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Balit N, Cermakian N, Khadra A. The influence of circadian rhythms on CD8 + T cell activation upon vaccination: A mathematical modeling perspective. J Theor Biol 2024; 590:111852. [PMID: 38796098 DOI: 10.1016/j.jtbi.2024.111852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/30/2024] [Accepted: 05/14/2024] [Indexed: 05/28/2024]
Abstract
Circadian rhythms have been implicated in the modulation of many physiological processes, including those associated with the immune system. For example, these rhythms influence CD8+ T cell responses within the adaptive immune system. The mechanism underlying this immune-circadian interaction, however, remains unclear, particularly in the context of vaccination. Here, we devise a molecularly-explicit gene regulatory network model of early signaling in the naïve CD8+ T cell activation pathway, comprised of three axes (or subsystems) labeled ZAP70, LAT and CD28, to elucidate the molecular details of this immune-circadian mechanism and its relation to vaccination. This is done by coupling the model to a periodic forcing function to identify the molecular players targeted by circadian rhythms, and analyzing how these rhythms subsequently affect CD8+ T cell activation under differing levels of T cell receptor (TCR) phosphorylation, which we designate as vaccine load. By performing both bifurcation and parameter sensitivity analyses on the model at the single cell and ensemble levels, we find that applying periodic forcing on molecular targets within the ZAP70 axis is sufficient to create a day-night discrepancy in CD8+ T cell activation in a manner that is dependent on the bistable switch inherent in CD8+ T cell early signaling. We also demonstrate that the resulting CD8+ T cell activation is dependent on the strength of the periodic coupling as well as on the level of TCR phosphorylation. Our results show that this day-night discrepancy is not transmitted to certain downstream molecules within the LAT subsystem, such as mTORC1, suggesting a secondary, independent circadian regulation on that protein complex. We also corroborate experimental results by showing that the circadian regulation of CD8+ T cell primarily acts at a baseline, pre-vaccination state, playing a facilitating role in priming CD8+ T cells to vaccine inputs according to the time of day. By applying an ensemble level analysis using bifurcation theory and by including several hypothesized molecular targets of this circadian rhythm, we further demonstrate an increased variability between CD8+ T cells (due to heterogeneity) induced by its circadian regulation, which may allow an ensemble of CD8+ T cells to activate at a lower vaccine load, improving its sensitivity. This modeling study thus provides insights into the immune targets of the circadian clock, and proposes an interaction between vaccine load and the influence of circadian rhythms on CD8+ T cell activation.
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Affiliation(s)
- Nasri Balit
- Department of Physiology, McGill University, Montreal, Quebec, Canada.
| | - Nicolas Cermakian
- Douglas Research Center, Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
| | - Anmar Khadra
- Department of Physiology, McGill University, Montreal, Quebec, Canada.
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Aragona F, Fazio F, Piccione G, Giannetto C. Chronophysiology of domestic animals. Chronobiol Int 2024; 41:888-903. [PMID: 38832548 DOI: 10.1080/07420528.2024.2360723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 05/19/2024] [Indexed: 06/05/2024]
Abstract
This review highlights recent findings on biological rhythms and discusses their implications for the management and production of domestic animals. Biological rhythms provide temporal coordination between organs and tissues in order to anticipate environmental changes, orchestrating biochemical, physiological and behavioural processes as the right process may occur at the right time. This allows animals to adapt their internal physiological functions, such as sleep-wake cycles, body temperature, hormone secretion, food intake and regulation of physical performance to environmental stimuli that constantly change. The study and evaluation of biological rhythms of various physiological parameters allows the assessment of the welfare status of animals. Alteration of biological rhythms represents an imbalance of the state of homeostasis that can be found in different management conditions.
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Affiliation(s)
- Francesca Aragona
- Department of Veterinary Sciences, University of Messina, Messina, Italy
| | - Francesco Fazio
- Department of Veterinary Sciences, University of Messina, Messina, Italy
| | - Giuseppe Piccione
- Department of Veterinary Sciences, University of Messina, Messina, Italy
| | - Claudia Giannetto
- Department of Veterinary Sciences, University of Messina, Messina, Italy
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Kim HJ, Jo SH. Nighttime administration of antihypertensive medication: a review of chronotherapy in hypertension. Korean J Intern Med 2024; 39:205-214. [PMID: 37967524 PMCID: PMC10918378 DOI: 10.3904/kjim.2023.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/14/2023] [Accepted: 09/01/2023] [Indexed: 11/17/2023] Open
Abstract
Hypertension remains a global health concern because of suboptimal blood pressure control despite advancements in antihypertensive treatments. Chronotherapy, defined as evening or bedtime administration of medication based on biological rhythms, is emerging as a potential strategy to improve blood pressure control and treatment outcomes. Clinical trials have investigated the potential effects of nighttime administration of antihypertensive medication in the improvement of 24 hours blood pressure control and reduction of cardiovascular risk. Implementing chronotherapy in clinical practice could have significant implications in enhancing blood pressure control and improving clinical outcomes in patients with hypertension, particularly those with resistant hypertension. However, recent trials have reported contradictory results, causing confusion in real-world practice. Herein we review, analyze, and critique the current evidence and propose suggestions regarding the clinical application and future directions of chronotherapy.
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Affiliation(s)
- Hyun-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sang-Ho Jo
- Division of Cardiology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
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Latief K, Akyirem S, Sithichoksakulchai S, Nurrika D, Sujarwadi M, Hasan F. The mediating effect of sleep disturbance on the association between hypertension and depression: a national data analysis. Clin Hypertens 2024; 30:5. [PMID: 38297373 PMCID: PMC10832256 DOI: 10.1186/s40885-024-00263-y] [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: 10/05/2023] [Accepted: 01/10/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Sleep disturbance is a common among people with hypertension. However, the mediating role of sleep disturbance in the association between hypertension and depression remains unclear. This study aims to investigate the mediating role of sleep disturbance in the association between hypertension and depression. MATERIALS AND METHODS This was cross-sectional study. The data were derived from the Indonesian Family Life Survey Fifth Wave (2014-2015). We include a total of 19,138 adults' participants with age range from 18 to 65 years old who completed response on the variable of hypertension, sleep disturbance, and depression. The mediating model analysis was processed using the PROCESS macro ins SPSS from Hayes model. RESULTS Depression was reported by 22% of total respondents. The group with hypertension showed a substantially higher prevalence of depression than non-hypertension group (P < 0.001). Hypertension had a significant overall effect on depression (β = 0.682; 95%CI 0.489 to 0.875, P < 0.001). The direct effect of hypertension on depression was significant (β = 0.418; 95%CI 0.244 to 0.592, P < 0.001) and the indirect effect that mediated by sleep disturbance was also significant (β = 0.264, 95%CI 0.174 to 0.356, P < 0.001). It is worth noting that sleep disturbance partially mediated the association between hypertension and depression. CONCLUSION The findings of this study indicated that sleep disturbance contributed to the etiology of depression and hypertension in adult populations. Nurses should be involved in managing sleep disturbances, such as using behavioral therapy, as it may serve as both a treatment and primary prevention measure for depression and hypertension.
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Affiliation(s)
- Kamaluddin Latief
- Global Health and Health Security, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Centre for Family Welfare, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Samuel Akyirem
- Yale School of Nursing, Yale University, New Haven, CT, USA
| | - Siriluk Sithichoksakulchai
- Department of Fundamental Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Dieta Nurrika
- Public Health Study Program, Banten School of Health Science, South Tangerang, Indonesia
- Culture, Research, and Technology, The Ministry of Education, Higher Education Service Institutions (LL-DIKTI) Region IV, Bandung, Indonesia
| | - Mokh Sujarwadi
- Faculty of Nursing, Universitas Jember, Jember, Indonesia
| | - Faizul Hasan
- Faculty of Nursing, Chulalongkorn University, Boromarajonani Srisataphat Building, 12th Floor Rama1 Road, Wang Mai, Pathum Wan, Bangkok, 10330, Thailand.
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Holmes KE, Fox N, King J, Presby DM, Kim J. Connection Between Sleep and Psychological Well-Being in U.S. Army Soldiers. Mil Med 2024; 189:e40-e48. [PMID: 37265329 PMCID: PMC10824482 DOI: 10.1093/milmed/usad187] [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: 01/10/2023] [Revised: 04/20/2023] [Accepted: 05/11/2023] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION The goal of this exploratory study was to examine the relationships between sleep consistency and workplace resilience among soldiers stationed in a challenging Arctic environment. MATERIALS AND METHODS A total of 862 soldiers (67 females) on an Army base in Anchorage, AK, were provided WHOOP 3.0, a validated sleep biometric capture device and were surveyed at onboarding and at the conclusion of the study. Soldiers joined the study from early January to early March 2021 and completed the study in July 2021 (650 soldiers completed the onboarding survey and 210 completed the exit survey, with 151 soldiers completing both). Three comparative analyses were conducted. First, soldiers' sleep and cardiac metrics were compared against the general WHOOP population and a WHOOP sample living in AK. Second, seasonal trends (summer versus winter) in soldiers' sleep metrics (time in bed, hours of sleep, wake duration during sleep, time of sleep onset/offset, and disturbances) were analyzed, and these seasonal trends were compared with the general WHOOP population and the WHOOP sample living in AK. Third, soldiers' exertion, sleep duration, and sleep consistency were correlated with their self-reported psychological functioning. All analyses were conducted with parametric and non-parametric statistics. This study was approved by The University of Queensland Human Research Ethics Committee (Brisbane, Australia) Institutional Review Board. RESULTS Because of the exploratory nature of the study, the critical significance value was set at P < .001. Results revealed that: (1) Arctic soldiers had poorer sleep consistency and sleep duration than the general WHOOP sample and the Alaskan WHOOP sample, (2) Arctic soldiers showed a decrease in sleep consistency and sleep duration in the summer compared to that in the winter, (3) Arctic soldiers were less able to control their bedroom environment in the summer than in the winter, and (4) sleep consistency but not sleep duration correlated positively with self-report measures of workplace resilience and healthy social networks and negatively with homesickness. CONCLUSIONS The study highlights the relationship between seasonality, sleep consistency, and psychological well-being. The results indicate the potential importance of sleep consistency in psychological functioning, suggesting that future work should manipulate factors known to increase sleep consistency to assess whether improved sleep consistency can enhance the well-being of soldiers. Such efforts would be of particular value in an Arctic environment, where seasonality effects are large and sleep consistency is difficult to maintain.
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Affiliation(s)
- Kristen E Holmes
- School of Psychology, University of Queensland, St Lucia, QLD 4072, Australia
- Performance Science, Whoop Inc., Boston, MA 02215, USA
| | - Nadia Fox
- School of Psychology, University of Queensland, St Lucia, QLD 4072, Australia
| | - Jemma King
- School of Psychology, University of Queensland, St Lucia, QLD 4072, Australia
- BioPsych Analytics, Tennyson, QLD 4105, Australia
| | | | - Jeongeun Kim
- Performance Science, Whoop Inc., Boston, MA 02215, USA
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Li J, Hu Z, Hou L, Li P, Yang R, Dong Y, Zhang H, Guo Y, Liu W, Liu Z. Mediating effect of subclinical inflammation on the process of morning hypertension leading to atrial fibrillation in community-based older adults. Clin Exp Hypertens 2023; 45:2253381. [PMID: 37652577 DOI: 10.1080/10641963.2023.2253381] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/14/2023] [Accepted: 08/24/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND The impacts and mechanisms of morning hypertension (MHT) on the risk of new-onset atrial fibrillation (AF) in the elderly have not been clarified. We aimed to investigate an association between MHT and new-onset AF and explore a mediating effect of subclinical inflammation on this association. METHODS From 2008 to 2010, 1789 older adults aged ≥60 years were recruited in Shandong area, China. Morning blood pressure (BP) was assessed using 24-hour ambulatory BP monitoring. MHT was defined as BP ≥ 135/85 mm Hg during the period from wake time to 0900 a.m. Subclinical inflammation was assessed by hypersensitive C-reactive protein (hsCRP), tumor necrosis factor-alpha (TNF-α), systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and galectin-3. New-onset AF was rated during the follow-up period. RESULTS Over an average 129.0 [standard deviation (SD): 21.58] months of follow-up, the hazard ratio of new-onset AF in MHT patients was 1.39 (95% confidence interval: 1.01 to 1.91) compared with non-MHT participants (Padjusted = 0.027). The risk of new-onset AF was 1.17-fold with one-SD increment of morning systolic BP. Subclinical inflammation was significantly associated with new-onset AF. The hazard ratios of new-onset AF were 2.29, 2.04, 2.08, 2.08, 2.03, and 3.25 for one-SD increment in hsCRP, TNF-α, SII, NLR, PLR, and galectin-3, respectively (Padjusted < 0.001). The analysis showed that hsCRP, TNF-α, SII, NLR, PLR, and galectin-3 separately mediated the process of MHT inducing new-onset AF (Padjusted < 0.05). CONCLUSIONS MHT is associated with an increased risk of new-onset AF. The subclinical inflammation might play a mediating role in this association.
