1
|
Zhang Y, Zhong Z, Tang Z, Wang R, Wu J, Na N, Zhang J. Insomnia and sleep duration for kidney function: Mendelian randomization study. Ren Fail 2024; 46:2387430. [PMID: 39132818 PMCID: PMC11321106 DOI: 10.1080/0886022x.2024.2387430] [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: 02/28/2024] [Revised: 07/05/2024] [Accepted: 07/29/2024] [Indexed: 08/13/2024] Open
Abstract
OBJECTIVES Extensive researches highlight the detrimental impact of sleep disorders such as insomnia and insufficient sleep duration on kidney function. However, establishing a clear causal relationship between insomnia, sleep duration, and kidney function remains challenging. This study aims to estimate this relationship using Mendelian randomization (MR). METHODS Independent genetic variants strongly associated with insomnia (N = 462,341) and sleep duration (N = 460,099) were selected as instrumental variables from corresponding genome-wide association studies (GWAS). Kidney function parameters, including serum creatinine, estimated glomerular filtration rate by cystatin C (eGFRcys), acute renal failure (ARF), chronic renal failure (CRF), kidney injury molecule-1, neutrophil gelatinase associated lipocalin, microalbuminuria, cystatin C, and β2 microglobulin, were derived from GWAS databases. A two-sample MR study was conducted to assess the causal relationship between sleep disorders and kidney function, and multivariable MR was used to identify potential mediators. The inverse-variance weighted was used as the primary estimate. RESULTS MR analysis found robust evidence indicating that insomnia and short sleep duration were associated with an increased risk of elevated serum creatinine, regardless of adjusting for obesity. Causal links between sleep duration and eGFRcys or cystatin C were also identified. While genetically predicted insomnia and sleep duration were found to potentially impact ARF, CRF, microalbuminuria, and β2 microglobulin, the p-values in multivariable MR analysis became nonsignificant. No pleiotropy was detected. CONCLUSIONS This study demonstrates a causal impact of insomnia on the risk of elevated serum creatinine and a positive effect of sleep duration on serum creatinine, eGFRcys, and cystatin C. Our findings also suggest their potential indirect effects on ARF, CRF, microalbuminuria, and β2 microglobulin mediated by obesity.
Collapse
Affiliation(s)
- Yang Zhang
- Department of Kidney Transplantation, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhaozhong Zhong
- Department of Urology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Quzhou, Zhejiang, China
| | - Zuofu Tang
- Department of Kidney Transplantation, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Ruojiao Wang
- Department of Kidney Transplantation, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jiaqing Wu
- Department of Kidney Transplantation, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Ning Na
- Department of Kidney Transplantation, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Diabetology, Guangzhou, Guangdong, China
| | - Jinhua Zhang
- Department of Kidney Transplantation, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| |
Collapse
|
2
|
Marques DR. Searching for cognitive behavioral therapy for insomnia on Google: an infodemiological perspective. Sleep 2024; 47:zsae144. [PMID: 38920312 DOI: 10.1093/sleep/zsae144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Indexed: 06/27/2024] Open
Affiliation(s)
- Daniel Ruivo Marques
- Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
- CINEICC - Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| |
Collapse
|
3
|
Berardelli I, Sarubbi S, Trocchia MA, Longhini L, Moschillo A, Rogante E, Cifrodelli M, Erbuto D, Innamorati M, Pompili M. The Mediating Role of Insomnia Severity in the Relationship Between Anxiety Symptoms and Suicidal Ideation: A Real-World Study in a Psychiatric Inpatient Setting. J Nerv Ment Dis 2024; 212:479-484. [PMID: 39120957 DOI: 10.1097/nmd.0000000000001793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2024]
Abstract
ABSTRACT Insomnia and anxiety symptoms are independent clinical variables involved in suicidal ideation in psychiatric inpatients. In this article, we investigated the relationship among insomnia severity, severity of anxiety symptoms, and suicidal ideation in a sample of psychiatric inpatients with severe mental disorders. We used a mediation model considering insomnia severity as the possible mediator of the relationship between anxiety severity and suicidal ideation. We administered the Columbia Suicide Severity Rating Scale, the Insomnia Severity Index, and the Hamilton Anxiety Rating Scale to 116 consecutive inpatients to the psychiatric unit of Sant'Andrea Hospital in Rome. The effect of anxiety symptoms was mediated by insomnia severity; patients who perceive higher anxiety symptoms were more likely to experience higher levels of insomnia and, thus, higher suicidal ideation intensity. Results showed the importance of assessing and treating both insomnia and anxiety in clinical practice.
Collapse
Affiliation(s)
- Isabella Berardelli
- Department of Neurosciences, Mental Health, and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Salvatore Sarubbi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Maria Anna Trocchia
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, Psychiatry Unit, Sant'Andrea Hospital, Rome, Italy
| | - Ludovica Longhini
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, Psychiatry Unit, Sant'Andrea Hospital, Rome, Italy
| | - Antonella Moschillo
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, Psychiatry Unit, Sant'Andrea Hospital, Rome, Italy
| | - Elena Rogante
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Mariarosaria Cifrodelli
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, Psychiatry Unit, Sant'Andrea Hospital, Rome, Italy
| | - Denise Erbuto
- Department of Neurosciences, Mental Health, and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Marco Innamorati
- Department of Human Sciences, European University of Rome, Rome, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health, and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
4
|
Lim ST, Lee E. Physical activity, body weight, and liver function as factors increasing Insomnia index among Korean adults: a cross-sectional analysis. Sleep Breath 2024:10.1007/s11325-024-03094-1. [PMID: 39186099 DOI: 10.1007/s11325-024-03094-1] [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: 03/01/2024] [Revised: 04/16/2024] [Accepted: 06/21/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND This study aimed to elucidate the relationship between physical activity, body weight, liver function, and insomnia in Korean adults, thereby providing a foundation for health promotion strategies. METHODS We recruited 11,645 adults (8,051 males and 3,594 females). Participants underwent assessments using the Korean version of the Insomnia Severity Index, measures of physical activity (PA), anthropometric data (body weight, height, body mass index [BMI], and waist circumference [WC]), and liver function (alanine aminotransferase, aspartate aminotransferase [AST], and gamma-glutamyl transferase). RESULTS One-way ANOVA revealed significant differences among male groups in height (p < .001), weight (p = .036), BMI (p = .002), diastolic blood pressure (p = .008), AST (p = .036), recreational PA (p = .026), moderate PA (p < .01), vigorous PA (p < .01), and moderate-to-vigorous PA (p < .001). Similarly, significant differences were found among female groups in height (p < .001), weight (p = .001), BMI (p = .006), WC (p = .013), moderate PA (p < .001), vigorous PA (p < .001), and moderate-to-vigorous PA (p < .001). CONCLUSION To prevent insomnia, it is essential to enhance physical activity and manage factors related to body weight and liver function, such as BMI, WC, and AST. Increasing moderate-to-vigorous physical activity is particularly crucial, as it has a substantial positive impact on reducing body weight and improving liver function.
Collapse
Affiliation(s)
- Seung-Taek Lim
- College of General Education, Kookmin University, Seoul, 02707, Republic of Korea
- Waseda Institute for Sport Sciences, Waseda University, Saitama, 341-0018, Japan
| | - Eunjae Lee
- Waseda Institute for Sport Sciences, Waseda University, Saitama, 341-0018, Japan.
- Institute of Sports and Arts Convergence (ISAC), Inha University, 100, Inha-ro, Michuhol-gu, Incheon, 22212, Republic of Korea.
| |
Collapse
|
5
|
Jiang TF, Chen ZY, Liu J, Yin XJ, Tan ZJ, Wang GL, Li B, Guo J. Acupuncture modulates emotional network resting-state functional connectivity in patients with insomnia disorder: a randomized controlled trial and fMRI study. BMC Complement Med Ther 2024; 24:311. [PMID: 39169368 PMCID: PMC11340108 DOI: 10.1186/s12906-024-04612-0] [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: 08/22/2023] [Accepted: 08/13/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND Insomnia disorder (ID) is one of the most common sleep problems, usually accompanied by anxiety and depression symptoms. Functional magnetic resonance imaging (fMRI) study suggests that both poor sleep quality and negative emotion are linked to the dysregulation of brain network related to emotion processing in ID patients. Acupuncture therapy has been proven effective in improving sleep quality and mood of ID patients, but the involved neurobiological mechanism remains unclear. We aimed to investigate the modulation effect of acupuncture on resting-state functional connectivity (rsFC) of the emotional network (EN) in patients experiencing insomnia. METHODS A total of 30 healthy controls (HCs) and 60 ID patients were enrolled in this study. Sixty ID patients were randomly assigned to real and sham acupuncture groups and attended resting-state fMRI scans before and after 4 weeks of acupuncture treatment. HCs completed an MRI/fMRI scan at baseline. The rsFC values within EN were calculated, and Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), Pittsburgh Sleep Quality Index (PSQI), Hyperarousal Scale (HAS), and actigraphy data were collected for clinical efficacy evaluation. RESULTS Resting-state FC analysis showed abnormalities in rsFC centered on the thalamus and dorsolateral prefrontal cortex within EN of ID patients compared to HCs. After real acupuncture treatment, rsFC of the anterior cingulate cortex, hippocampus, and amygdala were increased compared with the sham acupuncture group (p < 0.05, FDR corrected). In real acupuncture group, the rsFC value was decreased between left amygdala and left thalamus after 4 weeks of treatment compared with baseline. A trend of correlation was found that the increased rsFC value between the right amygdala and left hippocampus was positively correlated with the decreased HAMA scores across all ID patients, and the decreased left amygdala rsFC value with the left thalamus was negatively correlated with the increased sleep efficiency in the real acupuncture group. CONCLUSION Our findings showed that real acupuncture could produce a positive effect on modulating rsFC within network related to emotion processing in ID patients, which may illustrate the central mechanism underlying acupuncture for insomnia in improving sleep quality and emotion regulation. TRIAL REGISTRATION http://www.chictr.org.cn ., ChiCTR1800015282, 20/03/2018.
Collapse
Affiliation(s)
- Tong-Fei Jiang
- Department of Acupuncture and Moxibustion, Beijing Key Laboratory of Acupuncture Neuromodulation, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China
| | - Zhao-Yi Chen
- Department of Acupuncture and Moxibustion, Beijing Key Laboratory of Acupuncture Neuromodulation, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China
| | - Jiao Liu
- School of Traditional Chinese Medicine, Capital Medical University, Beijing, 100069, China
| | - Xue-Jiao Yin
- Department of Acupuncture and Moxibustion, Beijing Key Laboratory of Acupuncture Neuromodulation, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China
| | - Zhong-Jian Tan
- Department of Radiology, Dong Zhimen Hospital Beijing University of Chinese Medicine, Beijing, 100010, China
| | - Gui-Ling Wang
- Department of Acupuncture and Moxibustion, Beijing Key Laboratory of Acupuncture Neuromodulation, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China
| | - Bin Li
- Department of Acupuncture and Moxibustion, Beijing Key Laboratory of Acupuncture Neuromodulation, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China
| | - Jing Guo
- Department of Acupuncture and Moxibustion, Beijing Key Laboratory of Acupuncture Neuromodulation, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China.
| |
Collapse
|
6
|
Tekcan P, Erdem E. The Adolescent Insomnia Questionnaire: the Turkish validity and reliability study. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20240247. [PMID: 39166666 PMCID: PMC11329237 DOI: 10.1590/1806-9282.20240247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/20/2024] [Indexed: 08/23/2024]
Abstract
OBJECTIVE This study aimed to evaluate the Turkish validity and reliability of the Adolescent Insomnia Questionnaire. METHODS The study was carried out with 265 adolescents. Data were collected with the Adolescent Insomnia Questionnaire and the Cleveland Adolescent Sleepiness Questionnaire. Exploratory factor analysis and confirmatory factor analysis were used to analyze the construct validity of Adolescent Insomnia Questionnaire. The scale reliability was tested using test-retest, Cronbach's α test, Pearson correlation analysis, and inter-item correlation analysis. RESULTS The Cronbach's α coefficients were found to be above 0.80 for all sub-dimensions and the total scale. Correlations between Adolescent Insomnia Questionnaire and Cleveland Adolescent Sleepiness Questionnaire scores were positively highly significant. The test-retest correlation analysis of Adolescent Insomnia Questionnaire was 0.675. The results of confirmatory factor analysis were χ2/df=2.861, comparative fit index=0.966, incremental fit index=0.966, Tucker-Lewis index=0.956, normed fit index=0.949, root-mean-square error of approximation=0.084. The suitability of the data for exploratory factor analysis was evaluated with Bartlett's test of sphericity (p<0.05), and the sample adequacy was evaluated with the Kaiser-Meyer-Olkin test (0.77). CONCLUSION The Adolescent Insomnia Questionnaire Turkish version is a valid and reliable tool for measuring insomnia in adolescents aged 11-18 years. Adolescent Insomnia Questionnaire is a brief, practical, self-reported, age-appropriate, easily applicable, valid, and reliable tool in Turkish. This is the first Turkish validity and reliability study of Adolescent Insomnia Questionnaire.
Collapse
Affiliation(s)
- Pınar Tekcan
- Erciyes University, Institute of Health Sciences, Child Health and Diseases Nursing – Kayseri, Turkey
| | - Emine Erdem
- Erciyes University, Faculty of Health Sciences, Department of Nursing – Kayseri, Turkey
| |
Collapse
|
7
|
Fang L, Lyu Z, Ai S, Du S, Zhou W, Zeng S, Luo X, Guo J, Zhao Y, Li S, Hou Y, Lu C, Zhang B. Is cognitive behavioral therapy for insomnia more cost-effective? New-perspective on economic evaluations: a systematic review and meta-analysis. Sleep 2024; 47:zsae122. [PMID: 38795362 DOI: 10.1093/sleep/zsae122] [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: 01/10/2024] [Revised: 04/24/2024] [Indexed: 05/27/2024] Open
Abstract
STUDY OBJECTIVES To investigate the cost-effectiveness of cognitive behavioral therapy for insomnia (CBTI), with an additional focus on digital CBTI (dCBTI) in adults with insomnia. METHODS We searched eight electronic databases for economic evaluations of CBTI: PubMed, Scopus, Web of Science, psycINFO, Cochrane, Library, CINAHL, ProQuest, and National Health Service Economic Evaluation Database. Meta-analyses were performed to investigate the effects and costs between CBTI and control groups (no treatment, other treatments included hygiene education and treatment as usual). Subgroup analyses for dCBTI were conducted. RESULTS Twelve randomized controlled trial studies between 2004 and 2023 were included in our systematic review and meta-analyses. The incremental cost-utility ratios and incremental cost-effectiveness ratios showed that the CBTI and dCBTI groups were more cost-effective than controls, from healthcare perspective and societal perspective, respectively. Compared to controls, CBTI demonstrated significantly better efficacy within 12 months. Healthcare costs were significantly higher in the CBTI groups compared to the controls within 6 months but there was no difference at 12 months. Additionally, dCBTI was associated with significantly lower presenteeism costs compared to controls at 6 months. CONCLUSIONS Our findings suggest that CBTI is more cost-effective than other treatments or no treatment for adults with insomnia. It may bring more economic benefits in the long term, especially in long-lasting efficacy and cost reduction. In addition, dCBTI is one of the cost-effective options for insomnia. PROSPERO REGISTRATION NUMBER CRD42 022 383 440. URL www.crd.york.ac.uk/PROSPERO. NAME FOR PROSPERO REGISTRATION Cost-effectiveness of cognitive behavioral therapy for insomnia (CBTI): a systematic review with meta-analysis.
