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Wang Y, Liu X, Zhang J, Zhou B, Yue W, Hu K. Long sleep duration is associated with abdominal aortic calcification among male adults with chronic kidney disease: NHANES 2013-2014. Sci Rep 2024; 14:22076. [PMID: 39333665 PMCID: PMC11436971 DOI: 10.1038/s41598-024-72879-x] [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: 03/31/2024] [Accepted: 09/11/2024] [Indexed: 09/29/2024] Open
Abstract
There are no studies exploring the correlation between sleep duration and abdominal aortic calcification (AAC). This study aims to investigate this relationship and its significance. Additionally, given the higher prevalence of sleep disorders and AAC in patients with chronic kidney disease (CKD), we conducted further studies in this population. We analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2013-2014. Sleep duration was assessed by a sleep questionnaire and categorized into 2-5, 6-8, and ≥ 9 h. The AAC-24 score is determined using the Kauppila scoring system and used for AAC assessment. Multivariable linear and logistic regression analysis were used to explore the relationship between sleep duration and AAC. Among the 2,996 participants, 14.29% reported nightly short sleep (2-5 h), 77.64% reported intermediate sleep (6-8 h), and 8.08% reported long sleep (≥ 9 h). After adjusting for potential confounding factors, among male participants with CKD, long sleep (≥ 9 h) significantly increased AAC-24 scores compared with intermediate sleep (6-8 h) (β: 2.12; 95% CI: 0.75, 3.50), and the risk of severe AAC (SAAC) was increased by 1.55 times (OR: 2.55; 95% CI: 1.02, 6.36). And among female CKD and non-CKD participants, sleep duration was not associated with AAC. Long sleep duration increases the risk of AAC among male adults with CKD. Prospective studies are needed to confirm this finding.
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Affiliation(s)
- Yuhan Wang
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Xu Liu
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Jingyi Zhang
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Beini Zhou
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Wuriliga Yue
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Ke Hu
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
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Maki PM, Panay N, Simon JA. Sleep disturbance associated with the menopause. Menopause 2024; 31:724-733. [PMID: 38916279 DOI: 10.1097/gme.0000000000002386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
IMPORTANCE AND OBJECTIVES Sleep disturbance is one of the most common and debilitating symptoms experienced by women during the menopause transition. However, there are currently no therapies specifically approved for sleep disturbance associated with the menopause. Here, we consider how to characterize sleep disturbance associated with the menopause and discuss its etiology, including the latest advances in our understanding of the neuronal circuits that regulate reproduction, body temperature, sleep, and mood; and reflect on its impact on women's health and well-being. We also examine the current treatment landscape and look to the future of treatment for this condition. METHODS We conducted a review of the literature and combined this with discussion with experts in the fields of sleep and menopause as well as experiences from our own clinical practices. DISCUSSION AND CONCLUSIONS Sleep disturbance associated with the menopause is characterized by frequent night-time awakenings and increased awake time after sleep onset. Its impacts are wide-ranging, negatively affecting health as well as personal and social relationships, productivity, and work performance. There is currently an unmet need for effective, safe, and well-tolerated treatments to address this important symptom, and wider recognition of the association between sleep disturbances and the menopause is needed. Sleep disturbances associated with the menopause can result from hormone changes as well as vasomotor and mood symptoms. Growing research has contributed to our knowledge of the role of hypothalamic estrogen-sensitive kisspeptin/neurokinin B/dynorphin neurons. These neurons are thought to integrate the gonadotropin-releasing hormone pathway and the pathways responsible for the homeostatic control of body temperature and the circadian regulation of sleep-wake cycles. Understanding these neurons offers the potential to create treatments that target a key cause of sleep disturbance associated with the menopause. Further research to understand their etiology and characterize the neuronal circuits responsible could benefit the development of these targeted treatment approaches.
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Affiliation(s)
| | - Nick Panay
- Queen Charlotte's & Chelsea Hospital, Imperial College London, United Kingdom
| | - James A Simon
- George Washington University, IntimMedicine Specialists, Washington, DC
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Abstract
The menopausal transition period spans, on average, 2-8 years before the final menstrual period and is associated with an increase in clinical and subclinical cardiovascular risk. In this Review, we discuss the metabolic and cardiovascular changes that occur during the menopausal transition period and the role of ovarian ageing, chronological ageing and other ageing-related risk factors in mediating these changes. Disentangling the relative contributions of chronological and reproductive ageing to cardiovascular risk is challenging, but data from longitudinal studies in women transitioning from premenopause to post-menopause have provided valuable insights. We also discuss evidence on how cardiovascular risk is altered by premature or early menopause, surgical menopause, and vasomotor and other menopausal symptoms. Whether targeted interventions can slow the progression of atherosclerosis and subclinical disease during the menopausal transition, thus delaying or preventing the onset of cardiovascular events, remains to be determined. Furthermore, we consider the recommended strategies for cardiovascular risk reduction in women undergoing menopausal transition using the framework of the American Heart Association's Life's Essential 8 key measures for improving and maintaining cardiovascular health, and discuss the cardiovascular risks and benefits of menopausal hormone therapy. Finally, we also discuss novel therapies that might benefit this population in reducing cardiovascular risk.
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Affiliation(s)
- Jaya M Mehta
- Allegheny General Hospital Internal Medicine, Primary Care Institute, Allegheny Health Network, Pittsburgh, PA, USA.
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Vanden Noven ML, Larson M, Lee E, Reilly C, Tracy MF, Keller-Ross ML. Perceptions, Benefits, and Use of Complementary and Integrative Therapies to Treat Menopausal Symptoms: A Pilot Study. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:136-147. [PMID: 37008184 PMCID: PMC10061331 DOI: 10.1089/whr.2022.0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/03/2023] [Indexed: 03/29/2023]
Abstract
Background Menopause symptoms can be debilitating, and the use of menopausal hormone therapy (MHT) has declined significantly since the Women's Health Initiative. Materials and Methods We surveyed 508 peri- and postmenopausal females to determine (1) the use of complementary and integrative therapies (CIT), MHT; and pharmacotherapies; (2) the perceptions, perceived benefits/risks of CIT, MHT; and pharmacotherapy use; and (3) factors associated with CIT and MHT use for menopause symptom treatment. Results The majority of respondents used CIT to treat menopause symptoms based on physician recommendation and research studies. Treatments that were perceived as most beneficial included exercise, mind-body therapies, diet, and spiritual practices, with exercise and mind-body therapies chosen to treat the most common symptoms of sleep disturbances, depressive mood, and anxiety. Higher education level was the main predictive variable for choosing exercise (odds ratio [OR] = 1.27, p = 0.02) and mind-body therapies (OR = 1.57, p = 0.02) to treat menopausal symptoms. Perceptions, beliefs, and use of different CIT by primarily white, affluent, and educated peri- and postmenopausal females to treat menopause symptoms, including sleep disturbances, depression, and anxiety, are driven by conversations with physicians and evidence-based research. Conclusion These findings reinforce the necessity for both additional research in more diverse populations, as well as comprehensive, individualized personalized care from an interdisciplinary team that considers the best options available for all female patients.
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Affiliation(s)
- Marnie L. Vanden Noven
- Department of Exercise Science, College of Health Sciences and Nursing, Belmont University, Nashville, Tennessee, USA
| | - Mia Larson
- Medical Specialists of Kentuckiana, Owensboro, Kentucky, USA
| | - Emma Lee
- Division of Physical Therapy, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
| | - Cavan Reilly
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mary Fran Tracy
- Adult and Gerontological Health Cooperative, School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
| | - Manda L. Keller-Ross
- Division of Physical Therapy, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
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Association of hormone therapy and changes of objective sleep quality in women of late menopausal transition with sleep disorder: a preliminary study. Menopause 2022; 29:1296-1307. [PMID: 36219812 DOI: 10.1097/gme.0000000000002055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to investigate changes in objective sleep quality with hormone therapy (HT) in women with late menopausal transition. METHODS Healthy midlife women with sleep difficulty who received HT were included. Those undergoing late menopausal transition were screened. Sleep patterns and self-reported questionnaires were collected before and 10 weeks after starting HT. RESULTS Ten women who met the criteria (age, 50.1 ± 2.8 years) showed higher sleep efficiency and shorter wakefulness after sleep onset (WASO) 10 weeks after starting HT. However, no significant change was found in objective sleep quality after adjustment for multiple comparisons: sleep efficiency, 84.2 ± 7.7 versus 88.2% ± 4.7%, P = 0.037, adjusted P = 0.259; WASO, 59.0 ± 27.2 minutes versus 41.4 ± 17.4 minutes, P = 0.020, adjusted P = 0.140; average duration per awakening, 2.9 ± 1.0 minutes versus 2.2 ± 0.5 minutes, P = 0.033, adjusted P = 0.231. A better score of subjective sleep quality in the Pittsburgh Sleep Quality Index was observed 10 weeks after starting HT (2.0 ± 0.0 vs 1.2 ± 0.4, P = 0.006, adjusted P = 0.042), but sensitivity analysis did not show consistent results after adjustment for multiple comparisons (2.0 ± 0.0 vs 1.1 ± 0.4, P = 0.020, adjusted P = 0.140). Total scores of the Insomnia Severity Index and Menopause Rating Scale were better 10 weeks after starting HT (Insomnia Severity Index, 14.7 ± 3.0 vs 9.1 ± 3.8, P = 0.010; Menopause Rating Scale, 29.0 ± 5.2 vs 21.6 ± 3.0, P = 0.009) with consistent results in sensitivity analyses. There was no difference in the Epworth Sleepiness Scale before and after HT (7.2 ± 1.7 vs 8.6 ± 4.5, P = 0.309). The change in each objective sleep quality variable before and after HT showed strong positive or negative correlations with the change in only a few items in subjective sleep quality. CONCLUSION Women in the late menopausal transition period showed higher sleep efficiency and shorter WASO after HT; however, multiple comparisons showed no statistically significant difference in objective sleep quality between before and after HT.
