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Xin T, Hu F, Xu L, Kong F, Yang H, Li L, Qin A, Bao B, Chen C, Lan J. Association and mediators between the impact of oral health-related quality of life and depression. Oral Dis 2024; 30:4001-4010. [PMID: 38071189 DOI: 10.1111/odi.14832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/27/2023] [Accepted: 11/24/2023] [Indexed: 09/03/2024]
Abstract
OBJECTIVES Our research intended to explore the association and mediators (perceived social support and sleep quality) between the impact of oral health-related quality of life (OHRQoL) and depression among Chinese older adults. METHODS A stratified, multi-stage random sampling approach was used in our study. A total of 3896 older individuals aged 60 years and older were included. Process macro 3.5 for SPSS was utilized for testing mediation hypotheses. RESULTS The mean score of the OHRQoL of the elderly was 3.26 ± 7.15. The correlation coefficient between OHRQoL and depression was 0.25 (p < 0.001). Perceived social support (β = 0.009, 95% CI = 0.006, 0.012) and sleep quality (β = 0.073, 95% CI = 0.074, 0.093) mediated the relationship between OHRQoL and depression, respectively. The association between OHRQoL and depression was mediated sequentially by perceived social support and sleep quality (β = 0.004, 95% CI = 0.002, 0.006). CONCLUSIONS The participants reported relatively good OHRQoL. OHRQoL and depression showed a significant positive correlation. The relationship between OHRQoL and depression among Chinese seniors was mediated by perceived social support and sleep quality. Both directly and indirectly, OHRQoL can affect depression.
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Affiliation(s)
- Tianjiao Xin
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission (NHC) Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Fangfang Hu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission (NHC) Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Lingzhong Xu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission (NHC) Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Fanlei Kong
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission (NHC) Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Haifeng Yang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission (NHC) Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Lei Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission (NHC) Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Afei Qin
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission (NHC) Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Binghong Bao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission (NHC) Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Chiqi Chen
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission (NHC) Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Jing Lan
- Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Shandong Key Laboratory of Oral Tissue Regeneration, Jinan, Shandong, China
- Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, Shandong, China
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Wang S, Rossheim ME, Nandy RR, Nguyen US. Interaction between sleep duration and trouble sleeping on depressive symptoms among U.S. adults, NHANES 2015-2018. J Affect Disord 2024; 351:285-292. [PMID: 38302062 DOI: 10.1016/j.jad.2024.01.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 01/25/2024] [Accepted: 01/28/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND This study aims to examine the associations and interaction effects of sleep duration and trouble sleeping on depressive symptoms among U.S. adults. METHODS National Health and Nutrition Examination Survey (NHANES) data from 2015 to 2018 were analyzed (N = 10,044). Trouble sleeping and sleep duration were self-reported. Sleep duration was defined as short (≤6 h) or long (≥9 h), compared with normal (>6 and < 9 h). Depressive symptoms were determined by the Patient Health Questionnaire-9 score ≥ 10. Both multiplicative interaction and additive interaction were reported. RESULTS There was a significant positive additive interaction between short sleep duration and trouble sleeping on depressive symptoms in the fully adjusted model (Relative excess risk due to interaction, RERIOR = 4.42, 95 % CI: 1.12, 7.73), with 43 % of the association with depressive symptoms attributed to the interaction (attributable proportion of interaction, AP = 0.43, 95 % CI: 0.22, 0.64). Similarly, a significant positive additive interaction between long sleep duration and trouble sleeping on depressive symptoms was found (RERIOR = 4.17, 95 % CI: 0.96, 7.38), with 41 % of the association with depressive symptoms attributed to the interaction (AP = 0.41, 95 % CI: 0.21, 0.60). No multiplicative interaction was detected between short or long sleep duration and trouble sleeping. LIMITATIONS The cross-sectional design limits the ability to draw causal inferences. CONCLUSIONS Findings suggest that different aspects of sleep health interact synergistically, accounting for a substantial portion of the association with depressive symptoms. This underscores the importance of simultaneously considering multiple dimensions of sleep health in relation to depressive symptoms.
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Affiliation(s)
- Shanshan Wang
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA.
| | - Matthew E Rossheim
- Department of Health Administration & Health Policy, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Rajesh R Nandy
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Uyen-Sa Nguyen
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
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Zhang J, He M, Wang X, Jiang H, Huang J, Liang S. Association of sleep duration and risk of mental disorder: a systematic review and meta-analysis. Sleep Breath 2024; 28:261-280. [PMID: 37642884 PMCID: PMC10954977 DOI: 10.1007/s11325-023-02905-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/03/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND The effects of sleep duration on the development of mental illness remain controversial. Therefore, it is necessary to identify the effects of long or short sleep duration on psychological disorders, which could reveal new ways for preventing and treating mental health conditions cheaply. METHODS Identifying published papers was accomplished by using the following five English databases on March 16, 2022: PubMed, MEDLINE, Embase, Web of Science databases, and Scopus. Cross-sectional and cohort studies were considered if they evaluated the association of sleep duration with all kinds of mental illness in adults. We excluded case reports, editorials, narrative reviews, and studies without detailed information on sleep duration. Summary effect-size estimates were expressed as risk ratios (RRs) or odds ratios (ORs) with 95% confidence intervals and were evaluated using random-effect models. Mantel-Haenszel's random-effects model was used to estimate the inconsistency index (I2) and Tau2 index (measurement of heterogeneity). RESULTS A total of 52 studies were included in this analysis, consisting of 14 cohort studies and 38 cross-sectional studies. These studies involved a combined sample size of 1,407,891 participants who met the inclusion criteria. Cohort (adjusted RR = 1.42, 95% CI: 1.26-1.60, P < .001, I2 = 37.6%, Tau2 = 0.014) and cross-sectional studies (adjusted OR = 1.67, 95% CI: 1.57-1.77, P < .001, I2 = 79.7%, Tau2 = 0.060) concluded that short sleep duration increased mental disorder risks. The same conclusions were acquired in the subgroup analysis, especially for depression (adjusted RR = 1.43, 95% CI: 1.24-1.65, P < .001, I2 = 80.4%, Tau2 = 0.082), anxiety (adjusted RR = 1.30, 95% CI: 1.04-1.63, P = .002, I2 = 0.0%, Tau2 = 0.000), and PTSD (adjusted RR = 1.35, 95% CI: 1.04-1.76, P = .022, I2 = 24.1%, Tau2 = 0.013) in cohort studies. The results of subgroup analysis indicated that long sleep duration was not a risk factor for depression (adjusted RR = 1.15, 95% CI: 0.98-1.34, P = .088, I2 = 63.4%, Tau2 = 0.045) and anxiety (adjusted RR = 1.37, 95% CI: 0.93-2.03, P = .114, I2 = 0.0%, Tau2 = 0.000). CONCLUSIONS Short sleep duration, not long sleep duration, is an independent predictor of developing mental disorders, particularly anxiety and depression.
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Affiliation(s)
- Jinhe Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Mengyang He
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Xuan Wang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Hairong Jiang
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
| | - Jinchang Huang
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China.
| | - Sixiang Liang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
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Vestergaard CL, Skogen JC, Hysing M, Harvey AG, Vedaa Ø, Sivertsen B. Sleep duration and mental health in young adults. Sleep Med 2024; 115:30-38. [PMID: 38330693 DOI: 10.1016/j.sleep.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 01/10/2024] [Accepted: 01/21/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND The association between sleep duration and mental illness has been established in middle-aged and older populations, yet remains less explored in younger adults. Additionally, a common limitation to existing studies is the lack of statistical power to explore less common disorders. The purpose of this study was to examine sleep duration as a predictor for a range of mental disorders and well-being in a longitudinal sample of young adults. METHODS Data were derived from two waves (w1, w2) of the SHoT survey, which invited all full-time university and college students in Norway. The response rates were 34.4 % (n = 62,498) in 2021 (w1) and 35.1 % (n = 59,554) 2022 (w2). This study utilized a nested longitudinal sample from both w1 and w2, encompassing 21,289 students. Demographics, sleep duration (w1), and mental health (w2) were measured by self-report questionnaires. Sex-stratified linear regression models and log-link binomial regression analyses were employed to determine the proportion and calculate the risk ratios, respectively, for mental illness across different sleep duration categories. RESULTS The mean age of the sample was 24.8 years ± 4.5 years (w1). Students with shorter sleep durations, and to some degree longer sleep durations (illustrating a ᒐ-shaped association), exhibited a higher risk for all assessed mental disorders and well-being outcomes one year later, compared to students sleeping 8-9 h. The ᒐ-shaped trend was consistent for both female and male students. CONCLUSION Sleep duration appears to be a transdiagnostic marker for mental health in young adults.
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Affiliation(s)
- Cecilie L Vestergaard
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; Department of Research and Development, St. Olavs University Hospital, Trondheim, Norway.
| | - Jens C Skogen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway; Alcohol & Drug Research Western Norway, Stavanger University Hospital, Stavanger, Norway; Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway
| | - Mari Hysing
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Allison G Harvey
- Department of Psychology, University of California, Berkeley, USA
| | - Øystein Vedaa
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
| | - Børge Sivertsen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway; Department of Research and Innovation, Helse-Fonna HF, Haugesund, Norway
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Hu LK, Liu YH, Yang K, Chen N, Ma LL, Yan YX. Association between hypertriglyceridemic-waist phenotype and circadian syndrome risk: a longitudinal cohort study. Hormones (Athens) 2023; 22:457-466. [PMID: 37423976 DOI: 10.1007/s42000-023-00462-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 06/22/2023] [Indexed: 07/11/2023]
Abstract
Recently, circadian syndrome (CircS) has been proposed as a new predictor of cardiometabolic risk. We aimed to investigate the relationship between the hypertriglyceridemic-waist phenotype and its dynamic status with CircS in China. We conducted a two-stage study based on the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2015. Multivariate logistic regression models in cross-sectional analysis and Cox proportional hazards regression models in longitudinal analysis were used to estimate the associations of hypertriglyceridemic-waist phenotypes with CircS and its components. We then applied multiple logistic regression analysis to evaluate the odds ratios (ORs) and 95% confidence intervals (CIs) for CircS risk by transformation into the hypertriglyceridemic-waist phenotype. A total of 9863 participants were included in the cross-sectional analysis and 3884 participants in the longitudinal analysis. Compared with normal waist circumference (WC) and normal triglyceride (TG) level (NWNT), CircS risk was increased with enlarged WC and high TG level (EWHT) (hazard ratio (HR) 3.87 [95% CI: 2.38, 5.39]). Similar results were observed in subgroup analyses by sex, age, smoking status, and drinking status. During follow-up, CircS risk was increased in group K (stable EWNT during follow-up) (OR 9.97 [95% CI: 6.41, 15.49]) compared with group A (stable NWNT during follow-up), while group L (baseline enlarged WC and normal TG level transformed to follow-up EWHT) had the highest risk of CircS (OR 116.07 [95% CI: 72.77, 185.14]). In conclusion, the hypertriglyceridemic-waist phenotype and its dynamic status were associated with the risk of developing CircS in Chinese adults.
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Affiliation(s)
- Li-Kun Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmenWai, Fengtai District, Beijing, 100069, China
| | - Yu-Hong Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmenWai, Fengtai District, Beijing, 100069, China
| | - Kun Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmenWai, Fengtai District, Beijing, 100069, China
| | - Ning Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmenWai, Fengtai District, Beijing, 100069, China
| | - Lin-Lin Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmenWai, Fengtai District, Beijing, 100069, China
| | - Yu-Xiang Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmenWai, Fengtai District, Beijing, 100069, China.
- Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China.
