Tobacco-induced sleep disturbances: A systematic review and meta-analysis

Cerebrospinal Fluid Nitric Oxide Synthase is a Potential Mediator Between Cigarette Smoke Exposure and Sleep Disorders

Objective

Cigarette smoking and low peripheral nitric oxide synthase (NOS) levels are strongly associated with sleep disorders. However, whether cerebrospinal fluid (CSF) NOS relates to sleep disorders and whether CSF NOS mediates the relationship between cigarette smoking and sleep disorders is unclear.

Methods

We measured CSF levels of total NOS (tNOS) and its isoforms (inducible NOS [iNOS] and constitutive NOS [cNOS]) in 191 Chinese male subjects. We applied the Pittsburgh Sleep Quality Index (PSQI).

Results

The PSQI scores of active smokers were significantly higher than those of non-smokers, while CSF tNOS, iNOS, and cNOS were significantly lower (all p < 0.001). CSF tNOS, iNOS, and cNOS were negatively associated with PSQI scores in the general population (all p < 0.001). Mediation analysis suggested that CSF tNOS, iNOS, and cNOS mediate the relationship between smoking and PSQI scores, and the indirect effect accounted for 78.93%, 66.29%, and 81.65% of the total effect, respectively.

Conclusion

Cigarette smoking is associated with sleep disorders. Active smokers had significantly lower CSF levels of tNOS, iNOS, and cNOS. Furthermore, tNOS, iNOS, and cNOS mediate the relationship between cigarette smoking and sleep quality. This study provides insights into how cigarette smoke affects sleep disorders.

Association of sleep quality and mitochondrial DNA copy number in healthy middle-aged adults

OBJECTIVES

Mitochondria contribute to various compromised health, yet the association between sleep and mitochondria remains unclear. This study investigated the association between sleep quality and mitochondrial function in healthy middle-aged adults in the Republic of Korea.

METHOD

This cross-sectional study recruited 238 middle-aged adults using convenience sampling. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Mitochondrial function, represented by mitochondrial DNA copy number (mtDNAcn), was measured using real-time quantitative polymerase chain reaction on peripheral blood leukocytes. Multivariate linear regression analyses were performed to determine the association between sleep quality and mtDNAcn.

RESULTS

Sleep quality was negatively associated with mtDNAcn (r = -.15, p = .025); the poor sleep quality group had a notably lower mtDNAcn compared to the good sleep quality group (t = 2.40, p = .017). Among the PSQI components, sleep latency was significantly associated with reduced mtDNAcn (r = -.18, p = .005). Univariate regression analysis revealed that mtDNAcn was significantly associated with education level (β = 0.15, p = .017), shift work (β = -0.17, p = .010), global PSQI score (β = -0.15, p = .025), and sleep latency (β = -0.18, p = .005). After adjusting for educational level and shift work in the final model, longer sleep latency was independently associated with reduced mtDNAcn (β = -.16, p = .011).

CONCLUSIONS

Poor sleep quality is associated with reduced mtDNAcn, suggesting a potential biological mechanism whereby poor sleep quality, specifically long sleep latency, accelerates cellular aging and impairs health through mitochondrial dysfunction. These findings enhance our understanding of the health effects of sleep quality and highlight the importance of screening and intervention strategies for mitochondrial dysfunction.

Health-promoting work schedules among nurses and nurse assistants in France: results from nationwide AMADEUS survey

BACKGROUND

The study aimed to investigate the relationship between different work schedules and self-reported working conditions and health risk behaviours among nurses and nurse assistants (NNA) in France. It hypothesized that work schedules, particularly long shifts, could impact work-life balance, workload, stress levels, burnout, and smoking habits. NNA had the option to work either with a 7-hour schedule, 5 days per week, or with long work schedules consisting of ten to twelve-hour shifts, three days per week. These schedules could potentially influence various aspects of their professional lives.