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Genazzani AR, Monteleone P, Giannini A, Simoncini T. Hormone therapy in the postmenopausal years: considering benefits and risks in clinical practice. Hum Reprod Update 2021; 27:1115-1150. [PMID: 34432008 DOI: 10.1093/humupd/dmab026] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 05/03/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Menopausal symptoms can be very distressing and considerably affect a woman's personal and social life. It is becoming more and more evident that leaving bothersome symptoms untreated in midlife may lead to altered quality of life, reduced work productivity and, possibly, overall impaired health. Hormone therapy (HT) for the relief of menopausal symptoms has been the object of much controversy over the past two decades. At the beginning of the century, a shadow was cast on the use of HT owing to the concern for cardiovascular and cerebrovascular risks, and breast cancer, arising following publication of a large randomized placebo-controlled trial. Findings of a subanalysis of the trial data and extended follow-up studies, along with other more modern clinical trials and observational studies, have provided new evidence on the effects of HT. OBJECTIVE AND RATIONALE The goal of the following paper is to appraise the most significant clinical literature on the effects of hormones in postmenopausal women, and to report the benefits and risks of HT for the relief of menopausal symptoms. SEARCH METHODS A Pubmed search of clinical trials was performed using the following terms: estrogens, progestogens, bazedoxifene, tibolone, selective estrogen receptor modulators, tissue-selective estrogen complex, androgens, and menopause. OUTCOMES HT is an effective treatment for bothersome menopausal vasomotor symptoms, genitourinary syndrome, and prevention of osteoporotic fractures. Women should be made aware that there is a small increased risk of stroke that tends to persist over the years as well as breast cancer risk with long-term estrogen-progestin use. However, healthy women who begin HT soon after menopause will probably earn more benefit than harm from the treatment. HT can improve bothersome symptoms, all the while conferring offset benefits such as cardiovascular risk reduction, an increase in bone mineral density and a reduction in bone fracture risk. Moreover, a decrease in colorectal cancer risk is obtainable in women treated with estrogen-progestin therapy, and an overall but nonsignificant reduction in mortality has been observed in women treated with conjugated equine estrogens alone or combined with estrogen-progestin therapy. Where possible, transdermal routes of HT administration should be preferred as they have the least impact on coagulation. With combined treatment, natural progesterone should be favored as it is devoid of the antiapoptotic properties of other progestogens on breast cells. When beginning HT, low doses should be used and increased gradually until effective control of symptoms is achieved. Unless contraindications develop, patients may choose to continue HT as long as the benefits outweigh the risks. Regular reassessment of the woman's health status is mandatory. Women with premature menopause who begin HT before 50 years of age seem to have the most significant advantage in terms of longevity. WIDER IMPLICATIONS In women with bothersome menopausal symptoms, HT should be considered one of the mainstays of treatment. Clinical practitioners should tailor HT based on patient history, physical characteristics, and current health status so that benefits outweigh the risks.
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Affiliation(s)
- Andrea R Genazzani
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Andrea Giannini
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Tommaso Simoncini
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Hammad SK, Eissa RG, Shaheen MA, Younis NN. Resveratrol Ameliorates Aortic Calcification in Ovariectomized Rats via SIRT1 Signaling. Curr Issues Mol Biol 2021; 43:1057-1071. [PMID: 34563044 PMCID: PMC8928980 DOI: 10.3390/cimb43020075] [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] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 12/26/2022] Open
Abstract
Postmenopausal women are at an increased risk of vascular calcification which is defined as the pathological deposition of minerals in the vasculature, and is strongly linked with increased cardiovascular disease risk. Since estrogen-replacement therapy is associated with increased cancer risk, there is a strong need for safer therapeutic approaches. In this study we aimed to investigate the protective and therapeutic effects of the phytoestrogen resveratrol against vascular calcification in ovariectomized rats, a preclinical model of postmenopause. Furthermore, we aimed to compare the effects of resveratrol to those of estrogen and to explore the mechanisms underpinning those effects. Treatment with resveratrol or estrogen ameliorated aortic calcification in ovariectomized rats, as shown by reduced calcium deposition in the arterial wall. Mechanistically, the effects of resveratrol and estrogen were mediated via the activation of SIRT1 signaling. SIRT1 protein expression was downregulated in the aortas of ovariectomized rats, and upregulated in rats treated with resveratrol or estrogen. Moreover, resveratrol and estrogen reduced the levels of the osteogenic markers: runt-related transcription factor 2 (RUNX2), osteocalcin and alkaline phosphatase (ALP) which have been shown to play a role during vascular calcification. Additionally, the senescence markers (p53, p16 and p21) which were also reported to play a role in the pathogenesis of vascular calcification, were reduced upon treatment with resveratrol and estrogen. In conclusion, the phytoestrogen resveratrol may be a safer alternative to estrogen, as a therapeutic approach against the progression of vascular calcification during postmenopause.
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Affiliation(s)
- Sally K. Hammad
- Department of Biochemistry, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Egypt; (R.G.E.); (N.N.Y.)
| | - Rana G. Eissa
- Department of Biochemistry, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Egypt; (R.G.E.); (N.N.Y.)
| | - Mohamed A. Shaheen
- Department of Histology and Cell Biology, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt;
| | - Nahla N. Younis
- Department of Biochemistry, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Egypt; (R.G.E.); (N.N.Y.)
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8
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Christian LM, Webber S, Gillespie S, Strahm AM, Schaffir J, Gokun Y, Porter K. Maternal Depressive Symptoms, Sleep, and Odds of Spontaneous Early Birth: Implications for Racial Inequities in Birth Outcomes. Sleep 2021; 44:6279824. [PMID: 34019675 DOI: 10.1093/sleep/zsab133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/03/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Delivery prior to full term affects 37% of US births, including ~400,000 preterm births (<37 weeks) and >1,000,000 early term births (37-38 weeks). Approximately 70% of cases of shortened gestation are spontaneous - without medically-indicated cause. Elucidation of modifiable behavioral factors would have considerable clinical impact. METHODS This study examined the role of depressive symptoms and sleep quality in predicting the odds of spontaneous shortened gestation among 317 women (135 Black, 182 White) who completed psychosocial assessment in mid-pregnancy. RESULTS Adjusting for key covariates, Black women had 1.89 times higher odds of spontaneous shortened gestation compared to White women (OR (95% CI) = 1.89 (1.01, 3.53), p=0.046). Women who reported only poor subjective sleep quality (PSQI > 6) or only elevated depressive symptoms (CES-D ≥ 16) exhibited no statistically significant differences in odds of spontaneous shortened gestation compared to those with neither risk factor. However, women with comorbid poor sleep and depressive symptoms exhibited markedly higher odds of spontaneous shortened gestation than those with neither risk factor [39.2% versus 15.7%, [OR (95% CI) = 2.69 (1.27, 5.70), p = 0.01]. A higher proportion of Black women met criteria for both risk factors (23% of Black women versus 11% of White women; p=0.004), with a lower proportion experiencing neither risk factor (40.7% of Black versus 64.3% of White women; p < 0.001). CONCLUSIONS Additive effects of poor subjective sleep quality and depressive symptoms were observed with markedly higher odds of spontaneous shortened gestation among women with both risk factors. Racial inequities in rates of comorbid exposure corresponded with inequities in shortened gestation. Future empirical studies and intervention efforts should consider the interactive effects of these commonly co-morbid exposures.