Collapse
Affiliation(s)
- Leqin Fang
- Department of Psychiatry, Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou, China
| | - Zhihong Lyu
- Department of Psychiatry, Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou, China
| | - Sizhi Ai
- Center for Sleep and Circadian Medicine, the Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shixu Du
- Department of Psychiatry, Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou, China
| | - Wenjing Zhou
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Shufei Zeng
- Department of Psychiatry, Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou, China
| | - Xue Luo
- Department of Psychiatry, Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou, China
| | - Junlong Guo
- Department of Psychiatry, Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou, China
| | - Yuhan Zhao
- Department of Psychiatry, Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou, China
| | - Shuangyan Li
- Department of Psychiatry, Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou, China
| | - Yanfei Hou
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Bin Zhang
- Department of Psychiatry, Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou, China
| |
Collapse
|
8
|
Marques DR, Clemente V, Allen Gomes A, Dias SF, Miller CB, Espie CA, de Azevedo MHP. The Sleep Condition Indicator (SCI): Psychometric properties of the European Portuguese version. J Sleep Res 2024:e14305. [PMID: 39098042 DOI: 10.1111/jsr.14305] [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: 06/14/2024] [Revised: 07/10/2024] [Accepted: 07/19/2024] [Indexed: 08/06/2024]
Abstract
Insomnia is a highly prevalent sleep disorder. It is the most frequent sleep complaint among Higher Education students. The Sleep Condition Indicator is a self-report tool aimed at assessing insomnia based on the DSM-5 criteria. The principal goal of this study was to establish preliminary psychometric properties of the European Portuguese version of the Sleep Condition Indicator in a sample of Higher Education students. Data from a diverse pool of Higher Education students (N = 537) were collected online over a month. Most participants were women (75%) and aged approximately 27 years. The Sleep Condition Indicator demonstrated good internal consistency (α = 0.85), with all the items accounting significantly for the scale reliability. The most appropriate factor structure considering the ordinal nature of the items was unidimensional, with all items explaining 64% of the total variance. However, a two-factor structure (sleep pattern and sleep-related impact) was also plausible when other statistical estimators were used. The Sleep Condition Indicator correlated significantly with insomnia severity, vulnerability to stress-related sleep disturbance, and self-reported daytime sleepiness. The optimal cut-off point established based on the receiver operating characteristic curve analysis was ≤ 16. A short version comprising only two items was also viable as suggested by the literature. The Sleep Condition Indicator is a reliable and valid tool for screening for insomnia. More studies with other groups are now required, specifically with clinical samples.
Collapse
Affiliation(s)
- Daniel Ruivo Marques
- Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
- CINEICC - Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Vanda Clemente
- CINEICC - Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
- Sleep Medicine Centre, Coimbra University Hospital Centre (CHUC), Coimbra, Portugal
| | - Ana Allen Gomes
- CINEICC - Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
- Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Sofia Fontoura Dias
- Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
| | | | - Colin A Espie
- Sir Jules Thorn Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | |
Collapse
|
9
|
Lutke Schipholt IJ, Coppieters MW, Diepens M, Hoekstra T, Ostelo RWJG, Barbe MF, Meijer OG, Bontkes HJ, Scholten-Peeters GGM. Systemic Inflammation, Sleep, and Psychological Factors Determine Recovery Trajectories for People With Neck Pain: An Exploratory Study. THE JOURNAL OF PAIN 2024; 25:104496. [PMID: 38342190 DOI: 10.1016/j.jpain.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 02/13/2024]
Abstract
We conducted an explorative prospective cohort study with 6 months follow-up to 1) identify different pain and disability trajectories following an episode of acute neck pain, and 2) assess whether neuroimmune/endocrine, psychological, behavioral, nociceptive processing, clinical outcome, demographic and management-related factors differ between these trajectories. Fifty people with acute neck pain (ie, within 2 weeks of onset) were included. At baseline, and at 2, 4, 6, 12, and 26 weeks follow-up, various neuroimmune/endocrine (eg, inflammatory cytokines and endocrine factors), psychological (eg, stress symptoms), behavioral (eg, sleep disturbances), nociceptive processing (eg, condition pain modulation), clinical outcome (eg, trauma), demographic factors (eg, age), and management-related factors (eg, treatment received) were assessed. Latent class models were performed to identify outcome trajectories for neck pain and disability. Linear mixed models or the Pearson chi-square test were used to evaluate differences in these factors between the trajectories at baseline and at each follow-up assessment and over the entire 6 months period. For pain, 3 trajectories were identified. The majority of patients were assigned to the "Moderate pain - Favourable recovery" trajectory (n = 25; 50%) with smaller proportions assigned to the "Severe pain - Favourable recovery" (n = 16; 32%) and the "Severe pain - Unfavourable recovery" (n = 9; 18%) trajectories. For disability, 2 trajectories were identified: "Mild disability - Favourable recovery" (n = 43; 82%) and "Severe disability - Unfavourable recovery" (n = 7; 18%). Ongoing systemic inflammation (increased high-sensitive C-reactive protein), sleep disturbances, and elevated psychological factors (such as depression, stress and anxiety symptoms) were mainly present in the unfavorable outcome trajectories compared to the favorable outcome trajectories. PERSPECTIVE: Using exploratory analyses, different recovery trajectories for acute neck pain were identified based on disability and pain intensity. These trajectories were influenced by systemic inflammation, sleep disturbances, and psychological factors.
Collapse
Affiliation(s)
- Ivo J Lutke Schipholt
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences - Program Musculoskeletal Health, Amsterdam, Noord Holland, The Netherlands; Department of Clinical Chemistry, Laboratory Medical Immunology, Amsterdam University Medical Centre, Location Vrije Universiteit, Amsterdam, Noord Holland, The Netherlands
| | - Michel W Coppieters
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences - Program Musculoskeletal Health, Amsterdam, Noord Holland, The Netherlands; School of Health Sciences and Social Work, and Menzies Health Institute Queensland, Griffith University, Brisbane & Gold Coast, Queensland, Australia
| | - Maaike Diepens
- Department Family Medicine, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Trynke Hoekstra
- Department of Health Sciences and the Amsterdam Public Health Research Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Noord Holland, The Netherlands
| | - Raymond W J G Ostelo
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Research Institute Amsterdam, Amsterdam, Noord Holland, The Netherlands; Department of Epidemiology and Data Science, Amsterdam UMC, Location Vrije Universiteit, Amsterdam Movement Sciences Research Institute, Amsterdam, Noord Holland, The Netherlands
| | - Mary F Barbe
- Center for Translational Medicine, Lewis Katz School of Medicine, Philadelphia, Pennsylvania
| | - Onno G Meijer
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences - Program Musculoskeletal Health, Amsterdam, Noord Holland, The Netherlands; Orthopaedic Biomechanics Laboratory, Fujian Medical University, Quanzhou, Fujian, PR China
| | - Hetty J Bontkes
- Department of Clinical Chemistry, Laboratory Medical Immunology, Amsterdam University Medical Centre, Location Vrije Universiteit, Amsterdam, Noord Holland, The Netherlands
| | - Gwendolyne G M Scholten-Peeters
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences - Program Musculoskeletal Health, Amsterdam, Noord Holland, The Netherlands
| |
Collapse
|
10
|
Malfliet A, De Baets L, Bilterys T, Van Looveren E, Mairesse O, Cagnie B, Meeus M, Moens M, Goubert D, Munneke W, Daneels L, Ickmans K, Kamper S, Nijs J. Cognitive Behavioral Therapy for Insomnia in Pain Management for Nonspecific Chronic Spinal Pain: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2425856. [PMID: 39120902 PMCID: PMC11316234 DOI: 10.1001/jamanetworkopen.2024.25856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 06/07/2024] [Indexed: 08/10/2024] Open
Abstract
Importance Insomnia is highly prevalent in patients with nonspecific chronic spinal pain (nCSP). Given the close interaction between insomnia and pain, targeting sleep problems during therapy could improve treatment outcomes. Objective To evaluate the effectiveness of cognitive behavioral therapy for insomnia (CBTi) integrated in best-evidence pain management (BEPM) vs BEPM only in patients with nCSP and insomnia. Design, Setting, and Participants A multicenter randomized clinical trial with 1-year follow-up was conducted between April 10, 2018, and April 30, 2022. Data and statistical analysis were performed between May 1, 2022, and April 24, 2023. Patients with nCSP and insomnia were evaluated using self-report and at-home polysomnography, to exclude underlying sleep pathologic factors. Participants were treated at the University Hospital Brussels or University Hospital Ghent, Belgium. Intention-to-treat analysis was performed. Interventions Participants were randomized to either CBTi-BEPM or BEPM only. Both groups received 18 treatment sessions over 14 weeks. The CBTi-BEPM treatment included 6 CBTi sessions and 12 BEPM sessions. The BEPM treatment included pain neuroscience education (3 sessions) and exercise therapy (9 sessions in the CBTi-BEPM group, 15 sessions in the BEPM-only group). Main Outcomes and Measures The primary outcome was change in mean pain intensity (assessed with Brief Pain Inventory [BPI]) at 12 months after the intervention. Exploratory secondary outcomes included several pain- and sleep-related outcomes. Blinded outcome assessment took place at baseline, posttreatment, and at 3-, 6-, and 12-month follow-up. Results A total of 123 patients (mean [SD] age, 40.2 [11.18] years; 84 women [68.3%]) were included in the trial. In 99 participants (80.5%) with 12-month BPI data, the mean pain intensity at 12 months decreased by 1.976 points (reduction of 40%) in the CBTi-BEPM group and 1.006 points (reduction of 24%) points in the BEPM-only group. At 12 months, there was no significant difference in pain intensity change between groups (mean group difference, 0.970 points; 95% CI, -0.051 to 1.992; Cohen d, 2.665). Treatment with CBTi-BEPM resulted in a response for BPI average pain with a number needed to treat (NNT) of 4 observed during 12 months. On a preliminary basis, CBTi-BEPM was, consistently over time and analyses, more effective than BEPM only for improving insomnia severity (Cohen d, 4.319-8.961; NNT for response ranging from 2 to 4, and NNT for remission ranging from 5 to 12), sleep quality (Cohen d, 3.654-6.066), beliefs about sleep (Cohen d, 5.324-6.657), depressive symptoms (Cohen d, 2.935-3.361), and physical fatigue (Cohen d, 2.818-3.770). No serious adverse effects were reported. Conclusions and Relevance In this randomized clinical trial, adding CBTi to BEPM did not further improve pain intensity reduction for patients with nCSP and comorbid insomnia more than BEPM alone. Yet, as CBTi-BEPM led to significant and clinically important changes in insomnia severity and sleep quality, CBTi integrated in BEPM should be considered in the treatment of patients with nCSP and comorbid insomnia. Further research can investigate the patient characteristics that moderate the response to CBTi-BEPM in terms of pain-related outcomes, as understanding of these moderators may be of utmost clinical importance. Trial Registration Clinical Trials.gov Identifier: NCT03482856.
Collapse
Affiliation(s)
- Anneleen Malfliet
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussels, Brussels, Belgium
- Research Foundation–Flanders, Brussels, Belgium
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
- Pain in Motion International Research Consortium
| | - Liesbet De Baets
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussels, Brussels, Belgium
- Pain in Motion International Research Consortium
| | - Thomas Bilterys
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussels, Brussels, Belgium
- Pain in Motion International Research Consortium
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Eveline Van Looveren
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussels, Brussels, Belgium
- Pain in Motion International Research Consortium
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Olivier Mairesse
- Brain, Body and Cognition, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Barbara Cagnie
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Mira Meeus
- Pain in Motion International Research Consortium
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Maarten Moens
- Pain in Motion International Research Consortium
- Department of Neurosurgery and Radiology, University Hospital Brussels, Brussels, Belgium
- Stimulus Research Group, Vrije Universiteit Brussels, Brussels, Belgium
- Center of Neurosciences, Vrije Universiteit Brussels, Brussels, Belgium
| | - Dorien Goubert
- Pain in Motion International Research Consortium
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Wouter Munneke
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussels, Brussels, Belgium
- Pain in Motion International Research Consortium
- Department of Sport and Rehabilitation Sciences, University of Liège, Liège, Belgium
| | - Lieven Daneels
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Kelly Ickmans
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussels, Brussels, Belgium
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
- Pain in Motion International Research Consortium
- Movement & Nutrition for Health & Performance Research Group, Department of Movement and Sport Sciences, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussels, Brussels, Belgium
| | - Steven Kamper
- School of Health Sciences, University of Sydney, Camperdown, New South Wales, Australia
- Nepean Blue Mountains Local Health District, Sydney, New South Wales, Australia
| | - Jo Nijs
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussels, Brussels, Belgium
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
- Pain in Motion International Research Consortium
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
11
|
Bruni O, Angriman M, Miano S, DelRosso LM, Spruyt K, Mogavero MP, Ferri R. Individualized approaches to pediatric chronic insomnia: Advancing precision medicine in sleep disorders. Sleep Med Rev 2024; 76:101946. [PMID: 38735089 DOI: 10.1016/j.smrv.2024.101946] [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: 12/27/2023] [Revised: 02/25/2024] [Accepted: 05/02/2024] [Indexed: 05/14/2024]
Abstract
The manifestations of chronic insomnia undergo age-related changes. In younger infants and children, behavioral insomnia emerges as the most prevalent form and typically responds to behavioral interventions. However, distinct clusters of clinical presentations suggest the presence of various phenotypes, potentially implicating the primary involvement of specific neurotransmitters. These conceptualizations, coupled with genetic studies on pleiotropy and polygenicity, may aid in identifying individuals at risk of persistent insomnia into adulthood and shed light on novel treatment options. In school-age children, the predominant presentation is sleep-onset insomnia, often linked with nighttime fears, anxiety symptoms, poor sleep hygiene, limit-setting issues, and inadequate sleep duration. The manifestations of insomnia in adolescence correlate with the profound changes occurring in sleep architecture, circadian rhythms, and homeostatic processes. The primary symptoms during adolescence include delayed sleep onset, sleep misperception, persistent negative thoughts about sleep, and physiological hyperarousal-paralleling features observed in adult insomnia. An approach centered on distinct presentations may provide a framework for precision-based treatment options. Enhanced comprehension of insomnia's manifestations across diverse developmental stages can facilitate accurate assessment. Efforts to subtype insomnia in childhood align with this objective, potentially guiding the selection of appropriate treatments tailored to individual neurobiological, clinical, and familial features.
Collapse
Affiliation(s)
- Oliviero Bruni
- Developmental and Social Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185, Rome, Italy.
| | - Marco Angriman
- Child Neurology and Neurorehabilitation Unit, Bolzano Hospital, Via Guncina 54, 39100, Bolzano, Italy
| | - Silvia Miano
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Via Tesserete 46, 6900, Lugano, Switzerland
| | - Lourdes M DelRosso
- University of California San Francisco, Fresno, 2625 E. Divisadero St. Fresno, CA, 93721, USA
| | - Karen Spruyt
- Université de Paris, NeuroDiderot Inserm, Academic Hospital Robert Debré Ap-Hp in the Building Bingen, 48 Bd Sérurier, 75019, Paris, France
| | - Maria P Mogavero
- Vita-Salute San Raffaele University, Via Olgettina, 58, 20132, Milan, Italy; Sleep Disorders Center, Division of Neuroscience, San Raffaele Scientific Institute, Via Stamira d'Ancona, 20, 20127, Milan, Italy
| | - Raffaele Ferri
- Sleep Research Centre, Oasi Research Institute - IRCCS, Via C. Ruggero 73, 94018, Troina, Italy
| |
Collapse
|
12
|
Shi Y, Ren R, Zhang Y, Vitiello MV, Tang X. Factors influencing the effectiveness of digital cognitive behavioural therapy for chronic insomnia in clinical practice. J Sleep Res 2024; 33:e14077. [PMID: 37897204 DOI: 10.1111/jsr.14077] [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: 08/12/2023] [Revised: 10/03/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023]
Abstract
Digital cognitive behavioural therapy for chronic insomnia (D-CBT-I) has been shown to be as efficacious as traditional CBT-I. However, not all patients achieve insomnia remission after treatment. We explored the factors influencing the effectiveness of D-CBT-I in a clinical practice. A total of 414 Asian chronic insomniacs were studied during a 6 week D-CBT-I intervention. All patients were assessed at baseline and posttreatment and were determined to be remitters or non-remitters, responders or non-responders by posttreatment criteria; Insomnia Severity Index (ISI <8) or ISI reduction ≥8, to examine whether remission and response status were associated with patient baseline characteristics. The average baseline ISI score in all subjects was 16.29 points. At posttreatment, 192 (46.4%) patients achieved ISI remission and 218 (52.7%) patients demonstrated an ISI response. An increased baseline early morning awakening time and ISI score were independently associated with a lower odds for remission (OR, 0.995 and 0.991, respectively). Increased baseline Patients Health Questionnaire-9 score was independently associated with higher odds for response (OR, 1.114). Our results suggest that D-CBT-I can be recommended as the first-line treatment for chronic insomnia, particularly in insomniacs with milder insomnia symptoms and more severe depressive symptoms. Meanwhile, the effectiveness of D-CBT-I was adversely affected by longer early morning awakening time and higher insomnia severity at pretreatment, which may be improved by more intense intervention and greater therapeutic support or by traditional CBT-I.