METHODS

The survey followed the guidelines of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement and was administered to NNA working in public and private national healthcare facilities in France. The researchers used the Job Content Questionnaire to assess the work environment and the French version of the 22-item Maslach Burnout Inventory (MBI) scale to measure burnout.

RESULTS

A total of 3,133 NNA participated in the study, including 2,369 nurses (75.6%) and 764 nurse assistants (24.4%). Among them, 1,811 individuals (57.8%) followed a 7-hour work schedule, while 1,322 individuals (42.2%) had a long work schedule. Multivariate analyses revealed that NNA working with long schedules reported higher psychological demands, more frequent burnout, a higher number of daily smoked cigarettes, and greater coffee consumption. These findings were independent of other factors such as sector of employment, type of healthcare facility, job status, work schedules, night shifts, department specialty, age, and family responsibilities.

CONCLUSIONS

While some NNA may choose long schedules to have more days off, those working with these schedules experience greater work-related burdens and engage in worse health risk behaviours as a coping mechanism. It emphasizes the importance of considering health-promoting work schedules to address the high psychological demands and burnout experienced by NNA with long schedules. Implementing changes in work schedules could potentially improve the overall well-being and job satisfaction of these healthcare professionals.

Socioeconomic Background and Self-Reported Sleep Quality in Older Adults during the COVID-19 Pandemic: An Analysis of the English Longitudinal Study of Ageing (ELSA)

The COVID-19 pandemic negatively impacted sleep quality. However, research regarding older adults' sleep quality during the pandemic has been limited. This study examined the association between socioeconomic background (SEB) and older adults' sleep quality during the COVID-19 pandemic. Data on 7040 adults aged ≥50 were acquired from a COVID-19 sub-study of the English Longitudinal Study of Ageing (ELSA). SEB was operationalized using educational attainment, previous financial situation, and concern about the future financial situation. Sociodemographic, mental health, physical health, and health behavior variables were included as covariates. Chi-squared tests and binary logistic regression were used to examine associations between SEB and sleep quality. Lower educational attainment and greater financial hardship and concerns were associated with poor sleep quality. The relationship between educational attainment and sleep quality was explained by the financial variables, while the relationship between previous financial difficulties and sleep quality was explained by physical health and health behavior variables. Greater financial concerns about the future, poor mental health, and poor physical health were independent risk factors for poor sleep quality in older adults during the pandemic. Healthcare professionals and service providers should consider these issues when supporting older patients with sleep problems and in promoting health and wellness.

Effects of air pollution and residential greenness on sleep disorder: A 8-year nationwide cohort study

BACKGROUND

Sleep disorder influencing the quality of life, however, its contributing factors have not been fully identified yet. Recently the potential effects of environmental exposures like air pollution and greenness on sleep disorder have attracted attention, but the evidence in China is limited, particularly in the middle-aged and elderly.

METHODS

We conducted a nationwide prospective study that included 21,878 Chinese citizens aged 45 years or above. For each participant, the 3-year averaged exposure concentrations of air pollutants (including PM₁₀, PM_2.5, PM₁, NO₂) and greenness (assessed by NDVI) were estimated based on residential address. We used mixed-effects logistic models to examine the associations of sustained air pollutants and greenness exposures with the occurrence of sleep disorder, and used linear mixed-effects models to assess the associations with sleep duration. Specifically, interaction effects models were employed to identify potential modificators of the above associations.

RESULTS

A total of 39,580 survey responses were received, with the overall occurrence rate of sleep disorder was 25.7%. A 10 μg/m³ increment in PM₁₀ and PM_2.5 were associated with increased occurrence of sleep disorder at 2% (aOR = 1.02, 95%CI:1.01, 1.04) and 7% (aOR = 1.07, 95%CI: 1.04, 1.11), and were associated with reduced sleep duration by 0.07 (95% CI: 0.08, 0.05) and 0.04 (95% CI: 0.05, 0.03) hours, respectively. Residential greenness appears to the potential protective factor for sleep disorder, that a 0.1 higher of the NDVI was associated a 9% (aOR = 0.91, 95%CI: 0.86, 0.96) decreased occurrence of sleep disorder and 0.09 h (95% CI: 0.05, 0.13) longer of sleep duration. Age and residence were identified as modificators of the above significant associations.