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Glaus J, Kang SJ, Guo W, Lamers F, Strippoli MPF, Leroux A, Dey D, Plessen KJ, Vaucher J, Vollenweider P, Zipunnikov V, Merikangas KR, Preisig M. Objectively assessed sleep and physical activity in depression subtypes and its mediating role in their association with cardiovascular risk factors. J Psychiatr Res 2023; 163:325-336. [PMID: 37253320 DOI: 10.1016/j.jpsychires.2023.05.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 03/23/2023] [Accepted: 05/15/2023] [Indexed: 06/01/2023]
Abstract
The aims of this study were to investigate the associations of major depressive disorder (MDD) and its subtypes (atypical, melancholic, combined, unspecified) with actigraphy-derived measures of sleep, physical activity and circadian rhythms; and test the potentially mediating role of sleep, physical activity and circadian rhythms in the well-established associations of the atypical MDD subtype with Body Mass Index (BMI) and the metabolic syndrome (MeS). The sample consisted of 2317 participants recruited from an urban area, who underwent comprehensive somatic and psychiatric evaluations. MDD and its subtypes were assessed via semi-structured diagnostic interviews. Sleep, physical activity and circadian rhythms were measured using actigraphy. MDD and its subtypes were associated with several actigraphy-derived variables, including later sleep midpoint, low physical activity, low inter-daily stability and larger intra-individual variability of sleep duration and relative amplitude. Sleep midpoint and physical activity fulfilled criteria for partial mediation of the association between atypical MDD and BMI, and physical activity also for partial mediation of the association between atypical MDD and MeS. Our findings confirm associations of MDD and its atypical subtype with sleep and physical activity, which are likely to partially mediate the associations of atypical MDD with BMI and MeS, although most of these associations are not explained by sleep and activity variables. This highlights the need to consider atypical MDD, sleep and sedentary behavior as cardiovascular risk factors.
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Affiliation(s)
- Jennifer Glaus
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.
| | - Sun Jung Kang
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, 35 Convent Drive, MSC 3720, Bldg 35A, Room 2E422A, Bethesda, MD, USA
| | - Wei Guo
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, 35 Convent Drive, MSC 3720, Bldg 35A, Room 2E422A, Bethesda, MD, USA
| | - Femke Lamers
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Psychiatry, Boelalaan 1117, Amsterdam, the Netherlands; Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands
| | - Marie-Pierre F Strippoli
- Center for Research in Psychiatric Epidemiology and Psychopathology, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Andrew Leroux
- Department of Biostatistics and Informatics, University of Colorado, Anshutz Medical Campus, Aurora, CO, USA
| | - Debangan Dey
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, 35 Convent Drive, MSC 3720, Bldg 35A, Room 2E422A, Bethesda, MD, USA
| | - Kerstin J Plessen
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Julien Vaucher
- Department of Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Peter Vollenweider
- Department of Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Vadim Zipunnikov
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kathleen R Merikangas
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, 35 Convent Drive, MSC 3720, Bldg 35A, Room 2E422A, Bethesda, MD, USA
| | - Martin Preisig
- Center for Research in Psychiatric Epidemiology and Psychopathology, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
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Wu Y, Li S, Han D, Zhang M, Zhao J, Liao H, Ma Y, Yan C, Wang J. The Mediating Role of Depression in Association Between Total Sleep Time and Instrumental Activities of Daily Living in China. Int J Public Health 2023; 68:1605678. [PMID: 37081904 PMCID: PMC10110912 DOI: 10.3389/ijph.2023.1605678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/15/2023] [Indexed: 04/07/2023] Open
Abstract
Objectives: This study aims to investigate the mediating role of depression and the moderating effect of gender in the relationship between total sleep time (TST) and instrumental activities of daily living (IADL) in middle-aged and elderly people (aged 45 or above).Methods: The data used in this study is from the China Health and Retirement Longitudinal Study (CHARLS), including a total of 10,460 respondents. Associations between TST, IADL, depression, and gender were analyzed using logistic regression and Karlson, Holm, and Breen (KHB) methods.Results: Short (OR = 1.42, 95% CI = 1.28–1.58 of ≤6 h) and long TST (OR = 1.16, 95% CI = 1.02–1.32 of 8–9 h; OR = 1.35, 95% CI = 1.19–1.54 of >9 h) were both associated with IADL. The mediation effect analyses observed that depression explained 64.80% of the total effect of short TST (≤6 h) and IADL, but was insignificant in long TST (8–9 h and >9 h). Meanwhile, gender has moderating effects on the mediation effect model.Conclusion: The study suggests that health interventions that focused on the dimensions of TST and depression are crucial for preventing functional disability while accounting for gender differences.
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Affiliation(s)
- Yunyi Wu
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sangsang Li
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dan Han
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mei Zhang
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jie Zhao
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hui Liao
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Ma
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chaoyang Yan
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Wang
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- The Key Research Institute of Humanities and Social Science of Hubei Province, Huazhong University of Science and Technology, Wuhan, China
- Institute for Poverty Reduction and Development, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Jing Wang,
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The individual and joint associations of depression and sleep duration with cardiometabolic diseases and mortality: A prospective cohort study. Atherosclerosis 2022; 361:10-17. [PMID: 36252458 DOI: 10.1016/j.atherosclerosis.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Depression and sleep duration were only mutually adjusted in a few studies, and it is unknown whether these two factors are independent or overlapping risk factors for cardiometabolic diseases (CMDs) and mortality. This study aimed to evaluate the individual and joint associations of depression and sleep duration with CMDs and mortality. METHODS A total of 261,297 participants who were free of CMD at baseline were included. Sleep duration was divided into three groups (short: <7 h/day, referent: ages 39-64 years: 7-9 h/day; ages 65+ years: 7-8 h/day, and long: ages 39-64 years: >9 h/day; ages 65+ years: >8 h/day). The main outcomes were hypertension, stroke, CHD, DM, all-cause mortality, and cardiovascular mortality. RESULTS Among the 261,297 participants, depression and short or long sleep duration were independently associated with increased risk of CMDs and mortality (hazard ratio [HR], 1.10-1.38) when they were mutually adjusted, except for the association between short sleep duration and stroke (HR, 1.03; 95% confidence interval [CI], 0.97-1.10). We documented significant additive interactions between depression and short sleep duration in relation to all-cause mortality (relative excess risk due to interaction [RERI], 0.19; 95% CI, 0.02-0.37) and CHD (RERI, 0.30; 95% CI, 0.11-0.48). CONCLUSIONS In this study, depression and short or long sleep duration were independently associated with an increased risk of CMDs and mortality. We also observed significant additive interactions between depression and short sleep duration in relation to all-cause mortality and CHD.
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Brady SS, Bavendam TG, Bradway CK, Conroy B, Dowling-Castronovo A, Epperson CN, Hijaz AK, Hsi RS, Huss K, Kim M, Lazar J, Lee RK, Liu CK, Loizou CN, Miran S, Mody L, Norton JM, Reynolds WS, Sutcliffe S, Zhang N, Hokanson JA. Noncancerous Genitourinary Conditions as a Public Health Priority: Conceptualizing the Hidden Burden. Urology 2022; 166:39-49. [PMID: 34536410 PMCID: PMC8924010 DOI: 10.1016/j.urology.2021.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/07/2021] [Accepted: 08/30/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To provide a conceptual framework to guide investigations into burdens of noncancerous genitourinary conditions (NCGUCs), which are extensive and poorly understood. METHODS The National Institute of Diabetes and Digestive and Kidney Diseases convened a workshop of diverse, interdisciplinary researchers and health professionals to identify known and hidden burdens of NCGUCs that must be measured to estimate the comprehensive burden. Following the meeting, a subgroup of attendees (authors of this article) continued to meet to conceptualize burden. RESULTS The Hidden Burden of Noncancerous Genitourinary Conditions Framework includes impacts across multiple levels of well-being and social ecology, including individual (ie, biologic factors, lived experience, behaviors), interpersonal (eg, romantic partners, family members), organizational/institutional (eg, schools, workplaces), community (eg, public restroom infrastructure), societal (eg, health care and insurance systems, national workforce/economic output), and ecosystem (eg, landfill waste) effects. The framework acknowledges that NCGUCs can be a manifestation of underlying biological dysfunction, while also leading to biological impacts (generation and exacerbation of health conditions, treatment side effects). CONCLUSION NCGUCs confer a large, poorly understood burden to individuals and society. An evidence-base to describe the comprehensive burden is needed. Measurement of NCGUC burdens should incorporate multiple levels of well-being and social ecology, a life course perspective, and potential interactions between NCGUCs and genetics, sex, race, and gender. This approach would elucidate accumulated impacts and potential health inequities in experienced burdens. Uncovering the hidden burden of NCGUCs may draw attention and resources (eg, new research and improved treatments) to this important domain of health.
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Affiliation(s)
- Sonya S Brady
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN.
| | - Tamara G Bavendam
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | - Christine K Bradway
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA
| | - Britt Conroy
- Urology Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | | | - Cynthia Neill Epperson
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO
| | - Adonis K Hijaz
- Urology Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Ryan S Hsi
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Karen Huss
- Division of Extramural Science Programs, Symptom Science and Genetics, Self-Management Office, National Institute of Nursing Research, Bethesda, MD
| | - Michelle Kim
- Department of Urology, Massachusetts General Hospital, Boston, MA
| | - Jason Lazar
- Department of Medicine, SUNY Downstate Health Sciences University, New York, NY
| | - Richard K Lee
- Department of Urology, Weill Cornell Medical College, New York, NY
| | - Christine K Liu
- Section of Geriatrics, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA; Geriatric Research and Education Clinical Center, Palo Alto VA Health Care System, Palo Alto, CA; Section of Geriatrics, Department of Medicine, Boston University, Boston, MA
| | | | - Saadia Miran
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | - Lona Mody
- Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Ann Arbor, MI and VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Jenna M Norton
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | | | - Siobhan Sutcliffe
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO
| | - Nicole Zhang
- The Valley Foundation School of Nursing, College of Health and Human Sciences, San Jose State University, San Jose, CA
| | - James A Hokanson
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI
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Symptoms of depression are related to sedentary behavior and sleep duration in elderly individuals: A cross-sectional study of 49,317 older Chinese adults. J Affect Disord 2022; 308:407-412. [PMID: 35460733 DOI: 10.1016/j.jad.2022.04.102] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Depression is a common mental disorder in older adults. This study aimed to determine the incidence of depression and the relationship between sedentary behavior and sleep duration in elderly individuals. METHOD A total of 49,317 elderly adults from eight health centers in six Chinese provinces completed an online self-reported health questionnaire. Logistic regression was used to explore the association between sedentary behavior, sleep duration, and depression symptoms. RESULTS Symptoms of depression were present in 20.1% of older adults. Sedentary behaviors for >6 h/day (OR = 3.16; 95% CI: 2.90-3.44; p < 0.001) were a greater risk factor for depressive symptoms in older adults than sedentary behaviors for less than 3 h/day. Elderly individuals with short sleep durations (<7 h/day) were more likely to experience depression (OR = 2.20; 95% CI: 2.07-2.34; p < 0.001). CONCLUSION This study suggested that sedentary behavior and short sleep duration in older Chinese adults are associated with depressive symptoms. In China, further improvement of the mental health and lifestyle of elderly individuals may be warranted.
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Kennedy KER, Grandner MA. Long Sleep: Is There Such Thing as Too Much of a Good Thing? CURRENT SLEEP MEDICINE REPORTS 2022. [DOI: 10.1007/s40675-022-00224-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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12
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Zhu C, Wang J, Wang J, Zhong Q, Huang Y, Chen Y, Lian Z. Associations between depressive symptoms and sleep duration for predicting cardiovascular disease onset: A prospective cohort study. J Affect Disord 2022; 303:1-9. [PMID: 35104466 DOI: 10.1016/j.jad.2022.01.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND The joint effects of depressive symptoms and sleep on the risk of cardiovascular disease (CVD) are not well understood. The purpose of this study was to assess the combined impact of depressive symptoms and sleep duration on the incidence of CVD among middle-aged and older Chinese individuals. METHODS Data were from the China Health and Longitudinal Study conducted in 2013, 2015, and 2018. A total of 9595 participants aged ≥ 45 years without a history of CVD in 2013 were included. Depressive symptoms were measured using the 10-item Center for Epidemiological Studies Depression scale (elevated depressive symptoms cutoff ≥ 10). Average sleep duration was self-reported. Logistic regression analyses adjusted for age, sex, marital status, education and other potential confounders were conducted. RESULTS In total, 1072 (11.2%) participants reported CVD incidents over the 5-year period. Elevated depressive symptoms (OR = 1.49, 95% CI = 1.30-1.72) and short sleep duration (OR = 1.21, 95% CI = 1.05-1.40) were independently associated with an increased CVD risk in the fully adjusted model. Individuals with short sleep duration/low depressive symptoms (OR = 1.34, 95% CI = 1.12-1.60), short sleep duration/elevated depressive symptoms (OR = 1.70, 95% CI = 1.41-2.50), or long sleep duration/elevated depressive symptoms (OR = 2.13, 95% CI = 1.38-3.27) were more likely to develop CVD than those with normal sleep duration/low depressive symptoms. LIMITATIONS Depressive symptoms and sleep duration were self-reported. CONCLUSIONS A stronger risk of CVD was found when depressive symptoms and short or long sleep durations occurred together, suggesting that an integrated approach to sleep and depressive symptoms might be a feasible strategy for the prevention of CVD.
