.90 (95 % CI: 0.72-1.13); OR for the 2nd tertile 1.04 (95 % CI: 0.84-1.29); and OR for the 3rd tertile 1.02 (95 % CI: 0.82-1.27). CONCLUSIONS This study found no association between several metrics of sleep disturbance and risk of breast cancer. Our experience with developing metrics of sleep disturbance may be of use to others in sleep epidemiology wishing to expand their scope of sleep measurement.
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Geller AS. Benzodiazepine oncogenesis as mediated via diminished restorative sleep effected sympathoadrenal activation. Mayo Clin Proc 2012; 87:1034-5; author reply 1035. [PMID: 23036681 PMCID: PMC3498087 DOI: 10.1016/j.mayocp.2012.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Revised: 07/19/2012] [Accepted: 08/02/2012] [Indexed: 11/16/2022]
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