CONCLUSION

Sustained exposure to air pollutants can increase the occurrence of sleep disorder and can reduce sleep duration, while exposure to higher levels of greenness can protect sleep health from the side effects of air pollutants.

Association between use of electronic vaping products and insufficient sleep among adolescents: Findings from the 2017 and 2019 YRBS

BACKGROUND AND OBJECTIVE

Although studies have investigated the association between cigarette smoking and sleep outcomes among adolescents in the United States, few studies have examined the association between electronic vaping products (EVPs) use and insufficient sleep among adolescents. The objective of this study was to investigate the cross-sectional association between the use of EVPs and insufficient sleep among adolescents.

METHODS

Data were pooled from the 2017 and 2019 Youth Risk Behavior Survey. An analytic sample of 28,135 adolescents (51.2% female) was analyzed using binary logistic regression. The dependent variable investigated was insufficient sleep, and the main independent variable was the use of EVPs.

RESULTS

Of the 28,135 adolescents, 22.6%, 19.2%, and 58.2% were current, former, and never users of EVPs, respectively. More than three in four adolescents (76.5%) did not obtain the recommended 8 h of sleep on an average school night. Controlling for demographic factors and other covariates, adolescents who currently used EVPs had 1.33 times higher odds of having insufficient sleep (AOR = 1.33, p < .001, 95% CI = 1.16-1.52), and adolescents who previously used EVPs had 1.29 times higher odds of having insufficient sleep (AOR = 1.29, p < .001, 95% CI = 1.15-1.44) when compared to adolescents who had never used EVPs. Adolescents were more likely to get insufficient sleep if they were older, non-Hispanic Black, had symptoms of depression, experienced suicidal ideation, engaged in excessive screen-time behaviors, or currently used alcohol. Physical activity had a protective effect on insufficient sleep.

CONCLUSION

This study found that EVPs use was associated with insufficient sleep among adolescents over and above demographic and other covariates. As EVP use increases among adolescents, it is important to consider the potential impact on multiple domains, including sleep. Future studies that employ longitudinal designs may offer additional insight into the mechanisms underlying the association between EVPs use and insufficient sleep.

The association of 1-year weight loss from bariatric surgery and self-reported sleep: a prospective cohort

OBJECTIVE

This study examined the association of weight loss following bariatric surgery with self-reported sleep quality after accounting for other sleep-related factors.

METHODS

Participants were from the Bariatric Experience Long Term (BELONG) study. Participants completed a survey up to 6 months before surgery and approximately 1 year after surgery. The Pittsburgh Sleep Quality Index (PSQI) was used to measure sleep quality. One-year percentage total weight loss (%TWL) was determined from electronic medical records. Covariates included demographics, Charlson Comorbidity Index, geocoded variables to assess neighborhood quality, and physical activity. The authors assessed the association between %TWL at 1 year and PSQI component scores with separate cumulative logit models.

RESULTS

There were 997 participants in the analytic cohort. Participants were 86.2% women, 37.0% Hispanic, and 13.7% Black adults. Mean one-year %TWL was 26.3 (SD 8.7). Each 1% increase in %TWL was associated with a 3% better daytime dysfunction score (odds ratio = 1.03; 95% CI: 1.02-1.05) and a 2% better sleep quality score (odds ratio = 1.02; 95% CI: 1.00-1.03). No significant differences were found for the other PSQI components.

CONCLUSIONS

Weight loss from bariatric surgery was associated with better self-reported sleep at 1 year. For people undergoing bariatric surgery, there may be an added benefit of better sleep.