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Affiliation(s)
- Chunsu Zhu
- Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, No. 420, Fuma Road, Jinan, Fuzhou 350014, China
| | - Jianmin Wang
- Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, No. 420, Fuma Road, Jinan, Fuzhou 350014, China
| | - Jiaxue Wang
- Department of Pharmacy, Guizhou Provincial People's Hospital, Guiyang, China
| | - Qiaofeng Zhong
- Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, No. 420, Fuma Road, Jinan, Fuzhou 350014, China
| | - Yongying Huang
- Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, No. 420, Fuma Road, Jinan, Fuzhou 350014, China
| | - Ying Chen
- Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, No. 420, Fuma Road, Jinan, Fuzhou 350014, China
| | - Zhiwei Lian
- Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, No. 420, Fuma Road, Jinan, Fuzhou 350014, China.
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Smith P, Kandakatla A, Frankel CW, Bacon DR, Bush E, Mentz RJ, Snyder LD. Sleep quality, depressive symptoms, and transplant outcomes: Follow-up analyses from the ADAPT prospective pilot study. Gen Hosp Psychiatry 2021; 72:53-58. [PMID: 34298477 DOI: 10.1016/j.genhosppsych.2021.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 06/14/2021] [Accepted: 06/24/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Previous studies suggested that depressive symptoms and sleep quality may be important for long-term clinical outcomes following cardiothoracic transplant. Few studies, however, have systematically examined objective markers of these behavioral factors among ambulatory transplant recipients, or their association with clinical outcomes. METHODS We examined sleep quality and depressive symptoms with subsequent clinical outcomes (hospitalizations and death) in a sample of 66 lung or heart transplant recipients using a single-center, prospective cohort study. Recipients were assessed at approximately 6 months post-transplant and completed one week of actigraphy assessment to examine sleep quality and self-report measures of mood (Centers for Epidemiologic Studies of Depression [CESD]). Recipients were followed for clinical outcomes. RESULTS At 6-months following transplantation, recipients spent the majority of daytime activity at a sedentary level (61% of daily activity [SD = 10]) and elevated depressive symptoms were common (subclinical = 17%, mild = 12%, or moderate = 8%). Over a median follow-up of 4.5 years (IQR = 0.9, 5.1), 51 participants (77%) had at least one unplanned hospitalization and 11 (17%) participants died. In addition, sleep efficiency measurements suggested that a subset of participants exhibited suboptimal sleep (mean efficiency = 87% [SD = 7]). Poorer sleep quality, indexed by lower sleep efficiency and greater sleep fragmentation, was associated with greater depressive symptoms (r's = 0.37-0.50, P < .01). Better sleep quality at 6-months (HR = 0.75 [0.60, 0.95], P = .015), including sleep efficiency (HR = 0.74 [0.56, 0.99], P = .041) and sleep fragmentation (HR = 0.71 [0.53, 0.95], P = .020) were associated with lower risk of hospitalization or death. Compared with individuals without elevated depressive symptoms or sleep difficulties, individuals with either factor (HR = 1.72 [1.05, 2.81], P = .031) or both factors (HR = 2.37 [1.35, 4.18], P = .003) exhibited greater risk of clinical events in adjusted analyses. CONCLUSIONS Sleep quality is associated with depressive symptoms among cardiothoracic transplant recipients and enhances the prognostic association between biobehavioral risk factors and clinical outcomes.
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Affiliation(s)
- PatrickJ Smith
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, United States of America; Duke University Medical Center, Department of Medicine, Durham, NC, United States of America; Duke Clinical Research Institute, Durham, NC, United States of America.
| | - Apoorva Kandakatla
- Duke University Medical Center, Department of Medicine, Durham, NC, United States of America
| | - Courtney W Frankel
- Duke University Medical Center, Department of Medicine, Durham, NC, United States of America
| | - Daniel R Bacon
- University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, NC, United States of America
| | - Erika Bush
- Duke University Medical Center, Department of Medicine, Durham, NC, United States of America
| | - Robert J Mentz
- Duke University Medical Center, Department of Medicine, Durham, NC, United States of America; Duke Clinical Research Institute, Durham, NC, United States of America
| | - Laurie D Snyder
- Duke University Medical Center, Department of Medicine, Durham, NC, United States of America; Duke Clinical Research Institute, Durham, NC, United States of America
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Liang T, Munro HM, Hargreaves MK, Steinwandel MD, Blot WJ, Buchowski MS. Patterns and correlates of sleep duration in the Southern cohort community study. Sleep Med 2020; 75:459-467. [PMID: 32998092 DOI: 10.1016/j.sleep.2020.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate whether race (African American (AA) and white) is associated with sleep duration among adults from low socioeconomic (SES) strata and whether SES status, lifestyle behaviors, or health conditions are associated with sleep duration within race-sex groups. METHODS This cross-sectional study includes 78,549 participants from the Southern Community Cohort Study (SCCS). Averaged daily sleep duration was assessed by weighted averages of self-reported sleep duration on weekdays and weekends. Adjusted odds ratios (ORs) of very short (<5 h/day), short (5-6 h/day), and long sleep (≥9 h/day) associated with pre-selected risk factors in each race-sex group were determined by multinomial logistic models. RESULTS The prevalence of very short and short sleep was similar among AAs (6.2% and 29.1%) and whites (6.5% and 29.1%). Long sleep was considerably more prevalent among AAs (19.3%) than whites (13.0%). Very short sleep was associated with lower education and family income, with stronger associations among whites. Higher physical activity levels significantly decreased odds for both very short (OR = 0.80) and long sleep (OR = 0.78). Smoking, alcohol use, and dietary intake were not associated with sleep duration. Regardless of race or sex, very short, short, and long sleep were significantly associated with self-reported health conditions, especially depression (ORs were 2.06, 1.33, and 1.38, respectively). CONCLUSIONS Sleep duration patterns differed between AAs and whites from the underrepresented SCCS population with low SES. Sleep duration was associated with several socioeconomic, health behaviors, and health conditions depending on race and sex.
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Affiliation(s)
- Tao Liang
- Division of Gastroenterology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Heather M Munro
- International Epidemiology Field Station, Rockville, MD, USA; Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Mark D Steinwandel
- International Epidemiology Field Station, Rockville, MD, USA; Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - William J Blot
- International Epidemiology Field Station, Rockville, MD, USA; Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA; Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Maciej S Buchowski
- Division of Gastroenterology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
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Shih YC, Han SH, Burr JA. Are Spouses' Sleep Problems a Mechanism Through Which Health is Compromised? Evidence Regarding Insomnia and Heart Disease. Ann Behav Med 2020; 53:345-357. [PMID: 29947733 DOI: 10.1093/abm/kay048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Symptoms of insomnia have been widely identified as risk factors for health, including heart disease. Despite the expansive and growing literature on health concordance among coupled individuals, few studies have examined insomnia as a shared risk factor for heart disease among middle-aged and older couples. PURPOSE This study examined the association between insomnia and incident heart disease among couples. A dyadic modeling approach was employed to investigate the relationships between one's own insomnia and partners' insomnia for the risk of incident heart disease for each partner. METHODS Data from the 2010, 2012, and 2014 Health and Retirement Study were utilized in a prospective research design (N = 3,221 couples). Actor-partner interdependence models were employed to estimate actor and partner effects of insomnia symptoms for incident heart disease over the 4 year observation period. RESULTS Insomnia symptoms measured at baseline were related to an increased risk for heart disease for husbands, whereas for wives the association was attenuated after other health measures were controlled. Wives' insomnia was related to an increased risk of incident heart disease for husbands but husbands' insomnia was not related to wives' risk of heart disease. CONCLUSIONS This study showed how subjective insomnia symptoms among middle-aged and older adults in intimate partnerships are associated with their heart disease risk. Further research is needed to verify the results with objective measures of sleep problems and heart disease.
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Affiliation(s)
- Yao-Chi Shih
- Department of Social Welfare, National Chung Cheng University, Minxiong, Chiayi, Taiwan
| | - Sae Hwang Han
- Department of Gerontology, University of Massachusetts Boston, Boston, MA
| | - Jeffrey A Burr
- Department of Gerontology, University of Massachusetts Boston, Boston, MA
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Associations between dietary consumption and sleep quality in young Japanese males. Sleep Breath 2020; 25:199-206. [PMID: 32385731 DOI: 10.1007/s11325-020-02077-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 03/25/2020] [Accepted: 03/31/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Poor sleep quality has been reported to be a risk factor for cardiovascular disease, diabetes, and metabolic syndrome, as well as mental disorders including depression and anxiety. However, few studies have investigated the association between sleep quality and diet in young males. We aimed to assess this association, adjusting for psychological factors. METHODS In this study, a total of 124 male Japanese students were analyzed. Sleep quality, diet, and psychological symptoms were assessed using self-reported questionnaires, including the Pittsburgh Sleep Quality Index (PSQI), brief-type self-administered diet history questionnaire (BDHQ), 12-item General Health Questionnaire (GHQ12), and State-Trait Anxiety Inventory (STAI) A-Trait scale. RESULTS Among participants, 40% exhibited a PSQI total score ≥ 6, indicating poor sleep quality. Poor sleep quality was associated with poor mental health status and higher levels of anxiety. After adjusting for covariates including these psychological factors, poor sleep quality was significantly associated with low intakes of fat, beta-carotene, retinol, alpha-tocopherol, vitamin K, vitamin B1, daidzein, genistein, and iron. Poor sleep quality was also associated with low intake of pulses, fat and oil, as well as high intakes of sugar-sweetened beverages. CONCLUSIONS Our findings demonstrated that sleep quality among young Japanese males was associated with specific dietary features, independently of psychological status, which may help to elucidate the mechanisms underlying the link between sleep and sleep-related diseases.
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Abstract
AIMS The goals of the present study were to examine the associations between depressive symptoms, sleep problems and the risk of developing heart disease in a Canadian community sample. METHODS Baseline data were from the CARTaGENE study, a community health survey of adults aged 40-69 years in Quebec, Canada. Incidence of heart disease was examined in N = 33 455 participants by linking survey data with administrative health insurance data. Incident heart disease was identified using the World Health Organization's International Classification of Diseases, 9th or 10th edition (ICD-9 and ICD-10) diagnostic codes for heart disease. Sleep problems were assessed with diagnostic codes for sleep disorders within the 2 years preceding the baseline assessment. Average sleep duration was assessed by self-report. Depressive symptoms were assessed with the nine-item Patient Health Questionnaire. RESULTS In total, 2448 (7.3%) participants developed heart disease over an average follow-up period of 4.6 years. Compared to those without depressive symptoms and with no sleep disorders, those with elevated depressive symptoms and a sleep disorder (HR = 2.60, 95% CI 1.83-3.69), those with depressive symptoms alone (HR = 1.40, 95% CI 1.25-1.57) and those with sleep disorders alone (HR = 1.33, 95% CI 1.03-1.73) were more likely to develop heart disease. Test of additive interaction suggested a synergistic interaction between depressive symptoms and sleep disorders (synergy index = 2.17 [95% CI 1.01-4.64]). When sleep duration was considered, those with long sleep duration and elevated depressive symptoms were more likely to develop heart disease than those with long sleep alone (HR = 1.77, 95% CI 1.37-2.28; and HR = 1.16, 95% CI 0.99-1.36, respectively). CONCLUSIONS Depression and diagnosed sleep disorders or long sleep duration are independent risk factors for heart disease and are associated with a stronger risk of heart disease when occurring together.
