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Hou S, Zhu G, Liu X, Wang C, Liang J, Hao W, Kong L. Screening of preoperative obstructive sleep apnea by cardiopulmonary coupling and its risk factors in patients with plans to receive surgery under general anesthesia: a cross-sectional study. Front Neurol 2024; 15:1370609. [PMID: 39114535 PMCID: PMC11303281 DOI: 10.3389/fneur.2024.1370609] [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: 01/15/2024] [Accepted: 06/17/2024] [Indexed: 08/10/2024] Open
Abstract
Objective Preoperative obstructive sleep apnea (OSA) is supposed to be the abnormally high occurrence of OSA the night before surgery under general anesthesia. This study aimed to evaluate the prevalence preoperative OSA using cardiopulmonary coupling (CPC) and its correlation with imbalance of sympathetic/parasympathetic nervous system. Methods A total of 550 patients with plans to receive surgery under general anesthesia were enrolled. All patients were assigned to wear CPC on the night before surgery until the next day. Sleep quality characteristics, heart rate variation parameters, and apnea-hypopnea index were acquired. The diagnosis of pre-existing OSA was not considered in the current study. Results According to apnea-hypopnea index, 28.4%, 32.2%, 26.2%, and 13.3% patients were assessed as no, mild, moderate, and severe operative OSA, respectively. Multivariate logistic regression model revealed that higher age [p < 0.001, odds ratio (OR) = 1.043] was independently and positively associated with preoperative OSA; heart rate variation parameters representing the imbalance of sympathetic/parasympathetic nervous system, such as higher low-frequency (p < 0.001, OR = 1.004), higher low-frequency/high-frequency ratio (p = 0.028, OR = 1.738), lower NN20 count divided by the total number of all NN intervals (pNN20; p < 0.001, OR = 0.950), and lower high-frequency (p < 0.001, OR = 0.998), showed independent relationships with a higher probability of preoperative OSA. Higher age (p = 0.005, OR = 1.024), higher very-low-frequency (p < 0.001, OR = 1.001), and higher low-frequency/high-frequency ratio (p = 0.003, OR = 1.655) were associated with a higher probability of moderate-to-severe preoperative OSA, but higher pNN10 (p < 0.001, OR = 0.951) was associated with a lower probability of moderate-to-severe preoperative OSA. Conclusion Preoperative OSA is prevalent. Higher age and imbalance of sympathetic/parasympathetic nervous system are independently and positively associated with a higher occurrence of preoperative OSA. CPC screening may promote the management of preoperative OSA.
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Affiliation(s)
- Shujie Hou
- Graduate School of Hebei University of Traditional Chinese Medicine, Shijiazhuang, China
| | - Guojia Zhu
- Graduate School of Hebei University of Traditional Chinese Medicine, Shijiazhuang, China
| | - Xu Liu
- School of Basic Medicine, Hebei University of Traditional Chinese Medicine, Shijiazhuang, China
| | - Chuan Wang
- Department of Anesthesiology and Perioperative Medicine, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China
| | - Junchao Liang
- Department of Anesthesiology and Perioperative Medicine, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China
| | - Wei Hao
- Department of Anesthesiology and Perioperative Medicine, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China
| | - Lili Kong
- Department of Anesthesiology and Perioperative Medicine, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China
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Wang Q, Stone KL, Lu Z, Tian S, Zheng Y, Zhao B, Bao Y, Shi L, Lu L. Associations between Longitudinal Changes in Sleep Stages and Risk of Cognitive Decline in Older Men. Sleep 2024:zsae125. [PMID: 38829819 DOI: 10.1093/sleep/zsae125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Indexed: 06/05/2024] Open
Abstract
STUDY OBJECTIVES To investigate the relationships between longitudinal changes in sleep stages and the risk of cognitive decline in older men. METHODS This study included 978 community-dwelling older men who participated in the first (2003-2005) and second (2009-2012) sleep ancillary study visits of the Osteoporotic Fractures in Men Study. We examined the longitudinal changes in sleep stages at the initial and follow-up visits, and the association with concurrent clinically relevant cognitive decline during the 6.5-year follow-up. RESULTS Men with low to moderate (quartile 2, Q2) and moderate increase (Q3) in N1 sleep percentage had a reduced risk of cognitive decline on the Modified Mini-Mental State Examination compared to those with a substantial increase (Q4) in N1 sleep percentage. Additionally, men who experienced a low to moderate (Q2) increase in N1 sleep percentage had a lower risk of cognitive decline on the Trails B compared with men in the reference group (Q4). Furthermore, men with the most pronounced reduction (Q1) in N2 sleep percentage had a significantly higher risk of cognitive decline on the Trails B compared to those in the reference group (Q4). No significant association was found between changes in N3 and rapid eye movement sleep and the risk of cognitive decline. CONCLUSIONS Our results suggested that a relatively lower increase in N1 sleep showed a reduced risk of cognitive decline. However, a pronounced decrease in N2 sleep was associated with concurrent cognitive decline. These findings may help identify older men at risk of clinically relevant cognitive decline.