Life's Essential 8: Updating and Enhancing the American Heart Association's Construct of Cardiovascular Health: A Presidential Advisory From the American Heart Association

In 2010, the American Heart Association defined a novel construct of cardiovascular health to promote a paradigm shift from a focus solely on disease treatment to one inclusive of positive health promotion and preservation across the life course in populations and individuals. Extensive subsequent evidence has provided insights into strengths and limitations of the original approach to defining and quantifying cardiovascular health. In response, the American Heart Association convened a writing group to recommend enhancements and updates. The definition and quantification of each of the original metrics (Life's Simple 7) were evaluated for responsiveness to interindividual variation and intraindividual change. New metrics were considered, and the age spectrum was expanded to include the entire life course. The foundational contexts of social determinants of health and psychological health were addressed as crucial factors in optimizing and preserving cardiovascular health. This presidential advisory introduces an enhanced approach to assessing cardiovascular health: Life's Essential 8. The components of Life's Essential 8 include diet (updated), physical activity, nicotine exposure (updated), sleep health (new), body mass index, blood lipids (updated), blood glucose (updated), and blood pressure. Each metric has a new scoring algorithm ranging from 0 to 100 points, allowing generation of a new composite cardiovascular health score (the unweighted average of all components) that also varies from 0 to 100 points. Methods for implementing cardiovascular health assessment and longitudinal monitoring are discussed, as are potential data sources and tools to promote widespread adoption in policy, public health, clinical, institutional, and community settings.

Dual Orexin Receptor Antagonists (DORAs) as an Adjunct Treatment for Smoking Cessation

Smoking is recognized as the most avoidable cause for multiplicity of chronic diseases. However, smoking cessation rates remain low, in part due to the limited target engagement of the currently approved medications for smoking cessation. Sleep is a promising focus for increasing smoking cessation rates because smokers' sleep problems are exacerbated during the first week of smoking abstinence and are associated with poor smoking cessation outcomes. Furthermore, the currently approved smoking cessation pharmacological agents varenicline and nicotine replacement treatment exacerbate sleep problems beyond what would be observed as a consequence of natural nicotine withdrawal. Addressing sleep problems with dual orexin receptor antagonists (DORAs) is positioned to remedy the shortcoming of overlooking sleep as a viable smoking cessation intervention target. Based on previous animal literature, DORA agents suvorexant and lemborexant may accomplish this by diminishing withdrawal difficulty and reducing nicotine cravings. The pharmacologic focus is the orexin system, not only because orexin peptides mediate the sleep-wake cycle, but also because DORA agents have a milder adverse event profile over previous treatments for insomnia. A novel adjunct DORA treatment to a currently approved smoking cessation pharmacotherapy holds a potential to reduce morbidity and mortality caused by smoking.

Cannabis and Alcohol Use and Their Associations with Sleep: A Daily Diary Investigation of Single-Use and Co-Use in College Students

Introduction: Sleep continuity problems are widespread among college students and may be influenced by single-use and co-use of alcohol and cannabis. We examined the within-person associations of alcohol and cannabis use with subsequent sleep experiences in the everyday life of college students. Materials and Methods: A sample of 80 college students reported prior-night alcohol and cannabis use and sleep experiences for 14 consecutive days. Mixed-effects models examined the within-person relationships between alcohol and cannabis use (single- and co-use) and subsequent (1) sleep-onset latency, (2) total sleep time, (3) number of awakenings, and (4) early awakenings that night. Results: Compared to no-use evenings, alcohol and cannabis, used separately or together (co-use), were associated with shorter sleep-onset latency and longer total sleep time. Students reported more nightly awakenings after alcohol-only use compared to no-use and after co-use, and they reported fewer early awakenings after no-use and co-use. Conclusions: In line with previous experimental findings, we found that alcohol and cannabis use in the everyday life of college students were associated with sleep-inducing effects, and that alcohol use was associated with disturbed sleep continuity. The results suggest that cannabis may curb alcohol's detrimental effect on the number of awakenings and may reduce the incidence of early awakenings. Yet, due to lack of control for potentially important confounders (e.g., quantity of cannabis/alcohol consumed, withdrawal) the current results may be best seen as preliminary and further research is needed before causal inferences can be reached.