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18
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Henst RHP, Pienaar PR, Roden LC, Rae DE. The effects of sleep extension on cardiometabolic risk factors: A systematic review. J Sleep Res 2019; 28:e12865. [DOI: 10.1111/jsr.12865] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 03/27/2019] [Accepted: 03/28/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Rob H. P. Henst
- Health Through Physical Activity, Lifestyle and Sport Research Centre Department of Human Biology Faculty of Health Sciences University of Cape Town Cape Town South Africa
| | - Paula R. Pienaar
- Health Through Physical Activity, Lifestyle and Sport Research Centre Department of Human Biology Faculty of Health Sciences University of Cape Town Cape Town South Africa
| | - Laura C. Roden
- Department of Molecular and Cell Biology Faculty of Science University of Cape Town Cape Town South Africa
| | - Dale E. Rae
- Health Through Physical Activity, Lifestyle and Sport Research Centre Department of Human Biology Faculty of Health Sciences University of Cape Town Cape Town South Africa
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Madsen MT, Huang C, Zangger G, Zwisler ADO, Gögenur I. Sleep Disturbances in Patients With Coronary Heart Disease: A Systematic Review. J Clin Sleep Med 2019; 15:489-504. [PMID: 30853047 DOI: 10.5664/jcsm.7684] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 01/08/2019] [Indexed: 12/19/2022]
Abstract
STUDY OBJECTIVES Investigation into sleep and coronary heart disease (CHD) has predominantly been focused on sleep disturbances as a risk factor for developing CHD. Objectively measured and self-reported sleep at a patient level has only been sparsely and not systematically reported. Therefore, we set out to review the literature for studies using objectively measured and self-reported sleep in patients with CHD. The review focuses on patients with acute coronary syndrome (ACS) and stable CHD. METHODS A systematic review performed in four databases adhering to the PRISMA guidelines applying a qualitative synthesis of evidence. RESULTS Following ACS, we found sleep architecture to be significantly disturbed with changes normalizing over a period of up to 6 months. With increasing severity of CHD, sleep disturbances were more pronounced; however, the modulating effects of sleep-disordered breathing and ejection fraction on sleep in patients with CHD are conflicting. Overall, studies were predominantly cross-sectional in design and of low methodological quality. Polysomnography was the predominant outcome assessment tool and validated self-reported assessment tools were limited. CONCLUSIONS Future investigations in sleep and CHD applying both a longitudinal design and investigating objective and self-reported sleep assessments are warranted. SYSTEMATIC REVIEW REGISTRATION Registry: PROSPERO, Title: Sleep measures in relation to coronary heart disease: a systematic review, Identifier: CRD42017056377, URL: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=56377.
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Affiliation(s)
- Michael Tilling Madsen
- Center for Surgical Science, Zealand University Hospital, Denmark.,Department of Emergency, Zealand University Hospital, Denmark
| | - Chenxi Huang
- Center for Surgical Science, Zealand University Hospital, Denmark
| | - Graziella Zangger
- REHPA - Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Denmark
| | - Ann Dorthe Olsen Zwisler
- REHPA - Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Denmark
| | - Ismail Gögenur
- Center for Surgical Science, Zealand University Hospital, Denmark
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Poole L, Jackowska M. The association between depressive and sleep symptoms for predicting incident disease onset after 6-year follow-up: findings from the English Longitudinal Study of Ageing. Psychol Med 2019; 49:607-616. [PMID: 29807551 PMCID: PMC6378411 DOI: 10.1017/s0033291718001290] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 04/10/2018] [Accepted: 04/18/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND The independent effects of depressive symptoms and sleep problems for future physical illness risk have yet to be studied systematically across a variety of disease endpoints. METHODS We analysed data from 7395 participants (65.81 ± 9.39 years; 54.8% female) from the English Longitudinal Study of Ageing (ELSA). Baseline was wave 4 and participants were followed up for 6 years until wave 7. Sleep was measured using an adapted version of the Jenkins Sleep Problems questionnaire and depressive symptoms using the Centre for Epidemiological Studies Depression scale. Participants with the illness of interest at baseline [coronary heart disease (CHD), cancer, diabetes/high blood glucose, arthritis] were excluded from models predicting the onset of that illness at follow-up. Logistic regression was used, entering depressive symptoms and sleep problems simultaneously into models controlling for a wide range of covariates. RESULTS In fully adjusted models depressive symptoms predicted incident CHD (OR 1.11, 95% CI 1.04-1.20, p = 0.004) and diabetes/high blood glucose (OR 1.13, 95% CI 1.04-1.22, p = 0.002) independent of sleep problems; both depressive symptoms (OR 1.10, 95% CI 1.04-1.16, p = 0.002) and sleep problems (OR 1.14, 95% CI 1.02-1.26, p = 0.019) predicted incident arthritis. CONCLUSIONS Sleep problems and depressive symptoms, and a combination of both, were differentially associated with physical illness onset 6 years later. Our findings highlight the importance of taking into account somatic and affective experiences when looking across a variety of different physical illnesses.
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Affiliation(s)
- Lydia Poole
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
| | - Marta Jackowska
- Department of Psychology, University of Roehampton, London, SW15 4JD, UK
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Wang ID, Chien WC, Chung CH, Tsai PY, Chang SY, Meng FC, Peng CK. Non-Apnea Sleep Disorder associates with increased risk of incident heart failure-A nationwide population-based cohort study. PLoS One 2019; 14:e0209673. [PMID: 30650103 PMCID: PMC6334965 DOI: 10.1371/journal.pone.0209673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 12/09/2018] [Indexed: 02/04/2023] Open
Abstract
Purpose Non-apnea sleep disorder (NASD) increases the risk of cardiovascular events, such as hypertension and ischemic heart disease (IHD). Patients with heart failure (HF) are at higher risk for sleep disorder; however, there is no documentation on NASD’s association with HF to date. Therefore, our study aimed to determine whether NASD increases the risk of incident HF. Materials and methods Using the outpatient and inpatient data from Taiwan’s Longitudinal Health Insurance Database, we conducted a nationwide cohort study of patients with a first-time diagnosis of NASD in the year 2000 and followed up the risk of incident heart failure until December 31, 2013. We calculated risks and incidence ratios of HF for patients with NASD compared with the general population. The cumulative incidence of NASD and the subsequent risk of HF are assessed by the Kaplan-Meier method and Cox regression using a matched comparison cohort of HF patients without NASD. Results The NASD cohort had an adjusted hazard ratio (HR) of incident HF 19.7% higher than that of the cohort without NASD (95% CI = 1.130–1.270; p<0.001). In the NASD population, the mean interval to HF in males and females were 5.00±3.69 years and 5.00±3.66 years, respectively. The Kaplan-Meier analysis indicated that after the seventh year, the incidence of HF was higher in the NASD cohort than in the control cohort till the end of the follow up. Conclusions Our study demonstrates that NASD patients are associated with a higher risk of incident HF.
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Affiliation(s)
- I-Duo Wang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan
| | - Pei-Yi Tsai
- Department of Radiation Oncology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Shan-Yueh Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Fan-Chun Meng
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chung-Kan Peng
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Sleep Medicine Center, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- * E-mail:
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Twelve-Month Incidence of Depressive Symptoms in Suburb-Dwelling Chinese Older Adults: Role of Sarcopenia. J Am Med Dir Assoc 2019; 20:64-69. [DOI: 10.1016/j.jamda.2018.07.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 07/16/2018] [Accepted: 07/23/2018] [Indexed: 12/14/2022]
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Hein M, Lanquart JP, Loas G, Hubain P, Linkowski P. Risk of high blood pressure associated with objective insomnia and self-reported insomnia complaints in major depression: A study on 703 individuals. Clin Exp Hypertens 2018; 41:538-547. [PMID: 30303409 DOI: 10.1080/10641963.2018.1516775] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Since few studies have investigated the risk of high blood pressure associated with objective insomnia and self-reported insomnia complaints in major depression, the aim of this study was to examine this risk in a large sample of individuals with major depression. METHODS Data from 703 individuals with major depression recruited from the research database of the sleep laboratory of the Erasme Hospital were analysed. High blood pressure status was defined by the presence of one of the following: self-reports at interview of either a physician-diagnosis or taking antihypertensive medication; or an average systolic blood pressure ≥140 mmHg or an average diastolic blood pressure ≥90 mmHg during at least two medical examinations. Logistic regression analyses were conducted to examine the risk of high blood pressure associated with objective insomnia and self-reported insomnia complaints in major depression. RESULTS After adjustment for major confounding factors associated with high blood pressure, multivariate logistic regression analysis revealed that severe objective insomnia, low complaints of repeated nighttime awakenings or early morning awakening, and intermediate or low self-reported insomnia complaints were significant risk factors of high blood pressure in major depression. CONCLUSION In major depression, severe objective insomnia and lower self-reported insomnia complaints are associated with higher risk of high blood pressure, which justifies a better management of objective insomnia and a better assessment of insomnia complaints in this particular subpopulation to avoid the negative consequences related to the co-occurrence of high blood pressure and major depression. Abbreviations: AHI, Apnea-Hypopnea Index; BDI, Beck Depression Inventory; BMI, Body Mass Index; DSM IV-TR, Diagnostic and Statistical Manual of Mental Disorders fourth edition - Text Revision; ESS, Epworth Sleepiness scale; ISI, Insomnia Severity Index; HBP, High Blood Pressure; OSA, Obstructive Sleep Apnea Syndrome; REM, rapid eye movement sleep.
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Affiliation(s)
- Matthieu Hein
- a Erasme Hospital, Department of Psychiatry and Sleep Laboratory , Université libre de Bruxelles, ULB , Brussels , Belgium
| | - Jean-Pol Lanquart
- a Erasme Hospital, Department of Psychiatry and Sleep Laboratory , Université libre de Bruxelles, ULB , Brussels , Belgium
| | - Gwenolé Loas
- a Erasme Hospital, Department of Psychiatry and Sleep Laboratory , Université libre de Bruxelles, ULB , Brussels , Belgium
| | - Philippe Hubain
- a Erasme Hospital, Department of Psychiatry and Sleep Laboratory , Université libre de Bruxelles, ULB , Brussels , Belgium
| | - Paul Linkowski
- a Erasme Hospital, Department of Psychiatry and Sleep Laboratory , Université libre de Bruxelles, ULB , Brussels , Belgium
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Hein M, Lanquart JP, Loas G, Hubain P, Linkowski P. Objective sleep alterations and long-term use of short or intermediate half-life benzodiazepine receptor agonists are risk factors for high blood pressure in individuals with insomnia: a study in 1272 individuals referred for sleep examinations. Sleep Med 2018; 53:115-123. [PMID: 30508779 DOI: 10.1016/j.sleep.2018.08.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 08/14/2018] [Accepted: 08/27/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Given conflicting data in the literature, the aim of this study was to examine the risk of high blood pressure (HBP) associated with sleep alterations, measured during polysomnography, and long-term use of benzodiazepine receptor agonists in a large sample of individuals with insomnia. METHODS Demographic and polysomnographic data from 1272 individuals with insomnia recruited from the research database of the sleep laboratory of Erasme Hospital were analyzed. HBP status was defined by the presence of one of the following: self-report at interview of either a physician's diagnosis or taking antihypertensive medication; or an average systolic blood pressure ≥140 mm Hg or an average diastolic blood pressure ≥90 mm Hg at the medical examination. Logistic regression analyses were conducted to examine the risk of HBP associated with objective sleep alterations and long-term use of benzodiazepine receptor agonists in individuals with insomnia. RESULTS The prevalence of HBP in individuals with insomnia is 30.03%. After adjustment for major confounding factors associated with HBP, multivariate logistic regression analysis revealed that short sleep duration (<5 h), severely reduced sleep efficiency (<65%), high sleep fragmentation (sleep fragmentation index ≥18/h), and long-term use of short or intermediate half-life benzodiazepine receptor agonists were significant risk factors for HBP in individuals with insomnia. CONCLUSION In individuals with insomnia, objective sleep alterations and long-term use of short or intermediate half-life benzodiazepine receptor agonists are associated with higher risk of HBP. Therefore, better management of these reversible risk factors is required to avoid the negative consequences of the co-occurrence of insomnia and HBP.