Collapse
Affiliation(s)
- Yuan Shi
- Sleep Medicine Center, Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Rong Ren
- Sleep Medicine Center, Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ye Zhang
- Sleep Medicine Center, Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Michael V Vitiello
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Xiangdong Tang
- Sleep Medicine Center, Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
13
|
Zhan N, Xu Y, Pu J, Wang W, Xie Z, Huang H. The interaction between mental resilience and insomnia disorder on negative emotions in nurses in Guangdong Province, China. Front Psychiatry 2024; 15:1396417. [PMID: 39176229 PMCID: PMC11339876 DOI: 10.3389/fpsyt.2024.1396417] [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: 03/05/2024] [Accepted: 07/05/2024] [Indexed: 08/24/2024] Open
Abstract
Objective To investigate the current status of psychological resilience, insomnia and negative emotions among nurses in Guangdong Province, China. And to explore the effects of the interaction between psychological resilience and insomnia on negative emotions. Methods A cross-sectional survey method was used to select 1874 nurses in Guangdong Province from February 2023 to April 2023 for the survey. The Chinese version of the Psychological Resilience Scale (PRS), Insomnia Severity Index (ISI), Depression Anxiety and Stress Scale-21(DASS-21)were used in this study. We use SPSS 26.0 for statistical analysis. A simple effect analysis was established to analyze the association between psychological resilience, insomnia and negative emotions by using psychological resilience, insomnia and the interaction term. Results The overall PRS and ISI scores were (59.79 ± 17.29) and (9.83 ± 5.97). The scores of DASS-21 each dimension were (8.19 ± 9.02) for depression emotion,(7.93 ± 7.66) for anxiety emotion and (10.58 ± 9.77) for stress emotion. The results of the interaction effect analysis indicated that psychological resilience and insomnia exhibited statistically significant differences in the between-subjects effect test for depression emotion (r2 = 0.136, P<0.01), anxiety emotion (r2 = 0.127, P<0.01), and stress emotion (r2 = 0.142, P<0.01). Conclusion The nurses exhibited moderate levels of psychological resilience. Most of them have varying degrees of insomnia, with majority being classified as mild insomnia. Additionally, they demonstrated varying degrees of negative emotions. There was a negative correlation between psychological resilience and insomnia. Psychological resilience was negatively correlated with depression, anxiety and stress emotions. Insomnia was positively correlated with depression, anxiety and stress emotions. Furthermore, the interaction between psychological resilience and insomnia had an effect on all three dimensions of negative emotions. Consequently, hospital administrators may implement efficacious intervention strategies such as cognitive behavioral therapy and improving workplace climate in a timely manner according to the different psychological tolerance and severity of insomnia of nurses in order to reduce the occurrence of negative emotions among nurses and improve their mental health.
Collapse
Affiliation(s)
- Ningjing Zhan
- Guangdong Mental Health Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Department of Nursing, Guangdong Pharmaceutical University, Guangzhou, China
| | - Yixuan Xu
- Guangdong Mental Health Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Department of Nursing, Shantou University Medical College, Shantou, China
| | - Jiangfeng Pu
- Guangdong Mental Health Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Department of Nursing, Guangdong Pharmaceutical University, Guangzhou, China
| | - Waner Wang
- Guangdong Mental Health Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Department of Nursing, Guangdong Pharmaceutical University, Guangzhou, China
| | - Zhanghao Xie
- Guangdong Mental Health Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Department of Nursing, Shantou University Medical College, Shantou, China
| | - Huigen Huang
- Guangdong Mental Health Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Department of Nursing, Guangdong Pharmaceutical University, Guangzhou, China
- Department of Nursing, Shantou University Medical College, Shantou, China
- Department of Nursing, Southern Medical University, Guangzhou, China
| |
Collapse
|
14
|
Chiaramonte D. All Palliative Care Should Be Integrative Palliative Care. J Pain Palliat Care Pharmacother 2024:1-5. [PMID: 39046825 DOI: 10.1080/15360288.2024.2377998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/09/2024] [Accepted: 07/04/2024] [Indexed: 07/27/2024]
Abstract
Integrative medicine and palliative care are philosophically similar, with a focus on whole person care and wellbeing. Integrative medicine provides a large toolbox of evidence-informed treatment modalities but doesn't prioritize the care of seriously ill people. Palliative care takes a holistic approach to reducing the suffering of seriously ill people, their families, and their caregivers, but the available treatment toolbox is often limited to pharmaceuticals, procedures, and radiation. The ideal care of families facing serious illness employs the philosophy and conventional expertise of palliative care clinicians coupled with an evidence-supported expanded treatment toolbox provided by the field of complementary and integrative medicine. This emerging field is called integrative palliative care. Reducing physical, emotional, and spiritual suffering is the fundamental goal of palliative care and all available effective tools should be employed toward this aim. Therefore, all palliative care should be integrative palliative care.
Collapse
Affiliation(s)
- Delia Chiaramonte
- is with the Founder of Integrative Palliative Institute; Host of The Integrative Palliative Podcast; Adjunct Assistant Professor of University of Maryland, Baltimore, Maryland, USA
| |
Collapse
|
15
|
Su Z, Liu R, Zhou K, Wei X, Wang N, Lin Z, Xie Y, Wang J, Wang F, Zhang S, Zhang X. Exploring the relationship between response time sequence in scale answering process and severity of insomnia: A machine learning approach. Heliyon 2024; 10:e33485. [PMID: 39040408 PMCID: PMC11261114 DOI: 10.1016/j.heliyon.2024.e33485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 06/07/2024] [Accepted: 06/21/2024] [Indexed: 07/24/2024] Open
Abstract
Utilizing computer-based scales for cognitive and psychological evaluations allows for the collection of objective data, such as response time. This cross-sectional study investigates the significance of response time data in cognitive and psychological measures, with a specific focus on its role in evaluating sleep quality through the Insomnia Severity Index (ISI) scale. A mobile application was designed to administer scale tests and collect response time data from 2729 participants. We explored the relationship between symptom severity and response time. A machine learning model was developed to predict the presence of insomnia symptoms in participants using response time data. The result revealed a statistically significant difference (p < 0.01) in the total response time between participants with or without insomnia symptom. Furthermore, a strong correlation was observed between the severity of specific insomnia aspects and the response times at the individual questions level. The machine learning model demonstrated a high predictive Area Under the ROC Curve (AUROC) of 0.824 in predicting insomnia symptoms based on response time data. These findings highlight the potential utility of response time data to evaluate cognitive and psychological measures.
Collapse
Affiliation(s)
- Zhao Su
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Rongxun Liu
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- School of Psychology, Xinxiang Medical University, Xinxiang, Henan, China
| | - Keyin Zhou
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xinru Wei
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ning Wang
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- School of Public Health, Xinxiang Medical University, Xinxiang, Henan, China
| | - Zexin Lin
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yuanchen Xie
- The Fourth School of Clinical Medicine, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jie Wang
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Fei Wang
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Shenzhong Zhang
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xizhe Zhang
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, Jiangsu, China
| |
Collapse
|
16
|
Xu HY, Wu LN, Zhang Y, Ba T, Zhao XF. Efficacy and safety of electroacupuncture for insomnia: A systematic review and meta-analysis. JOURNAL OF INTEGRATIVE MEDICINE 2024; 22:459-472. [PMID: 38871592 DOI: 10.1016/j.joim.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 04/10/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Electroacupuncture is often used to treat insomnia. OBJECTIVE To evaluate the efficacy and safety of electroacupuncture for insomnia. SEARCH STRATEGY Databases including PubMed, Cochrane Library, Embase, Web of Science, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wanfang Data and VIP Full-text e-Journals Database were searched up to January 15, 2023. INCLUSION CRITERIA Randomized clinical trials were included if they compared the clinical efficacy and safety of electroacupuncture with sham acupuncture, no treatment or usual care (UC) and general acupuncture. DATA EXTRACTION AND ANALYSIS The full texts of the studies were reviewed to remove ineligible literature. The extracted data included authors, publication year, diagnostic criteria, sample size, population characteristics, interventions and outcomes. The above steps were performed independently by two reviewers and the data were cross-checked. Stata15.0 software was used to analyze the extracted outcome data. For continuous data (Pittsburgh Sleep Quality Index [PSQI] score and Insomnia Severity Index score), weighted mean difference (WMD) was calculated and 95% confidence interval (CI) was reported when the same scale was applied. For dichotomous variables (clinical response rate and adverse events), a meta-analysis was performed using risk ratio (RR) as the effect indicator. RESULTS Thirty-one trials with 2226 subjects were included. The meta-analysis suggested that electroacupuncture was more effective in improving insomnia compared with the control group (sham acupuncture, no treatment, UC and general acupuncture) (RR = 1.21; 95% CI: [1.16, 1.27]), significantly reducing the PSQI score in insomnia patients after treatment and at follow-up (WMD = -3.23; 95% CI: [-4.29, -2.17]; P < 0.001). There was no significant difference in the incidence of adverse events between the EA and control groups (sham acupuncture and no treatment or UC. RR = 1.48; 95% CI: [0.91, 2.40]; P = 0.117). In addition, the regression results revealed that receiving electroacupuncture for seven to nine weeks provided the best efficacy (P < 0.05). CONCLUSION Electroacupuncture can significantly promote better sleep quality in insomnia patients and is suitable for the treatment of various types of insomnia. However, the articles included were single-center trials with small sample sizes, and some articles were of poor quality. Therefore, further research is still needed to confirm these findings. Please cite this article as: Xu HY, Wu LN, Zhang Y, Ba T, Zhao XF. Efficacy and safety of electroacupuncture for insomnia: A systematic review and meta-analysis. J Integr Med. 2024; 22(4): 460-473.
Collapse
Affiliation(s)
- Han-Yu Xu
- Acupuncture and Moxibustion Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300193, China
| | - Lin-Na Wu
- Acupuncture and Moxibustion Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300193, China
| | - Yuan Zhang
- Acupuncture and Moxibustion Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300193, China
| | - Te Ba
- Acupuncture and Moxibustion Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300193, China
| | - Xiao-Feng Zhao
- Acupuncture and Moxibustion Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300193, China.
| |
Collapse
|
17
|
Marques DR, Gomes AA, de Azevedo MHP. Daytime sleepiness in insomnia: Are we focusing on what truly matters? Chronobiol Int 2024; 41:1068-1080. [PMID: 39007884 DOI: 10.1080/07420528.2024.2378025] [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: 01/04/2024] [Revised: 06/12/2024] [Accepted: 07/04/2024] [Indexed: 07/16/2024]
Abstract
Insomnia, the most prevalent sleep disorder, is commonly associated with other mental and somatic disorders, making it a significant health concern. It is characterized by nighttime symptoms and daytime dysfunction, with sleepiness being a potential criterion for the latter. Sleepiness is a normal physiological state that is typically experienced near usual bedtime, in normal circumstances. In insomnia, it seems somewhat logical the idea that there is significant daytime sleepiness. However, the topic has been the subject of various discussions in sleep medicine, with studies yielding contradictory and inconsistent results. In this article, we aim to critically examine daytime sleepiness in individuals with insomnia disorder and propose an alternative approach to addressing it, both in clinical practice and research settings. It is crucial to further investigate the role of daytime sleepiness in insomnia, particularly by focusing on sleepiness perception as a more relevant dimension to explore in majority of patients. It is plausible that certain insomnia phenotypes are objectively sleepy during the day, but more studies are necessary, particularly with well-defined clinical samples. The implications of assessing sleepiness perception in insomnia for clinical practice are discussed, and new avenues for research are suggested.
Collapse
Affiliation(s)
- Daniel Ruivo Marques
- Department of Education and Psychology, Campus Universitário de Santiago, University of Aveiro, Aveiro, Portugal
- CINEICC - Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Ana Allen Gomes
- CINEICC - Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
- Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | | |
Collapse
|
18
|
He C, Fang Z, Wu H, Li X, Cheng L, Wen Y, Lin J. A flexible and dissolving traditional Chinese medicine microneedle patch for sleep-aid intervention. Heliyon 2024; 10:e33025. [PMID: 38984296 PMCID: PMC11231539 DOI: 10.1016/j.heliyon.2024.e33025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 06/12/2024] [Accepted: 06/12/2024] [Indexed: 07/11/2024] Open
Abstract
About a quarter of the world's population suffers from insomnia, and the number of the insomniacs is gradually increasing. However, the current drug therapy and non-drug therapy sleep-aid methods have certain limitations. In general, the sleep-aid effect of drug therapy is better than that of Non-drug therapy, but western medicine may lead to some side effects and drug abuse. Although the side effects of Chinese Herbal Medicine (CHM) are relatively small, making the herbal decoction is complex and time-consuming. Therefore, exploring a novel sleep-aid method is very significant. In this paper, a flexible and dissolving Traditional Chinese Medicine (TCM) microneedle patch is proposed for sleep-aid intervention. The TCM microneedle patch is a micrometer-scale intrusive object, and the herbal extracts are carried by the patch. The materials, design method, and fabrication process of the microneedle patch have been described in detail. Besides, the mechanical characteristics of the microneedle patch, sleep-aid effect evaluation method, and experimental scheme have been presented. Three microneedle tips with radii of 5 μm, 15 μm, and 22 μm are selected for simulation analysis. Abaqus simulation results indicate that the smaller the radius of the microneedle tip, the smaller the piercing force. Considering that the microneedle should easily penetrate the skin without buckling, that is, the piercing force should be larger than the buckling force, thus 15 μm, instead of 5 μm or 22 μm, is more suitable to be adopted as the radius of the microneedle tip. For the microneedle with the radius of 15 μm, the piercing force is 0.033 N, and the difference between the piercing force and buckling force is 0.036 N. Experimental results demonstrate that the fracture force of the microneedle is about 0.29 N, which is far larger than the piercing force and buckling force. The single-lead EEG signals of the frontal lobe are used to evaluate the sleep-aid effect of the TCM microneedle patch. After sleep-aid intervention on the Anmian and Yintang acupoints using the patches, for most subjects, the ratios of the low-frequency brain wave energies to the high-frequency brain wave energies are increased obviously, indicating that the proposed sleep-aid method is effective.
Collapse
Affiliation(s)
- Chunhua He
- School of Computer, Guangdong University of Technology, Guangzhou, 510006, Guangdong, PR China
| | - Zewen Fang
- School of Computer, Guangdong University of Technology, Guangzhou, 510006, Guangdong, PR China
| | - Heng Wu
- School of Automation, Guangdong University of Technology, Guangzhou, 510006, Guangdong, PR China
| | - Xiaoping Li
- School of Computer, Guangdong University of Technology, Guangzhou, 510006, Guangdong, PR China
| | - Lianglun Cheng
- School of Computer, Guangdong University of Technology, Guangzhou, 510006, Guangdong, PR China
| | - Yangxing Wen
- First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, PR China
| | - Juze Lin
- Guangdong Provincial People's Hospital, Guangzhou, 510000, Guangdong, PR China
| |
Collapse
|
19
|
Zhao H, Liu C, Ye H, Shi K, Yao Y, Wang M. Advancements in the physiopathological study of acupuncture treatment for insomnia: A review. Medicine (Baltimore) 2024; 103:e38476. [PMID: 38941420 DOI: 10.1097/md.0000000000038476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2024] Open
Abstract
Insomnia is a common sleep disorder that significantly impacts an individual's psychological and physical health, characterized by persistent difficulties in falling asleep, decreased sleep quality, and impaired daytime functioning. Traditional treatment approaches primarily rely on pharmacotherapy and behavioral therapy, yet not all patients benefit from these methods, and they often come with certain side effects. Thus, identifying safe and effective alternative or adjunctive treatments is of paramount importance. The purpose of this paper is to review the research progress on acupuncture in the treatment of insomnia and to explore the mechanisms by which acupuncture may treat insomnia through regulating neurotransmitters and nervous system, anti-inflammatory actions, and improving neuroplasticity, providing evidence to support the broad application of acupuncture in clinical practice.
Collapse
Affiliation(s)
- Haishen Zhao
- Rehabilitation Department of Luchaogang Community Health Service Center in Pudong New Area, Shanghai, China
| | | | | | | | | | | |
Collapse
|
20
|
Lou Q, Wei HR, Chen D, Zhang Y, Dong WY, Qun S, Wang D, Luo Y, Zhang Z, Jin Y. A noradrenergic pathway for the induction of pain by sleep loss. Curr Biol 2024; 34:2644-2656.e7. [PMID: 38810638 DOI: 10.1016/j.cub.2024.05.005] [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: 12/08/2023] [Revised: 03/31/2024] [Accepted: 05/03/2024] [Indexed: 05/31/2024]
Abstract
An epidemic of sleep loss currently affects modern societies worldwide and is implicated in numerous physiological disorders, including pain sensitization, although few studies have explored the brain pathways affected by active sleep deprivation (ASD; e.g., due to recreation). Here, we describe a neural circuit responsible for pain sensitization in mice treated with 9-h non-stress ASD. Using a combination of advanced neuroscience methods, we found that ASD stimulates noradrenergic inputs from locus coeruleus (LCNA) to glutamatergic neurons of the hindlimb primary somatosensory cortex (S1HLGlu). Moreover, artificial inhibition of this LCNA→S1HLGlu pathway alleviates ASD-induced pain sensitization in mice, while chemogenetic activation of this pathway recapitulates the pain sensitization observed following ASD. Our study thus implicates activation of the LCNA→S1HLGlu pathway in ASD-induced pain sensitization, expanding our fundamental understanding of the multisystem interplay involved in pain processing.