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Affiliation(s)
- Lisa M Christian
- Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,The Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,The Department of Psychology, The Ohio State University, Columbus, OH, USA.,Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Shannon Webber
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | | | - Anna M Strahm
- Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,The Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jonathan Schaffir
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Yevgeniya Gokun
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, USA
| | - Kyle Porter
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, USA
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9
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Arslan NG, Pancar GS. Nailfold capillaroscopic changes of sleep apnea patients. Microvasc Res 2021; 137:104177. [PMID: 33984340 DOI: 10.1016/j.mvr.2021.104177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/01/2021] [Accepted: 05/06/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Obstructive Sleep Apnea Syndrome (OSAS) have frequent association with comorbidities and this makes it an independent risk factor for cardiovascular disease. Not only endothelial dysfunction, but also arterial stiffening, increased inflammatory mediators, oxidative stress after hypoxemia that develops due to OSAS, cause vascular pathologies in all diameters of vessels. Nail bed capillaroscopy is a simple, noninvasive, useful method to examine microcirculation and evaluate nail bed capillary abnormalities in diseases that cause vascular damage. The aim of this study is to examine microvascular changes in the nail bed of OSAS patients by capillaroscopy. METHODS 59 OSAS patients and 60 healthy cases (totally 119) were included. One single attended polysomnography was applied with Embla N7000 series (RemLogic Eastmed, Natus); and apnea-hypopnea index (AHI), oxygen de-saturation index >4% (ODI4%), minimum oxygen saturation (SaO2 Min.), total duration of oxygen desaturation, comorbidities, body mass index (BMI), smoking habit, sleep questionnaire applications were analyzed. Nailfold capillaroscopy was performed using a digital dermoscope (Molemax II, X30) and all images were evaluated for capillary density, capillary loop enlargement, capillary tortuosity, branching vessels, micro hemorrhages, avascular areas and splinter hemorrhages. RESULTS The prevalence rates of all capillaroscopy findings were significantly higher in the patient group (p < 0.05). There was an inverse and moderate relationship between AHI and mean saturation (p < 0.05). A statistically significant correlation was detected between the presence of hypertension (HT) and the severity of capillary tortuosity (CT) (p = 0.002), avascular area (AA) (p = 0.004), and periungual cyanosis (PUC) (p = 0.042); also between smoking habit and intensity of capillary dilatation, enlargement dilatation-enlarged giant capillaries (CELON) (p = 0.004), CT (p = 0.018) findings. Capillary distribution (CD), CELON, CT and AA findings were significantly higher in the group with low mean saturation (p < 0.05). DM was found to be significantly higher in individuals with high Epworth Sleep Scale (ESS) (p = 0.035). CONCLUSION In this study; 1) the nail bed capillaroscopy was used to examine vascular damage in OSAS, and 2) irregularities detected in the distal nail bed specific to a disease have been mentioned for the first time. It has been shown that endothelial damage is particularly related to the severity of hypoxia. HT and smoking history causes endothelial damage independent of the severity of the disease and hypoxia. Also, ESS may be more determinant in the screening of sleep disorders in diabetic patients.
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Affiliation(s)
- Nevra Gullu Arslan
- Samsun Educational and Research Hospital, Department of Pulmonology, TR-55000 Samsun, Turkey.
| | - Gunseli Sefika Pancar
- Samsun Education and Research Hospital, Department of Dermatology, TR-55000 İlkadim, Samsun, Turkey
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El Khoudary SR, Aggarwal B, Beckie TM, Hodis HN, Johnson AE, Langer RD, Limacher MC, Manson JE, Stefanick ML, Allison MA. Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association. Circulation 2020; 142:e506-e532. [PMID: 33251828 DOI: 10.1161/cir.0000000000000912] [Citation(s) in RCA: 377] [Impact Index Per Article: 94.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of death in women, who have a notable increase in the risk for this disease after menopause and typically develop coronary heart disease several years later than men. This observation led to the hypothesis that the menopause transition (MT) contributes to the increase in coronary heart disease risk. Over the past 20 years, longitudinal studies of women traversing menopause have contributed significantly to our understanding of the relationship between the MT and CVD risk. By following women over this period, researchers have been able to disentangle chronological and ovarian aging with respect to CVD risk. These studies have documented distinct patterns of sex hormone changes, as well as adverse alterations in body composition, lipids and lipoproteins, and measures of vascular health over the MT, which can increase a woman's risk of developing CVD postmenopausally. The reported findings underline the significance of the MT as a time of accelerating CVD risk, thereby emphasizing the importance of monitoring women's health during midlife, a critical window for implementing early intervention strategies to reduce CVD risk. Notably, the 2011 American Heart Association guidelines for CVD prevention in women (the latest sex-specific guidelines to date) did not include information now available about the contribution of the MT to increased CVD in women. Therefore, there is a crucial need to discuss the contemporary literature on menopause and CVD risk with the intent of increasing awareness of the significant adverse cardiometabolic health-related changes accompanying midlife and the MT. This scientific statement provides an up-to-date synthesis of the existing data on the MT and how it relates to CVD.
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11
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Insomnia symptoms in relation to menopause among middle-aged Chinese women: Findings from a longitudinal cohort study. Maturitas 2020; 141:1-8. [DOI: 10.1016/j.maturitas.2020.06.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/05/2020] [Accepted: 06/12/2020] [Indexed: 01/31/2023]
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12
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Hernandez R, Vu THT, Kershaw KN, Boehm JK, Kubzansky LD, Carnethon M, Trudel-Fitzgerald C, Knutson KL, Colangelo LA, Liu K. The Association of Optimism with Sleep Duration and Quality: Findings from the Coronary Artery Risk and Development in Young Adults (CARDIA) Study. Behav Med 2020; 46:100-111. [PMID: 31339814 PMCID: PMC7282476 DOI: 10.1080/08964289.2019.1575179] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 10/02/2018] [Accepted: 01/14/2019] [Indexed: 01/01/2023]
Abstract
Optimism is associated with better health outcomes with hypothesized effects due in part to optimism's association with restorative health processes. Limited work has examined whether optimism is associated with better quality sleep, a major restorative process. We test the hypothesis that greater optimism is associated with more favorable sleep quality and duration. Main analyses included adults aged 32-51 who participated in the Coronary Artery Risk Development in Young Adults (CARDIA) study (n = 3,548) during the fifth (Year 15: 2000-2001) and sixth (Year 20: 2005-2006) follow-up visits. Optimism was assessed using the revised Life-Orientation Test. Self-report measures of sleep quality and duration were obtained twice 5 years apart. A subset of CARDIA participants (2003-2005) additionally provided actigraphic data and completed the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). Multivariate regression analyses were used to examine associations of optimism and sleep indicators. In cross-sectional analyses of 3548 participants, each standard deviation (SD) higher optimism score resulted in 78% higher odds of self-reporting very good sleep quality. Prospectively, a 1-SD higher optimism score was related to higher odds of reporting persistently good sleep quality across 5-years relative to those with persistently poor sleep [OR = 1.31; 95%CI:1.10,1.56]. In participant with supplementary data, each SD higher optimism score was marginally associated with 22% greater odds of favorable sleep quality [OR = 1.22; 95%CI:1.00,1.49] as measured by the PSQI, with possible mediation by depressive symptoms. Optimism was unrelated to objective actigraphic sleep data. Findings support a positive cross-sectional and prospective association between optimism and self-reported sleep behavior.
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Affiliation(s)
- Rosalba Hernandez
- School of Social Work 1010 W Nevada St, Urbana IL, 61801, University of Illinois at Urbana-Champaign
| | - Thanh-Huyen T. Vu
- Dept of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL 60611
| | - Kiarri N. Kershaw
- Dept of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL 60611
| | - Julia K. Boehm
- Dept of Psychology, Chapman University, 1 University Drive, Orange, CA 92866
| | - Laura D. Kubzansky
- Dept of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115
| | - Mercedes Carnethon
- Dept of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL 60611
| | - Claudia Trudel-Fitzgerald
- Dept of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115
| | - Kristen L. Knutson
- Dept of Neurology (Sleep Medicine), Northwestern University Feinberg School of Medicine, 710 N. Lake Shore Drive, Chicago, IL 60611
| | - Laura A. Colangelo
- Dept of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL 60611
| | - Kiang Liu
- Dept of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL 60611
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13
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Bonanni E, Schirru A, Di Perri MC, Bonuccelli U, Maestri M. Insomnia and hot flashes. Maturitas 2019; 126:51-54. [PMID: 31239118 DOI: 10.1016/j.maturitas.2019.05.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/02/2019] [Accepted: 05/13/2019] [Indexed: 11/19/2022]
Abstract
The increased prevalence of sleep disorders associated with menopause has been emphasized by multiple international studies. Many factors are associated with insomnia during menopause, among them: hot flashes (HF), anxiety and depression, other medical conditions, behavioral and psychosocial factors and primitive sleep patterns. The domino hypothesis connects various factors and suggests that HF disturb sleep, thereby causing insomnia, which in turn increases vulnerability to depression. Nevertheless, sleep disorders predict mood disturbances more robustly than vasomotor symptoms (VMS), indicating that sleep also influences mood via other mechanisms. The medical conditions that may compromise sleep in this age group are common; they include obesity, gastroesophageal reflux, cancer, urinary incontinence and nocturia, thyroid dysfunction, chronic pain, fibromyalgia (often starting or worsening in menopause), and hypertension. Common causes of sleep disorders in middle-aged women include poor sleep hygiene, volitional factors, environmental disturbances, alcohol intake, marital dissatisfaction, requests for care from children, grandchildren and/or elderly parents, and financial worries. Evidence from other populations suggests that if insomnia is not treated, it may negatively affect the outcome of comorbid conditions. Taken together, these observations suggest that insomnia should be considered a disorder requiring specific attention and treatment. Moreover, recent cross-sectional data link sleep with subclinical markers of cardiovascular risk. It should also be noted that insomnia is common in patients with mild to moderate obstructive sleep apnea syndrome (OSAS).