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Affiliation(s)
- Jinping Li
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- School of Clinical and Basic Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Zhibo Hu
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- School of Clinical and Basic Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Liming Hou
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- School of Clinical and Basic Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
- Department of ECG Information, Shandong Engineering Research Center, Jinan, Shandong, China
| | - Peilin Li
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- School of Clinical and Basic Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Ruizhen Yang
- Department of Chronic Disease, Centers for Disease Control of Hanting District, Weifang, Shandong, China
| | - Yuanli Dong
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Hua Zhang
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- School of Clinical and Basic Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
- Department of ECG Information, Shandong Engineering Research Center, Jinan, Shandong, China
| | - Yuqi Guo
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- School of Clinical and Basic Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Weike Liu
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Zhendong Liu
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- School of Clinical and Basic Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
- Department of ECG Information, Shandong Engineering Research Center, Jinan, Shandong, China
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Zhou T, Dai X, Yuan Y, Xue Q, Li X, Wang M, Ma H, Heianza Y, Qi L. Adherence to a healthy sleep pattern is associated with lower risks of incident falls and fractures during aging. Front Immunol 2023; 14:1234102. [PMID: 37662961 PMCID: PMC10470625 DOI: 10.3389/fimmu.2023.1234102] [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: 06/03/2023] [Accepted: 07/28/2023] [Indexed: 09/05/2023] Open
Abstract
Background Autoimmune diseases are more common among people with unhealthy sleep behaviors, and these conditions have been linked to aging-related bone health. However, there have been few studies that examined the correlation between recently developed sleep patterns based on sleep duration, sleepiness, chronotype, snoring, insomnia, and the incidence of falls and fractures. Methods We used a newly developed sleep pattern with components of sleep 7 to 8 h per day, absence of frequent excessive daytime sleepiness, early chronotype, no snoring, and no frequent insomnia as healthy factors to study their relationship with the incidence of falls and fractures. The analysis was conducted among 289,000 participants from the UK Biobank. Results The mean follow-up period was 12.3 years (3.5 million person-years of follow-up), and 12,967 cases of falls and 16,121 cases of all fractures were documented. Compared to participants exhibiting an unfavorable sleep pattern, those adhering to a healthy sleep pattern experienced a 17% and 28% reduction in the risks of incident falls (hazard ratio [HR], 0.83; 95% CI, 0.74-0.93) and all fractures (HR, 0.72; 95% CI, 0.66-0.79) during follow-up. In addition, participants exhibiting a healthy sleep pattern, together with a high genetically determined bone mineral density (BMD), showed the lowest risks of falls and fractures. Conclusion A healthy sleep pattern was significantly linked to decreased risks of incident falls and fractures. The protective association was not modified by genetically determined BMD.
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Affiliation(s)
- Tao Zhou
- Department of Epidemiology, School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Xue Dai
- Department of Epidemiology, School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Yu Yuan
- Department of Occupational and Environmental Health, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiaochu Xue
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Xiang Li
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Mengying Wang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Hao Ma
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Yoriko Heianza
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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Škrlec I, Biloglav Z, Talapko J, Džijan S, Daus-Šebeđak D, Cesar V. Myocardial Infarction Susceptibility and the MTNR1B Polymorphisms. Int J Mol Sci 2023; 24:11444. [PMID: 37511203 PMCID: PMC10380655 DOI: 10.3390/ijms241411444] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
Melatonin is a circadian hormone with antioxidant properties that protects against myocardial ischemia-reperfusion injury. Genetic variations of the melatonin receptor 1B gene (MTNR1B) play an important role in the development of type 2 diabetes, a risk factor for cardiovascular diseases. Accordingly, MTNR1B polymorphisms are crucial in numerous disorders of the cardiovascular system. Therefore, the aim of the present study was to investigate a possible association of MTNR1B polymorphisms with chronotype and susceptibility to myocardial infarction. The present case-control study included 199 patients with myocardial infarction (MI) (57% men) and 198 control participants (52% men) without previous cardiovascular diseases who underwent genotyping for the MTNR1B polymorphisms rs10830963, rs1387153, and rs4753426 from peripheral blood samples. Chronotype was determined using the Morningness-Eveningness Questionnaire (MEQ). As estimated by the chi-square test, no significant association was found in the distribution of alleles and genotypes between myocardial infarction patients and controls. In addition, there was no association between MTNR1B polymorphisms and chronotype in MI patients. As some previous studies have shown, the present negative results do not exclude the role of the MTNR1B polymorphisms studied in the development of myocardial infarction. Rather, they may indicate that MTNR1B polymorphisms are a minor risk factor for myocardial infarction.
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Affiliation(s)
- Ivana Škrlec
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Zrinka Biloglav
- Department of Medical Statistics, Epidemiology and Medical Informatics, School of Public Health Andrija Štampar, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Jasminka Talapko
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Snježana Džijan
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- DNA Laboratory, Genos Ltd., 10000 Zagreb, Croatia
| | | | - Vera Cesar
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of Biology, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
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Lavie I, Lavie M, Dayan O, Gafter-Gvili A, Yahav D, Kozlovski D, Avni T. Is there a 'weekend effect' on mortality among hospitalised patients in an internal medicine ward? A retrospective study. Intern Med J 2023; 53:1240-1247. [PMID: 35189020 DOI: 10.1111/imj.15723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/11/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previous studies demonstrated a 'weekend effect' and a 'night effect' of increased mortality among patients admitted during weekends or night shifts, presumably due to understaffing. AIMS To examine whether death during hospitalisation follows a similar effect regardless of admission time. METHODS A retrospective cohort study among deceased patients hospitalised in the internal medicine wing of a tertiary medical centre in Israel, between 2019 and 2020. Demographic and medical data were retrieved from electronic medical charts. Causes of death were specifically categorised. We applied statistical models to test for differences in mortality using incidence rate ratio (IRR) according to the day, time and cause of death. RESULTS One thousand, two hundred and seventy-eight deceased patients were included. All-cause mortality was similar between weekends and weekdays. When sepsis was the cause of death, higher IRR were demonstrated on Fridays in comparison with weekdays (IRR 1.4; 95% confidence interval (CI) 1.1-1.9; P < 0.05). Other causes of death were not consistent with a 'weekend effect'. Mortality during night shifts was higher in comparison with the afternoon (IRR 1.5; 95% CI 1.3-4.7) and similar to the morning (IRR 1; 95% CI 0.9-1.2). CONCLUSION Our study did not find a pattern of 'weekend effect' or 'night effect' on all-cause mortality among hospitalised patients in internal medicine wards. Our findings suggest that perhaps specifically death from sepsis, and not all-cause mortality, can be used as a surrogate for the measurement of understaffing or quality of care in the internal ward.
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Affiliation(s)
- Inbar Lavie
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Michael Lavie
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Tel Aviv Souraski Medical Center, Tel Aviv, Israel
| | - Ofek Dayan
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Anat Gafter-Gvili
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Internal Medicine A, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Dafna Yahav
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Infectious Disease Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Dror Kozlovski
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Internal Medicine A, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Tomer Avni
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Internal Medicine A, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
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He L, Ma T, Cheng X, Bai Y. The association between sleep characteristics and the risk of all-cause mortality among individuals with cardiometabolic multimorbidity: a prospective study of UK Biobank. J Clin Sleep Med 2023; 19:651-658. [PMID: 36644852 PMCID: PMC10071379 DOI: 10.5664/jcsm.10404] [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: 08/20/2022] [Revised: 11/13/2022] [Accepted: 11/14/2022] [Indexed: 01/17/2023]
Abstract
STUDY OBJECTIVES To investigate the implications of both sleep factors and sleep patterns on the prognosis of cardiometabolic multimorbidity. METHODS From UK Biobank, individuals with cardiometabolic multimorbidity , defined as the coincidence of at least 2 cardiometabolic diseases (hypertension, diabetes mellitus, coronary heart disease, and stroke) were included in this study. Four low-risk sleep factors, including early chronotype, sleep 7-8 h/d, free of insomnia, and no frequent excessive daytime sleepiness, were used to generate a healthy sleep score ranging from 0 to 4. Participants with a score of 0-1, 2, 3-4 were clustered into groups with poor, intermediate, and healthy sleep pattern, respectively. We assessed the adjusted hazard ratios and 95% confidence intervals for all-cause mortality using the Cox proportional hazards model. RESULTS Among included 35,757 participants, the mean age (standard deviation)) was 61.82 (6.3) years. After full adjustment, early chronotype, sleep 7-8 h/d, no frequent excessive daytime sleepiness, and free of insomnia were independently associated with 8%, 12%, 11%, and 8% lower risk of all-cause mortality among all persons with cardiometabolic multimorbidity. We found the fully adjusted hazard ratio (95% confidence interval) for all-cause mortality was 0.90 (0.88-0.92) for a 1-point increase in the healthy sleep score. Compared with the reference group, participants with the intermediate and healthy sleep pattern had 9% and 23% lower risk of all-cause death, respectively, in the fully adjusted model. CONCLUSIONS A healthy sleep pattern combining 4 low-risk sleep factors could be regarded as a healthy lifestyle for individuals with cardiometabolic multimorbidity to lower the risk of all-cause mortality. CITATION He L, Ma T, Cheng X, Bai Y. The association between sleep characteristics and the risk of all-cause mortality among individuals with cardiometabolic multimorbidity: a prospective study of UK Biobank. J Clin Sleep Med. 2023;19(4):651-658.
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Affiliation(s)
- Lingfang He
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Tianqi Ma
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xunjie Cheng
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yongping Bai
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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11
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Waddell H, Stevenson TJ, Mole DJ. The role of the circadian rhythms in critical illness with a focus on acute pancreatitis. Heliyon 2023; 9:e15335. [PMID: 37089281 PMCID: PMC10119767 DOI: 10.1016/j.heliyon.2023.e15335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/20/2023] [Accepted: 04/03/2023] [Indexed: 04/25/2023] Open
Abstract
Circadian rhythms are responsible for governing various physiological processes, including hormone secretion, immune responses, metabolism, and the sleep/wake cycle. In critical illnesses such as acute pancreatitis (AP), circadian rhythms can become dysregulated due to disease. Evidence suggests that time of onset of disease, coupled with peripheral inflammation brought about by AP will impact on the circadian rhythms generated in the central pacemaker and peripheral tissues. Cells of the innate and adaptive immune system are governed by circadian rhythms and the diurnal pattern of expression can be disrupted during disease. Peak circadian immune cell release and gene expression can coincide with AP onset, that may increase pancreatic injury, tissue damage and the potential for systemic inflammation and multiple organ failure to develop. Here, we provide an overview of the role of circadian rhythms in AP and the underpinning inflammatory mechanisms to contextualise ongoing research into the chronobiology and chronotherapeutics of AP.
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Affiliation(s)
- Heather Waddell
- Medical Research Council Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Tyler J. Stevenson
- Institute of Biodiversity and Animal Health and Comparative Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, G61 1QH, UK
| | - Damian J. Mole
- Medical Research Council Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, EH16 4TJ, UK
- Clinical Surgery, School of Clinical Sciences and Community Health, The University of Edinburgh, Edinburgh, EH16 4SB, UK
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12
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Coskun A, Zarepour A, Zarrabi A. Physiological Rhythms and Biological Variation of Biomolecules: The Road to Personalized Laboratory Medicine. Int J Mol Sci 2023; 24:ijms24076275. [PMID: 37047252 PMCID: PMC10094461 DOI: 10.3390/ijms24076275] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/24/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
The concentration of biomolecules in living systems shows numerous systematic and random variations. Systematic variations can be classified based on the frequency of variations as ultradian (<24 h), circadian (approximately 24 h), and infradian (>24 h), which are partly predictable. Random biological variations are known as between-subject biological variations that are the variations among the set points of an analyte from different individuals and within-subject biological variation, which is the variation of the analyte around individuals’ set points. The random biological variation cannot be predicted but can be estimated using appropriate measurement and statistical procedures. Physiological rhythms and random biological variation of the analytes could be considered the essential elements of predictive, preventive, and particularly personalized laboratory medicine. This systematic review aims to summarize research that have been done about the types of physiological rhythms, biological variations, and their effects on laboratory tests. We have searched the PubMed and Web of Science databases for biological variation and physiological rhythm articles in English without time restrictions with the terms “Biological variation, Within-subject biological variation, Between-subject biological variation, Physiological rhythms, Ultradian rhythms, Circadian rhythm, Infradian rhythms”. It was concluded that, for effective management of predicting, preventing, and personalizing medicine, which is based on the safe and valid interpretation of patients’ laboratory test results, both physiological rhythms and biological variation of the measurands should be considered simultaneously.
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13
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Kazakou P, Nicolaides NC, Chrousos GP. Basic Concepts and Hormonal Regulators of the Stress System. Horm Res Paediatr 2023; 96:8-16. [PMID: 35272295 DOI: 10.1159/000523975] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/02/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Human organisms have to cope with a large number of external or internal stressful stimuli that threaten - or are perceived as threatening - their internal dynamic balance or homeostasis. To face these disturbing forces, or stressors, organisms have developed a complex neuroendocrine system, the stress system, which consists of the hypothalamic-pituitary-adrenal axis and the locus caeruleus/norepinephrine-autonomic nervous system. SUMMARY Upon exposure to stressors beyond a certain threshold, the activation of the stress system leads to a series of physiological and behavioral adaptations that help achieve homeostasis and increase the chances of survival. When, however, the stress response to stressors is inadequate, excessive, or prolonged, the resultant maladaptation may lead to the development of several stress-related pathologic conditions. Adverse environmental events, especially during critical periods of life, such as prenatal life, childhood, and puberty/adolescence, in combination with the underlying genetic background, may leave deep, long-term epigenetic imprints in the human expressed genome. KEY MESSAGES In this review, we describe the components of the stress system and its functional interactions with other homeostatic systems of the organism; we present the hormonal regulators of the stress response, and we discuss the development of stress-related pathologies.