Collapse
Affiliation(s)
- Qianqian Lou
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Hefei National Laboratory for Physical Sciences at the Microscale, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China
| | - Hong-Rui Wei
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Hefei National Laboratory for Physical Sciences at the Microscale, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China
| | - Danyang Chen
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Hefei National Laboratory for Physical Sciences at the Microscale, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China
| | - Yuzhuo Zhang
- Department of Physiology, School of Basic Medical Sciences, Anhui Medical University, Hefei 230022, China
| | - Wan-Ying Dong
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Hefei National Laboratory for Physical Sciences at the Microscale, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China
| | - Sen Qun
- Stroke Center and Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China
| | - Di Wang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Hefei National Laboratory for Physical Sciences at the Microscale, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China.
| | - Yanli Luo
- Department of Psychological Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
| | - Zhi Zhang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Hefei National Laboratory for Physical Sciences at the Microscale, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China; The Center for Advanced Interdisciplinary Science and Biomedicine, Institute of Health and Medicine, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China; Department of Biophysics and Neurobiology, CAS Key Laboratory of Brain Function and Disease, University of Science and Technology of China, Hefei 230026, China.
| | - Yan Jin
- Stroke Center and Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China; Department of Biophysics and Neurobiology, CAS Key Laboratory of Brain Function and Disease, University of Science and Technology of China, Hefei 230026, China.
| |
Collapse
|
21
|
Di Marco T, Scammell TE, Sadeghi K, Datta AN, Little D, Tjiptarto N, Djonlagic I, Olivieri A, Zammit G, Krystal A, Pathmanathan J, Donoghue J, Hubbard J, Dauvilliers Y. Hyperarousal features in the sleep architecture of individuals with and without insomnia. J Sleep Res 2024:e14256. [PMID: 38853521 DOI: 10.1111/jsr.14256] [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: 04/04/2024] [Revised: 05/08/2024] [Accepted: 05/20/2024] [Indexed: 06/11/2024]
Abstract
Sleep architecture encodes relevant information on the structure of sleep and has been used to assess hyperarousal in insomnia. This study investigated whether polysomnography-derived sleep architecture displays signs of hyperarousal in individuals with insomnia compared with individuals without insomnia. Data from Phase 3 clinical trials, private clinics and a cohort study were analysed. A comprehensive set of sleep architecture features previously associated with hyperarousal were retrospectively analysed focusing on sleep-wake transition probabilities, electroencephalographic spectra and sleep spindles, and enriched with a novel machine learning algorithm called the Wake Electroencephalographic Similarity Index. This analysis included 1710 individuals with insomnia and 1455 individuals without insomnia. Results indicate that individuals with insomnia had a higher likelihood of waking from all sleep stages, and showed increased relative alpha during Wake and N1 sleep and increased theta power during Wake when compared with individuals without insomnia. Relative delta power was decreased and Wake Electroencephalographic Similarity Index scores were elevated across all sleep stages except N3, suggesting more wake-like activity during these stages in individuals with insomnia. Additionally, sleep spindle density was decreased, and spindle dispersion was increased in individuals with insomnia. These findings suggest that insomnia is characterized by a dysfunction in sleep quality with a continuous hyperarousal, evidenced by changes in sleep-wake architecture.
Collapse
Affiliation(s)
- Tobias Di Marco
- Idorsia Pharmaceuticals Ltd, Allschwil, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Thomas E Scammell
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | | | - David Little
- Beacon Biosignals, Inc., Boston, Massachusetts, USA
| | | | - Ina Djonlagic
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Gary Zammit
- Clinilabs Drug Development Corporation, New York, New York, USA
| | - Andrew Krystal
- University of California, San Francisco, California, USA
| | | | | | | | - Yves Dauvilliers
- Centre National de Référence Narcolepsie, Unité du Sommeil, CHU Montpellier, Hôpital Gui-de-Chauliac, Université de Montpellier, INSERM INM, Montpellier, France
| |
Collapse
|
22
|
Occhionero M, Tonetti L, Giudetti F, Natale V. Activity-Based Prospective Memory in Insomniacs. SENSORS (BASEL, SWITZERLAND) 2024; 24:3612. [PMID: 38894403 PMCID: PMC11175320 DOI: 10.3390/s24113612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/21/2024] [Accepted: 05/31/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE To investigate the activity-based prospective memory performance in patients with insomnia, divided, on the basis of actigraphic evaluation, into sleep onset, maintenance, mixed and negative misperception insomnia. METHODS A total of 153 patients with insomnia (I, 83 females, mean age + SD = 41.37 + 16.19 years) and 121 healthy controls (HC, 78 females, mean age + SD = 36.99 + 14.91 years) wore an actigraph for one week. Insomnia was classified into sleep onset insomnia (SOI), maintenance insomnia (MaI), mixed insomnia (MixI) and negative misperception insomnia (NMI). To study their activity-based prospective memory performance, all the participants were required to push the actigraph event marker button twice, at bedtime (task 1) and at get-up time (task 2). RESULTS Only patients with maintenance and mixed insomnia had a significantly lower accuracy in the activity-based prospective memory task at get-up time compared with the healthy controls. CONCLUSION The results show that maintenance and mixed insomnia involve an impaired activity-based prospective memory performance, while sleep onset and negative misperception insomnia do not seem to be affected. This pattern of results suggests that the fragmentation of sleep may play a role in activity-based prospective memory efficiency at wake-up in the morning.
Collapse
Affiliation(s)
- Miranda Occhionero
- Department of Psychology “Renzo Canestrari”, University of Bologna, 40127 Bologna, Italy; (L.T.); (F.G.); (V.N.)
| | | | | | | |
Collapse
|
23
|
Ye R, Pan J, Hu X, Xie J, Li P. Association between sleep traits and sarcopenia-related traits: A two-sample bidirectional Mendelian randomization study. Geriatr Gerontol Int 2024; 24:537-545. [PMID: 38639007 DOI: 10.1111/ggi.14877] [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: 12/22/2023] [Revised: 02/17/2024] [Accepted: 03/13/2024] [Indexed: 04/20/2024]
Abstract
AIM Despite limited evidence regarding the impact of sleep quality on sarcopenia, it is widely recognized as being associated with various diseases. This study aimed to explore the causal relationship between sleep traits and sarcopenia-related traits. METHODS This study utilized a two-sample bidirectional Mendelian randomization analysis. Genetic genome-wide summary data of sleep quality indicators, including chronotype, morning wake-up time, sleep duration, daytime napping, insomnia and daytime dozing, were used. Data on sarcopenia-related traits, such as appendicular lean mass, grip strength of both hands, walking pace and waist circumference, were collected from a large cohort study. The primary method used was the inverse-variance weighted analysis. RESULTS A causal association was found between chronotype and appendicular lean mass (odds ratio [OR] 1.019, 95% confidence interval [CI] 1.016-1.211, P = 0.021). Napping during the day was connected with walking pace (OR 0.879, 95% CI 0.834-0.928, P = 2.289 × 10-6) and waist circumference (OR 1.234, 95% CI 1.081-1.408, P = 0.002). Insomnia was related to lower grip strength of the right hand (OR 0.844, 95% CI 0.747-0.954, P = 0.007), left hand (OR 0.836, 95% CI 0.742-0.943, P = 0.003), as well as walking pace (OR 0.871, 95% CI 0.798-0.951, P = 0.002). Furthermore, the reverse Mendelian randomization analysis showed associations between certain sarcopenia-related traits and poor sleep quality. CONCLUSIONS Some sleep traits were associated with the occurrence of sarcopenia. These findings emphasized the significance of prioritizing sleep quality as a preventive measure against sarcopenia. Geriatr Gerontol Int 2024; 24: 537-545.
Collapse
Affiliation(s)
- Ruifan Ye
- Department of Plastic and Aesthetic Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiajia Pan
- Department of Hernia and Abdominal Wall Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xinying Hu
- Department of Pediatric Internal Medicine, Maternal and Child Health Hospital, Yongkang, China
| | - Jinxiao Xie
- Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Pengfei Li
- Department of Plastic and Aesthetic Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
24
|
Shi Q, Guo W, Ji T, Tang X. Lumbar functional evaluation of pelvic bone sarcomas after surgical resection and spinal pelvic fixation: A clinical study of 304 cases. Cancer Med 2024; 13:e7282. [PMID: 38819113 PMCID: PMC11140840 DOI: 10.1002/cam4.7282] [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: 11/27/2023] [Revised: 04/22/2024] [Accepted: 04/30/2024] [Indexed: 06/01/2024] Open
Abstract
AIMS We endeavored to introduce a novel scoring system (Lumbar Functional Index, LFI) capable of evaluating lumbar function in pelvic bone sarcoma patients who underwent surgical resection and spinal pelvic fixation, while simultaneously identifying the incidence, outcomes, and risk factors of lumbar function impairment among these populations. PATIENTS AND METHODS A cohort of 304 primary bone sarcoma patients were recruited. The LFI was created based on the Oswestry Dysfunction Index (ODI) and Japanese Orthopaedic Association (JOA) scores. Lumbar function impairment was defined as LFI score ≥ 18 points, which was identified as high LFI. Demographic data, clinical characteristics, and oncological outcomes were analyzed. RESULTS The cohort included chondrosarcoma (39.8%), osteosarcoma (29.9%), Ewing sarcoma (8.6%), bone-derived undifferentiated pleomorphic sarcoma (7.2%), giant cell tumor of bone (7.2%), chordoma (2.3%), and other bone sarcomas (5.0%). The LFI score exhibited significant negative correlation with common scoring systems of bone sarcoma. The incidence of high LFI was 23.0%. Patients with high LFI demonstrated a higher prevalence of type I + II + III + IV pelvic tumor, more sacrificed nerve roots and bilateral lumbar spine fixation during surgery, while lower percentage of R0 resection and local control of pelvic tumor. Decreased median overall survival (30 vs. 52 months, p < 0.001) and recurrence-free survival (14 vs. 24 months, p < 0.001) time were observed in these patients. Type I + II + III + IV pelvic tumor and sacrificed nerve roots≥2 were identified as risk factors for high LFI, while R0 resection and local control were identified as protective factors. CONCLUSION The LFI scoring system exhibited a significant negative correlation to current scoring systems. High LFI patients had worse prognosis and distinct characteristics. The risk factors of high LFI included type I + II + III + IV pelvic tumor and sacrificed nerve roots≥2, and the protective factors included R0 resection and local control.
Collapse
Affiliation(s)
- Qianyu Shi
- Department of Musculoskeletal TumorPeople's Hospital, Peking UniversityBeijingChina
| | - Wei Guo
- Department of Musculoskeletal TumorPeople's Hospital, Peking UniversityBeijingChina
| | - Tao Ji
- Department of Musculoskeletal TumorPeople's Hospital, Peking UniversityBeijingChina
| | - Xiaodong Tang
- Department of Musculoskeletal TumorPeople's Hospital, Peking UniversityBeijingChina
| |
Collapse
|
25
|
Zeng H, Xu J, Zheng L, Zhan Z, Fang Z, Li Y, Zhao C, Xiao R, Zheng Z, Li Y, Yang L. Traditional Chinese herbal formulas modulate gut microbiome and improve insomnia in patients with distinct syndrome types: insights from an interventional clinical study. Front Cell Infect Microbiol 2024; 14:1395267. [PMID: 38817449 PMCID: PMC11137223 DOI: 10.3389/fcimb.2024.1395267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 04/26/2024] [Indexed: 06/01/2024] Open
Abstract
Background Traditional Chinese medicine (TCM) comprising herbal formulas has been used for millennia to treat various diseases, such as insomnia, based on distinct syndrome types. Although TCM has been proposed to be effective in insomnia through gut microbiota modulation in animal models, human studies remain limited. Therefore, this study employs machine learning and integrative network techniques to elucidate the role of the gut microbiome in the efficacies of two TCM formulas - center-supplementing and qi-boosting decoction (CSQBD) and spleen-tonifying and yin heat-clearing decoction (STYHCD) - in treating insomnia patients diagnosed with spleen qi deficiency and spleen qi deficiency with stomach heat. Methods Sixty-three insomnia patients with these two specific TCM syndromes were enrolled and treated with CSQBD or STYHCD for 4 weeks. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) every 2 weeks. In addition, variations in gut microbiota were evaluated through 16S rRNA gene sequencing. Stress and inflammatory markers were measured pre- and post-treatment. Results At baseline, patients exhibiting only spleen qi deficiency showed slightly lesser severe insomnia, lower IFN-α levels, and higher cortisol levels than those with spleen qi deficiency with stomach heat. Both TCM syndromes displayed distinct gut microbiome profiles despite baseline adjustment of PSQI, ISI, and IFN-α scores. The nested stratified 10-fold cross-validated random forest classifier showed that patients with spleen qi deficiency had a higher abundance of Bifidobacterium longum than those with spleen qi deficiency with stomach heat, negatively associated with plasma IFN-α concentration. Both CSQBD and STYHCD treatments significantly improved sleep quality within 2 weeks, which lasted throughout the study. Moreover, the gut microbiome and inflammatory markers were significantly altered post-treatment. The longitudinal integrative network analysis revealed interconnections between sleep quality, gut microbes, such as Phascolarctobacterium and Ruminococcaceae, and inflammatory markers. Conclusion This study reveals distinct microbiome profiles associated with different TCM syndrome types and underscores the link between the gut microbiome and efficacies of Chinese herbal formulas in improving insomnia. These findings deepen our understanding of the gut-brain axis in relation to insomnia and pave the way for precision treatment approaches leveraging TCM herbal remedies.
Collapse
Affiliation(s)
- Huimei Zeng
- Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jia Xu
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Liming Zheng
- Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhi Zhan
- Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zenan Fang
- Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yunxi Li
- Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chunyi Zhao
- The Second Clinical Medical College, Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Rong Xiao
- Department of Rehabilitation, The Eighth People’s Hospital of Hefei, Hefei, China
| | - Zhuanfang Zheng
- Teaching and research Center, Guangdong Provincial Trade Union Cadre School, Guangzhou, China
| | - Yan Li
- Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lingling Yang
- Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| |
Collapse
|
26
|
Liu YM, Li JC, Gu YF, Qiu RH, Huang JY, Xue R, Li S, Zhang Y, Zhang K, Zhang YZ. Cannabidiol Exerts Sedative and Hypnotic Effects in Normal and Insomnia Model Mice Through Activation of 5-HT 1A Receptor. Neurochem Res 2024; 49:1150-1165. [PMID: 38296858 DOI: 10.1007/s11064-024-04102-2] [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: 10/30/2023] [Revised: 01/02/2024] [Accepted: 01/05/2024] [Indexed: 02/02/2024]
Abstract
Cannabis sativa has been used for improving sleep for long history. Cannabidiol (CBD) has drown much attention as a non-addictive psychoactive component in Cannabis sativa extract. However, the effects of CBD on sleep architecture and it's acting mechanism remains unclear. In the present study, we evaluated the sedative-hypnotic effect of cannabidiol (CBD), assessed the effects of CBD on sleep using a wireless physiological telemetry system. We further explored the therapeutic effects of CBD using 4-chloro-dl-phenylalanine (PCPA) induced insomnia model and changes in sleep latency, sleep duration and intestinal flora were evaluated. CBD shortened sleep latency and increases sleep duration in both normal and insomnia mice, and those effects were blocked by 5-HT1A receptor antagonist WAY100635. We determined that CBD increases 5-HT1A receptors expression and 5-HT content in the hypothalamus of PCPA-pretreated mice and affects tryptophan metabolism in the intestinal flora. These results showed that activation of 5-HT1A receptors is one of the potential mechanisms underlying the sedative-hypnotic effect of CBD. This study validated the effects of CBD on sleep and evaluated its potential therapeutic effects on insomnia.
Collapse
Affiliation(s)
- Yu-Meng Liu
- Shenyang Pharmaceutical University, Shenyang, 110016, China
- Beijing Institute of Pharmacology and Toxicology, State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Key Laboratory of Neuropsychopharmacology, Beijing, 100850, China
| | - Jin-Cao Li
- Beijing Institute of Pharmacology and Toxicology, State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Key Laboratory of Neuropsychopharmacology, Beijing, 100850, China
| | - Yong-Fang Gu
- Beijing Institute of Pharmacology and Toxicology, State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Key Laboratory of Neuropsychopharmacology, Beijing, 100850, China
| | - Ren-Hong Qiu
- Beijing Institute of Pharmacology and Toxicology, State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Key Laboratory of Neuropsychopharmacology, Beijing, 100850, China
| | - Jia-Ying Huang
- Beijing Institute of Pharmacology and Toxicology, State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Key Laboratory of Neuropsychopharmacology, Beijing, 100850, China
| | - Rui Xue
- Beijing Institute of Pharmacology and Toxicology, State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Key Laboratory of Neuropsychopharmacology, Beijing, 100850, China
| | - Shuo Li
- Beijing Institute of Pharmacology and Toxicology, State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Key Laboratory of Neuropsychopharmacology, Beijing, 100850, China
| | - Yang Zhang
- Beijing Institute of Pharmacology and Toxicology, State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Key Laboratory of Neuropsychopharmacology, Beijing, 100850, China
| | - Kuo Zhang
- Shenyang Pharmaceutical University, Shenyang, 110016, China
| | - You-Zhi Zhang
- Shenyang Pharmaceutical University, Shenyang, 110016, China.