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Affiliation(s)
- Enrica Bonanni
- Department of Clinical and experimental Medicine, Neurological Clinic, University of Pisa, Italy.
| | - Alessandro Schirru
- Department of Clinical and experimental Medicine, Neurological Clinic, University of Pisa, Italy
| | - Maria Caterina Di Perri
- Department of Clinical and Experimental Medicine, Sleep Medicine Center of the Neurophysiopathology and Movement Disorders Unit, University of Messina, Messina, Italy
| | - Ubaldo Bonuccelli
- Department of Clinical and experimental Medicine, Neurological Clinic, University of Pisa, Italy
| | - Michelangelo Maestri
- Department of Clinical and experimental Medicine, Neurological Clinic, University of Pisa, Italy
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14
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Matthews KA, Hall MH, Lee L, Kravitz HM, Chang Y, Appelhans BM, Swanson LM, Neal-Perry GS, Joffe H. Racial/ethnic disparities in women's sleep duration, continuity, and quality, and their statistical mediators: Study of Women's Health Across the Nation. Sleep 2019; 42:zsz042. [PMID: 30778560 PMCID: PMC6519910 DOI: 10.1093/sleep/zsz042] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 01/09/2019] [Accepted: 02/08/2019] [Indexed: 11/15/2022] Open
Abstract
STUDY OBJECTIVES To describe racial/ethnic differences in sleep duration, continuity, and perceived sleep quality in postmenopausal women and to identify statistical mediators of differences in sleep characteristics. METHODS Recruited from the observational Study of Women's Health Across the Nation (SWAN), 1,203 (548 white, 303 black, 147 Chinese, 132 Japanese, and 73 Hispanic; mean age 65 years, 97% postmenopausal) women participated in a week-long actigraphy and daily diary study in 2013-2015. Actigraphic measures of sleep duration and wake after sleep onset (WASO), and diary-rated sleep quality were averaged across the week. Candidate mediators included health-related variables; stress; and emotional well-being assessed up to 13 times across 18 years from baseline to sleep study. RESULTS Whites slept longer than other groups; the significant mediators were concurrent financial hardship and increasing number of stressors for Hispanics or Japanese versus whites. Whites had less WASO than blacks and Hispanics; significant mediators were concurrent number of health problems, physical inactivity, waist circumference, vasomotor symptoms, number of life stressors, and financial hardship, and increasing number of health problems from baseline to sleep study. Whites reported better sleep quality than blacks, Chinese, and Japanese; significant mediators were concurrent physical inactivity, vasomotor symptoms, positive affect, and depressive symptoms. CONCLUSIONS Sleep differences between blacks or Hispanics versus whites were mediated by health problems, number of stressors, and financial hardship, whereas sleep differences between Chinese or Japanese versus whites were mediated by emotional well-being. This is the first study using formal mediational approaches.
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Affiliation(s)
- Karen A Matthews
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Martica H Hall
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Laisze Lee
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Howard M Kravitz
- Department of Psychiatry, Rush University Medical Center, Chicago, IL
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL
| | - Yuefang Chang
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA
| | | | | | | | - Hadine Joffe
- Connors Center for Women’s Health and Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
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15
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Nowakowski S, Matthews KA, von Känel R, Hall MH, Thurston RC. Sleep characteristics and inflammatory biomarkers among midlife women. Sleep 2019; 41:4956860. [PMID: 29617910 DOI: 10.1093/sleep/zsy049] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 02/12/2018] [Indexed: 12/19/2022] Open
Abstract
Study Objectives Research suggests that sleep disturbances are associated with elevated levels of inflammation. Some evidence indicates that women may be particularly vulnerable; increased levels of inflammatory biomarkers with sleep disturbances are primarily observed among women. Midlife, which encompasses the menopause transition, is typically reported as a time of poor sleep. We tested whether poorer objectively measured sleep characteristics were related to a poorer inflammatory profile in midlife women. Methods Two hundred ninety-five peri- and postmenopausal women aged 40-60 completed 3 days of wrist actigraphy, physiologic hot flash monitoring, questionnaires (e.g. Berlin sleep apnea risk questionnaire], and a blood draw for the assessment of inflammatory markers, including C-reactive protein (CRP), interleukin-6 (IL-6), and von Willebrand factor (VWF) antigen. Associations of objective (actigraphy) sleep with inflammatory markers were tested in regression models. Sleep efficiency was inverse log transformed. Covariates included age, race/ethnicity, education, body mass index, sleep apnea risk, homeostatic model assessment (a measure of insulin resistance), systolic blood pressure, low-density lipoprotein cholesterol, and physical activity. Results In separate models controlling for age, race/ethnicity, and education, lower sleep efficiency was associated with higher IL-6 [b(SE) = .02 (.10), p = .003] and VWF [b(SE) = .02 (.08), p = .002]. More minutes awake after sleep onset was associated with higher VWF [b(SE) = .12 (.06), p = .01]. Findings persisted in multivariable models. Conclusions Lower sleep efficiency and more minutes awake after sleep onset were independently associated with higher circulating levels of VWF. Lower sleep efficiency was associated with higher circulating levels of IL-6. These findings suggest that sleep disturbances are associated with greater circulating inflammation in midlife women.
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Affiliation(s)
- Sara Nowakowski
- Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston, TX.,Department of Psychiatry & Behavioral Sciences, University of Texas Medical Branch, Galveston, TX
| | - Karen A Matthews
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.,Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.,Department of Psychology, University of Pittsburgh, Pittsburgh, PA
| | - Roland von Känel
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martica H Hall
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.,Department of Psychology, University of Pittsburgh, Pittsburgh, PA
| | - Rebecca C Thurston
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.,Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.,Department of Psychology, University of Pittsburgh, Pittsburgh, PA
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16
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Blasco-Colmenares E, Moreno-Franco B, Latre ML, Mur-Vispe E, Pocovi M, Jarauta E, Civeira F, Laclaustra M, Casasnovas JA, Guallar E. Sleep duration and subclinical atherosclerosis: The Aragon Workers' Health Study. Atherosclerosis 2018; 274:35-40. [PMID: 29751282 DOI: 10.1016/j.atherosclerosis.2018.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 04/16/2018] [Accepted: 05/01/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Few studies have evaluated the association of sleep duration with subclinical atherosclerosis, and with heterogeneous findings. We evaluated the association of sleep duration with the presence of coronary, carotid, and femoral subclinical atherosclerosis in healthy middle-age men with low prevalence of clinical comorbidities. METHODS We performed a cross-sectional analysis of 1968 men, 40-60 years of age, participating in the Aragon Workers' Health Study (AWHS). Duration of sleep during a typical work week was assessed by questionnaire. Coronary artery calcium scores (CACS) was assessed by computed tomography and the presence of carotid plaque and femoral plaque by ultrasound. RESULTS In fully adjusted models, the odds ratios (95% CI) for CACS >0 comparing sleep durations of ≤5, 6, and ≥8 h with 7 h were 1.34 (0.98-1.85), 1.35 (1.08-1.69) and 1.21 (0.90-1.62), respectively (p = 0.04). A similar U-shaped association was observed for CACS ≥100 and for CACS. The corresponding odds ratios for the presence of at least one carotid plaque were ≤5, 6, and ≥8 h with 7 h were 1.23 (0.88-1.72), 1.09 (0.86-1.38), and 0.86 (0.63-1.17), respectively (p = 0.31), and for the presence of at least one femoral plaque were 1.25 (0.87-1.80), 1.19 (0.93-1.51) and 1.17 (0.86-1.61), respectively (p = 0.39). CONCLUSIONS Middle-aged men reporting 7 h of sleep duration had the lowest prevalence of subclinical coronary atherosclerosis as assessed by CACs. Our results support that men with very short or very long sleep durations are at increased risk of atherosclerosis.