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Affiliation(s)
- Paraskevi Kazakou
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.,Endocrine Unit, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nicolas C Nicolaides
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.,Division of Endocrinology and Metabolism, Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece.,University Research Institute of Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens Medical School, "Aghia Sophia" Children's Hospital, Athens, Greece.,Department of Molecular Genetics, Function and Therapy, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - George P Chrousos
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.,Division of Endocrinology and Metabolism, Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece.,University Research Institute of Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens Medical School, "Aghia Sophia" Children's Hospital, Athens, Greece
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14
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Eum SY, Schurhoff N, Teglas T, Wolff G, Toborek M. Circadian disruption alters gut barrier integrity via a ß-catenin-MMP-related pathway. Mol Cell Biochem 2023; 478:581-595. [PMID: 35976519 PMCID: PMC9938043 DOI: 10.1007/s11010-022-04536-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 08/04/2022] [Indexed: 10/15/2022]
Abstract
We evaluated the mechanistic link between circadian rhythms and gut barrier permeability. Mice were subjected to either constant 24-h light (LL) or 12-h light/dark cycles (LD). Mice housed in LL experienced a significant increase in gut barrier permeability that was associated with dysregulated ß-catenin expression and altered expression of tight junction (TJ) proteins. Silencing of ß-catenin resulted in disruption of barrier function in SW480 cells, with ß-catenin appearing to be an upstream regulator of the core circadian components, such as Bmal1, Clock, and Per1/2. In addition, ß-catenin silencing downregulated ZO-1 and occludin TJ proteins with only limited or no changes at their mRNA levels, suggesting post transcriptional regulation. Indeed, silencing of ß-catenin significantly upregulated expression of matrix metallopeptidase (MMP)-2 and MMP-9, and blocking MMP-2/9 activity attenuated epithelial disruption induced by ß-catenin silencing. These results indicate the regulatory role of circadian disruption on gut barrier integrity and the associations between TJ proteins and circadian rhythms, while demonstrating the regulatory role of ß-catenin in this process.
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Affiliation(s)
- Sung Yong Eum
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, FL, 33155, USA
| | - Nicolette Schurhoff
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, FL, 33155, USA
| | - Timea Teglas
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, FL, 33155, USA
| | - Gretchen Wolff
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, FL, 33155, USA
- Institute for Diabetes and Cancer (IDC), Helmholtz Diabetes Center, Helmholtz Centre Munich, Neuherberg, Germany
- Joint Heidelberg-IDC Translational Diabetes Program, Inner Medicine 1, Heidelberg University Hospital, Heidelberg, Germany
| | - Michal Toborek
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, FL, 33155, USA.
- Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, 40-065, Katowice, Poland.
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Suite 528, 1011 NW 15th Street, Miami, FL, 33136, USA.
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15
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Roth JR, Varshney S, de Moraes RCM, Melkani GC. Circadian-mediated regulation of cardiometabolic disorders and aging with time-restricted feeding. Obesity (Silver Spring) 2023; 31 Suppl 1:40-49. [PMID: 36623845 PMCID: PMC10089654 DOI: 10.1002/oby.23664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 11/17/2022] [Accepted: 11/24/2022] [Indexed: 01/11/2023]
Abstract
Circadian rhythms are present throughout biology, from the molecular level to complex behaviors such as eating and sleeping. They are driven by molecular clocks within cells, and different tissues can have unique rhythms. Circadian disruption can trigger obesity and other common metabolic disorders such as aging, diabetes, and cardiovascular disease, and circadian genes control metabolism. At an organismal level, feeding and fasting rhythms are key drivers of circadian rhythms. This underscores the bidirectional relationship between metabolism and circadian rhythms, and many metabolic disorders have circadian disruption or misalignment. Therefore, studying circadian rhythms may offer new avenues for understanding the etiology and management of obesity. This review describes how circadian rhythm dysregulation is linked with cardiometabolic disorders and how the lifestyle intervention of time-restricted feeding (TRF) regulates them. TRF reinforces feeding-fasting rhythms without reducing caloric intake and ameliorates metabolic disorders such as obesity and associated cardiac dysfunction, along with reducing inflammation. TRF optimizes the expression of genes and pathways related to normal metabolic function, linking metabolism with TRF's benefits and demonstrating the molecular link between metabolic disorders and circadian rhythms. Thus, TRF has tremendous therapeutic potential that could be easily adopted to reduce obesity-linked dysfunction and cardiometabolic disorders.
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Affiliation(s)
- Jonathan R. Roth
- Department of Pathology, Division of Molecular and Cellular Pathology, School of Medicine, The University of Alabama at Birmingham, AL 35294, USA
| | - Shweta Varshney
- Regulatory Biology Laboratory, Salk Institute for Biological Studies, La Jolla, CA 92037, USA
| | - Ruan Carlos Macedo de Moraes
- Department of Pathology, Division of Molecular and Cellular Pathology, School of Medicine, The University of Alabama at Birmingham, AL 35294, USA
| | - Girish C. Melkani
- Department of Pathology, Division of Molecular and Cellular Pathology, School of Medicine, The University of Alabama at Birmingham, AL 35294, USA
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16
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Artioli T, Gualandro DM, Cardozo FAM, Rojas MCE, Calderaro D, Yu PC, Casella IB, de Luccia N, Caramelli B. Impact of the period of the day on all-cause mortality and major cardiovascular complications after arterial vascular surgeries. PLoS One 2023; 18:e0279873. [PMID: 36602973 PMCID: PMC9815593 DOI: 10.1371/journal.pone.0279873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 12/18/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Conflicting results are reported about daytime variation on mortality and cardiac outcomes after non-cardiac surgeries. In this cohort study, we evaluate whether the period of the day in which surgeries are performed may influence all-cause mortality and cardiovascular outcomes in patients undergoing non-cardiac arterial vascular procedures. METHODS 1,267 patients who underwent non-cardiac arterial vascular surgeries between 2012 and 2018 were prospectively included in our cohort and categorized into two groups: morning (7 a.m. to 12 a.m., 79%) and afternoon/night (12:01 p.m. to 6:59 a.m. in the next day, 21%) surgeries. Primary endpoint was all-cause mortality within 30 days and one year. Secondary endpoints were the incidence of perioperative myocardial injury/infarction (PMI), and the incidence of major adverse cardiac events (MACE, including acute myocardial infarction, acute heart failure, arrhythmias, cardiovascular death) at hospital discharge. RESULTS After adjusting for confounders in the multivariable Cox proportional regression, all-cause mortality rates at 30 days and one year were higher among those who underwent surgery in the afternoon/night (aHR 1.6 [95%CI 1.1-2.3], P = 0.015 and aHR 1.7 [95%CI 1.3-2.2], P < 0.001, respectively). Afternoon/night patients had higher incidence of PMI (aHR 1.4 [95%CI 1.1-1.7], P < 0.001). There was no significant difference in the incidence of MACE (aHR 1.3 [95%CI 0.9-1.7], P = 0.074). CONCLUSIONS In patients undergoing arterial vascular surgery, being operated in the afternoon/night was independently associated with increased all-cause mortality rates and incidence of perioperative myocardial injury/infarction.
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Affiliation(s)
- Thiago Artioli
- Department of Medicine, ABC Medical College University Center, Santo André, São Paulo, Brazil
| | - Danielle Menosi Gualandro
- Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, São Paulo, Brasil
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Universitätsspital CH, Basel, Switzerland
| | - Francisco Akira Malta Cardozo
- Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, São Paulo, Brasil
| | - María Carmen Escalante Rojas
- Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, São Paulo, Brasil
| | - Daniela Calderaro
- Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, São Paulo, Brasil
| | - Pai Ching Yu
- Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, São Paulo, Brasil
| | - Ivan Benaduce Casella
- Vascular and Endovascular Surgery Division, Clinics Hospital, University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | - Nelson de Luccia
- Vascular and Endovascular Surgery Division, Clinics Hospital, University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | - Bruno Caramelli
- Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, São Paulo, Brasil
- * E-mail:
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17
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Joshi K, Das M, Sarma A, Arora MK, SInghal M, Kumar B. Insight on Cardiac Chronobiology and Latest Developments of Chronotherapeutic Antihypertensive Interventions for Better Clinical Outcomes. Curr Hypertens Rev 2023; 19:106-122. [PMID: 36624649 DOI: 10.2174/1573402119666230109142156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 11/10/2022] [Accepted: 11/15/2022] [Indexed: 01/11/2023]
Abstract
Cardiac circadian rhythms are an important regulator of body functions, including cardiac activities and blood pressure. Disturbance of circadian rhythm is known to trigger and aggravate various cardiovascular diseases. Thus, modulating the circadian rhythm can be used as a therapeutic approach to cardiovascular diseases. Through this work, we intend to discuss the current understanding of cardiac circadian rhythms, in terms of quantifiable parameters like BP and HR. We also elaborate on the molecular regulators and the molecular cascades along with their specific genetic aspects involved in modulating circadian rhythms, with specific reference to cardiovascular health and cardiovascular diseases. Along with this, we also presented the latest pharmacogenomic and metabolomics markers involved in chronobiological control of the cardiovascular system along with their possible utility in cardiovascular disease diagnosis and therapeutics. Finally, we reviewed the current expert opinions on chronotherapeutic approaches for utilizing the conventional as well as the new pharmacological molecules for antihypertensive chronotherapy.
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Affiliation(s)
- Kumud Joshi
- Department of Pharmacy, Lloyd Institute of Management and Technology, Greater Noida, India
| | - Madhubanti Das
- Department of Zoology, Gauhati University, Guwahati, Assam, India
| | - Anupam Sarma
- Advanced Drug Delivery Laboratory, GIPS, Girijananda Chowdhury University, Guwahati, Assam, India
| | - Mandeep K Arora
- School of Pharmacy and population health informatics, DIT University, Dehradun, India
| | - Manmohan SInghal
- School of Pharmacy and population health informatics, DIT University, Dehradun, India
| | - Bhavna Kumar
- School of Pharmacy and population health informatics, DIT University, Dehradun, India
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18
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Hong Y, Mo H, Cho SJ, Im HJ. Wake-up ischemic stroke associated with short sleep duration and sleep behavior: A stratified analysis according to risk of obstructive sleep apnea. Sleep Med 2023; 101:497-504. [PMID: 36527941 DOI: 10.1016/j.sleep.2022.11.038] [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: 09/02/2022] [Revised: 11/30/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Wake-up stroke (WUS) is an ischemic stroke occurring during nocturnal sleep with neurological deficits observed upon awakening. Our study aimed to investigate the association between WUS, sleep curtailment, and sleep behavior according to the obstructive sleep apnea (OSA) risk in patients with acute ischemic stroke. METHODS This single-centered, retrospective study included hospitalized subjects with acute ischemic stroke occurring within 30 days. A total of 250 participants were classified as WUS or not and enquired about their sleep habits concerning sleep time on weekdays and weekends, demographic factors, and assessed comorbid medical conditions. Weekend catch-up sleep (CUS) was defined as the extension of sleep duration during weekends. The average weekly sleep duration and chronotype were assessed. The association between WUS and sleep factors was analyzed. RESULTS WUS was observed in 70 patients (28.0%) with acute ischemic stroke. There were no significant differences in the demographic and stroke-related variables between the WUS and non-WUS (NWUS) groups. Upon stratified analysis based on risk of OSA, average weekly sleep duration (odds ratio, [OR] = 0.60, 95% confidence interval, [CI] = 0.41-0.89; p = 0.011), the presence of weekend CUS (OR = 0.07, 95% CI = 0.01-0.97; p = 0.047), and chronotype (OR = 0.62, 95% CI = 0.39-0.98; p = 0.041) were independently associated with WUS in low-risk group with OSA, but not in the high-risk group. CONCLUSIONS Short sleep duration and lack of compensation are significantly associated with WUS in low-risk OSA group. Insufficient sleep and sleep behaviors could play a different role in causing ischemic stroke during sleep when patients are stratified by their risk of sleep apnea.
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Affiliation(s)
- Yooha Hong
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea
| | - Heejung Mo
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea
| | - Soo-Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea
| | - Hee-Jin Im
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea.
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19
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Rabinovich-Nikitin I, Crandall M, Kirshenbaum LA. Circadian regulation of genetic and hormonal risk factors of cardiovascular disease in women. Can J Physiol Pharmacol 2023; 101:1-7. [PMID: 36318826 DOI: 10.1139/cjpp-2022-0222] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cardiovascular disease is the leading cause of morbidity and mortality worldwide. However, sex differences can impact differently the etiology and outcome of cardiovascular disease when comparing men and women. Women have unique genetic and hormonal risk factors that can be associated with the development of cardiovascular diseases. Furthermore, certain phenotypes of cardiovascular diseases are more prevalent to women. Molecular clocks control circadian rhythms of different physiological systems in our body, including the cardiovascular system. Increased evidence in recent years points to a link between cardiovascular disease and regulation by circadian rhythms. However, the difference between circadian regulation of cardiovascular disease in women and men is poorly understood. In this review, we highlight the recent advances in circadian-regulated cardiovascular diseases with a specific focus on the pathogenesis of heart disease in women. Understanding circadian-regulated pathways and sex-specific differences between men and women may contribute to better diagnosis and development of sex-targeted interventions to better treat cardiovascular diseases.
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Affiliation(s)
- Inna Rabinovich-Nikitin
- Department of Physiology and Pathophysiology, The Institute of Cardiovascular Sciences, St. Boniface Hospital Albrechtsen Research Centre, Winnipeg, MB, Canada
| | - Molly Crandall
- Department of Physiology and Pathophysiology, The Institute of Cardiovascular Sciences, St. Boniface Hospital Albrechtsen Research Centre, Winnipeg, MB, Canada
| | - Lorrie A Kirshenbaum
- Department of Physiology and Pathophysiology, The Institute of Cardiovascular Sciences, St. Boniface Hospital Albrechtsen Research Centre, Winnipeg, MB, Canada.,Department of Pharmacology and Therapeutics, Rady College of Medicine, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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20
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Effects of age and sex on vasomotor activity and baroreflex sensitivity during the sleep-wake cycle. Sci Rep 2022; 12:22424. [PMID: 36575245 PMCID: PMC9794808 DOI: 10.1038/s41598-022-26440-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/14/2022] [Indexed: 12/28/2022] Open
Abstract
Cardiovascular function is related to age, sex, and state of consciousness. We hypothesized that cardiovagal baroreflex sensitivity (BRS) demonstrates different patterns in both sexes before and after 50 years of age and that these patterns are associated with patterned changes during the sleep-wake cycle. We recruited 67 healthy participants (aged 20-79 years; 41 women) and divided them into four age groups: 20-29, 30-49, 50-69, and 70-79 years. All the participants underwent polysomnography and blood pressure measurements. For each participant, we used the average of the arterial pressure variability, heart rate variability (HRV), and BRS parameters during the sleep-wake stages. BRS and HRV parameters were significantly negatively correlated with age. The BRS indexes were significantly lower in the participants aged ≥ 50 years than in those aged < 50 years, and these age-related declines were more apparent during non-rapid eye movement sleep than during wakefulness. Only BRS demonstrated a significantly negative correlation with age in participants ≥ 50 years old. Women exhibited a stronger association than men between BRS and age and an earlier decline in BRS. Changes in BRS varied with age, sex, and consciousness state, each demonstrating a specific pattern. The age of 50 years appeared to be a crucial turning point for sexual dimorphism in BRS. Baroreflex modulation of the cardiovascular system during sleep sensitively delineated the age- and sex-dependent BRS patterns, highlighting the clinical importance of our results. Our findings may aid in screening for neurocardiac abnormalities in apparently healthy individuals.