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Affiliation(s)
- Matthieu Hein
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université Libre de Bruxelles, ULB, Brussels, Belgium.
| | - Jean-Pol Lanquart
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université Libre de Bruxelles, ULB, Brussels, Belgium
| | - Gwénolé Loas
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université Libre de Bruxelles, ULB, Brussels, Belgium
| | - Philippe Hubain
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université Libre de Bruxelles, ULB, Brussels, Belgium
| | - Paul Linkowski
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université Libre de Bruxelles, ULB, Brussels, Belgium
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The bidirectional relationship between sleep duration and depression in community-dwelling middle-aged and elderly individuals: evidence from a longitudinal study. Sleep Med 2018; 52:221-229. [PMID: 29861378 DOI: 10.1016/j.sleep.2018.03.011] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 02/24/2018] [Accepted: 03/13/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND There are several studies that have focused on the relationship between sleep duration and depression, however, only a few prospective studies have centered on the bidirectional relationship between them. This four-year longitudinal study aimed to identify the association between sleep duration and depression in community-dwelling mid-age and elderly individuals. METHODS 10,704 participants from the China Health and Retirement Longitudinal Study (CHARLS) were included for baseline and four-year follow up. Of these individuals, 7866 and 2956 were used to identify the effects of sleep duration on onset and recurrent depression respectively. 4504 individuals with normal sleep duration at baseline were included to examine the effects of depression on changes of sleep time. The 10-item version of the Centre for Epidemiological Studies Depression scale (CESD-10) was used to access depressive symptoms, as well sleep duration was self-reported. RESULTS Participants with short sleep duration (<5 and 5-6 h) had a higher risk of depression onset (OR 1.69 [1.36-2.11], 1.48 [1.19-1.84]) and recurrent depression (OR 1.44 [1.12-1.86], 1.32 [1.00-1.74]) compared to participants with normal sleep durations (7-8 h). Long sleep durations (>9 h) had no significant risks for depression. Males and the elderly (over 60 years-old) were more sensitive to short sleep durations and experienced a higher incidence of depression. Individuals with depression were more likely to have short sleep durations instead of long ones (RRR 1.20 [1.02-1.43]). CONCLUSIONS The present study identified the bidirectional relationship between sleep duration and depression. Short sleep durations were a risk factor for the onset and recurrent depression. Conversely, depression induced short sleep durations rather than excessive sleep durations. Future studies need to focus on identifying the mechanism between sleep duration and depression, and develop additional evidence-based cost-effective interventions to prevent depression and sleep problems.
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Fat mass and obesity-associated (FTO) rs9939609 polymorphism modifies the relationship between body mass index and affective symptoms through the life course: a prospective birth cohort study. Transl Psychiatry 2018; 8:62. [PMID: 29531329 PMCID: PMC5847566 DOI: 10.1038/s41398-018-0110-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Although bi-directional relationships between high body mass index (BMI) and affective symptoms have been found, no study has investigated the relationships across the life course. There has also been little exploration of whether the fat mass and obesity-associated (FTO) rs9939609 single-nucleotide polymorphism (SNP) is associated with affective symptoms and/or modifies the relationship between BMI and affective symptoms. In the MRC National Survey of Health and Development (NSHD), 4556 participants had at least one measure of BMI and affective symptoms between ages 11 and 60-64 years. A structural equation modelling framework was used with the BMI trajectory fitted as latent variables representing BMI at 11, and adolescent (11-20 years), early adulthood (20-36 years) and midlife (36-53 years) change in BMI. Higher levels of adolescent emotional problems were associated with greater increases in adult BMI and greater increases in early adulthood BMI were associated with higher subsequent levels of affective symptoms in women. The rs9939609 risk variant (A allele) from 2469 participants with DNA genotyping at age 53 years showed mostly protective effect modification of these relationship. Increases in adolescent and early adulthood BMI were generally not associated with, or were associated with lower levels, of affective symptoms in the FTO risk homozygote (AA) group, but positive associations were seen in the TT group. These results suggest bi-directional relationships between higher BMI and affective symptoms across the life course in women, and that the relationship could be ameliorated by rs9939609 risk variant.
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Lippman S, Gardener H, Rundek T, Seixas A, Elkind MSV, Sacco RL, Wright CB, Ramos AR. Short sleep is associated with more depressive symptoms in a multi-ethnic cohort of older adults. Sleep Med 2017; 40:58-62. [PMID: 29221780 PMCID: PMC5726583 DOI: 10.1016/j.sleep.2017.09.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/26/2017] [Accepted: 09/08/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To evaluate cross-sectional and prospective associations between short and long sleep duration and depressive symptoms in older adults (aged >65 years). METHODS The data from a subsample of the racially/ethnically diverse Northern Manhattan Study were analyzed. Depressive symptoms were assessed twice with the Center for Epidemiologic Studies Depression Scale (CES-D), approximately 5 years apart. The presence of depressive symptoms was defined as a CES-D score ≥16 or use of antidepressants. Self-reports of short (<6 h), intermediate (6-8 h) and long (≥9 h) sleep were assessed prior to the initial CES-D. Logistic regression was used to evaluate the cross-sectional associations between short and long sleep durations with depressive symptoms, using intermediate sleep as the reference. The prospective association between sleep duration and depression in a sample of participants without depressive symptoms at first CES-D was also analyzed. All models were adjusted for demographic, behavioral, and vascular risk factors. RESULTS The initial sample consisted of 1110 participants: 62% women, 69% Hispanic, 17% black, 14% white. Short sleep was reported by 25%, intermediate sleep by 65%, and long sleep by 9%. Depressive symptoms were described in 25% of the initial sample. Short sleep, but not long sleep, was associated with depressive symptoms at baseline (adjusted OR 1.8, 95% CI 1.3-2.6), and at follow-up (adjusted OR 1.9, 95% CI 1.1-3.5; median follow-up = 5.1 years). CONCLUSION Short sleep duration had a cross-sectional and prospective association with depressive symptoms in an urban multi-ethnic cohort of older adults.
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Affiliation(s)
- Suzanne Lippman
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hannah Gardener
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tatjana Rundek
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Azizi Seixas
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Mitchell S V Elkind
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Ralph L Sacco
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Clinton B Wright
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Alberto R Ramos
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
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Murray K, Godbole S, Natarajan L, Full K, Hipp JA, Glanz K, Mitchell J, Laden F, James P, Quante M, Kerr J. The relations between sleep, time of physical activity, and time outdoors among adult women. PLoS One 2017; 12:e0182013. [PMID: 28877192 PMCID: PMC5587264 DOI: 10.1371/journal.pone.0182013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 07/11/2017] [Indexed: 12/25/2022] Open
Abstract
Physical activity and time spent outdoors may be important non-pharmacological approaches to improve sleep quality and duration (or sleep patterns) but there is little empirical research evaluating the two simultaneously. The current study assesses the role of physical activity and time outdoors in predicting sleep health by using objective measurement of the three variables. A convenience sample of 360 adult women (mean age = 55.38 ±9.89 years; mean body mass index = 27.74 ±6.12) was recruited from different regions of the U.S. Participants wore a Global Positioning System device and ActiGraph GT3X+ accelerometers on the hip for 7 days and on the wrist for 7 days and 7 nights to assess total time and time of day spent outdoors, total minutes in moderate-to-vigorous physical activity per day, and 4 measures of sleep health, respectively. A generalized mixed-effects model was used to assess temporal associations between moderate-to-vigorous physical activity, outdoor time, and sleep at the daily level (days = 1931) within individuals. There was a significant interaction (p = 0.04) between moderate-to-vigorous physical activity and time spent outdoors in predicting total sleep time but not for predicting sleep efficiency. Increasing time outdoors in the afternoon (versus morning) predicted lower sleep efficiency, but had no effect on total sleep time. Time spent outdoors and the time of day spent outdoors may be important moderators in assessing the relation between physical activity and sleep. More research is needed in larger populations using experimental designs.
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Affiliation(s)
- Kate Murray
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Family Medicine & Public Health, University of California, San Diego, La Jolla, California, United States of America
| | - Suneeta Godbole
- Department of Family Medicine & Public Health, University of California, San Diego, La Jolla, California, United States of America
| | - Loki Natarajan
- Department of Family Medicine & Public Health, University of California, San Diego, La Jolla, California, United States of America
| | - Kelsie Full
- Department of Family Medicine & Public Health, University of California, San Diego, La Jolla, California, United States of America
| | - J. Aaron Hipp
- Department of Parks, Recreation, and Tourism Management, North Carolina State University, Raleigh, North Carolina, United States of America
- Center for Geospatial Analytics, North Carolina State University, Raleigh, North Carolina, United States of America
- Center for Human Health and the Environment, North Carolina State University, Raleigh, North Carolina, United States of America
| | - Karen Glanz
- Perelman School of Medicine and School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Jonathan Mitchell
- Division of Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Francine Laden
- Departments of Environmental Health and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Peter James
- Division of Chronic Disease Research Across the Lifecourse (CoRAL), Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States of America
| | - Mirja Quante
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Neonatology, University of Tuebingen, Tuebingen, Germany
| | - Jacqueline Kerr
- Department of Family Medicine & Public Health, University of California, San Diego, La Jolla, California, United States of America
- * E-mail:
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Yadav D, Hyun DS, Ahn SV, Koh SB, Kim JY. A prospective study of the association between total sleep duration and incident hypertension. J Clin Hypertens (Greenwich) 2016; 19:550-557. [DOI: 10.1111/jch.12960] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 11/03/2016] [Accepted: 11/11/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Dhananjay Yadav
- Department of Preventive Medicine; Yonsei University Wonju College of Medicine; Wonju South Korea
| | - Dae Sung Hyun
- Department of Preventive Medicine; Yonsei University Wonju College of Medicine; Wonju South Korea
| | - Song Vogue Ahn
- Department of Preventive Medicine; Yonsei University Wonju College of Medicine; Wonju South Korea
| | - Sang-Baek Koh
- Department of Preventive Medicine; Yonsei University Wonju College of Medicine; Wonju South Korea
| | - Jang Young Kim
- Department of Cardiology; Yonsei University Wonju College of Medicine; Wonju South Korea
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Yoo T, Ye B, Kim JI, Park S. Relationship of workplace violence and perpetrators on sleep disturbance-data from the 4th Korean working conditions survey. Ann Occup Environ Med 2016; 28:59. [PMID: 27777783 PMCID: PMC5069948 DOI: 10.1186/s40557-016-0142-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 09/28/2016] [Indexed: 12/25/2022] Open
Abstract
Objective The present study analyzed relationship of workplace violence and perpetrators of violence on sleep disturbance among wage workers in Korea. Methods The present study used data from the 4th Korean Working Conditions Survey (KWCS) of 2014 in selecting a total of 25,138wage workers as the study population, which excluded those who failed or refused to respond to questions required for the present study. The workplace violence experience group included people who satisfied at least one of six relevant criteria (verbal abuse, unwanted sexual attention, threatening or humiliating behavior, physical violence, bullying/harassment, and sexual harassment) and the group was divided according to whether the perpetrator of violence was a client or colleague. Presence of sleep disturbance was determined based on subjective symptoms felt within the past 12 months by each individual. A multiple logistic regression analysis was performed to identify the effects on sleep distance according to general, occupational, and psychosocial characteristics, as well as the types of workplace violence and perpetrators of violence. Results Workplace violence was found as a factor affecting sleep disturbance (OR = 3.773, 95 % CI = 3.058–4.655), and with respect to perpetrators of violence, complaint of sleep disturbance symptoms was higher when the perpetrator was a colleague or boss (OR = 5.688, 95 % CI 4.189–7.723) than a client (OR = 2.992, 95 % CI 2.301–3.890). Conclusion Workplace violence had an effect on occurrence of sleep disturbance and when the perpetrators of violence was a boss or colleague at work, the risk for symptoms such as sleep disturbance increased, which indicated the need for appropriate intervention from a workplace healthcare perspective, including preventive education of workplace violence among employees.
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Affiliation(s)
- Taejun Yoo
- Department of Occupational & Environmental Medicine, College of Medicine, Dong-A University, Busan, South Korea
| | - Byeongjin Ye
- Department of Occupational & Environmental Medicine, College of Medicine, Dong-A University, Busan, South Korea
| | - Jung-Il Kim
- Department of Occupational & Environmental Medicine, College of Medicine, Dong-A University, Busan, South Korea
| | - Siwoo Park
- Department of Occupational & Environmental Medicine, College of Medicine, Dong-A University, Busan, South Korea
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Garbarino S, Lanteri P, Durando P, Magnavita N, Sannita WG. Co-Morbidity, Mortality, Quality of Life and the Healthcare/Welfare/Social Costs of Disordered Sleep: A Rapid Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E831. [PMID: 27548196 PMCID: PMC4997517 DOI: 10.3390/ijerph13080831] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 08/10/2016] [Accepted: 08/11/2016] [Indexed: 12/15/2022]
Abstract
Sleep disorders are frequent (18%-23%) and constitute a major risk factor for psychiatric, cardiovascular, metabolic or hormonal co-morbidity and mortality. Low social status or income, unemployment, life events such as divorce, negative lifestyle habits, and professional requirements (e.g., shift work) are often associated with sleep problems. Sleep disorders affect the quality of life and impair both professional and non-professional activities. Excessive daytime drowsiness resulting from sleep disorders impairs efficiency and safety at work or on the road, and increases the risk of accidents. Poor sleep (either professional or voluntary) has detrimental effects comparable to those of major sleep disorders, but is often neglected. The high incidence and direct/indirect healthcare and welfare costs of sleep disorders and poor sleep currently constitute a major medical problem. Investigation, monitoring and strategies are needed in order to prevent/reduce the effects of these disorders.