- Beijing Institute of Pharmacology and Toxicology, State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Key Laboratory of Neuropsychopharmacology, Beijing, 100850, China.
| |
Collapse
|
27
|
Nepožitek J, Dostálová S, Věchetová G, Sieger T, Forejtová Z, Nováková L, Galušková K, Milata M, Varga Z, Tanaka H, Růžička E, Šonka K, Edwards M, Serranová T. Sleepiness and comorbid sleep disorders in functional motor disorders: a comparative study with central hypersomnia. J Sleep Res 2024; 33:e14098. [PMID: 37967854 DOI: 10.1111/jsr.14098] [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: 10/01/2023] [Revised: 10/20/2023] [Accepted: 10/29/2023] [Indexed: 11/17/2023]
Abstract
Sleep symptoms, including excessive sleepiness, are frequently reported by patients with functional motor disorders (FMD). We aimed to classify the comorbid sleep disorders in FMD, and to investigate the relationship between subjective sleepiness and objective measures of hypersomnia, comparing them with data from people with central hypersomnia. A total of 37 patients (mean [SD] age 46.4 [11.2] years) with clinically definite FMD, and 17 patients (mean [SD] age 41.1 [11.6] years) with central hypersomnia underwent structured medical and sleep history, neurological examination, polysomnography, multiple sleep latency test (MSLT), and questionnaires assessing sleepiness, fatigue, and depression. In all, 23 patients with FMD (62%) reported excessive daytime sleepiness. Evidence of specific sleep disorders was identified in our cohort, with 35% having restless legs syndrome; 49% obstructive sleep apnea; and 8% periodic limb movements in sleep; however, the presence of these disorders was not correlated with subjective sleepiness. Patients with FMD with self-reported sleepiness reported higher fatigue (p = 0.002), depression (p = 0.002), and had longer sleep latencies in the MSLT (p < 0.001) compared to the patients with central hypersomnia. No correlation was found between subjective and objective sleepiness in either group. Fatigue positively correlated with self-reported sleepiness in patients with FMD (p < 0.001). This study did not find objective correlates of increased sleepiness in patients with FMD. While sleep abnormalities were found to be common in FMD, they were not correlated with self-reports of excessive sleepiness. Positive correlations between self-reported sleepiness and fatigue support the current unified model of non-motor symptoms in FMD.
Collapse
Affiliation(s)
- Jiří Nepožitek
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Simona Dostálová
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Gabriela Věchetová
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Tomáš Sieger
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
- Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University, Prague, Czech Republic
| | - Zuzana Forejtová
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Lucia Nováková
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Karolína Galušková
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Martin Milata
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Zsóka Varga
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Hiroki Tanaka
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Evžen Růžička
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Karel Šonka
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Mark Edwards
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Tereza Serranová
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| |
Collapse
|
28
|
Boyle JT, Morales KH, Muench A, Ellis J, Vargas I, Grandner MA, Posner D, Perlis ML. The natural history of insomnia: evaluating illness severity from acute to chronic insomnia; is the first the worst? Sleep 2024; 47:zsae034. [PMID: 38310641 PMCID: PMC11009029 DOI: 10.1093/sleep/zsae034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 01/20/2024] [Indexed: 02/06/2024] Open
Abstract
STUDY OBJECTIVES The 3P and 4P models represent illness severity over the course of insomnia disorder. The 3P model suggests that illness severity is worst during acute onset. The 4P model suggests that illness severity crescendos with chronicity. The present analysis from an archival dataset assesses illness severity with new onset illness (i.e. from good sleep [GS] to acute insomnia [AI] to chronic insomnia [CI]). Illness severity is quantified in terms of total wake time (TWT). METHODS GSs (N = 934) were followed up to 1 year with digital sleep diaries, and classified as GS, AI, or CI. Data for CIs were anchored to the first of 14 days with insomnia so that day-to-day TWT was represented prior to and following AI onset. A similar graphic (+/-acute onset) was constructed for number of days per week with insomnia. GS data were temporally matched to CI data. Segmented linear mixed regression models were applied to examine the change in slopes in the AI-to-CI period compared to GS-to-AI period. RESULTS Twenty-three individuals transitioned to AI and then CI. Average TWT rose during the first 2 weeks of AI onset (b = 1.8, SE = 0.57, p = 0.001) and was then stable for 3 months (b = -0.02, SE = 0.04, p = 0.53). Average number of affected days was stable from AI to CI (b = 0.0005, SE = 0.002, p = 0.81). That is, while there was week-to-week variability in the number of days affected, no linear trend was evident. CONCLUSIONS In our sample of CIs, primarily with middle insomnia, the average severity and number of affected days were worst with the onset of AI (worst is first) and stable thereafter.
Collapse
Affiliation(s)
- Julia T Boyle
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Knashawn H Morales
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Alexandria Muench
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
- Chronobiology and Sleep Institute Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jason Ellis
- Northumbria Centre for Sleep Research, Northumbria University, Newcastle, UK
| | - Ivan Vargas
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, USA
| | - Michael A Grandner
- Sleep & Health Research Program, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Donn Posner
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
- Sleepwell Consultants, Newtonville, MA, USA
| | - Michael L Perlis
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
- Chronobiology and Sleep Institute Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
29
|
Barateau L, Baillieul S, Andrejak C, Bequignon É, Boutouyrie P, Dauvilliers Y, Gagnadoux F, Geoffroy PA, Micoulaud-Franchi JA, Montani D, Monaca C, Patout M, Pépin JL, Philip P, Pilette C, Tamisier R, Trzepizur W, Jaffuel D, Arnulf I. Guidelines for the assessment and management of residual sleepiness in obstructive apnea-hypopnea syndrome: Endorsed by the French Sleep Research and Medicine Society (SFRMS) and the French Speaking Society of Respiratory Diseases (SPLF). Respir Med Res 2024; 86:101105. [PMID: 38861872 DOI: 10.1016/j.resmer.2024.101105] [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: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 06/13/2024]
Abstract
Excessive daytime sleepiness (EDS) is frequent among patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and can persist despite the optimal correction of respiratory events (apnea, hypopnea and respiratory efforts), using continuous positive airway pressure (CPAP) or mandibular advancement device. Symptoms like apathy and fatigue may be mistaken for EDS. In addition, EDS has multi-factorial origin, which makes its evaluation complex. The marketing authorization [Autorisation de Mise sur le Marché (AMM)] for two wake-promoting agents (solriamfetol and pitolisant) raises several practical issues for clinicians. This consensus paper presents recommendations of good clinical practice to identify and evaluate EDS in this context, and to manage and follow-up the patients. It was conducted under the mandate of the French Societies for sleep medicine and for pneumology [Société Française de Recherche et de Médecine du Sommeil (SFRMS) and Société de Pneumologie de Langue Française (SPLF)]. A management algorithm is suggested, as well as a list of conditions during which the patient should be referred to a sleep center or a sleep specialist. The benefit/risk balance of a wake-promoting drug in residual EDS in OSAHS patients must be regularly reevaluated, especially in elderly patients with increased cardiovascular and psychiatric disorders risks. This consensus is based on the scientific knowledge at the time of the publication and may be revised according to their evolution.
Collapse
Affiliation(s)
- Lucie Barateau
- National Reference Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France; Sleep and Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac University Hospital, Montpellier, France; Institute of Neurosciences of Montpellier (INM), INSERM, University of Montpellier, France.
| | - Sébastien Baillieul
- Grenoble-Alpes university, HP2 Inserm laboratory, U1300, Pneumology and Physiology department, CHU Grenoble-Alpes, 38000 Grenoble, France; National Competence Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France
| | - Claire Andrejak
- Pneumology department, CHU Amiens-Picardie, 80054 Amiens, France; UR 4294 AGIR, Picardie Jules-Verne University, Amiens, France
| | - Émilie Bequignon
- ENT and oral maxillofacial surgery department, Intercommunal center Créteil, 94000 Créteil, France; CNRS, ERL 7000, Paris-Est Créteil University, 94010 Créteil, France
| | - Pierre Boutouyrie
- Pharmacology, Inserm PARCC U970, Georges-Pompidou European Hospital, Paris-Cité University, Assistance publique-Hôpitaux de Paris, Paris, France
| | - Yves Dauvilliers
- National Reference Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France; Sleep and Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac University Hospital, Montpellier, France; Institute of Neurosciences of Montpellier (INM), INSERM, University of Montpellier, France
| | - Frédéric Gagnadoux
- National Competence Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France; Pneumology and Sleep Medicine department, Angers CHU, Angers, France; Inserm 1083, UMR CNRS 6015, MITOVASC, Angers university, 49000 Angers, France
| | - Pierre-Alexis Geoffroy
- Département de psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, 75018 Paris, France; Centre ChronoS, GHU Paris - Psychiatry & Neurosciences, 1 rue Cabanis, 75014 Paris, France; Université de Paris, NeuroDiderot, Inserm U1141, 75019 Paris, France
| | - Jean-Arthur Micoulaud-Franchi
- University Sleep medicine unit, Bordeaux CHU, place Amélie-Raba-Léon, Bordeaux, France; SANPSY UMR 6033, Bordeaux University, 33000 Bordeaux, France
| | - David Montani
- Université Paris-Saclay, AP-HP, INSERM UMR_S 999, Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Centre, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
| | - Christelle Monaca
- National Competence Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France; Clinical neurophysiology, sleep disorders unit, U1172 - LilNCog - Lille, neurosciences & cognition, Lille university, Lille CHU, 59000 Lille, France
| | - Maxime Patout
- R3S department, Sleep pathologies unit, University hospital group, AP-HP-Sorbonne university, AP-HP, Pitié-Salpêtrière site, 75013 Paris, France; Inserm, UMRS1158 experimental and clinical respiratory neurophysiology, Sorbonne university, 75005 Paris, France
| | - Jean-Louis Pépin
- Grenoble-Alpes university, HP2 Inserm laboratory, U1300, Pneumology and Physiology department, CHU Grenoble-Alpes, 38000 Grenoble, France; National Competence Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France
| | - Pierre Philip
- National Reference Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France; University Sleep medicine unit, Bordeaux CHU, place Amélie-Raba-Léon, Bordeaux, France; SANPSY UMR 6033, Bordeaux University, 33000 Bordeaux, France
| | - Charles Pilette
- Saint-Luc university clinics, Institute for experimental and clinical research (Pneumology unit), UC Louvain, Brussels, Belgium
| | - Renaud Tamisier
- Grenoble-Alpes university, HP2 Inserm laboratory, U1300, Pneumology and Physiology department, CHU Grenoble-Alpes, 38000 Grenoble, France; National Competence Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France
| | - Wojciech Trzepizur
- National Competence Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France; Pneumology and Sleep Medicine department, Angers CHU, Angers, France; Inserm 1083, UMR CNRS 6015, MITOVASC, Angers university, 49000 Angers, France
| | - Dany Jaffuel
- Pneumology department, Arnaud-de-Villeneuve hospital, Montpellier CHRU, Montpellier, France; Inserm U1046, physiology and experimental medicine, heart and muscle, Montpellier university, Montpellier, France
| | - Isabelle Arnulf
- National Reference Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France; Pneumology department, Arnaud-de-Villeneuve hospital, Montpellier CHRU, Montpellier, France
| |
Collapse
|
30
|
Marques DR, Pires L, Broomfield NM, Espie CA. Sleep effort and its measurement: A scoping review. J Sleep Res 2024:e14206. [PMID: 38581186 DOI: 10.1111/jsr.14206] [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: 01/18/2024] [Revised: 03/15/2024] [Accepted: 03/21/2024] [Indexed: 04/08/2024]
Abstract
Insomnia disorder is characterized by disruption in sleep continuity and an overall dissatisfaction with sleep. A relevant feature of insomnia is sleep effort, which refers to both cognitive and behavioural conscious attempts to initiate sleep. The Glasgow Sleep Effort Scale is a self-report tool developed to assess this construct. The objective of the current scoping review was to map how sleep effort has been discussed in the literature and operationalized through its respective measure. Medline/PubMed, Scopus, Web of Science and PsycInfo databases were used to search for potential studies. The search query used in databases was the specific name of the self-reported tool itself (Glasgow Sleep Effort Scale) and "sleep effort" term. This scoping review followed JBI guidelines. To be included, records pertaining to any type of study that mentioned the Glasgow Sleep Effort Scale were considered. No language constraint was used. At the end, 166 initial records were retrieved. From those, 46 records met eligibility criteria and were analysed. Among the main findings, it was observed that the Glasgow Sleep Effort Scale has been increasingly used in recent years, with a notable observed upward trend, especially in the last 2 years. In addition to the original measure, only three published adapted versions of the instrument were identified. This suggests that there is limited research on adapting the scale for different populations or contexts. Sleep effort has been increasingly studied in the last few years. Nonetheless, more research on the Glasgow Sleep Effort Scale tool is recommended, including cross-cultural adaptations.
Collapse
Affiliation(s)
- Daniel Ruivo Marques
- Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
- CINEICC - Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Luís Pires
- CINEICC - Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
- Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Niall M Broomfield
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Colin A Espie
- Nuffield Department of Clinical Neurosciences, Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
| |
Collapse
|
31
|
Labie C, Runge N, Mairesse O, Nijs J, Malfliet A, Verschueren S, Van Assche D, de Vlam K, Luyten F, Bilterys T, Cools W, De Pourcq V, Delwiche B, Huysmans E, De Baets L. Integration of Cognitive Behavioral Therapy for Insomnia in Best-Practice Care for Patients With Knee Osteoarthritis and Insomnia: A Randomized Controlled Trial Protocol. Phys Ther 2024; 104:pzad181. [PMID: 38157312 DOI: 10.1093/ptj/pzad181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 08/04/2023] [Accepted: 11/05/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Knee osteoarthritis (KOA) is a common musculoskeletal problem worldwide and its key symptom is pain. Guidelines recommend incorporating comorbidity-specific therapies into patient-centered care. Patients diagnosed with KOA frequently have insomnia, which is associated with higher-pain severity. For this reason, this study protocol outlines the methodology of a randomized controlled trial (RCT) investigating the effectiveness of cognitive behavioral therapy for insomnia (CBTi) combined with best-practice KOA care (BPC) compared to best-practice KOA care and lifestyle education. METHODS A 2-arm RCT in patients with KOA and insomnia is conducted, in which a total of 128 patients are randomly allocated to an intervention or control group. The experimental intervention consists of 12 sessions of physical therapist-led BPC with an additional 6 sessions of CBTi. The control intervention also receives BPC, which is supplemented with 6 general lifestyle information sessions. The primary outcome is the between-group difference in change in pain severity at 6 months after intervention. Secondary outcomes are pain-related outcomes, sleep-related outcomes, symptoms of anxiety and depression, level of physical activity and function, perceived global improvement, biomarkers of inflammation, and health-related quality of life. Assessments are conducted at baseline, immediately after intervention, and 3, 6, and 12 months after intervention. Furthermore, a cost-utility analysis for the proposed intervention will be performed alongside the RCT. IMPACT This is the first RCT investigating the clinical and cost-effectiveness of a physical therapist-led intervention integrating CBTi into BPC in patients with KOA and insomnia. The results of this trial will add to the growing body of evidence on the effectiveness of individualized and comorbidity-specific KOA care, which can inform clinical decision-making and assist policymakers and other relevant stakeholders in optimizing the care pathway for patients with KOA.