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21
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Diurnal dynamic range as index of dysregulation of system dynamics. A cortisol examplar using data from the Study of Midlife in the United States. Psychoneuroendocrinology 2022; 142:105804. [PMID: 35623318 PMCID: PMC9262344 DOI: 10.1016/j.psyneuen.2022.105804] [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: 11/08/2021] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 11/22/2022]
Abstract
We discuss the importance of including measures of dysregulated system dynamics in the operationalization of allostatic load. The concept of allostatic load, as originally proposed by McEwen and Stellar, included dysregulation not only in the resting state of physiological systems, but also in system dynamics. We describe previous work on cortisol diurnal dynamic range (peak to nadir spread) as an index of the health of the hypothalamic-pituitary-adrenal axis, with compression of dynamic range being a marker of dysregulation. In particular, we review the evidence for a) diurnal dynamic range compression in people from disadvantaged backgrounds, b) cross-sectional association of cortisol diurnal dynamic range compression with dysregulation in other systems' resting states, and c) cross-sectional association of cortisol diurnal dynamic range compression with lower scores on cognitive testing. Then, we present new data from the Study of Midlife in the United States (MIDUS) on longitudinal associations of cortisol dynamic range compression with subsequent cognitive decline and all-cause mortality. Briefly, each standard deviation decrement in cortisol diurnal dynamic range is associated with adjusted mortality hazard ratio of 1.35 (95% confidence interval: 1.19, 1.54). Among those who scored at median or lower in executive functioning at baseline and survive, each standard deviation decrement in cortisol dynamic range is associated with 1% greater decline in executive functioning over a decade (95% confidence interval: 0.4%, 2.0%). We conclude that including measures of system dynamics like diurnal dynamic range in the next generation of allostatic load measurement will likely advance understanding of the cumulative physiological burden of chronic stress and life experiences, and improve the prediction of future health consequences.
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22
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Abstract
SUMMARY Ischemic strokes most often occur between 6 am and 12 am after awakening from sleep but up to 30% occur during sleep. Wake-up strokes (WUS) are new focal neurological deficit(s) persisting for ≥ 24 hours attributable to an ischemic event present on patient awakening. Obstructive sleep apnea (OSA) is a major risk factor for WUS because it compounds the instability of the morning environment and increases the likelihood of cardiovascular events, including hypertension, atrial fibrillation, right-to-left shunts, and stroke. Circadian-driven alterations in structural, homeostatic, and serological factors also predispose to WUS. Also, WUS patients are often not considered candidates for time-dependent intravenous thrombolysis therapy because of an uncertain onset time. However, using the tissue clock (positive diffusion weighted imaging-negative fluid-attenuated inversion recovery mismatch) dates the WUS as 3 to 4.5 hours old and permits consideration for intravenous thrombolysis and if needed mechanical thrombectomy. Given the high prevalence of moderate/severe OSA in stroke patients and its impact on stroke outcomes, screening with overnight pulse oximetry and home sleep apnea test is needed. Treating OSA poststroke remains challenging. Polysomnographic changes in sleep architecture following acute/subacute stroke may also impact upon stroke outcome.
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Affiliation(s)
- Atif Zafar
- Department of Neurology, University of Toronto, Toronto, ON, Canada
| | - Parth Dhruv
- Department of Neurology, Kaiser Permanente, Santa Clara, California, U.S.A
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23
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He L, Ma T, Li J, Luo Y, Zhang G, Cheng X, Bai Y. Adherence to a Healthy Sleep Pattern and Incidence of Cardiometabolic Multimorbidity Among Hypertensive Patients: A Prospective Study of UK Biobank. Sleep 2022; 45:6615411. [PMID: 35738866 PMCID: PMC9548671 DOI: 10.1093/sleep/zsac141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 06/13/2022] [Indexed: 11/15/2022] Open
Abstract
Study Objectives To investigate whether a healthy sleep pattern would reduce the risk of cardiometabolic multimorbidity (CMM) among hypertensives. Methods This is a prospective cohort analysis from the UK Biobank. A total of 69 524 hypertensives without a history of diabetes mellitus, coronary heart disease, or stroke at baseline were enrolled. Five dimensions of healthy sleep at baseline including early chronotype, sleep 7–8 h/d, free of insomnia, no snoring, and no frequent excessive daytime sleepiness were used to generate a healthy sleep score ranging from 0 to 5 (one point was given for each dimension of healthy sleep). A higher score indicated a healthier sleep pattern. We set five groups corresponding to the healthy sleep score of 5, 4, 3, 2, and 0–1, respectively. The primary outcome was the incidence of overall CMM among enrolled hypertensives. We assessed the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) by Fine-Gray subdistribution hazard models. Results We found the full-adjusted HR (95% CI) for overall CMM was 0.93 (0.91–0.95) for a 1-point increase in the healthy sleep score. Compared to hypertensives with a healthy sleep score of 0–1, those with a score of 5 had a 27% lower risk of overall CMM, and 37%, 23%, and 20% lower risks of diabetes mellitus, coronary heart disease, and stroke, respectively, after adjusting for sociodemographic characteristic, lifestyle, and clinical factors. Conclusions Our results indicated that a healthy sleep pattern was associated with lower risks of CMM outcomes among hypertensives.
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Affiliation(s)
- Lingfang He
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Tianqi Ma
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jinchen Li
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yi Luo
- Department of Cardiovascular Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Guogang Zhang
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, China.,Department of Cardiovascular Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Xunjie Cheng
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yongping Bai
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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杨 若, 王 梦, 李 春, 于 欢, 王 小, 吴 俊, 王 斯, 王 伽, 陈 大, 吴 涛, 胡 永. [Interaction between ischemic stroke risk loci identified by genome-wide association studies and sleep habits]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2022; 54:412-420. [PMID: 35701116 PMCID: PMC9197694 DOI: 10.19723/j.issn.1671-167x.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To explore the relationship between sleep habits (sleep duration, sleep efficiency, sleep onset timing) and ischemic stroke, and whether there is an interaction between sleep habits and ischemic stroke susceptibility gene loci. METHODS A questionnaire survey, physical examination, blood biochemical testing and genotyping were conducted among rural residents in Beijing, and the gene loci of ischemic stroke suggested by previous genome-wide association studies (GWAS) were screened. Multivariable generalized linear model was used to analyze the correlation between sleep habits, sleep-gene interaction and ischemic stroke. RESULTS A total of 4 648 subjects with an average age of (58.5±8.7) years were enrolled, including 1 316 patients with ischemic stroke. Compared with non-stroke patients, stroke patients with sleep duration ≥9 hours, sleep efficiency < 80%, and sleep onset timing earlier than 22:00 accounted for a higher proportion (P < 0.05). There was no significant association between sleep duration and risk of ischemic stroke (OR=1.04, 95%CI: 0.99-1.10, P=0.085). Sleep efficiency was inversely associated with the risk of ischemic stroke (OR=0.18, 95%CI: 0.06-0.53, P=0.002). The risk of ischemic stroke in the subjects with sleep efficiency < 80% was 1.47-fold (95%CI: 1.03-2.10, P=0.033) of that in the subjects with sleep efficiency ≥80%. Falling asleep earlier than 22:00 was associated with 1.26 times greater risk of stroke than falling asleep between 22:00 and 22:59 (95%CI: 1.04-1.52, P=0.017). Multifactorial adjustment model showed that rs579459 on ABO gene had an interaction with sleep time (P for interaction =0.040). When there were two T alleles for rs579459 on the ABO gene, those who fell asleep before 22:00 had 1.56 times (95%CI: 1.20-2.04, P=0.001) the risk of stroke compared with those who fell asleep between 22:00 and 22:59, and there was no significant difference when the number of pathogenic alleles was 0 or 1. In the model adjusted only for gender, age and family structure, sleep duration and the number of T allele rs2634074 on PITX2 gene had an interaction with ischemic stroke (P for interaction=0.033). CONCLUSION Decreased sleep efficiency is associated with increased risk of ischemic stroke, and falling asleep earlier than 22:00 is associated with higher risk of ischemic stroke. Sleep onset timing interacted with rs579459 in ABO gene and the risk of ischemic stroke. Sleep duration and PITX2 rs2634074 may have a potential interaction with ischemic stroke risk.
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Affiliation(s)
- 若彤 杨
- />北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 梦莹 王
- />北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 春男 李
- />北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 欢 于
- />北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 小文 王
- />北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 俊慧 吴
- />北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 斯悦 王
- />北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 伽婷 王
- />北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 大方 陈
- />北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 涛 吴
- />北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 永华 胡
- />北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
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Rabinovich-Nikitin I, Love M, Kirshenbaum LA. Intersection of autophagy regulation and circadian rhythms in the heart. Biochim Biophys Acta Mol Basis Dis 2022; 1868:166354. [DOI: 10.1016/j.bbadis.2022.166354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 01/06/2022] [Accepted: 01/13/2022] [Indexed: 12/14/2022]
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Xu C, Dong M, Sun L, Deng Y, Zhou J, Yuan Z. Sex differences in the impact of day/Night distribution of ST-segment elevation myocardial infarction onset on in-hospital outcomes: Findings from the improving care for cardiovascular disease in China-Acute Coronary Syndrome Project. Sleep Med 2022; 95:112-119. [DOI: 10.1016/j.sleep.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/08/2022] [Accepted: 04/18/2022] [Indexed: 11/26/2022]
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Rossi A, Calogiuri G, Maffi S, Pedreschi D, Clifton DA, Morelli D. Physiological recovery among workers in long-distance sleddog races: A case study on female veterinarians in Finnmarksløpet. Work 2022; 71:749-760. [DOI: 10.3233/wor-210331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: During Finnmarksløpet (FL, one of the longest distance sleddog races in the world), veterinarians are exposed to extreme environmental conditions and tight working schedules, with little and fragmented sleep. OBJECTIVE: The aim of this case study was to examine cardiovascular parameters and sleep-wake patterns among veterinarians working within FL, during and after (for a month) the end of the race. METHODS: Six female veterinarians volunteered for the study. The participants wore a wrist device for a total of eight weeks in order to passively and semi-continuously record physiological responses throughout the day (i.e., heart rate, heart rate variability, number of steps, and sleep quality). Moreover, perceived sleep quality was assessed by Pittsburgh Sleep Quality Index (PSQI) at three time-points. RESULTS: During and for one month after completion of the FL, most veterinarians presented an alteration of cardiovascular parameters and sleep quality. The heart rate circadian rhythm returned to pre-race values within about two weeks. CONCLUSIONS: The long-lasting alteration of the veterinarians’ cardiovascular parameters and sleep-wake patterns might have negative consequences for their health in the long-term, especially if similar experiences are repeated more times though the course of a year or season. More research is needed in order to understand the health risks, as well as how to prevent them, among veterinarians in long-distance sleddog races or other similar events.
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Affiliation(s)
- Alessio Rossi
- Department of Computer Science, University of Pisa, Pisa, Italy
| | - Giovanna Calogiuri
- Centre for Health and Technology, Department of Nursing and Health Sciences, Faculty of Social and Health Sciences, University of South-Eastern Norway, Drammen, Norway
- Department of Public Health and Sport Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Sergio Maffi
- Clinica Veterinaria Dott. Maffi Sergio, Palazzolo sull’Oglio, Italy
| | - Dino Pedreschi
- Department of Computer Science, University of Pisa, Pisa, Italy
| | - David A. Clifton
- Department of Engineering Science, Institute of Biomedical Engineering, Oxford, UK
| | - Davide Morelli
- Department of Engineering Science, Institute of Biomedical Engineering, Oxford, UK
- Huma Therapeutics Limited, London, UK
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Mortaş H, Bilici S, Öztürk H, Karakan T. Changes in intestinal parameters and their association with dietary patterns in rotational shift workers. Chronobiol Int 2022; 39:872-885. [PMID: 35232303 DOI: 10.1080/07420528.2022.2044349] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Circadian rhythm disturbances induced by rotating shift work contribute to development of metabolic disorders. However, their effects on intestinal parameters such as epithelial permeability and fecal short chain fatty acid (SCFA) levels have not been established yet. This study was planned to investigate the changes in intestinal integrity, fecal SCFA levels, gut microbiota and nutritional intake of rotational shift workers. The study was conducted on ten male rotational shift workers, 25-40 years old. Circadian rhythm disruption was assumed to have occurred after 14 days in the night shift. Dietary data which was obtained by using 24 h record for 7 days, physical activity data, anthropometric measurements, fecal and blood samples were collected during day and night shift. Changes in dietary consumption, anthropometric measurements, blood chemistry and intestinal epithelial permeability indicator according to day and night shifts were not significant (p > .05). Additionally, acetic, propionic and total SCFA were associated with the intestinal permeability biomarker in night shift, but not in day shift (p < .05). Consumption of dark green vegetables and beans and peas was positively associated with fecal isobutyric acid and fecal total SCFA concentration (r = 0.685, p = .029; r = 0.695, p = .026, respectively). The proportions of the genus including Blautia, Bifidobacterium, Dialister, and Ruminococcus gnavus group increased when individuals shifted to the night shift. Gut microbiota changes responding to circadian rhythm disruption became more prominent when consumed high sugar diet. So, changes have been observed in the gut microbiota of rotational shift workers, especially in individuals with certain dietary pattern. Moreover, in individuals with the circadian rhythm disruption SCFAs levels have been demonstrated to be associated with intestinal barrier integrity. A better understanding of the relation among fecal SCFAs, gut microbiota, intestinal epithelial permeability and circadian rhythm disruption is necessary for the development of new dietary strategies for gut health.