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Affiliation(s)
- Elena Blasco-Colmenares
- Division of Internal Medicine and Welch Center for Prevention, Epidemiology and Clinical Research, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Belén Moreno-Franco
- Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, CIBER Cardiovascular, Zaragoza, Spain; Universidad de Zaragoza, Zaragoza, Spain.
| | - Montserrat León Latre
- Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, CIBER Cardiovascular, Zaragoza, Spain; Universidad de Zaragoza, Zaragoza, Spain
| | | | - Miguel Pocovi
- Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, CIBER Cardiovascular, Zaragoza, Spain; Universidad de Zaragoza, Zaragoza, Spain
| | - Estíbaliz Jarauta
- Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, CIBER Cardiovascular, Zaragoza, Spain
| | - Fernando Civeira
- Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, CIBER Cardiovascular, Zaragoza, Spain; Universidad de Zaragoza, Zaragoza, Spain
| | - Martín Laclaustra
- Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, CIBER Cardiovascular, Zaragoza, Spain
| | - José A Casasnovas
- Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, CIBER Cardiovascular, Zaragoza, Spain; Universidad de Zaragoza, Zaragoza, Spain
| | - Eliseo Guallar
- Division of Internal Medicine and Welch Center for Prevention, Epidemiology and Clinical Research, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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17
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Monteleone P, Mascagni G, Giannini A, Genazzani AR, Simoncini T. Symptoms of menopause - global prevalence, physiology and implications. Nat Rev Endocrinol 2018; 14:199-215. [PMID: 29393299 DOI: 10.1038/nrendo.2017.180] [Citation(s) in RCA: 316] [Impact Index Per Article: 52.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The symptoms of menopause can be distressing, particularly as they occur at a time when women have important roles in society, within the family and at the workplace. Hormonal changes that begin during the menopausal transition affect many biological systems. Accordingly, the signs and symptoms of menopause include central nervous system-related disorders; metabolic, weight, cardiovascular and musculoskeletal changes; urogenital and skin atrophy; and sexual dysfunction. The physiological basis of these manifestations is emerging as complex and related, but not limited to, oestrogen deprivation. Findings generated mainly from longitudinal population studies have shown that ethnic, geographical and individual factors affect symptom prevalence and severity. Moreover, and of great importance to clinical practice, the latest research has highlighted how certain menopausal symptoms can be associated with the onset of other disorders and might therefore serve as predictors of future health risks in postmenopausal women. The goal of this Review is to describe in a timely manner new research findings on the global prevalence and physiology of menopausal symptoms and their impact on future health.
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Affiliation(s)
- Patrizia Monteleone
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, Pisa 56126, Italy
| | - Giulia Mascagni
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, Pisa 56126, Italy
| | - Andrea Giannini
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, Pisa 56126, Italy
| | - Andrea R Genazzani
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, Pisa 56126, Italy
| | - Tommaso Simoncini
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, Pisa 56126, Italy
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18
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Kowall B, Lehmann N, Mahabadi AA, Lehnich AT, Moebus S, Budde T, Seibel R, Grönemeyer D, Erbel R, Jöckel KH, Stang A. Sleep characteristics and progression of coronary artery calcification: Results from the Heinz Nixdorf Recall cohort study. Atherosclerosis 2018; 271:45-52. [PMID: 29459265 DOI: 10.1016/j.atherosclerosis.2018.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 12/28/2017] [Accepted: 02/08/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Sleep characteristics are associated with incident cardiovascular diseases (CVD), but there is a lack of studies on the association between sleep characteristics and incidence/progression of coronary artery calcification (CAC). METHODS In the Heinz Nixdorf Recall Study, a population-based cohort study in Germany, CAC was assessed by electron-beam tomography at baseline and at 5-year follow-up. In an analysis set of 3043 subjects (age at baseline 45-74 years; 47% men), we fitted logistic and linear regression models to assess associations between self-rated sleep characteristics (nocturnal and total sleep duration; napping; various sleep disorders) and CAC incidence/CAC progression. Progression was measured as 5-year progression factor, as categories of absolute CAC change, and additionally characterized as rapid or slow compared to an extrapolation of baseline CAC values. RESULTS We observed barely any association between sleep characteristics and CAC progression regardless of the chosen statistical approach; associations between sleep and CAC incidence were slightly larger, e.g., the geometric mean of the 5-year CAC progression factor was 6.8% (95% confidence interval: -9.5; 25.9) larger for ≤5 h, 2.9% (-7.3; 14.3) larger for 5.1-6.9 h and 7.1% (-2.4; 15.7) smaller for ≥7.5 h total sleep compared to 7- <7.5 h total sleep. For subjects with any regular sleep disorder, the geometric mean of the 5-year CAC progression was 3.5% (-4.7; 11.2) smaller compared to subjects without any regular sleep disorder. CONCLUSIONS In this German cohort study, sleep characteristics were barely associated with CAC progression.
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Affiliation(s)
- Bernd Kowall
- Center of Clinical Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany.
| | - Nils Lehmann
- Institute for Medical Informatics, Biometry and Epidemiology, University Clinic Essen, University Duisburg-Essen, Essen, Germany
| | - Amir-Abbas Mahabadi
- West-German Heart and Vascular Center Essen, Department of Cardiology, University Clinic Essen, Essen, Germany
| | - Anna-Therese Lehnich
- Center of Clinical Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - Susanne Moebus
- Center for Urban Epidemiology, Institute for Medical Informatics, Biometry, and Epidemiology, University Clinic Essen, Essen, Germany
| | | | | | - Dietrich Grönemeyer
- Department of Radiology and Microtherapy, University Witten/Herdecke, Bochum, Germany
| | - Raimund Erbel
- Institute for Medical Informatics, Biometry and Epidemiology, University Clinic Essen, University Duisburg-Essen, Essen, Germany
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University Clinic Essen, University Duisburg-Essen, Essen, Germany
| | - Andreas Stang
- Center of Clinical Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany; School of Public Health, Department of Epidemiology Boston University, 715 Albany Street, Talbot Building, Boston, MA 02118, USA
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19
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Suzuki S, Arima H, Miyazaki S, Fujiyoshi A, Kadota A, Takashima N, Hisamatsu T, Kadowaki S, Zaid M, Torii S, Horie M, Murata K, Miura K, Ueshima H. Self-reported Sleep Duration and Subclinical Atherosclerosis in a General Population of Japanese Men. J Atheroscler Thromb 2018; 25:186-198. [PMID: 28747590 PMCID: PMC5827088 DOI: 10.5551/jat.40527] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Aim: There are few data regarding associations between sleep duration and subclinical atherosclerosis in Japan. The aim of this study was to evaluate associations of self-reported sleep duration with calcification in the coronary arteries (CAC) and carotid intima media thickness (IMT) in Japanese men. Methods: This was a cross-sectional survey of 1093 randomly selected men from Kusatsu City, Japan. Average sleep duration on weekdays was estimated through questionnaire; CAC by computed tomography; and carotid IMT by ultrasonography. Results: The prevalence of CAC was 50.0% for participants with sleep duration < 5.5 h, 43.9% with 5.5–6.4 h, 50.0% with 6.5–7.4 h, 49.3% with 7.5–8.4 h, and 62.5% with ≥ 8.5 h. In univariate analysis, participants with sleep duration ≥ 8.5 h had significantly higher prevalence of CAC than those with 6.5–7.4 h (p = 0.043). After adjustment for age and other risk factors, however, the association was not significant (p = 0.776). The average IMT was 0.85 mm for participants with sleep duration < 5.5 h, 0.83 mm with 5.5–6.4 h, 0.85 mm with 6.5–7.4 h, 0.88 mm with 7.5–8.4 h, and 0.90 mm with ≥ 8.5 h. None of the differences in IMT observed in crude or multivariable-adjusted analyses was significant (all p > 0.1). Conclusion: Self-reported sleep duration was not associated with increased CAC or carotid IMT in a general population of Japanese men.
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Affiliation(s)
- Sentaro Suzuki
- Department of Public Health, Shiga University of Medical Science
| | - Hisatomi Arima
- Department of Public Health, Shiga University of Medical Science.,Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science
| | | | - Akira Fujiyoshi
- Department of Public Health, Shiga University of Medical Science
| | - Aya Kadota
- Department of Public Health, Shiga University of Medical Science.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science
| | | | - Takashi Hisamatsu
- Department of Public Health, Shiga University of Medical Science.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science.,Department of Environmental Medicine and Public Health, Faculty of Medicine, Shimane University
| | - Sayaka Kadowaki
- Department of Public Health, Shiga University of Medical Science
| | - Maryam Zaid
- Department of Public Health, Shiga University of Medical Science.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science
| | - Sayuki Torii
- Department of Public Health, Shiga University of Medical Science.,Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science
| | - Minoru Horie
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science
| | - Kiyoshi Murata
- Department of Radiology, Shiga University of Medical Science
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science
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20
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Baker FC, de Zambotti M, Colrain IM, Bei B. Sleep problems during the menopausal transition: prevalence, impact, and management challenges. Nat Sci Sleep 2018; 10:73-95. [PMID: 29445307 PMCID: PMC5810528 DOI: 10.2147/nss.s125807] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
A substantial number of women experience sleep difficulties in the approach to menopause and beyond, with 26% experiencing severe symptoms that impact daytime functioning, qualifying them for a diagnosis of insomnia. Here, we review both self-report and polysomnographic evidence for sleep difficulties in the context of the menopausal transition, considering severity of sleep complaints and links between hot flashes (HFs) and depression with poor sleep. Longitudinal population-based studies show that sleep difficulties are uniquely linked with menopausal stage and changes in follicle-stimulating hormone and estradiol, over and above the effects of age. A major contributor to sleep complaints in the context of the menopausal transition is HFs, and many, although not all, HFs are linked with polysomnographic-defined awakenings, with HF-associated wake time contributing significantly to overall wakefulness after sleep onset. Some sleep complaints may be comorbid with depressive disorders or attributed to sleep-related breathing or movement disorders, which increase in prevalence especially after menopause, and for some women, menopause, age, and environmental/behavioral factors may interact to disrupt sleep. Considering the unique and multifactorial basis for sleep difficulties in women transitioning menopause, we describe clinical assessment approaches and management options, including combination treatments, ranging from cognitive behavioral therapy for insomnia to hormonal and nonhormonal pharmacological options. Emerging studies suggest that the impact of severe insomnia symptoms could extend beyond immediate health care usage and quality of life issues to long-term mental and physical health, if left untreated in midlife women. Appropriate treatment, therefore, has immediate benefit as well as advantages for maintaining optimal health in the postmenopausal years.