Collapse
Affiliation(s)
- Céline Labie
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussel, Belgium
- Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Nils Runge
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussel, Belgium
- Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Olivier Mairesse
- Brain, Body and Cognition (BBCO), Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Laboratoire de Psychologie Médicale et d'Addictologie (ULB312), Department of Psychiatry, Brugmann University Hospital, Université Libre de Bruxelles (ULB) and Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussel, Belgium
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anneleen Malfliet
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussel, Belgium
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
- Research Foundation Flanders (FWO), Brussels, Belgium
| | - Sabine Verschueren
- Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Dieter Van Assche
- Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Kurt de Vlam
- Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium
- Skeletal Biology & Engineering Research Center, Department of Development & Regeneration, KU Leuven, Leuven, Belgium
| | - Frank Luyten
- Skeletal Biology & Engineering Research Center, Department of Development & Regeneration, KU Leuven, Leuven, Belgium
| | - Thomas Bilterys
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussel, Belgium
| | - Wilfried Cools
- Core facility - Support for Quantitative and Qualitative Research (SQUARE), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Veerle De Pourcq
- ReumaNet vzw, Flemish Patient Organization for Rheumatological Conditions, Zaventem, Belgium
| | - Bérénice Delwiche
- Brain, Body and Cognition (BBCO), Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Sleep Unit, University Hospital Brussels, Brussels, Belgium
| | - Eva Huysmans
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussel, Belgium
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Liesbet De Baets
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussel, Belgium
| |
Collapse
|
32
|
Takeshima M, Yoshizawa K, Ogasawara M, Kudo M, Itoh Y, Ayabe N, Mishima K. Treatment Failure and Long-Term Prescription Risk for Guideline-Recommended Hypnotics in Japan. JAMA Netw Open 2024; 7:e246865. [PMID: 38630476 PMCID: PMC11024780 DOI: 10.1001/jamanetworkopen.2024.6865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/19/2024] [Indexed: 04/19/2024] Open
Abstract
Importance Although insomnia guidelines recommend the use of several individual hypnotics, the most useful hypnotic for treating insomnia in a clinical setting remains unclear. Objective To determine which guideline-recommended hypnotics have lower risks of monotherapy failure and which hypnotics have a higher risk of long-term prescription for insomnia treatment. Design, Setting, and Participants This retrospective observational cohort study used data from the Japan Medical Data Center Claims Database from April 1, 2005, to March 31, 2021. Participants included adults whose first prescribed pharmaceutical treatment for insomnia was guideline-recommended hypnotic monotherapy. Data were analyzed from December 24, 2022, to September 26, 2023. Exposures Suvorexant, ramelteon, eszopiclone, zolpidem, and triazolam monotherapy. Main Outcomes and Measures The primary outcome was monotherapy failure, defined as a change in hypnotic or having an additional hypnotic prescribed for insomnia within 6 months of the first prescription of a guideline-recommended hypnotic monotherapy. The secondary outcome was monotherapy discontinuation, defined as no prescription of any hypnotic for 2 consecutive months within 6 months after prescribing a guideline-recommended hypnotic in patients for whom monotherapy did not fail. Monotherapy failure and discontinuation were compared using Cox proportional hazards and logistic regression models, respectively. Results The study included 239 568 adults (median age, 45 [IQR, 34-55] years; 50.2% women) whose first prescription for insomnia was guideline-recommended hypnotic monotherapy. During the 6-month follow-up period, 24 778 patients (10.3%) experienced failure of monotherapy with a guideline-recommended hypnotic. In comparison with eszopiclone, there were more cases of monotherapy failure for ramelteon (adjusted hazard ratio [AHR], 1.23 [95% CI], 1.17-1.30; P < .001), fewer cases for zolpidem (AHR, 0.84 [95% CI, 0.81-0.87]; P < .001) and triazolam (AHR, 0.82 [95% CI, 0.78-0.87]; P < .001), and no significant difference between suvorexant and eszopiclone. Among those without monotherapy failure, monotherapy was discontinued in 84.6% of patients, with more discontinuations for ramelteon (adjusted odds ratio [AOR], 1.31 [95% CI, 1.24-1.40]; P < .001) and suvorexant (AOR, 1.20 [95% CI, 1.15-1.26]; P < .001) than for eszopiclone and no significant difference between zolpidem or triazolam and eszopiclone. Conclusions and Relevance Due to uncontrolled confounding factors in this cohort study, no conclusions regarding the pharmacologic properties of guideline-recommended hypnotics can be drawn based on these results. Further studies accounting for confounding factors, including diagnoses of chronic vs acute insomnia disorder, insomnia and psychiatric symptom severity, and physician attitudes toward hypnotic prescription, are needed.
Collapse
Affiliation(s)
- Masahiro Takeshima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Kazuhisa Yoshizawa
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Masaya Ogasawara
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Mizuki Kudo
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Yu Itoh
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Naoko Ayabe
- Department of Regional Studies and Humanities, Faculty of Education and Human Studies, Akita University, Akita, Japan
| | - Kazuo Mishima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| |
Collapse
|
33
|
Chang Y, Xie X, Liu Y, Liu M, Zhang H. Exploring clinical applications and long-term effectiveness of benzodiazepines: An integrated perspective on mechanisms, imaging, and personalized medicine. Biomed Pharmacother 2024; 173:116329. [PMID: 38401518 DOI: 10.1016/j.biopha.2024.116329] [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: 11/21/2023] [Revised: 02/13/2024] [Accepted: 02/21/2024] [Indexed: 02/26/2024] Open
Abstract
Benzodiazepines have been long-established treatments for various conditions, including anxiety disorders and insomnia. Recent FDA warnings emphasize the risks of misuse and dependence associated with benzodiazepines. This article highlights their benefits and potential drawbacks from various perspectives. It achieves this by explaining how benzodiazepines work in terms of neuroendocrinology, immunomodulation, sleep, anxiety, cognition, and addiction, ultimately improving their clinical effectiveness. Benzodiazepines play a regulatory role in the HPA axis and impact various systems, including neuropeptide Y and cholecystokinin. Benzodiazepines can facilitate sleep-dependent memory consolidation by promoting spindle wave activity, but they can also lead to memory deficits in older individuals due to reduced slow-wave sleep. The cognitive effects of chronic benzodiazepines use remain uncertain; however, no adverse findings have been reported in clinical imaging studies. This article aims to comprehensively review the evidence on benzodiazepines therapy, emphasizing the need for more clinical studies, especially regarding long-term benzodiazepines use.
Collapse
Affiliation(s)
- Yiheng Chang
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Xueting Xie
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yudan Liu
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Meichen Liu
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
| | - Huimin Zhang
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
| |
Collapse
|
34
|
Varinthra P, Anwar SNMN, Shih SC, Liu IY. The role of the GABAergic system on insomnia. Tzu Chi Med J 2024; 36:103-109. [PMID: 38645778 PMCID: PMC11025592 DOI: 10.4103/tcmj.tcmj_243_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/09/2023] [Accepted: 11/25/2023] [Indexed: 04/23/2024] Open
Abstract
Sleep is an essential activity for the survival of mammals. Good sleep quality helps promote the performance of daily functions. In contrast, insufficient sleep reduces the efficiency of daily activities, causes various chronic diseases like Alzheimer's disease, and increases the risk of having accidents. The GABAergic system is the primary inhibitory neurotransmitter system in the central nervous system. It transits the gamma-aminobutyric acid (GABA) neurotransmitter via GABAA and GABAB receptors to counterbalance excitatory neurotransmitters, such as glutamate, noradrenaline, serotonin, acetylcholine, orexin, and dopamine, which release and increase arousal activities during sleep. Several studies emphasized that dysfunction of the GABAergic system is related to insomnia, the most prevalent sleep-related disorder. The GABAergic system comprises the GABA neurotransmitter, GABA receptors, GABA synthesis, and degradation. Many studies have demonstrated that GABA levels correlate with sleep quality, suggesting that modulating the GABAergic system may be a promising therapeutic approach for insomnia. In this article, we highlight the significance of sleep, the classification and pathology of insomnia, and the impact of the GABAergic system changes on sleep. In addition, we also review the medications that target the GABAergic systems for insomnia, including benzodiazepines (BZDs), non-BZDs, barbiturates, GABA supplements, and Chinese herbal medicines.
Collapse
Affiliation(s)
| | - Shameemun Naseer Mohamed Nizarul Anwar
- Department of Biotechnology, School of Bioengineering, College of Engineering and Technology, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, India
| | - Shu-Ching Shih
- Department of Molecular Biology and Human Genetics, Tzu Chi University, Hualien, Taiwan
| | - Ingrid Y. Liu
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| |
Collapse
|
35
|
Cai Y, Gong D, Xiang T, Zhang X, Pan J. Markers of intestinal barrier damage in patients with chronic insomnia disorder. Front Psychiatry 2024; 15:1373462. [PMID: 38606411 PMCID: PMC11007705 DOI: 10.3389/fpsyt.2024.1373462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/12/2024] [Indexed: 04/13/2024] Open
Abstract
Objective Insomnia disorder stands out as one of the prevalent clinical sleep and psychiatric disorders. Prior research has unequivocally demonstrated variations in the diversity and abundance of gut microbiota among individuals with insomnia disorder. These alterations may play a direct or indirect role in the onset and progression of insomnia disorder by compromising the integrity of the intestinal barrier. This study aims to evaluate the impairment of the intestinal barrier in individuals with insomnia disorder by scrutinizing the serum functionality of this barrier. Materials and methods 45 patients with chronic insomnia disorder and 30 matched healthy volunteers were meticulously selected based on inclusion criteria. ELISA technology was employed to measure serum levels of diamine oxidase (DAO), D-lactic acid (D-LA), intestinal fatty acid binding protein (I-FABP), and endothelin (ET). Spearman correlation analysis was used to explore the relationship between intestinal mucosal markers and clinical characteristics. Data were analyzed using SPSS 26.0. Results Compared to the healthy control group, the insomnia disorder group exhibited significantly elevated scores on subjective mood and sleep scales (GAD-7, PHQ-9, HAMA, HAMD, PSQI, and ISI) (P < 0.05). Overnight PSG indicated a notable increase in bed time, total wake time, sleep onset latency, and wake after sleep onset in individuals with insomnia disorder. Additionally, there was a decrease in sleep efficiency and alterations in sleep structure (increased proportion of N1 and N3 stages, prolonged N1 stage) (P < 0.05). The chronic insomnia disorder group displayed significantly reduced concentrations of serum DAO, D-LA, I-FABP, and ET (P < 0.05). Furthermore, significant positive correlations were identified between intestinal epithelial barrier markers and sleep efficiency, while negative correlations were found with wake after sleep onset, total wake time, PSQI, HAMA, and HAMD. Additionally, D-LA levels were significantly positively correlated with ET concentrations. Conclusion Individuals with chronic insomnia disorder manifest disruptions in sleep structure, heightened susceptibility to anxiety and depressive moods, and impaired intestinal barrier function. These findings suggest that the occurrence and development of insomnia disorder may be linked to the impairment of the intestinal barrier.
Collapse
Affiliation(s)
- Yixian Cai
- Department of Psychiatry, Sleep Medicine Centre, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Di Gong
- Shenzhen Eye Hospital, Jinan University, Shenzhen, China
| | - Ting Xiang
- Department of Sleep Disorders, Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Xiaotao Zhang
- Department of Psychiatry, Sleep Medicine Centre, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jiyang Pan
- Department of Psychiatry, Sleep Medicine Centre, The First Affiliated Hospital of Jinan University, Guangzhou, China
| |
Collapse
|
36
|
Li B, Yang Y, Song Z, Tang Z. Comparative Analysis of the Sedative and Hypnotic Effects among Various Parts of Zizyphus spinosus Hu and Their Chemical Analysis. Pharmaceuticals (Basel) 2024; 17:413. [PMID: 38675375 PMCID: PMC11054641 DOI: 10.3390/ph17040413] [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: 03/05/2024] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
Zizyphus spinosus Hu (ZS), as a "medicinal and food-homologous" plant, has been used for a long history. The study was to assess the sedative and hypnotic effects among various parts of ZS. The model, diazepam (DZP), ZS kernel (ZSS), ZS flesh (ZSF), and ZS husk (ZSKS) group occurred subsequent to the successful establishment of the para-chlorophenylalanine induced insomnia model via intraperitoneal injection. The latency and duration of sleep in mice in each group were recorded. The substance basis of various parts of ZS was analyzed by the UPLC-QTOF-MS technique. The results showed that relative to the model group, DZP, ZSS, ZSF, and ZSKS groups demonstrated shortened sleep latency (p < 0.05) and extended sleep duration (p < 0.01). The GABA, 5-HT, and BDNF levels were significantly upregulated in the brain tissues of the mice in the DZP, ZSF, and ZSS groups (p < 0.01). However, the improvement in ZSKS was non-significant. Additionally, the mRNA and protein expression levels of 5-HT1AR, GABAARα1, and BDNF in mice in the DZP, ZSS, and ZSF groups were significantly enhanced (p < 0.01). However, the improvement in the ZSKS group was insignificant (p < 0.05). The examination of the substance composition across different parts revealed that the shared chemical basis contributing to the sedative and hypnotic potency of different parts of ZS may involve the presence of compounds such as (1) magnoflorine, (8) betulinic acid, (9) ceanothic acid, and (10) alphitolic acid. It provides a basis for further elucidation of the substance basis responsible for the functional and medicinal effects of ZS.
Collapse
Affiliation(s)
- Baojian Li
- Shaanxi Collaborative Innovation Center of Chinese Medicine Resources Industrialization, State Key Laboratory of Research & Development of Characteristic Qin Medicine Resources (Cultivation), Shaanxi Innovative Drug Research Center and College of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang 712046, China; (B.L.); (Z.S.)
| | - Yuangui Yang
- Shaanxi Collaborative Innovation Center of Chinese Medicine Resources Industrialization, State Key Laboratory of Research & Development of Characteristic Qin Medicine Resources (Cultivation), Shaanxi Innovative Drug Research Center and College of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang 712046, China; (B.L.); (Z.S.)
| | - Zhongxing Song
- Shaanxi Collaborative Innovation Center of Chinese Medicine Resources Industrialization, State Key Laboratory of Research & Development of Characteristic Qin Medicine Resources (Cultivation), Shaanxi Innovative Drug Research Center and College of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang 712046, China; (B.L.); (Z.S.)
| | - Zhishu Tang
- Shaanxi Collaborative Innovation Center of Chinese Medicine Resources Industrialization, State Key Laboratory of Research & Development of Characteristic Qin Medicine Resources (Cultivation), Shaanxi Innovative Drug Research Center and College of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang 712046, China; (B.L.); (Z.S.)
- China Academy of Chinese Medical Sciences, Beijing 100700, China
| |
Collapse
|
37
|
Pajėdienė E, Urbonavičiūtė V, Ramanauskaitė V, Strazdauskas L, Stefani A. Sex Differences in Insomnia and Circadian Rhythm Disorders: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:474. [PMID: 38541200 PMCID: PMC10971860 DOI: 10.3390/medicina60030474] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/04/2024] [Accepted: 03/08/2024] [Indexed: 07/23/2024]
Abstract
Insomnia and circadian rhythm disorders are increasingly common in modern society and lead to significant challenges for people's health and well-being. Some studies suggests that men and women differ in neurohormonal secretion, biological processes, and brain morphology. Thus, such differences may affect the etiology, manifestation, and course of sleep disorders, including insomnia and circadian rhythm. This systematic review aims to synthesize the existing literature on sex differences in insomnia and circadian rhythm disorders. PubMed, MEDLINE, Epistemonikos, and Cochrane databases were searched for articles published from inception until 5 September 2023, not older than five years. We performed a systematic search using MESH and non-MESH queries: (sex differences) or (male and female differences) or (men and women differences) or (men and women) AND (insomnia) or (sleep wake disorder*) or (sleep wake rhythm disorder*) or (circadian rhythm disorder*) or (sleep cycle disruption) or (sleep cycle disorder*). Out off 2833 articles screened, 11 studies were included. The prevalence of insomnia is higher among women, and their sleep is more regular and stable compared to men. Studies evaluating the impact of the stressful situation associated with the lockdown on women's and men's insomnia present discordant results concerning sex differences. Women's circadian rhythm was found to be more stable and less fragmented than men's. However, the progression of peak activity time with age was more pronounced in men. The current literature suggests that risk factors for insomnia and circadian rhythm disorders affect men and women differently. These include cerebrovascular and cardiometabolic factors, shift work, and infections. The long-term effects of insomnia seem to be more relevant for the male sex, shortening lifespan more than in women. By summarizing and analyzing existing studies, we highlight the need for further research to improve understanding of the interaction between sex and sleep.
Collapse
Affiliation(s)
- Evelina Pajėdienė
- Department of Neurology, Lithuanian University of Health Sciences, Eivenių g. 2, 50161 Kaunas, Lithuania
| | - Viltė Urbonavičiūtė
- Faculty of Medicine, Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, 44307 Kaunas, Lithuania; (V.R.); (L.S.)
| | - Vita Ramanauskaitė
- Faculty of Medicine, Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, 44307 Kaunas, Lithuania; (V.R.); (L.S.)
| | - Lukas Strazdauskas
- Faculty of Medicine, Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, 44307 Kaunas, Lithuania; (V.R.); (L.S.)