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Affiliation(s)
- Sergio Garbarino
- Center of Sleep Medicine, Genoa 16132, Italy.
- Department of Neuroscience, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa 16132, Italy.
| | - Paola Lanteri
- Child Neurology and Psychiatry Unit, Istituto Giannina Gaslini, Genoa 16148, Italy.
| | - Paolo Durando
- Department of Health Sciences, Postgraduate School in Occupational Medicine, University of Genoa and Occupational Medicine Unit, IRCCS AOU San Martino IST, Genoa 16132, Italy.
| | - Nicola Magnavita
- Department of Public Health, Università Cattolica del Sacro Cuore, Rome 00168, Italy.
| | - Walter G Sannita
- Center of Sleep Medicine, Genoa 16132, Italy.
- Department of Neuroscience, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa 16132, Italy.
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Castañeda SF, Buelna C, Giacinto RE, Gallo LC, Sotres-Alvarez D, Gonzalez P, Fortmann AL, Wassertheil-Smoller S, Gellman MD, Giachello AL, Talavera GA. Cardiovascular disease risk factors and psychological distress among Hispanics/Latinos: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Prev Med 2016; 87:144-150. [PMID: 26921653 PMCID: PMC4884536 DOI: 10.1016/j.ypmed.2016.02.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 01/25/2016] [Accepted: 02/22/2016] [Indexed: 12/17/2022]
Abstract
Studies show that cardiovascular disease (CVD) risk factors are correlated with psychological distress, yet research examining these relationships among Hispanic/Latinos is lacking. The population-based Hispanic Community Health Study/Study of Latinos enrolled a cohort of Hispanic/Latino adults (N=16,415) 18-74years of age at the time of recruitment, from four US metropolitan areas, between March 2008 and June 2011. Psychological distress (i.e., 10-item Center for Epidemiological Studies Depression Scale, 10 item Spielberger Trait Anxiety Scale, and a combined depression/anxiety score), socio-demographics (i.e., age, education, income, insurance, sex, and Hispanic/Latino background), acculturation (i.e., country of birth and language preference), and traditional CVD risk factors (i.e., dyslipidemia, obesity, current cigarette smoking, diabetes, and hypertension) were assessed at baseline. Associations between CVD risk factors and psychological distress measures by sex were examined using multiple linear regression models, accounting for complex survey design and sampling weights and controlling for socio-demographic and acculturation covariates. In adjusted analyses, all three psychological distress measures were significantly related to smoking. For females, greater psychological distress was significantly related to obesity and current smoking. For males, diabetes and current smoking were associated with psychological distress. For males and females, dyslipidemia and hypertension were not associated with psychological distress after adjusting for other factors. Elevated depression and anxiety symptoms were associated with CVD risk factors for Hispanic/Latino men and women. However, these results were not consistent across Hispanic/Latino groups. As promoted by the integrative care model, psychosocial concerns should be considered in research on CVD risk and chronic disease prevention.
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Affiliation(s)
- Sheila F Castañeda
- Graduate School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, CA 92182, USA.
| | - Christina Buelna
- Graduate School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, CA 92182, USA
| | - Rebeca Espinoza Giacinto
- Graduate School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, CA 92182, USA
| | - Linda C Gallo
- Department of Psychology, San Diego State University, 5500 Campanile Dr, San Diego, CA 92182, USA
| | - Daniela Sotres-Alvarez
- Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina, 137 E. Franklin Street, Suite 203, CB#8030, Chapel Hill, NC 27514, USA
| | - Patricia Gonzalez
- Graduate School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, CA 92182, USA
| | - Addie L Fortmann
- Scripps Whittier Diabetes Institute, 10140 Campus Point Drive, San Diego, CA 92121, USA
| | - Sylvia Wassertheil-Smoller
- Department of Epidemiology and Population Health, Einstein College of Medicine, 1300 Morris Park Avenue, Belfer Building, Room 1312, Bronx, NY 10461, USA
| | - Marc D Gellman
- Behavioral Medicine Research Center, University of Miami, 1251 Stanford Dr, Coral Gables, FL 33146, USA
| | - Aida L Giachello
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Dr, Suite 1400, Chicago, IL 60611, USA
| | - Gregory A Talavera
- Graduate School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, CA 92182, USA
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Kim JY, Yadav D, Ahn SV, Koh SB, Park JT, Yoon J, Yoo BS, Lee SH. A prospective study of total sleep duration and incident metabolic syndrome: the ARIRANG study. Sleep Med 2015; 16:1511-5. [DOI: 10.1016/j.sleep.2015.06.024] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 05/24/2015] [Accepted: 06/24/2015] [Indexed: 10/23/2022]
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Mukherjee S, Patel SR, Kales SN, Ayas NT, Strohl KP, Gozal D, Malhotra A. An Official American Thoracic Society Statement: The Importance of Healthy Sleep. Recommendations and Future Priorities. Am J Respir Crit Care Med 2015; 191:1450-8. [PMID: 26075423 DOI: 10.1164/rccm.201504-0767st] [Citation(s) in RCA: 148] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
RATIONALE Despite substantial public interest, few recommendations on the promotion of good sleep health exist to educate health care providers and the general public on the importance of sleep for overall health. OBJECTIVES The aim of this American Thoracic Society (ATS) statement is to provide a review of the current scientific literature to assist health care providers, especially pulmonologists and sleep physicians, in making recommendations to patients and the general public about the importance of achieving good quality and adequate quantity of sleep. METHODS ATS members were invited, based on their expertise in sleep medicine, and their conclusions were based on both empirical evidence identified after comprehensive literature review and clinical experience. MAIN RESULTS We focus on sleep health in both children and adults, including the impact of occupation on sleep, the public health implications of drowsy driving, and the common sleep disorders of obstructive sleep apnea and insomnia. This ATS statement also delineates gaps in research and knowledge that should be addressed and lead to new focused research priorities to advance knowledge in sleep and sleep health. CONCLUSIONS Good quality and quantity of sleep are essential for good health and overall quality of life; therefore a strong recommendation was made for the implementation of public education programs on the importance of sleep health.
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Helbig AK, Stöckl D, Heier M, Ladwig KH, Meisinger C. Symptoms of Insomnia and Sleep Duration and Their Association with Incident Strokes: Findings from the Population-Based MONICA/KORA Augsburg Cohort Study. PLoS One 2015; 10:e0134480. [PMID: 26230576 PMCID: PMC4521822 DOI: 10.1371/journal.pone.0134480] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 07/10/2015] [Indexed: 12/21/2022] Open
Abstract
Objective To examine the relationship between symptoms of insomnia and sleep duration and incident total (non-fatal plus fatal) strokes, non-fatal strokes, and fatal strokes in a large cohort of men and women from the general population in Germany. Methods In four population-based MONICA (monitoring trends and determinants in cardiovascular disease)/KORA (Cooperative Health Research in the Region of Augsburg) surveys conducted between 1984 and 2001, 17,604 men and women (aged 25 to 74 years) were asked about issues like sleep, health behavior, and medical history. In subsequent surveys and mortality follow-ups, incident stroke cases (cerebral hemorrhage, ischemic stroke, transient ischemic attack, unknown stroke type) were gathered prospectively until 2009. Sex-specific hazard ratios (HR) and their 95% confidence intervals (CI) were estimated using sequential Cox proportional hazards regression models. Results During a mean follow-up of 14 years, 917 strokes (710 non-fatal strokes and 207 fatal strokes) were observed. Trouble falling asleep and difficulty staying asleep were not significantly related to any incident stroke outcome in either sex in the multivariable models. Among men, the HR for the association between short (≤5 hours) and long (≥10 hours) daily sleep duration and total strokes were 1.44 (95% CI: 1.01–2.06) and 1.63 (95% CI: 1.16–2.29), after adjustment for basic confounding variables. As for non-fatal strokes and fatal strokes, in the analyses adjusted for age, survey, education, physical activity, alcohol consumption, smoking habits, body mass index, hypertension, diabetes, and dyslipidemia, the increased risks persisted, albeit somewhat attenuated, but no longer remained significant. Among women, in the multivariable analyses the quantity of sleep was also not related to any stroke outcome. Conclusion In the present study, symptoms of insomnia and exceptional sleep duration were not significantly predictive of incident total strokes, non-fatal strokes, and fatal strokes in either sex.
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Affiliation(s)
- A Katharina Helbig
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Doris Stöckl
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Margit Heier
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Karl-Heinz Ladwig
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Department for Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christa Meisinger
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
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Matthews KA, Pantesco EJM. Sleep characteristics and cardiovascular risk in children and adolescents: an enumerative review. Sleep Med 2015; 18:36-49. [PMID: 26459685 DOI: 10.1016/j.sleep.2015.06.004] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 04/23/2015] [Accepted: 06/01/2015] [Indexed: 01/10/2023]
Abstract
Cardiovascular risk factors develop in childhood and adolescence. This enumerative review addresses whether sleep characteristics, including sleep duration, continuity, quality, and daytime sleepiness, are associated with cardiovascular risk factors in young people. Thirty-nine studies were identified, which examined the following risk factors: metabolic syndrome, glucose and insulin, lipids, blood pressure, and cardiovascular responses to psychological stressors. Due to the availability of other reviews, 16 longitudinal studies of obesity published in 2011 and later were also included in this report. Excluded from the review were studies of participants with suspected or diagnosed sleep disorders and reports from sleep deprivation experiments. Combining studies, evidence was strongest for obesity, followed by glucose, insulin, blood pressure (especially ambulatory blood pressure), and parasympathetic responses to psychological stressors. There was little evidence for metabolic syndrome cluster, lipids, and blood pressure responses to psychological stressors. The more positive associations were obtained for studies that incorporated objective measures of sleep and that included adolescents. The foundational evidence is almost entirely cross-sectional, except for work on obesity. In summary, available evidence suggests that the associations between sleep characteristics and cardiovascular risk vary by risk factor. It is time to conduct studies to determine antecedent and consequent relationships, and to expand risk factors to include markers of inflammation.
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Affiliation(s)
- Karen A Matthews
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
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Chen JC, Espeland MA, Brunner RL, Lovato LC, Wallace RB, Leng X, Phillips LS, Robinson JG, Kotchen JM, Johnson KC, Manson JE, Stefanick ML, Sarto GE, Mysiw WJ. Sleep duration, cognitive decline, and dementia risk in older women. Alzheimers Dement 2015; 12:21-33. [PMID: 26086180 DOI: 10.1016/j.jalz.2015.03.004] [Citation(s) in RCA: 158] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 12/03/2014] [Accepted: 03/02/2015] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Consistent evidence linking habitual sleep duration with risks of mild cognitive impairment (MCI) and dementia is lacking. METHODS We conducted a prospective study on 7444 community-dwelling women (aged 65-80 y) with self-reported sleep duration, within the Women's Health Initiative Memory Study in 1995-2008. Incident MCI/dementia cases were ascertained by validated protocols. Cox models were used to adjust for multiple sociodemographic and lifestyle factors, depression, cardiovascular disease (CVD), and other clinical characteristics. RESULTS We found a statistically significant (P = .03) V-shaped association with a higher MCI/dementia risk in women with either short (≤6 hours/night) or long (≥8 hours/night) sleep duration (vs. 7 hours/night). The multicovariate-adjusted hazard for MCI/dementia was increased by 36% in short sleepers irrespective of CVD, and by 35% in long sleepers without CVD. A similar V-shaped association was found with cognitive decline. DISCUSSION In older women, habitual sleep duration predicts the future risk for cognitive impairments including dementia, independent of vascular risk factors.