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Affiliation(s)
- Fiona C Baker
- Center for Health Sciences, SRI International, Menlo Park, CA, USA.,Brain Function Research Group, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Ian M Colrain
- Center for Health Sciences, SRI International, Menlo Park, CA, USA.,Melbourne School of Psychological Sciences, University of Melbourne
| | - Bei Bei
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University.,Centre for Women's Mental Health, Department of Psychiatry, University of Melbourne, Royal Women's Hospital, Melbourne, VIC, Australia
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21
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Thurston RC, Chang Y, von Känel R, Barinas-Mitchell E, Jennings JR, Hall MH, Santoro N, Buysse DJ, Matthews KA. Sleep Characteristics and Carotid Atherosclerosis Among Midlife Women. Sleep 2017; 40:2666709. [PMID: 28364498 DOI: 10.1093/sleep/zsw052] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction Midlife, which encompasses the menopause transition in women, can be a time of disrupted sleep and accelerated atherosclerosis accumulation. Short or poor sleep quality has been associated with cardiovascular disease (CVD) risk; few studies have investigated relations among midlife women. We tested whether shorter actigraphy sleep time or poorer subjective sleep quality was associated with carotid atherosclerosis among midlife women. Aims and Methods Two hundred fifty-six peri- and postmenopausal women aged 40-60 years completed 3 days of wrist actigraphy, hot flash monitoring, questionnaires (Pittsburgh Sleep Quality Index [PSQI], Berlin), a blood draw, and carotid ultrasound [intima media thickness (IMT), plaque]. Associations of objective (actigraphy) and subjective (PSQI) sleep with IMT/plaque were tested in regression models (covariates: age, race, education, body mass index, blood pressure, lipids, insulin resistance, medications, snoring, depressive symptoms, sleep hot flashes, and estradiol). Results Shorter objective sleep time was associated with higher odds of carotid plaque (for each hour shorter sleep, plaque score ≥ 2, odds ratio (OR) [95% confidence interval, CI] = 1.58 [1.11-2.27], p = .01; plaque score = 1, OR [95% CI] = 0.95 [0.68-1.32], p = .75, vs. no plaque, multivariable). Poorer subjective sleep quality was associated with higher mean IMT [β, b (standard error, SE) = 0.004 (0.002), p = .03], maximal IMT [b (SE) = 0.009 (0.003), p = .005], and plaque [plaque score ≥ 2, OR (95% CI) = 1.23 (1.09-1.40), p = .001; score = 1, OR (95% CI) = 1.06 (0.93-1.21), p = .37, vs. no plaque] in multivariable models. Findings persisted additionally adjusting for sleep hot flashes and estradiol. Conclusions Shorter actigraphy-assessed sleep time and poorer subjective sleep quality were associated with increased carotid atherosclerosis among midlife women. Associations persisted adjusting for CVD risk factors, hot flashes, and estradiol.
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Affiliation(s)
- Rebecca C Thurston
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213.,Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA 15213.,Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260
| | - Yuefang Chang
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213
| | - Roland von Känel
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, 3010 Bern, Switzerland
| | - Emma Barinas-Mitchell
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA 15213
| | - J Richard Jennings
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213
| | - Martica H Hall
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213.,Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Denver, CO 80238
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213
| | - Karen A Matthews
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213.,Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA 15213.,Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260
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22
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Stafford M, Bendayan R, Tymoszuk U, Kuh D. Social support from the closest person and sleep quality in later life: Evidence from a British birth cohort study. J Psychosom Res 2017; 98:1-9. [PMID: 28554363 PMCID: PMC5478069 DOI: 10.1016/j.jpsychores.2017.04.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 04/20/2017] [Accepted: 04/21/2017] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Supportive social relationships have been found to be related to fewer sleep problems and better sleep quality. We examined associations between positive and negative support from the nominated close person across 15years of follow-up with sleep quality in older age. METHODS MRC National Survey of Health and Development study members reported sleep quality at age 68 (n=2446). Cumulative exposure to and changes in positive and negative support were derived from data at age 53, 60-64 and 68years. Pittsburgh Sleep Quality Index scores were regressed on social support measures adjusted for i) gender only then additionally ii) education, marital status, number in household, limiting illness, body mass index, caregiving, iii) and affective symptoms. RESULTS Greater exposure to positive support and lower exposure to negative support over 15years were independently associated with better sleep quality at age 68. Sleep quality was poorer for those who experienced declining positive support or increasing negative support. Those who nominated their spouse/partner as their closest person at age 53 but not at age 68 had poorer sleep quality than those who nominated their spouse on both occasions. These associations were not explained by the covariates, including affective symptoms. CONCLUSIONS Based on repeat data on support from the closest person, this study finds a link between declining social relationship quality and poor sleep quality. Whilst acknowledging that the association may be bi-directional, the study suggests that interventions to improve older people's social relationships may have benefits for sleep.
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Affiliation(s)
- Mai Stafford
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK.
| | | | - Ula Tymoszuk
- Department of Epidemiology and Public Health, UCL, London, UK
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
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Aziz M, Ali SS, Das S, Younus A, Malik R, Latif MA, Humayun C, Anugula D, Abbas G, Salami J, Elizondo JV, Veledar E, Nasir K. Association of Subjective and Objective Sleep Duration as well as Sleep Quality with Non-Invasive Markers of Sub-Clinical Cardiovascular Disease (CVD): A Systematic Review. J Atheroscler Thromb 2016; 24:208-226. [PMID: 27840384 PMCID: PMC5383537 DOI: 10.5551/jat.36194] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Aim: Abnormal daily sleep duration and quality have been linked to hypertension, diabetes, stroke, and overall cardiovascular disease (CVD) morbidity & mortality. However, the relationship between daily sleep duration and quality with subclinical measures of CVD remain less well studied. This systematic review evaluated how daily sleep duration and quality affect burden of subclinical CVD in subjects free of symptomatic CVD. Methods: Literature search was done via MEDLINE, EMBASE, Web of Science until June 2016 and 32 studies met the inclusion criteria. Sleep duration and quality were measured either via subjective methods, as self-reported questionnaires or Pittsburg Sleep Quality Index (PSQI) or via objective methods, as actigraphy or polysomnography or by both. Among subclinical CVD measures, coronary artery calcium (CAC) was measured by electron beam computed tomography, Carotid intima-media thickness (CIMT) measured by high-resolution B-mode ultrasound on carotid arteries, endothelial/microvascular function measured by flow mediated dilation (FMD) or peripheral arterial tone (PAT) or iontophoresis or nailfold capillaroscopy, and arterial stiffness measured by pulse wave velocity (PWV) or ankle brachial index (ABI). Results: Subjective short sleep duration was associated with CAC and CIMT, but variably associated with endothelial dysfunction (ED) and arterial stiffness; however, subjective long sleep duration was associated with CAC, CIMT and arterial stiffness, but variably associated with ED. Objective short sleep duration was positively associated with CIMT and variably with CAC but not associated with ED. Objective long sleep duration was variably associated with CAC and CIMT but not associated with ED. Poor subjective sleep quality was significantly associated with ED and arterial stiffness but variably associated with CAC and CIMT. Poor objective sleep quality was significantly associated with CIMT, and ED but variably associated with CAC. Conclusions: Overall, our review provided mixed results, which is generally in line with published literature, with most of the studies showing a significant relationship with subclinical CVD, but only some studies failed to demonstrate such an association. Although such mechanistic relationship needs further evaluation in order to determine appropriate screening strategies in vulnerable populations, this review strongly suggested the existence of a relationship between abnormal sleep duration and quality with increased subclinical CVD burden.