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| |
Collapse
|
38
|
Tian C, Wei Y, Xu M, Liu J, Tong B, Ning J, Wang Y, Wang Y, Estill J, Ge L. The effects of exercise on insomnia disorders: An umbrella review and network meta-analysis. Sleep Med 2024; 115:66-75. [PMID: 38335829 DOI: 10.1016/j.sleep.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/29/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE To summarize the evidence of various exercise modalities on population with insomnia disorders. METHOD PubMed, Embase, Cochrane Library, and Web of Science were searched for eligible studies published from inception to October 2022 and updated on September 2023. Systematic reviews with meta-analyses and randomized controlled trials designed to investigate the effect of various exercise modalities on population with insomnia were eligible. RESULTS A total of 4 SRs with (very) low methodological quality and 1034 participants in 10 network meta-analyses explored the association between different types and intensity exercise modalities with insomnia disorders. Various exercise modalities could significantly improve total sleep time and sleep quality and alleviate insomnia severity. Compared to passive control, moderate aerobic exercise, moderate aerobic exercise combined with light intensity strength and mind-body exercise can improve sleep efficiency and reduce wake after sleep onset by objectively measured. Moderate intensity strength, light intensity strength and mind-body exercise can improve sleep efficiency subjectively measured; mind-body exercise can reduce sleep onset latency and wake time after sleep onset, and increase total sleep time; moderate aerobic exercise can reduce sleep onset latency. Moderate intensity strength, light intensity strength, mind body exercise and moderate aerobic exercise combined with light intensity strength can the severity of insomnia and improv sleep quality. CONCLUSION Exercise had a positive effect on relief insomnia and improve sleep quality. Moderate aerobic exercise, mind-body exercise and moderate aerobic exercise combined with light intensity strength play an important role in improving the sleep quality in people with insomnia disorders.
Collapse
Affiliation(s)
- Chen Tian
- Evidence-Based Social Sciences Research Centre, School of Public Health, Lanzhou University, Lanzhou, China; Depertment of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Yuanyuan Wei
- Nursing School of Lanzhou University, Lanzhou, China; Department of VIP Outpatient/Chronic Disease Management, First Hospital of Lanzhou University, Lanzhou, China
| | - Meng Xu
- Evidence-Based Social Sciences Research Centre, School of Public Health, Lanzhou University, Lanzhou, China; Depertment of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Jianing Liu
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, China
| | - Bo Tong
- Depertment of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China
| | - Jinling Ning
- Evidence-Based Social Sciences Research Centre, School of Public Health, Lanzhou University, Lanzhou, China; Depertment of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China
| | - Yong Wang
- First Clinical School of Medicine, Lanzhou University, Lanzhou, China
| | - Yiyun Wang
- Depertment of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China
| | - Janne Estill
- Institute of Global Health, University of Geneva, Geneva, Switzerland; School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Long Ge
- Evidence-Based Social Sciences Research Centre, School of Public Health, Lanzhou University, Lanzhou, China; Depertment of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China.
| |
Collapse
|
39
|
Shao Z, Guo Y, Yue L, Liu X, Liu J, Zhao X, Sheng X, Yu D, Zhu Y, Yuan K. Comparisons of transcranial alternating current stimulation and repetitive transcranial magnetic stimulation treatment therapy for insomnia: a pilot study. Gen Psychiatr 2024; 37:e101184. [PMID: 38390243 PMCID: PMC10882281 DOI: 10.1136/gpsych-2023-101184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/18/2023] [Indexed: 02/24/2024] Open
Affiliation(s)
- Ziqiang Shao
- School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, China
| | - Yongjian Guo
- School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, China
| | - Lirong Yue
- School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, China
| | - Xiaoyang Liu
- School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, China
| | - Jiayi Liu
- Department of Psychosomatic Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xumeng Zhao
- Department of Psychosomatic Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xiaona Sheng
- Department of Psychosomatic Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Dahua Yu
- Information Processing Laboratory, School of Information Engineering, Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia, China
| | - Yifei Zhu
- Department of Psychosomatic Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Kai Yuan
- School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, China
| |
Collapse
|
40
|
Song Z, Li W, Han Y, Xu Y, Wang Y. Investigating the shared genetic architecture between frailty and insomnia. Front Aging Neurosci 2024; 16:1358996. [PMID: 38425786 PMCID: PMC10903740 DOI: 10.3389/fnagi.2024.1358996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Background The epidemiological association between frailty and insomnia is well established, yet the presence of a common genetic etiology is still uncertain. Further exploration is needed to ascertain the causal relationship between frailty and insomnia. Methods Utilizing data obtained from genome-wide association studies (GWAS) summaries, we utilized the linkage disequilibrium score regression (LDSC) to determine the genetic correlation existing between frailty and insomnia. The determination of causality was achieved through the application of two-sample Mendelian randomization. We investigated the enrichment of single nucleotide polymorphism (SNP) at various tissue types utilizing stratified LD score regression (S-LDSC) and multimarker analysis of genome annotation (MAGMA). Common risk SNPs were identified using Multi-Trait Analysis of GWAS (MTAG) and Cross-Phenotype Association (CPASSOC). We further investigated the expression profiles of risk genes in tissues using Summary-data-based Mendelian randomization(SMR) based on pooled data, to explore potential functional genes. Results Our findings indicated a significant genetic correlation between frailty and insomnia, highlighting SNPs sharing risk (rs34290943, rs10865954), with a pronounced correlation in the localized genomic region 3p21.31. Partitioned genetic analysis revealed 24 functional elements significantly associated with both frailty and insomnia. Furthermore, mendelian randomization revealed a causal connection between frailty and insomnia. The genetic correlation between frailty and insomnia showed enrichment in 11 brain regions (S-LDSC) and 9 brain regions (MAGMA), where four functional genes (RMB6, MST1R, RF123, and FAM212A) were identified. Conclusion This study suggests the existence of a genetic correlation and common risk genes between frailty and insomnia, contributing to a deeper comprehension of their pathogenesis and assists in identifying potential therapeutic targets.
Collapse
Affiliation(s)
- Zhiwei Song
- Department of Neurology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Wangyu Li
- Department of Pain Management, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Yupeng Han
- Department of Anesthesiology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Yiya Xu
- Department of Neurology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Yinzhou Wang
- Department of Neurology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
- Fujian Key Laboratory of Medical Analysis, Fujian Academy of Medical Sciences, Fuzhou, Fujian, China
| |
Collapse
|
41
|
Mehrotra R, Cukor D, McCurry SM, Rue T, Roumelioti ME, Heagerty PJ, Unruh M. Effectiveness of Existing Insomnia Therapies for Patients Undergoing Hemodialysis : A Randomized Clinical Trial. Ann Intern Med 2024; 177:177-188. [PMID: 38224591 DOI: 10.7326/m23-1794] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Chronic insomnia is common in patients undergoing in-center hemodialysis, yet there is limited evidence on effective treatments for this population. OBJECTIVE To compare the effectiveness of cognitive behavioral therapy for insomnia (CBT-I), trazodone, and placebo for insomnia in patients undergoing long-term hemodialysis. DESIGN Randomized, multicenter, double-blinded, placebo-controlled trial. (ClinicalTrials.gov: NCT03534284). SETTING 26 dialysis units in Albuquerque, New Mexico, and Seattle, Washington. PARTICIPANTS Patients with Insomnia Severity Index (ISI) score of 10 or greater, with sleep disturbances on 3 or more nights per week for 3 or more months. INTERVENTION Participants were randomly assigned to 6 weeks of CBT-I, trazodone, or placebo. MEASUREMENTS The primary outcome was the ISI score at 7 and 25 weeks from randomization. RESULTS A total of 923 patients were prescreened, and of the 411 patients with chronic insomnia, 126 were randomly assigned to CBT-I (n = 43), trazodone (n = 42), or placebo (n = 41). The change in ISI scores from baseline to 7 weeks with CBT-I or trazodone was no different from placebo: CBT-I, -3.7 (95% CI, -5.5 to -1.9); trazodone, -4.2 (CI, -5.9 to -2.4); and placebo, -3.1 (CI, -4.9 to -1.3). There was no meaningful change in ISI scores from baseline to 25 weeks: CBT-I, -4.8 (CI, -7.0 to -2.7); trazodone, -4.0 (CI, -6.0 to -1.9); and placebo, -4.3 (CI, -6.4 to -2.2). Serious adverse events (SAEs), particularly serious cardiovascular events, were more frequent with trazodone (annualized cardiovascular SAE incidence rates: CBT-I, 0.05 [CI, 0.00 to 0.29]; trazodone, 0.64 [CI, 0.34 to 1.10]; and placebo, 0.21 [CI, 0.06 to 0.53]). LIMITATION Modest sample size and most participants had mild or moderate insomnia. CONCLUSION In patients undergoing hemodialysis with mild or moderate chronic insomnia, there was no difference in the effectiveness of 6 weeks of CBT-I or trazodone compared with placebo. The incidence of SAEs was higher with trazodone. PRIMARY FUNDING SOURCE National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases.
Collapse
Affiliation(s)
- Rajnish Mehrotra
- Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington (R.M.)
| | - Daniel Cukor
- The Rogosin Institute, New York, New York (D.C.)
| | - Susan M McCurry
- School of Nursing, University of Washington, Seattle, Washington (S.M.M.)
| | - Tessa Rue
- Center for Biomedical Statistics, University of Washington School of Public Health, Seattle, Washington (T.R., P.J.H.)
| | - Maria-Eleni Roumelioti
- Division of Nephrology, Department of Medicine, University of New Mexico, Albuquerque, New Mexico (M.-E.R., M.U.)
| | - Patrick J Heagerty
- Center for Biomedical Statistics, University of Washington School of Public Health, Seattle, Washington (T.R., P.J.H.)
| | - Mark Unruh
- Division of Nephrology, Department of Medicine, University of New Mexico, Albuquerque, New Mexico (M.-E.R., M.U.)
| |
Collapse
|
42
|
Xu M, Tian C, Liang S, Tong B, Wu Y, Zhou L, Nian T, Wang Y, Yang K, Li X. Comparative efficacy of exercise modalities on sleep quality in populations with sleep disorders: A systematic review and network meta-analysis. Sleep Med Rev 2024; 73:101877. [PMID: 38006755 DOI: 10.1016/j.smrv.2023.101877] [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: 07/04/2023] [Revised: 11/03/2023] [Accepted: 11/11/2023] [Indexed: 11/27/2023]
Abstract
The effect of various exercise modalities on people with sleep disorders remains unclear. This network meta-analysis aims to explore the effects of various exercise modalities in improving sleep quality in people with sleep disorders. Four electronic databases were searched from inception to April 8, 2023. We conducted pairwise meta-analyses and frequentist network meta-analyses with random effects models. A total of 17 randomized controlled trials enrolled 1090 participants were included. Compared with passive control, with moderate-to-low certainty of evidence, mind-body exercise combined with treatment as usual [standard mean difference (SMD) = -2.26, 95% confidence interval (CI) (-3.29, -1,24)], moderate aerobic exercise combined with light strength exercise [SMD = -1.26, 95% CI (-2.22, -0.31)], mind-body exercise [SMD = -0.81, 95% CI (-1.37, -0.25)] and moderate aerobic exercise [SMD = -0.75, 95% CI (-1.38, -0.13)] were more effect in improving sleep disorders. Various exercise modalities have favorable effects on sleep quality for people with sleep disorders compared with passive control. However, due to the low quality of evidence, well-designed trials should be conducted to elucidate these promising findings in the future.
Collapse
Affiliation(s)
- Meng Xu
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China
| | - Chen Tian
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Shanshan Liang
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China
| | - Bo Tong
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Yanan Wu
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China
| | - Liying Zhou
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China
| | - Tao Nian
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China
| | - Yongsheng Wang
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China
| | - Kehu Yang
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China.
| | - Xiuxia Li
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China.
| |
Collapse
|
43
|
Berra F, Fasiello E, Zucconi M, Casoni F, De Gennaro L, Ferini-Strambi L, Galbiati A. Neurophysiological Parameters Influencing Sleep-Wake Discrepancy in Insomnia Disorder: A Preliminary Analysis on Alpha Rhythm during Sleep Onset. Brain Sci 2024; 14:97. [PMID: 38275517 PMCID: PMC10813212 DOI: 10.3390/brainsci14010097] [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: 12/07/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
Sleep state misperception (SSM) is a common issue in insomnia disorder (ID), causing a discrepancy between objective and subjective sleep/wake time estimation and increased daytime impairments. In this context, the hyperarousal theory assumes that sustained central nervous system activation contributes to the SSM. This study investigates factors influencing SSM during sleep latency (SL) and total sleep time (TST). Objective polysomnographic sleep variables (the alpha density index, latency-to-sleep stages and the first K-complex, and Rapid Eye Movement (REM) arousal density) and subjective sleep indices, taken from sleep diaries, were analyzed in 16 ID patients. Correlation analyses revealed a positive association between the degree of SL misperception (SLm) and the percentage of epochs that contained a visually scored stereotyped alpha rhythm during objective SL. A regression analysis showed that the REM arousal density and alpha density index significantly predicted TST misperception (TSTm). Furthermore, the degree of SLm was associated with an increased probability of transitioning from stage 1 of non-REM sleep to wakefulness during subjective SL. These findings support the role of hyperarousal in SSM and highlight the importance of alpha activity in unravelling the heterogeneous underpinnings of SSM.
Collapse
Affiliation(s)
- Francesca Berra
- Department of Psychology, “Vita-Salute” San Raffaele University, 20132 Milan, Italy; (F.B.); (E.F.); (L.F.-S.)
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology–Sleep Disorders Center, 20132 Milan, Italy; (M.Z.); (F.C.)
| | - Elisabetta Fasiello
- Department of Psychology, “Vita-Salute” San Raffaele University, 20132 Milan, Italy; (F.B.); (E.F.); (L.F.-S.)
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology–Sleep Disorders Center, 20132 Milan, Italy; (M.Z.); (F.C.)
| | - Marco Zucconi
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology–Sleep Disorders Center, 20132 Milan, Italy; (M.Z.); (F.C.)
| | - Francesca Casoni
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology–Sleep Disorders Center, 20132 Milan, Italy; (M.Z.); (F.C.)
| | - Luigi De Gennaro
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy;
- Body and Action Lab, IRCCS Fondazione Santa Lucia, 00179 Rome, Italy
| | - Luigi Ferini-Strambi
- Department of Psychology, “Vita-Salute” San Raffaele University, 20132 Milan, Italy; (F.B.); (E.F.); (L.F.-S.)
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology–Sleep Disorders Center, 20132 Milan, Italy; (M.Z.); (F.C.)
| | - Andrea Galbiati
- Department of Psychology, “Vita-Salute” San Raffaele University, 20132 Milan, Italy; (F.B.); (E.F.); (L.F.-S.)
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology–Sleep Disorders Center, 20132 Milan, Italy; (M.Z.); (F.C.)
| |
Collapse
|
44
|
Li S, He M, Lin L, Chen Q, Ru T, Zhou G. Altered neurophysiological responses during empathy for pain in insomnia: evidence from an EEG study in non-clinical samples. J Physiol Anthropol 2024; 43:4. [PMID: 38172965 PMCID: PMC10765821 DOI: 10.1186/s40101-023-00351-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND This study aims to investigate the behavioral and neurophysiological changes accompanying the empathy for pain among individuals with insomnia in nonclinical samples, which has been scarcely explored in the existing literature despite the deleterious effects of sleep disturbance on social behavior, and interactions had been well-documented. METHODS Twenty-one individuals with insomnia in nonclinical samples and 20 healthy individuals as normal controls participated in the study. Electroencephalograph (EEG) was continuously recorded, while the participants underwent an empathy for pain task. RESULTS Subjective ratings of pain for painful and non-painful images revealed no statistically significant differences between the insomnia and control groups. The painful images induced a smaller P2 compared to non-painful images in the insomnia group, whereas no such difference was revealed for the controls. Moreover, a higher power density of the alpha and theta2 bands in the posterior brain regions was found in the insomnia group compared to the control group. CONCLUSION These findings suggest that individuals with insomnia exhibit altered neurophysiological responses to pain stimuli and a lower capacity to share empathy for pain. These alterations may be associated with changes in attentional mechanisms.
Collapse
Affiliation(s)
- Siyu Li
- School of Psychology, South China Normal University, Guangzhou, 510631, China
| | - Meiheng He
- School of Psychology, South China Normal University, Guangzhou, 510631, China
| | - Li Lin
- School of Psychology, South China Normal University, Guangzhou, 510631, China
| | - Qingwei Chen
- Lab of Light and Physio-Psychological Health, National Center for International Research On Green Optoelectronics, South China Normal University, Guangzhou, 510006, China.