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Affiliation(s)
- Jiu-Chiuan Chen
- Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA.
| | - Mark A Espeland
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Robert L Brunner
- Department of Family and Community Medicine, University of Nevada School of Medicine, Reno, NV, USA
| | - Laura C Lovato
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Robert B Wallace
- Departments of Epidemiology & Medicine, University of Iowa, Iowa City, IA, USA
| | - Xiaoyan Leng
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Lawrence S Phillips
- Atlanta VA Medical Center and Division of Endocrinology, Emory University School of Medicine, Atlanta, GA, USA
| | - Jennifer G Robinson
- Departments of Epidemiology & Medicine, University of Iowa, Iowa City, IA, USA
| | - Jane M Kotchen
- Department of Population Health, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Gloria E Sarto
- University of Wisconsin Center for Women's Health Research, Madison, WI, USA
| | - W Jerry Mysiw
- Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, OH, USA
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Frank E, Wallace ML, Hall M, Hasler B, Levenson JC, Janney CA, Soreca I, Fleming MC, Buttenfield J, Ritchey FC, Kupfer DJ. An Integrated Risk Reduction Intervention can reduce body mass index in individuals being treated for bipolar I disorder: results from a randomized trial. Bipolar Disord 2015; 17:424-37. [PMID: 25495748 PMCID: PMC4458204 DOI: 10.1111/bdi.12283] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 09/25/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVES We conducted a randomized, controlled trial comparing the efficacy of an Integrated Risk Reduction Intervention (IRRI) to a control condition with the objective of improving mood stability and psychosocial functioning by reducing cardiometabolic risk factors in overweight/obese patients with bipolar I disorder. METHODS A total of 122 patients were recruited from our outpatient services and randomly allocated to IRRI (n = 61) or psychiatric care with medical monitoring (n = 61). Individuals allocated to IRRI received psychiatric treatment and assessment, medical monitoring by a nurse, and a healthy lifestyle program from a lifestyle coach. Those allocated to the control condition received psychiatric treatment and assessment and referral, if indicated, for medical problems. A mixed-effects model was used to examine the impact of the interventions on body mass index (BMI). Exploratory moderator analyses were used to characterize those individuals likely to benefit from each treatment approach. RESULTS Analyses were conducted on data for the IRRI (n = 58) and control (n = 56) participants with ≥ 1 study visit. IRRI was associated with a significantly greater rate of decrease in BMI (d = -0.51, 95% confidence interval: -0.91 to -0.14). Three variables (C-reactive protein, total cholesterol, and instability of total sleep time) contributed to a combined moderator of faster decrease in BMI with IRRI treatment. CONCLUSIONS Overweight/obese patients with bipolar disorder can make modest improvements in BMI, even when taking medications with known potential for weight gain. Our finding that a combination of three baseline variables provides a profile of patients likely to benefit from IRRI will need to be tested further to evaluate its utility in clinical practice.
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Affiliation(s)
- Ellen Frank
- Department of Psychiatry; University of Pittsburgh School of Medicine; Pittsburgh PA USA
| | - Meredith L Wallace
- Department of Psychiatry; University of Pittsburgh School of Medicine; Pittsburgh PA USA
| | - Martica Hall
- Department of Psychiatry; University of Pittsburgh School of Medicine; Pittsburgh PA USA
| | - Brant Hasler
- Department of Psychiatry; University of Pittsburgh School of Medicine; Pittsburgh PA USA
| | - Jessica C Levenson
- Department of Psychiatry; University of Pittsburgh School of Medicine; Pittsburgh PA USA
| | - Carol A Janney
- Department of Psychiatry; University of Pittsburgh School of Medicine; Pittsburgh PA USA
| | - Isabella Soreca
- Department of Psychiatry; University of Pittsburgh School of Medicine; Pittsburgh PA USA
| | - Matthew C Fleming
- Department of Psychiatry; University of Pittsburgh School of Medicine; Pittsburgh PA USA
| | - Joan Buttenfield
- Department of Psychiatry; University of Pittsburgh School of Medicine; Pittsburgh PA USA
| | - Fiona C Ritchey
- Department of Psychiatry; University of Pittsburgh School of Medicine; Pittsburgh PA USA
| | - David J Kupfer
- Department of Psychiatry; University of Pittsburgh School of Medicine; Pittsburgh PA USA
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Abstract
OBJECTIVES The aim of this article is to draw attention to the clinical importance of disordered sleep in psychiatry and to demonstrate the growing awareness of medical illness as a complication of disordered sleep. As background to these main objectives, some general points are made to illustrate present-day approaches to the common and often serious problem of sleep disturbance. METHODS The review is based on a literature search from which key publications were selected to illustrate, in turn, main connections between disordered sleep and psychiatric and medical conditions. RESULTS Many such connections are described. Throughout psychiatry, regarding patients whatever their age, these connections have implications for clinical assessment and management. Emphasis is placed on the risk of misdiagnosis of sleep disorders as psychiatric or medical conditions. Examples of this are provided. The growing evidence that disordered sleep can predispose to medical illness is discussed. CONCLUSION As the subject of sleep and its disorders is particular relevant in psychiatry, a working knowledge of modern sleep medicine is important in all branches of psychiatric and other medical practice as well as in clinical research.
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Poor sleep quality is associated with impaired glucose tolerance in women after gestational diabetes. J Psychiatr Res 2015; 65:166-71. [PMID: 25930074 DOI: 10.1016/j.jpsychires.2015.02.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 01/16/2015] [Accepted: 02/05/2015] [Indexed: 01/12/2023]
Abstract
We analyzed the association of sleep quality and glucose metabolism in women after gestational diabetes (pGDM) and in women after normoglycemic pregnancy (controls). Data during pregnancy and a visit within the first 15 months after delivery were collected from 61 pGDM and 30 controls in a prospective cohort study. This included a medical history, physical examination, questionnaires (Pittsburgh Sleep Quality Index (PSQI), and Perceived Stress Scale (PSS)), and 5-point oral glucose tolerance test with insulin measurements to determine indices of insulin sensitivity and insulin secretion. We used Spearman correlation coefficients and multivariate regression models for analysis.9.3 ± 3.2 months after delivery, pGDM had significantly higher fasting and 2 h glucose levels and lower insulin sensitivity than controls. There was no significant difference in age, BMI and sleep quality as assessed with the PSQI between the two groups. The PSQI score correlated with the ogtt-2 h plasma glucose in pGDM (δ = 0.41; p = 0.0012), but not in controls. This association was confirmed with a multivariate linear regression model with adjustment for age, BMI and months post-delivery. Perceived stress was an independent risk factor (OR 1.12; 95% CI 1.02-1.23) for impaired sleep. Our findings suggest that post-delivery sleep quality significantly influences glucose tolerance in women after GDM and that impaired sleep is associated with increased stress perception. Measures to improve of sleep quality and reduce perceived stress should therefore be tested as additional strategies to prevent progression to type 2 diabetes after GDM.
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Rothenberger SD, Krafty RT, Taylor BJ, Cribbet MR, Thayer JF, Buysse DJ, Kravitz HM, Buysse ED, Hall MH. Time-varying correlations between delta EEG power and heart rate variability in midlife women: the SWAN Sleep Study. Psychophysiology 2015; 52:572-84. [PMID: 25431173 PMCID: PMC4376638 DOI: 10.1111/psyp.12383] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 09/25/2014] [Indexed: 11/30/2022]
Abstract
No studies have evaluated the dynamic, time-varying relationship between delta electroencephalographic (EEG) sleep and high frequency heart rate variability (HF-HRV) in women. Delta EEG and HF-HRV were measured during sleep in 197 midlife women (M(age) = 52.1, SD = 2.2). Delta EEG-HF-HRV correlations in nonrapid eye movement (NREM) sleep were modeled as whole-night averages and as continuous functions of time. The whole-night delta EEG-HF-HRV correlation was positive. The strongest correlations were observed during the first NREM sleep period preceding and following peak delta power. Time-varying correlations between delta EEG-HF-HRV were stronger in participants with sleep-disordered breathing and self-reported insomnia compared to healthy controls. The dynamic interplay between sleep and autonomic activity can be modeled across the night to examine within- and between-participant differences including individuals with and without sleep disorders.
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Affiliation(s)
- Scott D Rothenberger
- Department of Statistics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Sleep and multisystem biological risk: a population-based study. PLoS One 2015; 10:e0118467. [PMID: 25714703 PMCID: PMC4340787 DOI: 10.1371/journal.pone.0118467] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 01/17/2015] [Indexed: 12/29/2022] Open
Abstract
Background Short sleep and poor sleep quality are associated with risk of cardiovascular disease, diabetes, cancer, and mortality. This study examines the contribution of sleep duration and sleep quality on a multisystem biological risk index that is known to be associated with morbidity and mortality. Methods Analyses include a population-based sample from the Midlife Development in the United States survey recruited to the Biomarker substudy. A total of 1,023 participants aged 54.5 years (SD = 11.8), 56% female and 77.6% white, were included in the analyses. A multisystem biological risk index was derived from 22 biomarkers capturing cardiovascular, immune, lipid-metabolic, glucose-metabolic, sympathetic, parasympathetic, and hypothalamic-pituitary-adrenal systems. Self-reported average sleep duration was categorized as short (<5 hrs), below normal (5 to <6.5 hrs), normal (6.5 to <8.5 hrs), and long sleepers (8.5+ hrs). Sleep quality was determined using the Pittsburgh Sleep Quality Index categorized as normal (≤5) and poor quality (>5) sleep. Findings Linear mixed effect models adjusting for age, gender, race, education, income, BMI, and health status were performed. As compared to normal sleepers, multisystem biological risk in both short (B(SE) = .38(.15), p<.01) and long sleepers (B(SE) = .28(.11), p<.01) were elevated. Poor quality sleep alone was associated with elevated multisystem biological risk (B(SE) = .15(.06), p = .01), but was not significant after adjustment for health status. All short sleepers reported poor sleep quality. However in the long sleepers, only those who reported poor sleep quality exhibited elevated multisystem biological risk (B(SE) = .93(.3), p = .002). Conclusions Self-reported poor sleep quality with either short or long sleep duration is associated with dysregulation in physiological set points across regulatory systems, leading to elevated multisystem biological risk. Physicians should inquire about sleep health in the assessment of lifestyle factors related to disease risk, with evidence that healthy sleep is associated with lower multisystem biological risk.
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Subclinical hearing loss, longer sleep duration, and cardiometabolic risk factors in Japanese general population. Int J Otolaryngol 2014; 2014:218218. [PMID: 25214844 PMCID: PMC4158149 DOI: 10.1155/2014/218218] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 07/06/2014] [Accepted: 07/20/2014] [Indexed: 12/02/2022] Open
Abstract
Hearing loss leads to impaired social functioning and quality of life. Hearing loss is also associated with sleeping disorders and cardiometabolic risk factors. Here, we determined whether subclinical hearing loss is associated with sleep duration and cardiometabolic risk factors in a cross-sectional and longitudinal study of healthy Japanese general population. 48,091 men and women aged 20–79 years who underwent medical checkups were included in a cross-sectional study, and 6,674 were included in an 8-year longitudinal study. The prevalence of audiometrically determined hearing loss (>25 dB) at 4000 and 1000 Hz increased significantly with increasing sleep duration in any age strata. Logistic regression analysis showed that compared with reference sleep duration (6 h) longer sleep duration (≥8 h) was significantly associated with hearing loss, even after adjusting for potential confounding factors. Simultaneously, hearing loss was significantly associated with male sex, diabetes, and no habitual exercise. In the longitudinal study, the risk of longer sleep duration (≥8 h) after 8 years was significantly greater in subjects with hearing loss at 4000 Hz at baseline. In conclusion, current results suggest a potential association of subclinical hearing loss with longer sleep duration and cardiometabolic risk factors in a Japanese general population.
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Canivet C, Nilsson PM, Lindeberg SI, Karasek R, Östergren PO. Insomnia increases risk for cardiovascular events in women and in men with low socioeconomic status: a longitudinal, register-based study. J Psychosom Res 2014; 76:292-9. [PMID: 24630179 DOI: 10.1016/j.jpsychores.2014.02.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 01/31/2014] [Accepted: 02/04/2014] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Insomnia and short and long sleep durations have all been linked to cardiovascular disease. Male gender and low socioeconomic status are also related to cardiovascular disease, but it is unclear whether these two factors modify the impact of poor sleep on cardiovascular disease incidence. METHODS Participants (5875 men and 7742 women ages 45 to 64 with no history of cardiovascular disease from the general population of Malmö, Sweden; participation rate 41%) were enrolled from 1992 to 1994 and followed until 2005 or until the first cardiovascular event (defined as myocardial infarction, stroke, or death due to ischemic heart disease), as recorded by official registers. Baseline blood pressure, BMI, and inquiry data concerning psychosocial circumstances and self-reported sleep habits were compared with hazard ratios (HRs) of cardiovascular events. RESULTS Affirming 'moderate' or 'considerable' problems with at least one out of the four insomnia symptoms was associated with cardiovascular event in women (fully-adjusted HR 1.4 [95% CI 1.2-1.6] and population attributable fraction 17.3%). The same was true of men with past or present manual occupation (HR 1.3 [95% CI 1.1-1.6] and population attributable fraction 11.8%). The HRs increased further in women where insomnia symptoms were combined with short or long sleep duration. CONCLUSIONS Insomnia is a significant public health problem with implications for cardiovascular disease incidence. Taking gender and socioeconomic status into account is a worthwhile approach in research on sleep and cardiovascular disease outcomes.