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Affiliation(s)
- Hande Mortaş
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Saniye Bilici
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Hakan Öztürk
- Department of Physiology, Faculty of Veterinary Medicine, Ankara University, Ankara, Turkey
| | - Tarkan Karakan
- Department of Internal Medicine Gastroenterology, Faculty of Medicine, Gazi University, Ankara, Turkey
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Lal B, Alonso-Caneiro D, Read SA, Tran B, Van Bui C, Tang D, Fiedler JT, Ho S, Carkeet A. Changes in Retinal Optical Coherence Tomography Angiography Indexes Over 24 Hours. Invest Ophthalmol Vis Sci 2022; 63:25. [PMID: 35348589 PMCID: PMC8976927 DOI: 10.1167/iovs.63.3.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Purpose To evaluate changes in the retinal microvasculature of young adults over 24 hours using optical coherence tomography angiography (OCT-A). Methods Participants (n = 44, mean age 23.2 ± 4.1 years, 24 myopes and 20 nonmyopes) with normal ophthalmological findings were recruited. Two macular OCT-A and OCT scans, systemic blood pressure, intraocular pressure (IOP), and biometry measurements were taken every four hours over 24 hours. Superficial and deep retinal layer en face images were analyzed to extract magnification-corrected vascular indexes using image analysis including foveal avascular zone metrics, vessel density, and perfusion density for the foveal, parafoveal, and perifoveal zones. Results Significant diurnal variations (P < 0.001) were observed in the vessel and perfusion density in the three superficial retinal layer regions, with acrophase between 4:30 PM and 8:30 PM. Only foveal and parafoveal regions of the deep retinal layer exhibited significant diurnal variations with acrophase between 9 AM and 3 PM. Myopes and nonmyopes had different acrophases but not amplitudes in the parafoveal perfusion density of superficial retinal layer (P = 0.039). Significant correlations were observed between diurnal amplitudes or acrophases of superficial retinal layer indexes and systemic pulse pressure, IOP, axial length and retinal thickness. Conclusions This study shows, for the first time, that significant diurnal variation exists in OCT-A indexes of macular superficial and deep retinal layer over 24 hours and were related to variations in various ocular and systemic measurements. Myopes and nonmyopes showed differences in the timing but not in amplitude of the superficial retinal layer parafoveal perfusion density variations but not in deep retinal layer.
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Affiliation(s)
- Barsha Lal
- School of Optometry & Vision Science, Queensland University of Technology, Kelvin Grove, Brisbane, Australia
| | - David Alonso-Caneiro
- School of Optometry & Vision Science, Queensland University of Technology, Kelvin Grove, Brisbane, Australia
| | - Scott A Read
- School of Optometry & Vision Science, Queensland University of Technology, Kelvin Grove, Brisbane, Australia
| | - Binh Tran
- School of Optometry & Vision Science, Queensland University of Technology, Kelvin Grove, Brisbane, Australia
| | - Cong Van Bui
- School of Optometry & Vision Science, Queensland University of Technology, Kelvin Grove, Brisbane, Australia
| | - Daniel Tang
- School of Optometry & Vision Science, Queensland University of Technology, Kelvin Grove, Brisbane, Australia
| | - Joshua T Fiedler
- School of Optometry & Vision Science, Queensland University of Technology, Kelvin Grove, Brisbane, Australia
| | - Steven Ho
- School of Optometry & Vision Science, Queensland University of Technology, Kelvin Grove, Brisbane, Australia
| | - Andrew Carkeet
- School of Optometry & Vision Science, Queensland University of Technology, Kelvin Grove, Brisbane, Australia
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Mehra R, Tjurmina OA, Ajijola OA, Arora R, Bolser DC, Chapleau MW, Chen PS, Clancy CE, Delisle BP, Gold MR, Goldberger JJ, Goldstein DS, Habecker BA, Handoko ML, Harvey R, Hummel JP, Hund T, Meyer C, Redline S, Ripplinger CM, Simon MA, Somers VK, Stavrakis S, Taylor-Clark T, Undem BJ, Verrier RL, Zucker IH, Sopko G, Shivkumar K. Research Opportunities in Autonomic Neural Mechanisms of Cardiopulmonary Regulation: A Report From the National Heart, Lung, and Blood Institute and the National Institutes of Health Office of the Director Workshop. JACC Basic Transl Sci 2022; 7:265-293. [PMID: 35411324 PMCID: PMC8993767 DOI: 10.1016/j.jacbts.2021.11.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 12/22/2022]
Abstract
This virtual workshop was convened by the National Heart, Lung, and Blood Institute, in partnership with the Office of Strategic Coordination of the Office of the National Institutes of Health Director, and held September 2 to 3, 2020. The intent was to assemble a multidisciplinary group of experts in basic, translational, and clinical research in neuroscience and cardiopulmonary disorders to identify knowledge gaps, guide future research efforts, and foster multidisciplinary collaborations pertaining to autonomic neural mechanisms of cardiopulmonary regulation. The group critically evaluated the current state of knowledge of the roles that the autonomic nervous system plays in regulation of cardiopulmonary function in health and in pathophysiology of arrhythmias, heart failure, sleep and circadian dysfunction, and breathing disorders. Opportunities to leverage the Common Fund's SPARC (Stimulating Peripheral Activity to Relieve Conditions) program were characterized as related to nonpharmacologic neuromodulation and device-based therapies. Common themes discussed include knowledge gaps, research priorities, and approaches to develop novel predictive markers of autonomic dysfunction. Approaches to precisely target neural pathophysiological mechanisms to herald new therapies for arrhythmias, heart failure, sleep and circadian rhythm physiology, and breathing disorders were also detailed.
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Key Words
- ACE, angiotensin-converting enzyme
- AD, autonomic dysregulation
- AF, atrial fibrillation
- ANS, autonomic nervous system
- Ach, acetylcholine
- CNS, central nervous system
- COPD, chronic obstructive pulmonary disease
- CSA, central sleep apnea
- CVD, cardiovascular disease
- ECG, electrocardiogram
- EV, extracellular vesicle
- GP, ganglionated plexi
- HF, heart failure
- HFpEF, heart failure with preserved ejection fraction
- HFrEF, heart failure with reduced ejection fraction
- HRV, heart rate variability
- LQT, long QT
- MI, myocardial infarction
- NE, norepinephrine
- NHLBI, National Heart, Lung, and Blood Institute
- NPY, neuropeptide Y
- NREM, non-rapid eye movement
- OSA, obstructive sleep apnea
- PAH, pulmonary arterial hypertension
- PV, pulmonary vein
- REM, rapid eye movement
- RV, right ventricular
- SCD, sudden cardiac death
- SDB, sleep disordered breathing
- SNA, sympathetic nerve activity
- SNSA, sympathetic nervous system activity
- TLD, targeted lung denervation
- asthma
- atrial fibrillation
- autonomic nervous system
- cardiopulmonary
- chronic obstructive pulmonary disease
- circadian
- heart failure
- pulmonary arterial hypertension
- sleep apnea
- ventricular arrhythmia
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Affiliation(s)
- Reena Mehra
- Cleveland Clinic, Cleveland, Ohio, USA
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Olga A. Tjurmina
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | | | - Rishi Arora
- Feinberg School of Medicine at Northwestern University, Chicago, Illinois, USA
| | | | - Mark W. Chapleau
- University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | | | | | | | - Michael R. Gold
- Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - David S. Goldstein
- National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA
| | - Beth A. Habecker
- Oregon Health and Science University School of Medicine, Portland, Oregon, USA
| | - M. Louis Handoko
- Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | | | - James P. Hummel
- Yale University School of Medicine, New Haven, Connecticut, USA
| | | | | | | | | | - Marc A. Simon
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- University of California-San Francisco, San Francisco, California, USA
| | | | - Stavros Stavrakis
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | | | | | - Richard L. Verrier
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - George Sopko
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
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Zhao J, Zeng Y, Weng J, Zhang J, Yao T, Yuan M, Shen X. Evening versus morning administration of drug therapy for hypertension: a meta-analysis of randomized controlled trials. Eur J Integr Med 2022. [DOI: 10.1016/j.eujim.2022.102111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Gabryelska A, Turkiewicz S, Karuga FF, Sochal M, Strzelecki D, Białasiewicz P. Disruption of Circadian Rhythm Genes in Obstructive Sleep Apnea Patients-Possible Mechanisms Involved and Clinical Implication. Int J Mol Sci 2022; 23:ijms23020709. [PMID: 35054894 PMCID: PMC8775490 DOI: 10.3390/ijms23020709] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/29/2021] [Accepted: 01/05/2022] [Indexed: 02/06/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a chronic condition characterized by recurrent pauses in breathing caused by the collapse of the upper airways, which results in intermittent hypoxia and arousals during the night. The disorder is associated with a vast number of comorbidities affecting different systems, including cardiovascular, metabolic, psychiatric, and neurological complications. Due to abnormal sleep architecture, OSA patients are at high risk of circadian clock disruption, as has been reported in several recent studies. The circadian clock affects almost all daily behavioral patterns, as well as a plethora of physiological processes, and might be one of the key factors contributing to OSA complications. An intricate interaction between the circadian clock and hypoxia may further affect these processes, which has a strong foundation on the molecular level. Recent studies revealed an interaction between hypoxia-inducible factor 1 (HIF-1), a key regulator of oxygen metabolism, and elements of circadian clocks. This relationship has a strong base in the structure of involved elements, as HIF-1 as well as PER, CLOCK, and BMAL, belong to the same Per-Arnt-Sim domain family. Therefore, this review summarizes the available knowledge on the molecular mechanism of circadian clock disruption and its influence on the development and progression of OSA comorbidities.
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Affiliation(s)
- Agata Gabryelska
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, 92-215 Lodz, Poland; (S.T.); (F.F.K.); (M.S.); (P.B.)
- Correspondence: ; Tel.: +48-660796004
| | - Szymon Turkiewicz
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, 92-215 Lodz, Poland; (S.T.); (F.F.K.); (M.S.); (P.B.)
| | - Filip Franciszek Karuga
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, 92-215 Lodz, Poland; (S.T.); (F.F.K.); (M.S.); (P.B.)
| | - Marcin Sochal
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, 92-215 Lodz, Poland; (S.T.); (F.F.K.); (M.S.); (P.B.)
| | - Dominik Strzelecki
- Department of Affective and Psychotic Disorders, Medical University of Lodz, 92-215 Lodz, Poland;
| | - Piotr Białasiewicz
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, 92-215 Lodz, Poland; (S.T.); (F.F.K.); (M.S.); (P.B.)
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Zhou T, Yuan Y, Xue Q, Li X, Wang M, Ma H, Heianza Y, Qi L. Adherence to a healthy sleep pattern is associated with lower risks of all-cause, cardiovascular and cancer-specific mortality. J Intern Med 2022; 291:64-71. [PMID: 34237797 PMCID: PMC8688171 DOI: 10.1111/joim.13367] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Individual unhealthy sleep behaviours have been associated with increased risks of all-cause mortality and deaths due to cardiovascular disease (CVD) or cancer. The evidence regarding the association of sleep patterns with these risks is limited. OBJECTIVE To examine the associations of sleep patterns with all-cause, CVD and cancer mortality in a large prospective cohort. METHODS This prospective cohort study included 283,443 adults from UK Biobank without CVD and cancer at baseline. We created a healthy sleep score and sleep patterns combining five individual sleep behaviours. RESULTS During a mean (standard deviation) of 8.9 (1.1) years (2.5 million person-years) of follow up, a total of 7936 all-cause deaths, 762 CVD-caused deaths, and 4540 cancer-caused deaths occurred during follow up. One point increase of the healthy sleep score was associated with a 4-11% lower risk of all-cause mortality (Hazard Ratio [HR], 0.94; 95% CI, 0.92-0.96), CVD mortality (HR, 0.89; 95% CI, 0.83-0.95) and cancer mortality (HR, 0.96; 95% CI, 0.93-0.99), with adjustment for age, sex, assessment centres, smoking status, alcohol intake status, socioeconomic status and physical activity. Compared with participants with an unfavourable sleep pattern, those with a favourable sleep pattern had 24-42% lower risks of all-cause and CVD mortality. The association with all-cause mortality tended to be stronger among underweight participants and those with insufficient physical activity. CONCLUSIONS A healthy sleep pattern was associated with lower risks of all-cause mortality and mortality from CVD and cancer. Our findings highlight the importance of improving overall sleep behaviours in lowering mortality.