- Guangdong Provincial Key Laboratory of Optical Information Materials and Technology & Institute of Electronic Paper Displays, South China Academy of Advanced Optoelectronics, South China Normal University, Guangzhou, 510006, China.
| | - Taotao Ru
- Lab of Light and Physio-Psychological Health, National Center for International Research On Green Optoelectronics, South China Normal University, Guangzhou, 510006, China.
- Guangdong Provincial Key Laboratory of Optical Information Materials and Technology & Institute of Electronic Paper Displays, South China Academy of Advanced Optoelectronics, South China Normal University, Guangzhou, 510006, China.
| | - Guofu Zhou
- Lab of Light and Physio-Psychological Health, National Center for International Research On Green Optoelectronics, South China Normal University, Guangzhou, 510006, China
- Guangdong Provincial Key Laboratory of Optical Information Materials and Technology & Institute of Electronic Paper Displays, South China Academy of Advanced Optoelectronics, South China Normal University, Guangzhou, 510006, China
| |
Collapse
|
45
|
Tian QQ, Cheng C, Yin ZX, Yuan YY, Wang C, Zeng X, Sun JB, Yang Q, Yang XJ, Qin W. Combined transcutaneous auricular vagus stimulation (taVNS) with 0.1Hz slow breathing enhances insomnia treatment efficacy: A pilot study. Brain Stimul 2024; 17:4-6. [PMID: 38042286 DOI: 10.1016/j.brs.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/26/2023] [Accepted: 11/27/2023] [Indexed: 12/04/2023] Open
Affiliation(s)
- Qian-Qian Tian
- Engineering Research Center of Molecular and Neuro Imaging of the Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, Shaan xi, 710126, China; Intelligent Non-invasive Neuromodulation Technology and Transformation Joint Laboratory, Xidian University, Xi'an, Shaan xi, 710126, China
| | - Chen Cheng
- Engineering Research Center of Molecular and Neuro Imaging of the Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, Shaan xi, 710126, China; Intelligent Non-invasive Neuromodulation Technology and Transformation Joint Laboratory, Xidian University, Xi'an, Shaan xi, 710126, China
| | - Zi-Xin Yin
- Engineering Research Center of Molecular and Neuro Imaging of the Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, Shaan xi, 710126, China; Intelligent Non-invasive Neuromodulation Technology and Transformation Joint Laboratory, Xidian University, Xi'an, Shaan xi, 710126, China
| | - Yang-Yang Yuan
- Engineering Research Center of Molecular and Neuro Imaging of the Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, Shaan xi, 710126, China; Intelligent Non-invasive Neuromodulation Technology and Transformation Joint Laboratory, Xidian University, Xi'an, Shaan xi, 710126, China
| | - Cong Wang
- Intelligent Non-invasive Neuromodulation Technology and Transformation Joint Laboratory, Xidian University, Xi'an, Shaan xi, 710126, China
| | - Xiao Zeng
- Engineering Research Center of Molecular and Neuro Imaging of the Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, Shaan xi, 710126, China; Intelligent Non-invasive Neuromodulation Technology and Transformation Joint Laboratory, Xidian University, Xi'an, Shaan xi, 710126, China
| | - Jin-Bo Sun
- Engineering Research Center of Molecular and Neuro Imaging of the Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, Shaan xi, 710126, China; Intelligent Non-invasive Neuromodulation Technology and Transformation Joint Laboratory, Xidian University, Xi'an, Shaan xi, 710126, China; Guangzhou Institute of Technology, Xidian University, Xi'an, Shaanxi, China
| | - Qun Yang
- Department of Medical Psychology, Air Force Medical University, Xi'an, Shaanxi, 710032, China
| | - Xue-Juan Yang
- Engineering Research Center of Molecular and Neuro Imaging of the Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, Shaan xi, 710126, China; Intelligent Non-invasive Neuromodulation Technology and Transformation Joint Laboratory, Xidian University, Xi'an, Shaan xi, 710126, China; Guangzhou Institute of Technology, Xidian University, Xi'an, Shaanxi, China.
| | - Wei Qin
- Engineering Research Center of Molecular and Neuro Imaging of the Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, Shaan xi, 710126, China; Intelligent Non-invasive Neuromodulation Technology and Transformation Joint Laboratory, Xidian University, Xi'an, Shaan xi, 710126, China; Guangzhou Institute of Technology, Xidian University, Xi'an, Shaanxi, China.
| |
Collapse
|
46
|
Xu YX, Huang Y, Zhou Y, Wan YH, Su PY, Tao FB, Sun Y. Association Between Bedroom Light Pollution With Subjectively and Objectively Measured Sleep Parameters Among Chinese Young Adults. J Adolesc Health 2024; 74:169-176. [PMID: 37791923 DOI: 10.1016/j.jadohealth.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE To investigate the cross-sectional associations between real-world multiperiod bedroom light at night and sleep parameters among 365 Chinese young adults. METHODS Bedroom light exposure was estimated at the individual level for two consecutive days using a portable illuminance meter. Subjective sleep parameters were measured with the Pittsburgh Sleep Quality Index, and objective sleep parameters were assessed by wrist-worn ActiGraph accelerometers for seven consecutive days. RESULTS Compared with the low-exposure group (average light intensity < 3lx), the high-exposure group (average light intensity ≥ 3lx) was associated with decreased 1.15% in sleep efficiency (sleep efficiency, 95% CI: -1.78, -0.52; p < .001), increased 3.94 minutes in wake after sleep onset (wake after sleep onset, 95% CI: 1.55, 6.33; p = .001), increased 1.05 unit in movement index (95% CI: 0.20, 1.89; p = .015), and increased 2.16 unit in sleep fragmentation index ( 95% CI: 0.63, 3.68; p = .006). In comparison, each interquartile increase in 2h-average and 1h-average intensity of preawake light (PAL) (PAL-2h and PAL-1h) was associated with 7.04 minutes of increases in total sleep time (95% CI: 0.87, 13.22; p = .025) and 6.69 minutes of increases in total sleep time (95% CI: 0.51, 12.87; p = .034), respectively. DISCUSSION Altogether, our results support the role of bedroom light exposure in sleep and imply the importance of bedroom light exposure management as a potential strategy to reduce the public health burden of sleep problems. Keeping the bedroom environment dark at night and allowing moderate morning light exposure may be important measures for improving the sleep quality of young adults.
Collapse
Affiliation(s)
- Yu-Xiang Xu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Yan Huang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Yi Zhou
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Yu-Hui Wan
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Hefei, Anhui, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, Anhui, China
| | - Pu-Yu Su
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Hefei, Anhui, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, Anhui, China
| | - Fang-Biao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Hefei, Anhui, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, Anhui, China
| | - Ying Sun
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Hefei, Anhui, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, Anhui, China.
| |
Collapse
|
47
|
Gao T, Hou M, Wang Q, Liu D, Chen F, Xing Y, Mei J. The roles of serum vitamin D and tobacco smoke exposure in insomnia: a cross-sectional study of adults in the United States. Front Nutr 2023; 10:1285494. [PMID: 38170097 PMCID: PMC10759233 DOI: 10.3389/fnut.2023.1285494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/23/2023] [Indexed: 01/05/2024] Open
Abstract
Aim Tobacco smoke exposure and vitamin D (VD) status were both associated with insomnia. However, the combined effect of smoking and VD on insomnia has not been discussed. This study aimed to explore the role of VD in the association between tobacco smoke exposure and insomnia. Methods Data on adults were extracted from the National Health and Nutrition Examination Surveys (NHANES) database in 2005-2008 for this cross-sectional study. Weighted univariate and multivariate logistic regression analyses were used to explore the associations between serum cotinine, serum VD, and insomnia. A surface diagram was drawn to reflect the effect of VD on the association between serum cotinine and insomnia. In addition, the potential regulating effect of VD in subgroups of smoking status was also performed. The evaluation index was odds ratios (ORs) with 95% confidence intervals (CIs). Results Among the eligible participants, 1,766 had insomnia. After adjusting for covariates, we found that elevated serum cotinine levels were associated with higher odds of insomnia [OR = 1.55, 95% CI: (1.22, 1.97)]. However, the relationship between serum VD level and insomnia was not significant (P = 0.553). Higher serum cotinine levels were also associated with higher odds of insomnia [OR = 1.52, 95% CI: (1.17, 1.98)] when serum VD level was <75 nmol/L; however, this relationship became non-significant when serum VD concentration was elevated (P = 0.088). Additionally, the potential regulating effect of VD was also found in adults who were not smoking. Conclusion VD may play a potential regulative role in the association between tobacco smoke exposure and insomnia. Further studies are needed to clarify the causal relationships between VD, tobacco smoke exposure, and insomnia.
Collapse
Affiliation(s)
- Tianci Gao
- Graduate School, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, China
- Department of Emergency, First Affiliated Hospital, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, China
| | - Mengxing Hou
- Graduate School, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, China
- Department of Emergency, First Affiliated Hospital, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, China
| | - Qianfei Wang
- Graduate School, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, China
- Department of Emergency, First Affiliated Hospital, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, China
| | - Dong Liu
- Graduate School, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, China
- Department of Traditional Chinese Medicine, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Fenqiao Chen
- Department of Emergency, First Affiliated Hospital, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, China
| | - Yueyi Xing
- School of Basic Medicine, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, China
| | - Jianqiang Mei
- Graduate School, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, China
- Department of Emergency, First Affiliated Hospital, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, China
| |
Collapse
|
48
|
Gong Q, Guo C. Genetic study of the causal effect of lipid profiles on insomnia risk: a Mendelian randomization trial. BMC Med Genomics 2023; 16:325. [PMID: 38087303 PMCID: PMC10714578 DOI: 10.1186/s12920-023-01761-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/04/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES In response to the controversy surrounding observational studies of the association between lipid profiles and the risk of insomnia, the aim of this study was to analyze lipid profiles, including triglycerides (TG), apolipoprotein A-1 (ApoA-1), apolipoprotein B (ApoB) and lipoprotein A (LPA), in a European population to further assess the causal relationship between these lipid types and insomnia. MATERIALS AND METHODS This study explores the causal effect of lipid profiles on insomnia based on a genome-wide association study (GWAS)-derived public dataset using two-sample and multivariate Mendelian randomization (MVMR) analysis. The main MR analyses used inverse variance weighting (IVW) odds ratio (OR), and the sensitivity analyses included weighted median (WM) and MR‒Egger. RESULTS Both MR and MVMR showed that lowering ApoA-1 and LPA levels had causal effects on the risk of insomnia [MR: per 10 units, ApoA-1: OR: 0.7546, 95% CI: 0.6075-0.9372, P = 0.011; LPA: OR: 0.8392, 95% CI: 0.7202-0.9778, P = 0.025; MVMR: per 10 units, ApoA-1: OR: 0.7600, 95% CI: 0.6362-0.9079, P = 0.002; LPA, OR: 0.903, 95% CI: 0.8283-0.9845, P = 0.021]. There were no causal effects of TG or ApoB on insomnia (all P > 0.05). The MR‒Egger intercept test, funnel plot, and IVW methods all suggested an absence of strong directional pleiotropy, and leave-one-out permutation analysis did not detect any single single-nucleotide polymorphism that had a strong influence on the results. CONCLUSION Elevated levels of ApoA-1 and LPA were independently and causally associated with the risk of insomnia, suggesting that elevated ApoA-1 and LPA levels may contribute to a reduced risk of insomnia.
Collapse
Affiliation(s)
- Quancai Gong
- Department of Neurology, Affiliated Hospital of Jianghan University, Wuhan, 430015, Hubei, China
| | - Canshou Guo
- Department of Neurology, Affiliated Hospital of Jianghan University, Wuhan, 430015, Hubei, China.
- , No.168, Hong Kong Road, Jiangan District, Wuhan, Hubei Province, China.
| |
Collapse
|
49
|
Manber R, Simpson N, Gumport NB. Perspectives on increasing the impact and reach of CBT-I. Sleep 2023; 46:zsad168. [PMID: 37903637 PMCID: PMC10710991 DOI: 10.1093/sleep/zsad168] [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: 04/02/2023] [Revised: 06/06/2023] [Indexed: 11/01/2023] Open
Abstract
Cognitive behavioral therapy for insomnia is now recognized as the front-line treatment for chronic insomnia, yet many challenges remain in improving its impact and reach. This manuscript describes our perspective on some of these challenges. Based on the literature that maladaptive cognitions predict low adherence and that high levels of cognitive-emotional hyperarousal may be associated with poor outcomes, we propose added focus on cognitive therapy strategies in CBT-I. Specifically, we propose broadening the range of traditional cognitive therapy strategies, utilizing acceptance-based strategies, and fuller integration of the broadened range of cognitive strategies into CBT-I throughout the course of treatment. We also highlight a few other promising emerging approaches to enhance the impact of CBT-I. These include involving partners to promote adherence with CBT-I treatment recommendations, using culturally relevant treatment adaptations to increase retention of patients in treatment, and using strategies for timely identification of barriers to engagement. We propose broadening the public health impact of CBT-I by integrating support for reduction in long-term use of hypnotic sleep medications, which is in line with current medical guidelines. We advocate for a case conceptualization-based approach for implementing CBT-I in a patient-centered manner, flexibly, yet with fidelity, to enhance its impact by addressing the factors above. For increasing the reach of CBT-I, we discuss the need to train more clinicians and ways to combine therapist and digital deliveries of CBT-I, highlighting stepped care strategies.
Collapse
Affiliation(s)
- Rachel Manber
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA. 94305USA
| | - Norah Simpson
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA. 94305USA
| | - Nicole B Gumport
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA. 94305USA
| |
Collapse
|
50
|
Jiang T, Yin X, Zhu L, Jia W, Tan Z, Li B, Guo J. Abnormal alterations of regional spontaneous neuronal activity and functional connectivity in insomnia patients with difficulty falling asleep: a resting-state fMRI study. BMC Neurol 2023; 23:430. [PMID: 38049760 PMCID: PMC10694975 DOI: 10.1186/s12883-023-03481-3] [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: 09/07/2023] [Accepted: 11/28/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Insomnia disorder (ID) seriously affects people's daily life. Difficulty falling asleep is the most commonly reported complaint in patients with ID. However, the mechanism of prolonged sleep latency (SL) is still obscure. The aim of our present study was to investigate the relationship between prolonged SL and alterations in spontaneous neural activity and brain functional connectivity (FC) in ID patients using functional magnetic resonance imaging (fMRI). METHODS A total of 52 insomniacs with difficulty falling asleep and 30 matched healthy controls (HCs) underwent resting-state fMRI. The amplitude of low-frequency fluctuation (ALFF) was measured and group differences were compared. The peak areas with significantly different ALFF values were identified as the seed regions to calculate FC to the whole brain. SL was assessed by a wrist actigraphy device in ID patients. The Pittsburgh Sleep Quality Index (PSQI), Hamilton Anxiety Rating Scale (HAMA), and Hyperarousal Scale (HAS) were evaluated in both ID patients and HCs. Finally, correlation analyses were performed between the clinical features and FC/ALFF values. RESULTS ID patients showed higher PSQI, HAMA, HAS scores than HCs. The functional MRI results indicated increased ALFF value in the left insula and right amygdala and decreased ALFF value in the right superior parietal lobe (SPL) in ID patients. The seed-based FC analysis demonstrated increased FC between the left insula and the bilateral precentral gyrus and FC between the right amygdala and the left posterior cingulate cortex (PCC) in patients with ID. Correlation analysis indicated that the increased FC value of the right amygdala-left PCC was positively correlated with SL measured by actigraphy. CONCLUSION This study revealed abnormal regional spontaneous fluctuations in the right amygdala, left insula, and right SPL, as well as increased FC in the left insula-precentral and right amygdala-left PCC. Moreover, the prolonged SL was positively correlated with the abnormal FC in the right amygdala-left PCC in ID patients. The current study showed the correlation between prolonged SL and the abnormal function of emotion-related brain regions in ID patients, which may contribute to a better understanding of the neural mechanisms underlying difficulty falling asleep in patients with ID. CLINICAL TRIAL REGISTRATION http://www.chictr.org.cn ., ChiCTR1800015282. Registered on 20th March 2018.
Collapse
Affiliation(s)
- Tongfei Jiang
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Key Laboratory of Acupuncture Neuromodulation, Beijing, 100010, China
| | - Xuejiao Yin
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Key Laboratory of Acupuncture Neuromodulation, Beijing, 100010, China
| | - Liying Zhu
- Graduate School, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Weilin Jia
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Key Laboratory of Acupuncture Neuromodulation, Beijing, 100010, China
| | - Zhongjian Tan
- Department of Radiology, Dong Zhimen Hospital Beijing University of Chinese Medicine, Beijing, 100010, China
| | - Bin Li
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Key Laboratory of Acupuncture Neuromodulation, Beijing, 100010, China
| | - Jing Guo
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Key Laboratory of Acupuncture Neuromodulation, Beijing, 100010, China.
| |
Collapse
|