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Affiliation(s)
- Muhammad Aziz
- Center for Healthcare Advancement & Outcomes, Baptist Health South Florida
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24
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Srivastava P, Gupta R, Chari D, Rawat A, Goel D. Comparison of prevalence of obstructive sleep apnea, restless legs syndrome, and poor sleep quality in patients with coronary artery disease and depression. SOMNOLOGIE 2016. [DOI: 10.1007/s11818-016-0053-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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25
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Abstract
OBJECTIVE Insomnia both as a symptom and as part of chronic insomnia disorder is quite common in menopause. Comorbid conditions, such as restless legs syndrome and obstructive sleep apnea, occur with high prevalence among perimenopausal women with insomnia. Insomnia in this population group is associated with adverse health outcomes, and there are no clear standards on how to treat it. METHODS Based on extensive literature search, 76 articles were identified. Two authors independently graded evidence according to the Oxford Centre for Evidence-Based Medicine Levels of Evidence. RESULTS Evaluation and treatment of other comorbid sleep disorders are recommended, as is cognitive-behavioral therapy for insomnia. Hormone therapy, eszopiclone, escitalopram, gabapentin, isoflavones, valerian, exercise, and hypnosis are suggested. Zolpidem, quiteiapine XL, citalopram, mirtazapine followed by long-acting melatonin, ramelteon, Pycnogenol, Phyto-Female Complex, yoga, and massage may be considered. Kampo formulas are not recommended. Acupuncture may not be suggested, and cognitive-behavioral therapy that is not tailored for insomnia probably should not be considered. CONCLUSIONS Although a variety of interventions are shown to be helpful in improving sleep in menopause, there is a need for well-designed head-to-head trials with uniform outcome measures.
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Kim CW, Chang Y, Zhao D, Cainzos-Achirica M, Ryu S, Jung HS, Yun KE, Choi Y, Ahn J, Zhang Y, Rampal S, Baek Y, Lima JA, Shin H, Guallar E, Cho J, Sung E. Sleep Duration, Sleep Quality, and Markers of Subclinical Arterial Disease in Healthy Men and Women. Arterioscler Thromb Vasc Biol 2015; 35:2238-45. [DOI: 10.1161/atvbaha.115.306110] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 07/24/2015] [Indexed: 01/26/2023]
Affiliation(s)
- Chan-Won Kim
- From the Center for Cohort Studies, Total Healthcare Center (C.-W.K., Y. Chang, S. Ryu, H.-S.J., K.E.Y., Y. Choi, J.A., Y.B., J.C.) and Department of Occupational and Environmental Medicine (Y.C., S. Ryu), Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea; Departments of Epidemiology (D.Z., M.C.-A., Y.Z., S. Rampal, E.G., J.C.) and Medicine (E.G.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of
| | - Yoosoo Chang
- From the Center for Cohort Studies, Total Healthcare Center (C.-W.K., Y. Chang, S. Ryu, H.-S.J., K.E.Y., Y. Choi, J.A., Y.B., J.C.) and Department of Occupational and Environmental Medicine (Y.C., S. Ryu), Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea; Departments of Epidemiology (D.Z., M.C.-A., Y.Z., S. Rampal, E.G., J.C.) and Medicine (E.G.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of
| | - Di Zhao
- From the Center for Cohort Studies, Total Healthcare Center (C.-W.K., Y. Chang, S. Ryu, H.-S.J., K.E.Y., Y. Choi, J.A., Y.B., J.C.) and Department of Occupational and Environmental Medicine (Y.C., S. Ryu), Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea; Departments of Epidemiology (D.Z., M.C.-A., Y.Z., S. Rampal, E.G., J.C.) and Medicine (E.G.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of
| | - Miguel Cainzos-Achirica
- From the Center for Cohort Studies, Total Healthcare Center (C.-W.K., Y. Chang, S. Ryu, H.-S.J., K.E.Y., Y. Choi, J.A., Y.B., J.C.) and Department of Occupational and Environmental Medicine (Y.C., S. Ryu), Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea; Departments of Epidemiology (D.Z., M.C.-A., Y.Z., S. Rampal, E.G., J.C.) and Medicine (E.G.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of
| | - Seungho Ryu
- From the Center for Cohort Studies, Total Healthcare Center (C.-W.K., Y. Chang, S. Ryu, H.-S.J., K.E.Y., Y. Choi, J.A., Y.B., J.C.) and Department of Occupational and Environmental Medicine (Y.C., S. Ryu), Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea; Departments of Epidemiology (D.Z., M.C.-A., Y.Z., S. Rampal, E.G., J.C.) and Medicine (E.G.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of
| | - Hyun-Suk Jung
- From the Center for Cohort Studies, Total Healthcare Center (C.-W.K., Y. Chang, S. Ryu, H.-S.J., K.E.Y., Y. Choi, J.A., Y.B., J.C.) and Department of Occupational and Environmental Medicine (Y.C., S. Ryu), Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea; Departments of Epidemiology (D.Z., M.C.-A., Y.Z., S. Rampal, E.G., J.C.) and Medicine (E.G.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of
| | - Kyung Eun Yun
- From the Center for Cohort Studies, Total Healthcare Center (C.-W.K., Y. Chang, S. Ryu, H.-S.J., K.E.Y., Y. Choi, J.A., Y.B., J.C.) and Department of Occupational and Environmental Medicine (Y.C., S. Ryu), Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea; Departments of Epidemiology (D.Z., M.C.-A., Y.Z., S. Rampal, E.G., J.C.) and Medicine (E.G.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of
| | - Yuni Choi
- From the Center for Cohort Studies, Total Healthcare Center (C.-W.K., Y. Chang, S. Ryu, H.-S.J., K.E.Y., Y. Choi, J.A., Y.B., J.C.) and Department of Occupational and Environmental Medicine (Y.C., S. Ryu), Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea; Departments of Epidemiology (D.Z., M.C.-A., Y.Z., S. Rampal, E.G., J.C.) and Medicine (E.G.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of
| | - Jiin Ahn
- From the Center for Cohort Studies, Total Healthcare Center (C.-W.K., Y. Chang, S. Ryu, H.-S.J., K.E.Y., Y. Choi, J.A., Y.B., J.C.) and Department of Occupational and Environmental Medicine (Y.C., S. Ryu), Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea; Departments of Epidemiology (D.Z., M.C.-A., Y.Z., S. Rampal, E.G., J.C.) and Medicine (E.G.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of
| | - Yiyi Zhang
- From the Center for Cohort Studies, Total Healthcare Center (C.-W.K., Y. Chang, S. Ryu, H.-S.J., K.E.Y., Y. Choi, J.A., Y.B., J.C.) and Department of Occupational and Environmental Medicine (Y.C., S. Ryu), Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea; Departments of Epidemiology (D.Z., M.C.-A., Y.Z., S. Rampal, E.G., J.C.) and Medicine (E.G.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of
| | - Sanjay Rampal
- From the Center for Cohort Studies, Total Healthcare Center (C.-W.K., Y. Chang, S. Ryu, H.-S.J., K.E.Y., Y. Choi, J.A., Y.B., J.C.) and Department of Occupational and Environmental Medicine (Y.C., S. Ryu), Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea; Departments of Epidemiology (D.Z., M.C.-A., Y.Z., S. Rampal, E.G., J.C.) and Medicine (E.G.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of
| | - Youngji Baek
- From the Center for Cohort Studies, Total Healthcare Center (C.-W.K., Y. Chang, S. Ryu, H.-S.J., K.E.Y., Y. Choi, J.A., Y.B., J.C.) and Department of Occupational and Environmental Medicine (Y.C., S. Ryu), Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea; Departments of Epidemiology (D.Z., M.C.-A., Y.Z., S. Rampal, E.G., J.C.) and Medicine (E.G.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of
| | - Joao A. Lima
- From the Center for Cohort Studies, Total Healthcare Center (C.-W.K., Y. Chang, S. Ryu, H.-S.J., K.E.Y., Y. Choi, J.A., Y.B., J.C.) and Department of Occupational and Environmental Medicine (Y.C., S. Ryu), Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea; Departments of Epidemiology (D.Z., M.C.-A., Y.Z., S. Rampal, E.G., J.C.) and Medicine (E.G.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of
| | - Hocheol Shin
- From the Center for Cohort Studies, Total Healthcare Center (C.-W.K., Y. Chang, S. Ryu, H.-S.J., K.E.Y., Y. Choi, J.A., Y.B., J.C.) and Department of Occupational and Environmental Medicine (Y.C., S. Ryu), Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea; Departments of Epidemiology (D.Z., M.C.-A., Y.Z., S. Rampal, E.G., J.C.) and Medicine (E.G.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of
| | - Eliseo Guallar
- From the Center for Cohort Studies, Total Healthcare Center (C.-W.K., Y. Chang, S. Ryu, H.-S.J., K.E.Y., Y. Choi, J.A., Y.B., J.C.) and Department of Occupational and Environmental Medicine (Y.C., S. Ryu), Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea; Departments of Epidemiology (D.Z., M.C.-A., Y.Z., S. Rampal, E.G., J.C.) and Medicine (E.G.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of
| | - Juhee Cho
- From the Center for Cohort Studies, Total Healthcare Center (C.-W.K., Y. Chang, S. Ryu, H.-S.J., K.E.Y., Y. Choi, J.A., Y.B., J.C.) and Department of Occupational and Environmental Medicine (Y.C., S. Ryu), Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea; Departments of Epidemiology (D.Z., M.C.-A., Y.Z., S. Rampal, E.G., J.C.) and Medicine (E.G.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of
| | - Eunju Sung
- From the Center for Cohort Studies, Total Healthcare Center (C.-W.K., Y. Chang, S. Ryu, H.-S.J., K.E.Y., Y. Choi, J.A., Y.B., J.C.) and Department of Occupational and Environmental Medicine (Y.C., S. Ryu), Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea; Departments of Epidemiology (D.Z., M.C.-A., Y.Z., S. Rampal, E.G., J.C.) and Medicine (E.G.), Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of
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Abstract
Objective Sleep disturbances are common among women in midlife; prevalence increases among perimenopausal/postmenopausal women with vasomotor symptoms. Paroxetine 7.5 mg is the only nonhormonal treatment that has been approved in the United States for moderate to severe vasomotor symptoms associated with menopause. In two pivotal phase 3 studies evaluating its efficacy and safety, improvements in sleep disturbances were also prospectively evaluated. Methods Postmenopausal women with moderate to severe vasomotor symptoms were randomly assigned to paroxetine 7.5 mg (n = 591) or placebo (n = 593) once daily for 12 weeks (both studies) or 24 weeks (24-wk study). Predefined assessments on weeks 4, 12, and 24 included number of nighttime awakenings attributed to vasomotor symptoms, sleep-onset latency, sleep duration, and sleep-related adverse events. The two studies’ data for weeks 1 to 12 were pooled. Results At baseline, participants reported a mean of 3.6 awakenings/night attributed to vasomotor symptoms. Nighttime awakenings attributed to vasomotor symptoms were significantly reduced within 4 weeks of initiating paroxetine 7.5 mg treatment (39% reduction vs 28% for placebo; P = 0.0049), and reductions were sustained through 12 or 24 weeks of treatment. Paroxetine 7.5 mg treatment also significantly increased nighttime sleep duration (week 4, +31 vs +16 min for placebo; P = 0.0075), but no significant between-group differences in sleep-onset latency or sleep-related adverse events such as sedation were observed. Conclusions In postmenopausal women treated for menopausal vasomotor symptoms, paroxetine 7.5 mg significantly reduces the number of nighttime awakenings attributed to vasomotor symptoms and increases sleep duration without differentially affecting sleep-onset latency or sedation.