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Affiliation(s)
- Tao Zhou
- Department of Epidemiology and Biostatistics, School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, China.,Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Yu Yuan
- Department of Occupational and Environmental Health, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiaochu Xue
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Xiang Li
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Mengying Wang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA.,Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Hao Ma
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Yoriko Heianza
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA.,Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
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Fischer D, Hilditch CJ. Light in ecological settings: Entrainment, circadian disruption, and interventions. PROGRESS IN BRAIN RESEARCH 2022; 273:303-330. [DOI: 10.1016/bs.pbr.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Hermida-Ayala RG, Mojón A, Fernández JR, Smolensky MH, Hermida RC. Ingestion-time differences in the pharmacodynamics of dual-combination hypertension therapies: Systematic review and meta-analysis of published human trials. Chronobiol Int 2021; 39:493-512. [PMID: 34906002 DOI: 10.1080/07420528.2021.2005084] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The pharmacodynamics of hypertension medications can be significantly affected by circadian rhythms in the biological mechanisms of the 24 h blood pressure (BP) pattern. Hypertension guidelines fail to recommend the time of day when patients, including those who require treatment with multiple medications, are to ingest BP-lowering therapy. We conducted a systematic review of published prospective trials that investigated hypertension medications for ingestion-time differences in BP-lowering, safety, patient adherence, and markers of target organ pathology. Among the search-retried 155 trials, 17 published between 1991 and 2020 totaling 1,508 hypertensive participants concerned the differential ingestion-time dependent effects of 14 unique dual-combination therapies. All but one (94.1%) of the trials, involving 98.5% of the total number of investigated individuals, reported clinically and statistically significant benefits - including enhanced reduction of asleep BP without induction of sleep-time hypotension, reduced prevalence of BP non-dipping, decreased adverse effects, improved kidney function, and reduced cardiac pathology - when dual-combination hypertension medications were ingested at-bedtime/evening rather than upon-waking/morning. A systematic and comprehensive review of the literature published in the past three decades reveals no single dual-combination hypertension trial reported significantly better benefit of the still conventional, yet unjustified by medical evidence, upon-waking/morning hypertension treatment scheme.
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Affiliation(s)
- Ramón G Hermida-Ayala
- Circadian Ambulatory Technology & Diagnostics (CAT&D), Santiago de Compostela, Spain
| | - Artemio Mojón
- Bioengineering & Chronobiology Laboratories;Atlantic Research Center for Telecommunication Technologies (atlanTTic); University of Vigo, Vigo, Spain
| | - José R Fernández
- Bioengineering & Chronobiology Laboratories;Atlantic Research Center for Telecommunication Technologies (atlanTTic); University of Vigo, Vigo, Spain
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, the University of Texas at Austin, Austin, Texas, USA.,Department of Internal Medicine, McGovern School of Medicine, the University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Ramón C Hermida
- Bioengineering & Chronobiology Laboratories;Atlantic Research Center for Telecommunication Technologies (atlanTTic); University of Vigo, Vigo, Spain.,Department of Biomedical Engineering, Cockrell School of Engineering, the University of Texas at Austin, Austin, Texas, USA
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Nikbakhtian S, Reed AB, Obika BD, Morelli D, Cunningham AC, Aral M, Plans D. Accelerometer-derived sleep onset timing and cardiovascular disease incidence: a UK Biobank cohort study. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2021; 2:658-666. [PMID: 36713092 PMCID: PMC9708010 DOI: 10.1093/ehjdh/ztab088] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/29/2021] [Accepted: 10/12/2021] [Indexed: 02/01/2023]
Abstract
Aims Growing evidence suggests that poor sleep health is associated with cardiovascular risk. However, research in this area often relies upon recollection dependent questionnaires or diaries. Accelerometers provide an alternative tool for measuring sleep parameters objectively. This study examines the association between wrist-worn accelerometer-derived sleep onset timing and cardiovascular disease (CVD). Methods and results We derived sleep onset and waking up time from accelerometer data collected from 103 712 UK Biobank participants over a period of 7 days. From this, we examined the association between sleep onset timing and CVD incidence using a series of Cox proportional hazards models. A total of 3172 cases of CVD were reported during a mean follow-up period of 5.7 (±0.49) years. An age- and sex-controlled base analysis found that sleep onset time of 10:00 p.m.-10:59 p.m. was associated with the lowest CVD incidence. An additional model, controlling for sleep duration, sleep irregularity, and established CVD risk factors, did not attenuate this association, producing hazard ratios of 1.24 (95% confidence interval, 1.10-1.39; P < 0.005), 1.12 (1.01-1.25; P = 0.04), and 1.25 (1.02-1.52; P = 0.03) for sleep onset <10:00 p.m., 11:00 p.m.-11:59 p.m., and ≥12:00 a.m., respectively, compared to 10:00 p.m.-10:59 p.m. Importantly, sensitivity analyses revealed this association with increased CVD risk was stronger in females, with only sleep onset <10:00 p.m. significant for males. Conclusions Our findings suggest the possibility of a relationship between sleep onset timing and risk of developing CVD, particularly for women. We also demonstrate the potential utility of collecting information about sleep parameters via accelerometry-capable wearable devices, which may serve as novel cardiovascular risk indicators.
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Affiliation(s)
- Shahram Nikbakhtian
- Huma Therapeutics, 13-14th Floor, Millbank Tower, 21-24 Millbank, London SW1P 4QP, UK
| | - Angus B Reed
- Huma Therapeutics, 13-14th Floor, Millbank Tower, 21-24 Millbank, London SW1P 4QP, UK
| | - Bernard Dillon Obika
- Huma Therapeutics, 13-14th Floor, Millbank Tower, 21-24 Millbank, London SW1P 4QP, UK,Barking, Haveridge and Redbridge University Hospitals NHS Trust, London, UK
| | - Davide Morelli
- Huma Therapeutics, 13-14th Floor, Millbank Tower, 21-24 Millbank, London SW1P 4QP, UK,Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Parks Road, Oxford, OX1 3PJ, UK
| | - Adam C Cunningham
- Huma Therapeutics, 13-14th Floor, Millbank Tower, 21-24 Millbank, London SW1P 4QP, UK
| | - Mert Aral
- Huma Therapeutics, 13-14th Floor, Millbank Tower, 21-24 Millbank, London SW1P 4QP, UK
| | - David Plans
- Huma Therapeutics, 13-14th Floor, Millbank Tower, 21-24 Millbank, London SW1P 4QP, UK,Department of Science, Innovation, Technology and Entrepreneurship, University of Exeter, Rennes Drive, Exeter EX4 4PU, UK,Department of Experimental Psychology, University of Oxford, Anna Watts Building, Woodstock Rd, Oxford OX2 6GG, UK,Corresponding author. Tel: +44 7527 016574,
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Effect of Temporal Difference on Clinical Outcomes of Patients with Out-of-Hospital Cardiac Arrest: A Retrospective Study from an Urban City of Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111020. [PMID: 34769541 PMCID: PMC8582961 DOI: 10.3390/ijerph182111020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 10/15/2021] [Accepted: 10/17/2021] [Indexed: 11/17/2022]
Abstract
Circadian pattern influence on the incidence of out-of-hospital cardiac arrest (OHCA) has been demonstrated. However, the effect of temporal difference on the clinical outcomes of OHCA remains inconclusive. Therefore, we conducted a retrospective study in an urban city of Taiwan between January 2018 and December 2020 in order to investigate the relationship between temporal differences and the return of spontaneous circulation (ROSC), sustained (≥24 h) ROSC, and survival to discharge in patients with OHCA. Of the 842 patients with OHCA, 371 occurred in the daytime, 250 in the evening, and 221 at night. During nighttime, there was a decreased incidence of OHCA, but the outcomes of OHCA were significant poor compared to the incidents during the daytime and evening. After multivariate adjustment for influencing factors, OHCAs occurring at night were independently associated with lower probabilities of achieving sustained ROSC (aOR = 0.489, 95% CI: 0.285–0.840, p = 0.009) and survival to discharge (aOR = 0.147, 95% CI: 0.03–0.714, p = 0.017). Subgroup analyses revealed significant temporal differences in male patients, older adult patients, those with longer response times (≥5 min), and witnessed OHCA. The effects of temporal difference on the outcome of OHCA may be a result of physiological factors, underlying etiology of arrest, resuscitative efforts in prehospital and in-hospital stages, or a combination of factors.
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Haghayegh S, Smolensky MH, Khoshnevis S, Hermida RC, Castriotta RJ, Diller KR. The Circadian Rhythm of Thermoregulation Modulates both the Sleep/Wake Cycle and 24 h Pattern of Arterial Blood Pressure. Compr Physiol 2021; 11:2645-2658. [PMID: 34636410 DOI: 10.1002/cphy.c210008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Borbély proposed an interacting two-component model of sleep regulation comprising a homeostatic Process S and a circadian Process C. The model has provided understanding of the association between core body temperature (CBT) as a key element of Process C that is deterministic of sleep onset and offset. However, it additionally provides a new perspective of the importance of the thermoregulatory mechanisms of Process C in modulating the circadian rhythm of arterial blood pressure (ABP). Herein, we examine the circadian physiology of thermoregulation, including at the end of the activity span the profound redistribution of cardiac output from the systemic circulation to the arteriovenous anastomoses of the glabrous skin that markedly enhances convective transfer of heat from the body to the environment to cause (i) decrease of the CBT as a pathway to sleep onset and (ii) attenuation of the asleep ABP mean and augmentation of the ABP decline (dipping) from the wake-time mean, in combination the strongest predictors of the risk for blood vessel and organ pathology and morbid and mortal cardiovascular disease events. We additionally review the means by which blood perfusion to the glabrous skin can be manipulated on demand by selective thermal stimulation, that is, mild warming, on the skin of the cervical spinal cord to intensify Process C as a way to facilitate sleep induction and promote healthy asleep ABP. © 2021 American Physiological Society. Compr Physiol 11:1-14, 2021.
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Affiliation(s)
- Shahab Haghayegh
- Department of Biostatics, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.,Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, USA
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, USA.,Department of Internal Medicine, Division of Pulmonary and Sleep Medicine, McGovern School of Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Sepideh Khoshnevis
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, USA
| | - Ramon C Hermida
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, USA.,Bioengineering and Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies, University of Vigo, Vigo, Spain
| | - Richard J Castriotta
- Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Kenneth R Diller
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, Texas, USA
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Fischer K, Diec S. Once- Versus Twice-Daily Angiotensin-Converting Enzyme Inhibitors for Blood Pressure Control in Adult Patients With Hypertension. Cureus 2021; 13:e17331. [PMID: 34567875 PMCID: PMC8451516 DOI: 10.7759/cureus.17331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2021] [Indexed: 11/29/2022] Open
Abstract
This review aimed to assess the efficacy and safety of once- versus twice-daily administration of angiotensin-converting enzyme (ACE) inhibitors for the management of hypertension. A literature search on PubMed and Google Scholar was performed (January 1980 to June 2020) using the following search terms: ACE inhibitors, lisinopril, enalapril, fosinopril, trandolapril, ramipril, perindopril, captopril, benazepril, ambulatory blood pressure, hypertension, twice-daily dosing, once-daily dosing. Reference lists from retrieved articles were examined for additional reports. Relevant English-language studies or those conducted in humans were considered. Overall, six studies were included that compared the efficacy of once-daily to twice-daily dosing of ACE inhibitors. Similar blood pressure-lowering effects, and, in some studies, greater blood pressure lowering has been noted in the twice-daily administration arm than once-daily administration of ACE inhibitors. ACE inhibitors' pharmacokinetic and pharmacodynamic properties play an integral role in determining the expected blood pressure-lowering outcome. It is noteworthy that adherence issues may arise when transitioning from a once-daily regimen to a twice-daily regimen. There appear to be no added safety concerns between twice-daily and once-daily administration of ACE inhibitors regarding safety outcomes. After reviewing the available literature, twice-daily dosing of ACE inhibitors may promote added blood pressure-lowering effects, with the advantages of reducing cost, reducing the risk of drug-drug interactions, reducing polypharmacy, and reducing patient confusion about their medications. Recommendations for twice-daily administration of ACE -inhibitors should be made via shared decision-making with the patient, and clinician judgment, to drive treatment selection.
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Affiliation(s)
- Kyle Fischer
- Pharmacy, University of Texas Southwestern Medical Center, Dallas, USA
| | - Sandy Diec
- Pharmacy, University of Houston, College of Pharmacy, Houston, USA
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Hermida RC, Mojón A, Smolensky MH, Fernández JR. Lowering Nighttime Blood Pressure With Bedtime Dosing of Antihypertensive Medications: Controversies in Hypertension-Pro Side of the Argument. Hypertension 2021; 78:879-893. [PMID: 34379438 DOI: 10.1161/hypertensionaha.120.16500] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ramón C Hermida
- From the Bioengineering & Chronobiology Laboratories; Atlantic Research Center for Information and Communication Technologies (atlanTTic); Universidade de Vigo, Spain (R.C.H., A.M., J.R.F.).,Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin (R.C.H., M.H.S.)
| | - Artemio Mojón
- From the Bioengineering & Chronobiology Laboratories; Atlantic Research Center for Information and Communication Technologies (atlanTTic); Universidade de Vigo, Spain (R.C.H., A.M., J.R.F.)
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin (R.C.H., M.H.S.).,Department of Internal Medicine, McGovern School of Medicine, The University of Texas Health Science Center at Houston (M.H.S.)
| | - José R Fernández
- From the Bioengineering & Chronobiology Laboratories; Atlantic Research Center for Information and Communication Technologies (atlanTTic); Universidade de Vigo, Spain (R.C.H., A.M., J.R.F.)