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Affiliation(s)
- Qianwen Wang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Katie L Stone
- Department of Research Institute, California Pacific Medical Center, San Francisco, CA, United States
| | - Zhengan Lu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Shanshan Tian
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Yongbo Zheng
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Bingxin Zhao
- Department of Statistics and Data Science, University of Pennsylvania, Philadelphia, PA, United States
| | - Yanping Bao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Le Shi
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Lin Lu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
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Höller Y, Eyjólfsdóttir SG, Rusiňák M, Guðmundsson LS, Trinka E. Movement Termination of Slow-Wave Sleep-A Potential Biomarker? Brain Sci 2024; 14:493. [PMID: 38790471 PMCID: PMC11120257 DOI: 10.3390/brainsci14050493] [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: 04/10/2024] [Revised: 05/06/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024] Open
Abstract
The duration of slow-wave sleep (SWS) is related to the reported sleep quality and to the important variables of mental and physical health. The internal cues to end an episode of SWS are poorly understood. One such internal cue is the initiation of a body movement, which is detectable as electromyographic (EMG) activity in sleep-electroencephalography (EEG). In the present study, we characterized the termination of SWS episodes by movement to explore its potential as a biomarker. To this end, we characterized the relation between the occurrence of SWS termination by movement and individual characteristics (age, sex), SWS duration and spectral content, chronotype, depression, medication, overnight memory performance, and, as a potential neurological application, epilepsy. We analyzed 94 full-night EEG-EMG recordings (75/94 had confirmed epilepsy) in the video-EEG monitoring unit of the EpiCARE Centre Salzburg, Austria. Segments of SWS were counted and rated for their termination by movement or not through the visual inspection of continuous EEG and EMG recordings. Multiple linear regression was used to predict the number of SWS episodes that ended with movement by depression, chronotype, type of epilepsy (focal, generalized, no epilepsy, unclear), medication, gender, total duration of SWS, occurrence of seizures during the night, occurrence of tonic-clonic seizures during the night, and SWS frequency spectra. Furthermore, we assessed whether SWS movement termination was related to overnight memory retention. According to multiple linear regression, patients with overall longer SWS experienced more SWS episodes that ended with movement (t = 5.64; p = 0.001). No other variable was related to the proportion of SWS that ended with movement, including no epilepsy-related variable. A small sample (n = 4) of patients taking Sertraline experienced no SWS that ended with movement, which was significant compared to all other patients (t = 8.00; p < 0.001) and to n = 35 patients who did not take any medication (t = 4.22; p < 0.001). While this result was based on a small subsample and must be interpreted with caution, it warrants replication in a larger sample with and without seizures to further elucidate the role of the movement termination of SWS and its potential to serve as a biomarker for sleep continuity and for medication effects on sleep.
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Affiliation(s)
- Yvonne Höller
- Faculty of Psychology, University of Akureyri, 600 Akureyri, Iceland; (S.G.E.); (M.R.)
| | | | - Matej Rusiňák
- Faculty of Psychology, University of Akureyri, 600 Akureyri, Iceland; (S.G.E.); (M.R.)