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Affiliation(s)
- Catarina Canivet
- Lund University, Social Medicine and Global Health, Malmö, Sweden.
| | - Peter M Nilsson
- Internal Medicine, Department of Clinical Sciences Malmö, Lund University, Sweden
| | - Sara I Lindeberg
- Lund University, Social Medicine and Global Health, Malmö, Sweden
| | - Robert Karasek
- Department of Work Environment, University of Massachusetts, Lowell MA, USA
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Da Silva MA, Singh-Manoux A, Shipley MJ, Vahtera J, Brunner EJ, Ferrie JE, Kivimäki M, Nabi H. Sleep duration and sleep disturbances partly explain the association between depressive symptoms and cardiovascular mortality: the Whitehall II cohort study. J Sleep Res 2014; 23:94-7. [PMID: 23898807 PMCID: PMC3864599 DOI: 10.1111/jsr.12077] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 06/30/2013] [Indexed: 11/28/2022]
Abstract
Depressive symptoms are associated with an increased risk of death, but most of this association remains unexplained. Our aim was to explore the contribution of sleep duration and disturbances to the association between depressive symptoms, all-cause and cardiovascular disease mortality. A total of 5813 (4220 men and 1593 women) aged 50-74 years at baseline, participants of the British Whitehall II prospective cohort study, were included. Depressive symptoms, sleep duration and disturbances were assessed in 2003-04. Mortality was ascertained through linkage to the national mortality register until August 2012, with a mean follow-up of 8.8 years. Depressive symptoms were associated with an increased risk of mortality from all causes [hazard ratio (HR) = 1.51; 95% confidence interval (CI): 1.16-1.97)] and cardiovascular diseases (HR = 1.63; 95% CI: 1.01-2.64) after adjustment for sociodemographic characteristics. Further adjustment for sleep duration and disturbances reduced the association between depressive symptoms and cardiovascular mortality by 21% (HR = 1.53; 95% CI: 0.91-2.57). Sleep seems to have a role, as a mediator or confounder, in explaining the association between depressive symptoms and cardiovascular mortality. These findings need replication in larger studies with longer follow-up.
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Affiliation(s)
- Marine Azevedo Da Silva
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Epidemiology of occupational and social determinants of health, F-94807, Villejuif, France
- Université de Versailles St Quentin, UMRS 1018, F-94807, Villejuif, France
| | - Archana Singh-Manoux
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Epidemiology of occupational and social determinants of health, F-94807, Villejuif, France
- Université de Versailles St Quentin, UMRS 1018, F-94807, Villejuif, France
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, WC1E 6BT London, United Kingdom
- Centre de Gérontologie, Hôpital Ste Périne, AP-HP, Paris, France
| | - Martin J Shipley
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, WC1E 6BT London, United Kingdom
| | - Jussi Vahtera
- Finnish Institute of Occupational Health, Lemminkäisenkatu 14-18b, 20520, Turku, Finland
- Department of Public Health, University of Turku, and Turku University Hospital, Turku, Finland
| | - Eric J Brunner
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, WC1E 6BT London, United Kingdom
| | - Jane E Ferrie
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, WC1E 6BT London, United Kingdom
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, WC1E 6BT London, United Kingdom
| | - Hermann Nabi
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Epidemiology of occupational and social determinants of health, F-94807, Villejuif, France
- Université de Versailles St Quentin, UMRS 1018, F-94807, Villejuif, France
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Scharnholz B, Gilles M, Marzina A, Kommer M, Lederbogen F, Wudy SA, Hartmann MF, Westphal S, Roth HJ, Kahl KG, Meyer-Lindenberg A, Michaely HJ, Deuschle M. Do depressed patients without activation of the hypothalamus-pituitary-adrenal (HPA) system have metabolic disturbances? Psychoneuroendocrinology 2014; 39:104-110. [PMID: 24275009 DOI: 10.1016/j.psyneuen.2013.09.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 09/02/2013] [Accepted: 09/25/2013] [Indexed: 10/26/2022]
Abstract
This study compared features of the metabolic syndrome between healthy controls and depressed patients without activation of the hypothalamus-pituitary-adrenal (HPA) system. After exclusion of non-suppressors to 1mg dexamethasone, we included 20 depressed inpatients and 34 healthy controls in the analyses. We assessed HPA system activity (diurnal saliva cortisol profile, cortisol excretion), normetanephrine excretion as well as fasting glucose, lipid profile and blood pressure. With regard to body composition, we measured waist circumference as well as visceral fat and adrenal volume by magnetic resonance (MR) imaging. Five depressed patients (25%) and five healthy controls (15%) fulfilled the criteria of the metabolic syndrome according NCEP-ATP-III. Depression was significantly related with fasting glucose and negatively associated with mean blood pressure (BP) and, by trend, with low HDL-cholesterol. We conclude that depressed patients may have modest metabolic disturbances even in the complete absence of activation of stress-responsive systems. Hence some metabolic disturbances in depressed patients may not be explicable by HPA activation. Additional factors are required to mediate the link between affective and metabolic disorders.
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Affiliation(s)
- Barbara Scharnholz
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, 68159 Mannheim, Germany.
| | - Maria Gilles
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, 68159 Mannheim, Germany
| | - Annika Marzina
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, 68167 Mannheim, Germany
| | - Marcel Kommer
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, 68167 Mannheim, Germany
| | - Florian Lederbogen
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, 68159 Mannheim, Germany
| | - Stefan A Wudy
- Steroid Research and Mass Spectrometry Unit, Division of Pediatric Endocrinology and Diabetology, Center of Child and Adolescent Medicine, Justus Liebig University Giessen, 35390 Gießen, Germany
| | - Michaela F Hartmann
- Steroid Research and Mass Spectrometry Unit, Division of Pediatric Endocrinology and Diabetology, Center of Child and Adolescent Medicine, Justus Liebig University Giessen, 35390 Gießen, Germany
| | - Sabine Westphal
- Institute of Clinical Chemistry, Magdeburg University Hospital, 39120 Magdeburg, Germany
| | | | - Kai G Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, University of Hannover, 30625 Hannover, Germany
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, 68159 Mannheim, Germany
| | - Henrik J Michaely
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, 68167 Mannheim, Germany
| | - Michael Deuschle
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, 68159 Mannheim, Germany
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Boudreau P, Yeh WH, Dumont GA, Boivin DB. Circadian variation of heart rate variability across sleep stages. Sleep 2013; 36:1919-28. [PMID: 24293767 PMCID: PMC3825442 DOI: 10.5665/sleep.3230] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Nocturnal cardiovascular events are more frequent at the beginning and end of the night. It was proposed that this pattern reflects the nocturnal distribution of sleep and sleep stages. Using heart rate variability (HRV), we recently showed an interaction between the circadian system and vigilance states on the regulation of cardiac rhythmicity. Here, we further investigate this interaction in order to clarify the specific effects of sleep stages on the regulation of the heart. DESIGN Participants underwent a 72-h ultradian sleep-wake cycle procedure in time isolation consisting of alternating 60-min wake episodes in dim light and 60-min nap opportunities in total darkness. SETTING Time isolation suite. PATIENTS OR PARTICIPANTS Fifteen healthy young participants; two were subsequently excluded. INTERVENTIONS N/A. MEASUREMENTS AND RESULTS The current study revealed that sleep onset and progression to deeper sleep stages was associated with a shift toward greater parasympathetic modulation, whereas rapid eye movement (REM) sleep was associated with a shift toward greater sympathetic modulation. We found a circadian rhythm of heart rate (HR) and high-frequency power during wakefulness and all non-REM sleep stages. A significant circadian rhythm of HR and sympathovagal balance of the heart was also observed during REM sleep. During slow wave sleep, maximal parasympathetic modulation was observed at ∼02:00, whereas during REM sleep, maximal sympathetic modulation occurred in the early morning. CONCLUSION The circadian and sleep stage-specific effects on heart rate variability are clinically relevant and contribute to the understanding of the degree of cardiovascular vulnerability during sleep.
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Affiliation(s)
- Philippe Boudreau
- Centre for Study and Treatment of Circadian Rhythms, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada
| | - Wei-Hsien Yeh
- Centre for Study and Treatment of Circadian Rhythms, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada
| | - Guy A. Dumont
- Department of Electrical and Computer Engineering, University of British Colombia, Vancouver, British Colombia, Canada
| | - Diane B. Boivin
- Centre for Study and Treatment of Circadian Rhythms, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada
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Alcántara C, Davidson KW. Mental disorders and coronary heart disease risk: could the evidence elude us while we sleep? Circulation 2013; 129:139-41. [PMID: 24190956 DOI: 10.1161/circulationaha.113.006515] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Carmela Alcántara
- Department of Medicine, Columbia University Medical Center, New York, NY
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Mezick EJ, Wing RR, McCaffery JM. Associations of self-reported and actigraphy-assessed sleep characteristics with body mass index and waist circumference in adults: moderation by gender. Sleep Med 2013; 15:64-70. [PMID: 24239499 DOI: 10.1016/j.sleep.2013.08.784] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 07/26/2013] [Accepted: 08/23/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Self-reported sleep duration has been linked to body mass index (BMI) and waist circumference in previous work; however, data regarding if these associations are stronger in men or women have been mixed, and few studies have objectively measured sleep. We investigated self-reported and actigraphy-assessed sleep characteristics in relation to BMI and waist circumference and examined the extent to which these associations differ by gender. DESIGN Archived cross-sectional data collected from 2004 to 2006 from the National Survey of Midlife Development in the United States (MIDUS) Biomarkers Study were used. Participants included 1248 adults (43% men) who reported their habitual sleep duration, and a subset of participants (N=441; 40% men) who underwent seven nights of wrist actigraphy. RESULTS Self-reported total sleep time (TST), actigraphy-assessed TST, and actigraphy-assessed sleep efficiency (SE) were inversely associated with BMI in the full sample of both men and women. Gender moderated associations between actigraphy assessments of sleep and anthropometric variables; however, TST and SE were related to BMI and waist circumference in women only. Associations between sleep and waist circumference were independent of BMI. CONCLUSIONS Sleep duration and sleep continuity are associated with body weight and distribution of body fat, but these associations were stronger or were only present in women.
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Affiliation(s)
- Elizabeth J Mezick
- The Miriam Hospital and Warren Alpert School of Medicine at Brown University, Providence, RI, United States
| | - Rena R Wing
- The Miriam Hospital and Warren Alpert School of Medicine at Brown University, Providence, RI, United States
| | - Jeanne M McCaffery
- The Miriam Hospital and Warren Alpert School of Medicine at Brown University, Providence, RI, United States.
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Liu Y, Wheaton AG, Chapman DP, Croft JB. Sleep duration and chronic diseases among U.S. adults age 45 years and older: evidence from the 2010 Behavioral Risk Factor Surveillance System. Sleep 2013; 36:1421-7. [PMID: 24082301 DOI: 10.5665/sleep.3028] [Citation(s) in RCA: 160] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
STUDY OBJECTIVE To examine the effects of obesity and frequent mental distress (FMD) on the relationship of sleep duration with coronary heart disease (CHD), stroke, and diabetes. DESIGN Cross-sectional study. SETTING Population-based surveillance. PARTICIPANTS There were 54,269 adults age 45 y or older who completed the 2010 Behavioral Risk Factor Surveillance System survey in 14 states. RESULTS Nearly one third (31.1% or an estimated 11.1 million) of respondents age 45 y and older reported being short sleepers (≤ 6 h), 64.8% being optimal sleepers (7-9 h), and 4.1% being long sleepers (≥ 10 h) in a 24-h period. Compared with the optimal sleep duration, both short and long sleep durations were significantly associated with obesity, FMD (mental health was not good ≥ 14 days during the past 30 days), CHD, stroke, and diabetes after controlling for sex, age, race/ethnicity, and education. The U-shaped relationships of sleep duration with CHD, stroke, and diabetes were moderately attenuated by FMD. The relationship between sleep duration and diabetes was slightly attenuated by obesity. CONCLUSIONS Sleep duration had U-shaped relationships with leading chronic diseases. Further prospective studies are needed to determine how mental health and maintenance of a normal weight may interact with sleep duration to prevent chronic diseases.
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Affiliation(s)
- Yong Liu
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, GA
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