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Rabinovich-Nikitin I, Rasouli M, Reitz CJ, Posen I, Margulets V, Dhingra R, Khatua TN, Thliveris JA, Martino TA, Kirshenbaum LA. Mitochondrial autophagy and cell survival is regulated by the circadian Clock gene in cardiac myocytes during ischemic stress. Autophagy 2021; 17:3794-3812. [PMID: 34085589 DOI: 10.1080/15548627.2021.1938913] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Cardiac function is highly reliant on mitochondrial oxidative metabolism and quality control. The circadian Clock gene is critically linked to vital physiological processes including mitochondrial fission, fusion and bioenergetics; however, little is known of how the Clock gene regulates these vital processes in the heart. Herein, we identified a putative circadian CLOCK-mitochondrial interactome that gates an adaptive survival response during myocardial ischemia. We show by transcriptome and gene ontology mapping in CLOCK Δ19/Δ19 mouse that Clock transcriptionally coordinates the efficient removal of damaged mitochondria during myocardial ischemia by directly controlling transcription of genes required for mitochondrial fission, fusion and macroautophagy/autophagy. Loss of Clock gene activity impaired mitochondrial turnover resulting in the accumulation of damaged reactive oxygen species (ROS)-producing mitochondria from impaired mitophagy. This coincided with ultrastructural defects to mitochondria and impaired cardiac function. Interestingly, wild type CLOCK but not mutations of CLOCK defective for E-Box binding or interaction with its cognate partner ARNTL/BMAL-1 suppressed mitochondrial damage and cell death during acute hypoxia. Interestingly, the autophagy defect and accumulation of damaged mitochondria in CLOCK-deficient cardiac myocytes were abrogated by restoring autophagy/mitophagy. Inhibition of autophagy by ATG7 knockdown abrogated the cytoprotective effects of CLOCK. Collectively, our results demonstrate that CLOCK regulates an adaptive stress response critical for cell survival by transcriptionally coordinating mitochondrial quality control mechanisms in cardiac myocytes. Interdictions that restore CLOCK activity may prove beneficial in reducing cardiac injury in individuals with disrupted circadian CLOCK.Abbreviations: ARNTL/BMAL1: aryl hydrocarbon receptor nuclear translocator-like; ATG14: autophagy related 14; ATG7: autophagy related 7; ATP: adenosine triphosphate; BCA: bovine serum albumin; BECN1: beclin 1, autophagy related; bHLH: basic helix- loop-helix; CLOCK: circadian locomotor output cycles kaput; CMV: cytomegalovirus; COQ5: coenzyme Q5 methyltransferase; CQ: chloroquine; CRY1: cryptochrome 1 (photolyase-like); DNM1L/DRP1: dynamin 1-like; EF: ejection fraction; EM: electron microscopy; FS: fractional shortening; GFP: green fluorescent protein; HPX: hypoxia; i.p.: intraperitoneal; I-R: ischemia-reperfusion; LAD: left anterior descending; LVIDd: left ventricular internal diameter diastolic; LVIDs: left ventricular internal diameter systolic; MAP1LC3/LC3: microtubule-associated protein 1 light chain 3; MFN2: mitofusin 2; MI: myocardial infarction; mPTP: mitochondrial permeability transition pore; NDUFA4: Ndufa4, mitochondrial complex associated; NDUFA8: NADH: ubiquinone oxidoreductase subunit A8; NMX: normoxia; OCR: oxygen consumption rate; OPA1: OPA1, mitochondrial dynamin like GTPase; OXPHOS: oxidative phosphorylation; PBS: phosphate-buffered saline; PER1: period circadian clock 1; PPARGC1A/PGC-1α: peroxisome proliferative activated receptor, gamma, coactivator 1 alpha; qPCR: quantitative real-time PCR; RAB7A: RAB7, member RAS oncogene family; ROS: reactive oxygen species; RT: room temperature; shRNA: short hairpin RNA; siRNA: small interfering RNA; TFAM: transcription factor A, mitochondrial; TFEB: transcription factor EB; TMRM: tetra-methylrhodamine methyl ester perchlorate; WT: wild -type; ZT: zeitgeber time.
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Affiliation(s)
- Inna Rabinovich-Nikitin
- Department of Physiology and Pathophysiology, The Institute of Cardiovascular Sciences, St. Boniface Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada
| | - Mina Rasouli
- Centre for Cardiovascular Investigations, Biomedical Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Cristine J Reitz
- Centre for Cardiovascular Investigations, Biomedical Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Illana Posen
- Department of Physiology and Pathophysiology, The Institute of Cardiovascular Sciences, St. Boniface Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada
| | - Victoria Margulets
- Department of Physiology and Pathophysiology, The Institute of Cardiovascular Sciences, St. Boniface Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada
| | - Rimpy Dhingra
- Department of Physiology and Pathophysiology, The Institute of Cardiovascular Sciences, St. Boniface Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada
| | - Tarak N Khatua
- Centre for Cardiovascular Investigations, Biomedical Sciences, University of Guelph, Guelph, Ontario, Canada
| | - James A Thliveris
- Department of Human Anatomy and Cell Science, Rady College of Medicine, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tami A Martino
- Centre for Cardiovascular Investigations, Biomedical Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Lorrie A Kirshenbaum
- Department of Physiology and Pathophysiology, The Institute of Cardiovascular Sciences, St. Boniface Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada.,Department of Pharmacology and Therapeutics, Rady College of Medicine, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Hong M, Wei L, Duan H, Chen T, Shi L, You Y, Chen Y, Li H, Ma J. Biological variations in hemodynamics and electrocardiogram rhythms among telemetered cynomolgus monkeys. J Pharmacol Toxicol Methods 2021; 112:107108. [PMID: 34363962 DOI: 10.1016/j.vascn.2021.107108] [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: 01/26/2021] [Revised: 07/30/2021] [Accepted: 08/01/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Telemetered cynomolgus monkeys are widely used in cardiovascular toxicology research. However, the biological variations in their hemodynamics and electrocardiogram rhythms have not been fully elucidated. METHOD To determine the potential effects of sex, handling stress, and circadian rhythm on the hemodynamics and electrocardiogram rhythms, data from 23 cynomolgus monkeys, implanted with DSI telemetry devices were examined. RESULTS Our data showed that males had a longer RR interval (RRi), slower heart rate (HR), shorter QT and corrected QT intervals (QTc), and lower blood pressure than females. During the night time, the animals showed a longer RRi, PRi, QTi, and QTc; slower HR, and lower blood pressure. Handling stress at 0.25- to 1-h post-treatment caused a decrease in RRi and increase in HR and QTi. For RRi, HR, and systolic, diastolic, and mean blood pressure, the coefficients of variation (CVs) between studies of individual animals were less than 30%; for other parameters, the CVs were less than 20%. DISCUSSION We demonstrated that sex, circadian rhythms, and handling stress all contributed towards variations in telemetry data, albeit to different extents. For each individual animal, the biological variation across different studies was relatively small and acceptable.
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Affiliation(s)
- Min Hong
- Shanghai Innostar Bio-tech Co. Ltd., 199 Guoshoujing Road, Shanghai 201203, China.
| | - Liping Wei
- Shanghai Innostar Bio-tech Co. Ltd., 199 Guoshoujing Road, Shanghai 201203, China.
| | - Huailong Duan
- Shanghai Innostar Bio-tech Co. Ltd., 199 Guoshoujing Road, Shanghai 201203, China.
| | - Tao Chen
- Shanghai Innostar Bio-tech Co. Ltd., 199 Guoshoujing Road, Shanghai 201203, China.
| | - Lei Shi
- Shanghai Innostar Bio-tech Co. Ltd., 199 Guoshoujing Road, Shanghai 201203, China.
| | - Yanfei You
- Shanghai Innostar Bio-tech Co. Ltd., 199 Guoshoujing Road, Shanghai 201203, China.
| | - Yan Chen
- Shanghai Innostar Bio-tech Co. Ltd., 199 Guoshoujing Road, Shanghai 201203, China.
| | - Hua Li
- Shanghai Innostar Bio-tech Co. Ltd., 199 Guoshoujing Road, Shanghai 201203, China.
| | - Jing Ma
- Shanghai Innostar Bio-tech Co. Ltd., 199 Guoshoujing Road, Shanghai 201203, China.
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Latimer MN, Sonkar R, Mia S, Frayne IR, Carter KJ, Johnson CA, Rana S, Xie M, Rowe GC, Wende AR, Prabhu SD, Frank SJ, Rosiers CD, Chatham JC, Young ME. Branched chain amino acids selectively promote cardiac growth at the end of the awake period. J Mol Cell Cardiol 2021; 157:31-44. [PMID: 33894212 PMCID: PMC8319101 DOI: 10.1016/j.yjmcc.2021.04.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 03/31/2021] [Accepted: 04/16/2021] [Indexed: 12/14/2022]
Abstract
Essentially all biological processes fluctuate over the course of the day, manifesting as time-of-day-dependent variations with regards to the way in which organ systems respond to normal behaviors. For example, basic, translational, and epidemiologic studies indicate that temporal partitioning of metabolic processes governs the fate of dietary nutrients, in a manner in which concentrating caloric intake towards the end of the day is detrimental to both cardiometabolic and cardiovascular parameters. Despite appreciation that branched chain amino acids impact risk for obesity, diabetes mellitus, and heart failure, it is currently unknown whether the time-of-day at which dietary BCAAs are consumed influence cardiometabolic/cardiovascular outcomes. Here, we report that feeding mice a BCAA-enriched meal at the end of the active period (i.e., last 4 h of the dark phase) rapidly increases cardiac protein synthesis and mass, as well as cardiomyocyte size; consumption of the same meal at the beginning of the active period (i.e., first 4 h of the dark phase) is without effect. This was associated with a greater BCAA-induced activation of mTOR signaling in the heart at the end of the active period; pharmacological inhibition of mTOR (through rapamycin) blocked BCAA-induced augmentation of cardiac mass and cardiomyocyte size. Moreover, genetic disruption of the cardiomyocyte circadian clock abolished time-of-day-dependent fluctuations in BCAA-responsiveness. Finally, we report that repetitive consumption of BCAA-enriched meals at the end of the active period accelerated adverse cardiac remodeling and contractile dysfunction in mice subjected to transverse aortic constriction. Thus, our data demonstrate that the timing of BCAA consumption has significant implications for cardiac health and disease.
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Affiliation(s)
- Mary N Latimer
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ravi Sonkar
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sobuj Mia
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Isabelle Robillard Frayne
- Department of Nutrition, Université de Montréal and Montreal Heart Institute, Montréal, Québec, Canada
| | - Karen J Carter
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Christopher A Johnson
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Samir Rana
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Min Xie
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Glenn C Rowe
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Adam R Wende
- Division of Molecular Cellular Pathology, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sumanth D Prabhu
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Stuart J Frank
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Endocrinology Section, Birmingham VAMC Medical Service, Birmingham, AL, USA
| | - Christine Des Rosiers
- Department of Nutrition, Université de Montréal and Montreal Heart Institute, Montréal, Québec, Canada
| | - John C Chatham
- Division of Molecular Cellular Pathology, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Martin E Young
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
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Fang X, Liu HY, Wang ZY, Yang Z, Cheng TY, Hu CH, Hao HW, Meng FG, Guan YG, Ma YS, Liang SL, Lin JL, Zhao MM, Li LM. Preoperative Heart Rate Variability During Sleep Predicts Vagus Nerve Stimulation Outcome Better in Patients With Drug-Resistant Epilepsy. Front Neurol 2021; 12:691328. [PMID: 34305797 PMCID: PMC8292667 DOI: 10.3389/fneur.2021.691328] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/28/2021] [Indexed: 01/03/2023] Open
Abstract
Objective: Vagus nerve stimulation (VNS) is an adjunctive and well-established treatment for patients with drug-resistant epilepsy (DRE). However, it is still difficult to identify patients who may benefit from VNS surgery. Our study aims to propose a VNS outcome prediction model based on machine learning with multidimensional preoperative heart rate variability (HRV) indices. Methods: The preoperative electrocardiography (ECG) of 59 patients with DRE and of 50 healthy controls were analyzed. Responders were defined as having at least 50% average monthly seizure frequency reduction at 1-year follow-up. Time domain, frequency domain, and non-linear indices of HRV were compared between 30 responders and 29 non-responders in awake and sleep states, respectively. For feature selection, univariate filter and recursive feature elimination (RFE) algorithms were performed to assess the importance of different HRV indices to VNS outcome prediction and improve the classification performance. Random forest (RF) was used to train the classifier, and leave-one-out (LOO) cross-validation was performed to evaluate the prediction model. Results: Among 52 HRV indices, 49 showed significant differences between DRE patients and healthy controls. In sleep state, 35 HRV indices of responders were significantly higher than those of non-responders, while 16 of them showed the same differences in awake state. Low-frequency power (LF) ranked first in the importance ranking results by univariate filter and RFE methods, respectively. With HRV indices in sleep state, our model achieved 74.6% accuracy, 80% precision, 70.6% recall, and 75% F1 for VNS outcome prediction, which was better than the optimal performance in awake state (65.3% accuracy, 66.4% precision, 70.5% recall, and 68.4% F1). Significance: With the ECG during sleep state and machine learning techniques, the statistical model based on preoperative HRV could achieve a better performance of VNS outcome prediction and, therefore, help patients who are not suitable for VNS to avoid the high cost of surgery and possible risks of long-term stimulation.