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Blair LM, Porter K, Leblebicioglu B, Christian LM. Poor Sleep Quality and Associated Inflammation Predict Preterm Birth: Heightened Risk among African Americans. Sleep 2015; 38:1259-67. [PMID: 25845693 DOI: 10.5665/sleep.4904] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 03/07/2015] [Indexed: 12/18/2022] Open
Abstract
STUDY OBJECTIVES Poor sleep promotes inflammation. In turn, inflammation is a causal mechanism in term as well as preterm parturition. In the United States, a persistent racial disparity in preterm birth exists, with African Americans showing ∼1.5 times greater risk. This study examined associations among sleep quality, serum proinflammatory cytokines, and length of gestation in a racially diverse sample of 138 pregnant women. DESIGN Observational. MEASUREMENTS Women completed the Pittsburgh Sleep Quality Index (PSQI) and other psychosocial and behavioral measures during midpregnancy. Serum levels of interleukin (IL)-6, IL-8, IL-1β, and tumor necrosis factor (TNF)-α were determined by high-sensitivity assays. Birth outcomes were determined via medical record review. RESULTS Among African American women (n = 79), shorter gestation was predicted by poorer overall sleep (rs = -0.35, P = 0.002) as well the following PSQI subscales: subjective sleep quality (rs = -0.34, P = 0.002), sleep latency (rs = -0.27, P = 0.02), and sleep efficiency (rs = -0.27, P = 0.02). African American women with poor sleep quality (PSQI > 5) had 10.2 times the odds of preterm birth compared to those with good sleep quality. In contrast, among European American women (n = 53), gestational length was not significantly predicted by sleep quality (Ps > 0.12). Bootstrapping analyses showed that, among African Americans, IL-8 significantly mediated the association between sleep quality and length of gestation (indirect effect estimate -0.029; 95% confidence interval -0.06, -0.002). CONCLUSIONS The data provide novel evidence that African American women exhibit greater inflammation in response to sleep disturbance than European American women and these effects correspond with length of gestation. Racial differences in susceptibility to sleep induced immune dysregulation may contribute to marked racial disparities in preterm birth.
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Affiliation(s)
- Lisa M Blair
- College of Nursing, The Ohio State University, Columbus, OH
| | - Kyle Porter
- Center for Biostatistics, The Ohio State University, Columbus, OH
| | | | - Lisa M Christian
- Department of Psychiatry, The Institute for Behavioral Medicine Research, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH; Department of Psychology, The Ohio State University, Columbus, OH
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Hall MH, Kline CE, Nowakowski S. Insomnia and sleep apnea in midlife women: prevalence and consequences to health and functioning. F1000PRIME REPORTS 2015; 7:63. [PMID: 26097736 PMCID: PMC4447062 DOI: 10.12703/p7-63] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Sleep disturbance is common during the menopausal transition, with numerous downstream consequences to health and functioning, including reduced quality of life, impaired mental health, and increased physical health morbidity. Insomnia affects approximately 50% of midlife women and is characterized by nocturnal symptoms of difficulties initiating or maintaining sleep (or both) and daytime symptoms that impair occupational, social, or other components of functioning. In addition, approximately 20% of midlife women develop sleep-disordered breathing during the menopausal transition. This commentary summarizes the prevalence, risk factors, and treatment options for each of these sleep disorders in midlife women, with specific focus on first-line treatments for insomnia (cognitive behavioral therapy for insomnia) and sleep-disordered breathing (continuous positive airway pressure) and unique considerations for treating sleep disorders in midlife women. Future directions are also discussed.
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Affiliation(s)
- Martica H. Hall
- Department of Psychiatry, University of Pittsburgh School of Medicine3811 O'Hara Street, Pittsburgh, PA 15213USA
| | - Christopher E. Kline
- Department of Psychiatry, University of Pittsburgh School of Medicine3811 O'Hara Street, Pittsburgh, PA 15213USA
| | - Sara Nowakowski
- Department of Obstetrics and Gynecology, University of Texas Medical Branch301 University Boulevard, Galveston, TX 77555-0587USA
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Schmidt F, Kolle K, Kreuder K, Schnorbus B, Wild P, Hechtner M, Binder H, Gori T, Münzel T. Nighttime aircraft noise impairs endothelial function and increases blood pressure in patients with or at high risk for coronary artery disease. Clin Res Cardiol 2014; 104:23-30. [PMID: 25145323 PMCID: PMC4300412 DOI: 10.1007/s00392-014-0751-x] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 08/01/2014] [Indexed: 11/10/2022]
Abstract
Aims Epidemiological studies suggest the existence of a relationship between aircraft noise exposure and increased risk for myocardial infarction and stroke. Patients with established coronary artery disease and endothelial dysfunction are known to have more future cardiovascular events. We therefore tested the effects of nocturnal aircraft noise on endothelial function in patients with or at high risk for coronary artery disease. Methods 60 Patients (50p 1–3 vessels disease; 10p with a high Framingham Score of 23 %) were exposed in random and blinded order to aircraft noise and no noise conditions. Noise was simulated in the patients’ bedroom and consisted of 60 events during one night. Polygraphy was recorded during study nights, endothelial function (flow-mediated dilation of the brachial artery), questionnaires and blood sampling were performed on the morning after each study night. Results The mean sound pressure levels Leq(3) measured were 46.9 ± 2.0 dB(A) in the Noise 60 nights and 39.2 ± 3.1 dB(A) in the control nights. Subjective sleep quality was markedly reduced by noise from 5.8 ± 2.0 to 3.7 ± 2.2 (p < 0.001). FMD was significantly reduced (from 9.6 ± 4.3 to 7.9 ± 3.7 %; p < 0.001) and systolic blood pressure was increased (from 129.5 ± 16.5 to 133.6 ± 17.9 mmHg; p = 0.030) by noise. The adverse vascular effects of noise were independent from sleep quality and self-reported noise sensitivity. Conclusions Nighttime aircraft noise markedly impairs endothelial function in patients with or at risk for cardiovascular disease. These vascular effects appear to be independent from annoyance and attitude towards noise and may explain in part the cardiovascular side effects of nighttime aircraft noise.
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Affiliation(s)
- Frank Schmidt
- 2 Medical Clinic, Cardiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
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Are sleep difficulties the "canary in the coalmine" for aortic calcification in women? Sleep Med 2013; 14:389-90. [PMID: 23490737 DOI: 10.1016/j.sleep.2013.01.006] [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] [Received: 01/21/2013] [Accepted: 01/22/2013] [Indexed: 01/06/2023]
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