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Affiliation(s)
- Xi Fang
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Hong-Yun Liu
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China.,Medical Innovation Research Division, Research Center for Biomedical Engineering, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Zhi-Yan Wang
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Zhao Yang
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Tung-Yang Cheng
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Chun-Hua Hu
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Hong-Wei Hao
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Fan-Gang Meng
- Department of Neurosurgery, Beijing Neurosurgical Institute, Beijing, China.,Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Yu-Guang Guan
- Department of Neurosurgery, Sanbo Brain Hospital Capital Medical University, Beijing, China
| | - Yan-Shan Ma
- Department of Neurosurgery, Peking University First Hospital FengTai Hospital, Beijing, China
| | - Shu-Li Liang
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jiu-Luan Lin
- Department of Neurosurgery, Tsinghua University Yuquan Hospital, Beijing, China
| | - Ming-Ming Zhao
- Department of Neurosurgery, Aerospace Center Hospital, Beijing, China
| | - Lu-Ming Li
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China.,Precision Medicine and Healthcare Research Center, Tsinghua-Berkeley Shenzhen Institute, Shenzhen, China.,Institute of Human-Machine, School of Aerospace Engineering, Tsinghua University, Beijing, China.,Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China
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Hermida RC, Mojón A, Fernández JR, Hermida-Ayala RG, Crespo JJ, Ríos MT, Domínguez-Sardiña M, Otero A, Smolensky MH. Elevated asleep blood pressure and non-dipper 24h patterning best predict risk for heart failure that can be averted by bedtime hypertension chronotherapy: A review of the published literature. Chronobiol Int 2021; 40:63-82. [PMID: 34190016 DOI: 10.1080/07420528.2021.1939367] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Several prospective studies consistently report elevated asleep blood pressure (BP) and blunted sleep-time relative systolic BP (SBP) decline (non-dipping) are jointly the most significant prognostic markers of cardiovascular disease (CVD) risk, including heart failure (HF); therefore, they, rather than office BP measurements (OBPM) and ambulatory awake and 24 h BP means, seemingly are the most worthy therapeutic targets for prevention. Published studies of the 24 h BP pattern in HF are sparse in number and of limited sample size. They report high prevalence of the abnormal non-dipper/riser 24 h SBP patterning. Despite the established clinical relevance of the asleep BP, past as do present hypertension guidelines recommend the diagnosis of hypertension rely on OBPM and, when around-the-clock ambulatory BP monitoring (ABPM) is conducted to confirm the elevated OBPM, either on the derived 24 h or "daytime" BP means. Additionally, hypertension guidelines do not advise the time-of-day when BP-lowering medications should be ingested, in spite of known ingestion-time differences in their pharmacokinetics and pharmacodynamics. Between 1976 and 2020, 155 unique trials of ingestion-time differences in the effects of 37 different single and 14 dual-combination hypertension medications, collectively involving 23,972 patients, were published. The vast majority (83.9%) of them found the at-bedtime/evening in comparison to upon-waking/morning treatment schedule resulted in more greatly enhanced: (i) reduction of asleep BP mean without induced sleep-time hypotension; (ii) reduction of the prevalence of the higher CVD risk non-dipper/riser 24 h BP phenotypes; (iii) improvement of kidney function, reduction of cardiac pathology, and with lower incidence of adverse effects. Most notably, no single published randomized trial found significantly better BP-lowering, particularly during sleep, or medical benefits of the most popular upon-waking/morning hypertension treatment-time scheme. Additionally, prospective outcome trials have substantiated that the bedtime relative to the upon-waking, ingestion of BP-lowering medications not only significantly reduces risk of HF but also improves overall CVD event-free survival time.
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Affiliation(s)
- Ramón C Hermida
- Bioengineering & Chronobiology Laboratories; Atlantic Research Center for Information and Communication Technologies (Atlantic), Universidade de Vigo, Vigo, Spain.,Department of Biomedical Engineering, Cockrell School of Engineering, the University of Texas at Austin, Austin, Texas, -USA
| | - Artemio Mojón
- Bioengineering & Chronobiology Laboratories; Atlantic Research Center for Information and Communication Technologies (Atlantic), Universidade de Vigo, Vigo, Spain
| | - José R Fernández
- Bioengineering & Chronobiology Laboratories; Atlantic Research Center for Information and Communication Technologies (Atlantic), Universidade de Vigo, Vigo, Spain
| | - Ramón G Hermida-Ayala
- Circadian Ambulatory Technology & Diagnostics (CAT&D), Santiago de Compostela, Spain
| | - Juan J Crespo
- Bioengineering & Chronobiology Laboratories; Atlantic Research Center for Information and Communication Technologies (Atlantic), Universidade de Vigo, Vigo, Spain.,Estructura de Xestión Integrada de Vigo, Servicio Galego de Saúde (SERGAS), Vigo, Spain
| | - María T Ríos
- Bioengineering & Chronobiology Laboratories; Atlantic Research Center for Information and Communication Technologies (Atlantic), Universidade de Vigo, Vigo, Spain.,Estructura de Xestión Integrada de Vigo, Servicio Galego de Saúde (SERGAS), Vigo, Spain
| | | | - Alfonso Otero
- Servicio de Nefrología, Complejo Hospitalario Universitario de Ourense, Estructura de Xestión Integrada de Ourense, Verín E O Barco de Valdeorras, Servicio Galego de Saúde (SERGAS), Ourense, Spain
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, the University of Texas at Austin, Austin, Texas, -USA.,Department of Internal Medicine, McGovern School of Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, USA
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46
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Wang MC, Lloyd-Jones DM. Cardiovascular Risk Assessment in Hypertensive Patients. Am J Hypertens 2021; 34:569-577. [PMID: 33503227 DOI: 10.1093/ajh/hpab021] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/10/2021] [Accepted: 01/24/2021] [Indexed: 12/21/2022] Open
Abstract
Hypertension is a highly prevalent and causal risk factor for cardiovascular disease (CVD). Quantitative cardiovascular (CV) risk assessment is a new paradigm for stratifying hypertensive patients into actionable groups for clinical management and prevention of CVD. The large heterogeneity in hypertensive patients makes this evaluation complex, but recent advances have made CV risk assessment more feasible. In this review, we first describe the prognostic significance of various levels and temporal patterns of blood pressure (BP). We then discuss CV risk prediction equations and the rationale of taking global risk into account in hypertensive patients. Finally, we review several adjunctive biomarkers that may refine risk assessment in certain patients. We observe that, beyond individual cross-sectional measurements, both short-term and long-term BP patterns are associated with incident CVD; that current CV risk prediction performs well, and its incorporation into hypertension management is associated with potential population benefit; and that adjunctive biomarkers of target organ damage show the most promise in sequential screening strategies that target biomarker measurement to patients in whom the results are most likely to change clinical management. Implementation of quantitative risk assessment for CVD has been facilitated by tools and direct electronic health record integrations that make risk estimates accessible for counseling and shared decision making for CVD prevention. However, it should be noted that treatment does not return an individual to the risk of someone who never develops hypertension, underscoring the need for primordial prevention in addition to continued innovation in risk assessment.
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Affiliation(s)
- Michael C Wang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Hermida RC, Hermida-Ayala RG, Mojón A, Smolensky MH, Fernández JR. Systematic review and quality evaluation of published human ingestion-time trials of blood pressure-lowering medications and their combinations. Chronobiol Int 2021; 38:1460-1476. [PMID: 34107831 DOI: 10.1080/07420528.2021.1931280] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The pharmacokinetics (PK) - absorption, distribution, metabolism, and elimination - and pharmacodynamics (PD) of hypertension medications can be significantly affected by circadian rhythms. As a consequence, the time when blood pressure (BP) lowering medications are ingested, with reference to the staging of all involved circadian rhythms modulating PK and PD, can affect their duration of action, magnitude of effect on features of the 24 h BP profile, and safety. We conducted a systematic and comprehensive review of published prospective human trials that investigated individual hypertension medications of all classes and their combinations for ingestion-time differences in BP-lowering, safety, patient adherence, and markers of hypertension-associated target organ pathology of the kidney and heart. The systematic review yielded 155 trials published between 1976 and 2020 - totaling 23,972 hypertensive individuals - that evaluated 37 different single and 14 dual-combination therapies. The vast (83.9%) majority of them reported clinically and statistically significant benefits - including enhanced reduction of asleep BP mean without induced sleep-time hypotension, reduced prevalence of the higher cardiovascular risk non-dipper 24 h BP profile, decreased incidence of adverse effects, improved kidney function, and reduced cardiac pathology - when hypertension medications are ingested at-bedtime/evening rather than upon-waking/morning. Nonetheless, the findings and conclusions of some past conducted trials are inconsistent, often due to disparities and deficiencies of the investigative protocols. Accordingly, we developed a quality assessment method based upon the eight items identified as crucial according to the recently published guidelines of the International Society for Chronobiology and the American Association for Medical Chronobiology and Chronotherapeutics for the design and conduct of human clinical trials on ingestion-time differences of hypertension medications. Among the most frequent deficiencies are: absence or miscalculation of minimum required sample size (83.2%), incorrect choice of primary BP endpoint (53.6%), and inappropriate arbitrary and unrepresentative clock hours chosen for tested treatment times (53.6%). The inability of the very small proportion (16.1%) of trials to verify the advantages of the at-bedtime/evening treatment strategy is likely explained by deficiencies of their study design and conduct. Nonetheless, regardless of the quality score of the 155 trials retrieved by our systematic review, it is most noteworthy that no single published prospective randomized trial reported significantly enhanced BP-lowering, safety, compliance, or other benefits of the unjustified by medical evidence, yet still most recommended, upon-waking/morning hypertension treatment-time scheme.
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Affiliation(s)
- Ramón C Hermida
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (atlanTTic), Universidade de Vigo, Vigo, Spain.,Department of Biomedical Engineering, Cockrell School of Engineering, the University of Texas at Austin, Austin, Texas, USA
| | - Ramón G Hermida-Ayala
- Circadian Ambulatory Technology & Diagnostics (CAT&D), Santiago de Compostela, Spain
| | - Artemio Mojón
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (atlanTTic), Universidade de Vigo, Vigo, Spain
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, the University of Texas at Austin, Austin, Texas, USA.,Department of Internal Medicine, McGovern School of Medicine, the University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - José R Fernández
- Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (atlanTTic), Universidade de Vigo, Vigo, Spain
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48
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Pathway-level analysis of genome-wide circadian dynamics in diverse tissues in rat and mouse. J Pharmacokinet Pharmacodyn 2021; 48:361-374. [PMID: 33768484 DOI: 10.1007/s10928-021-09750-3] [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: 11/03/2020] [Accepted: 03/17/2021] [Indexed: 10/21/2022]
Abstract
A computational framework is developed to enable the characterization of genome-wide, multi-tissue circadian dynamics at the level of "functional groupings of genes" defined in the context of signaling, cellular/genetic processing and metabolic pathways in rat and mouse. Our aim is to identify how individual genes come together to generate orchestrated rhythmic patterns and how these may vary within and across tissues. We focus our analysis on four tissues (adipose, liver, lung, and muscle). A genome-wide pathway-centric analysis enables us to develop a comprehensive picture on how the observed circadian variation at the individual gene level, orchestrates functional responses at the pathway level. Such pathway-based "meta-data" analysis enables the rational integration and comparison across platforms and/or experimental designs evaluating emergent dynamics, as opposed to comparisons of individual elements. One of our key findings is that when considering the dynamics at the pathway level, a complex behavior emerges. Our work proposes that tissues tend to coordinate gene's circadian expression in a way that optimizes tissue-specific pathway activity, depending of each tissue's broader role in homeostasis.
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Light therapy improves diurnal blood pressure control in night shift workers via reduction of catecholamines: the EuRhythDia study. J Hypertens 2021; 39:1678-1688. [PMID: 33710166 DOI: 10.1097/hjh.0000000000002848] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Night shift work is associated with high rates of hypertension and cardiometabolic disease, which are linked to disrupted circadian rhythms. We hypothesized that timed light therapy might improve disrupted circadian rhythms and stabilize diurnal control of blood pressure and glucose in night shift workers. METHODS We randomized 24 rotating night shift workers (mean age, 36 ± 13 years, 7 men) who had spent a median of 6 years on rotating night shifts (median, six night shifts per month) to 12 weeks of light therapy or no intervention and compared them with 12 daytime workers (37 ± 11 years, 6 men). We measured oral glucose tolerance (OGTT), 24-h blood pressure and arterial stiffness, and the circadian profiles of melatonin, cortisol, metanephrine and nor-metanephrine at baseline, after 12 weeks of intervention, and 12 weeks after the end of intervention. RESULTS At baseline, fewer night shift workers showed dipper status as compared with daytime workers (29 vs. 58%; P < 0.001). After 12 weeks of light therapy, there was a highly significant increase in the proportion of dippers (to 58%; P < 0.0001). We also observed a significant decrease in serum glucose during OGTT in the light therapy group (-22%; P < 0.05) with no change in serum insulin. Whilst circadian profiles of melatonin and cortisol were unchanged, plasma metanephrine and nor-metanephrine levels were significantly reduced in the light therapy group (P < 0.01). CONCLUSION Timed light therapy improves diurnal blood pressure control and glucose tolerance in rotating night shift workers. This effect is unrelated to melatonin and cortisol but is paralleled by reduced catecholamine levels.
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50
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Suarez-Roca H, Mamoun N, Sigurdson MI, Maixner W. Baroreceptor Modulation of the Cardiovascular System, Pain, Consciousness, and Cognition. Compr Physiol 2021; 11:1373-1423. [PMID: 33577130 DOI: 10.1002/cphy.c190038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Baroreceptors are mechanosensitive elements of the peripheral nervous system that maintain cardiovascular homeostasis by coordinating the responses to external and internal environmental stressors. While it is well known that carotid and cardiopulmonary baroreceptors modulate sympathetic vasomotor and parasympathetic cardiac neural autonomic drive, to avoid excessive fluctuations in vascular tone and maintain intravascular volume, there is increasing recognition that baroreceptors also modulate a wide range of non-cardiovascular physiological responses via projections from the nucleus of the solitary tract to regions of the central nervous system, including the spinal cord. These projections regulate pain perception, sleep, consciousness, and cognition. In this article, we summarize the physiology of baroreceptor pathways and responses to baroreceptor activation with an emphasis on the mechanisms influencing cardiovascular function, pain perception, consciousness, and cognition. Understanding baroreceptor-mediated effects on cardiac and extra-cardiac autonomic activities will further our understanding of the pathophysiology of multiple common clinical conditions, such as chronic pain, disorders of consciousness (e.g., abnormalities in sleep-wake), and cognitive impairment, which may result in the identification and implementation of novel treatment modalities. © 2021 American Physiological Society. Compr Physiol 11:1373-1423, 2021.
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Affiliation(s)
- Heberto Suarez-Roca
- Department of Anesthesiology, Center for Translational Pain Medicine, Duke University, Durham, North Carolina, USA
| | - Negmeldeen Mamoun
- Department of Anesthesiology, Division of Cardiothoracic Anesthesia and Critical Care Medicine, Duke University, Durham, North Carolina, USA
| | - Martin I Sigurdson
- Department of Anesthesiology and Critical Care Medicine, Landspitali, University Hospital, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - William Maixner
- Department of Anesthesiology, Center for Translational Pain Medicine, Duke University, Durham, North Carolina, USA
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