- Faculty of Social Studies, Masaryk University, 601 77 Brno, Czech Republic
| | | | - Eugen Trinka
- Department of Neurology, Neurointensive Care and Neurorehabilitation, Christian-Doppler University Hospital, Paracelsus Medical University, Centre for Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, 5020 Salzburg, Austria
- Neuroscience Institute, Christian-Doppler University Hospital, Centre for Cognitive Neuroscience, 5020 Salzburg, Austria
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Tanaka Y, Baba-Mori N, Yonaga T, Mochizuki K, Igarashi S, Ando T, Kohda T, Ito Y, Soejima K, Sakurai D. Sleep status of older adults with sleep apnoea syndrome may vary by body mass index. FRONTIERS IN AGING 2024; 5:1331448. [PMID: 38751649 PMCID: PMC11094249 DOI: 10.3389/fragi.2024.1331448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 04/15/2024] [Indexed: 05/18/2024]
Abstract
Obesity and ageing are the most important risk factors for sleep apnoea syndrome (SAS); however, the role of body mass index (BMI) on sleep status in healthy older adults is unclear. To explore sleep parameters according to BMI among active older adults, we cross-sectionally examined the relationship between sleep-related parameters and BMI in 32 Japanese adults aged from 83 to 95 years without long-term care who were unaware of having SAS. Correlation and linear regression analyses were performed. Moderate or severe SAS prevalence was high in both those with low (68.8%) and high (68.8%) BMI. A higher increase in apnoea-hypopnoea index (AHI) was negatively correlated with sleep depth in the high-BMI group. In the low-BMI group, the number of awakenings and age were positively correlated with AHI. Older adults may have SAS regardless of their BMI, and the sleep status of patients with SAS may vary by BMI.
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Affiliation(s)
- Yuji Tanaka
- New Industry Creation Hatchery Center, Tohoku University, Sendai, Japan
| | - Naana Baba-Mori
- Department of Advanced Biomedical Research, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Takaaki Yonaga
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Kazuki Mochizuki
- Laboratory of Food and Nutritional Sciences, Department of Local Produce and Food Sciences, Faculty of Life and Environmental Sciences, University of Yamanashi, Yamanashi, Japan
| | - Satoshi Igarashi
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Takashi Ando
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Takashi Kohda
- Laboratory of Embryology and Genomics, Faculty of Life and Environmental Sciences, University of Yamanashi, Yamanashi, Japan
| | - Yasumi Ito
- Faculty of Engineering, University of Yamanashi, Yamanashi, Japan
| | - Kenzo Soejima
- Department of Respiratory Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Daiju Sakurai
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
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Liu J, Yang X, Li G, Liu P. Pharmacological interventions for the treatment of obstructive sleep apnea syndrome. Front Med (Lausanne) 2024; 11:1359461. [PMID: 38495117 PMCID: PMC10943699 DOI: 10.3389/fmed.2024.1359461] [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: 02/22/2024] [Indexed: 03/19/2024] Open
Abstract
Obstructive Sleep Apnea Syndrome (OSAS) affects 13-33% of males and 6-9% of females globally and poses significant treatment challenges, including poor adherence to Continuous Positive Airway Pressure (CPAP) and residual excessive sleepiness (RES). This review aims to elucidate the emerging interest in pharmacological treatments for OSAS, focusing on recent advancements in this area. A thorough analysis of extensive clinical trials involving various drugs, including selective dopamine reuptake inhibitors, selective norepinephrine inhibitors, combined antimuscarinic agents, and orexin agonists, was conducted. These trials focused on ameliorating respiratory metrics and enhancing sleep quality in individuals affected by OSAS. The studied pharmacological agents showed potential in improving primary outcomes, notably the apnea-hypopnea index (AHI) and the Epworth sleepiness scale (ESS). These improvements suggest enhanced sleep quality and symptom management in OSAS patients. With a deeper understanding of OSAS, pharmacological interventions are emerging as a promising direction for its effective management. This review provides a comprehensive overview of the current state of drug research in OSAS, highlighting the potential of these treatments in addressing the disorder's complex challenges.
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Affiliation(s)
- Jin Liu
- Department of Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Shiyan, China
| | - Xiaolan Yang
- Department of Pediatrics, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi City, China
| | - Guangcai Li
- Department of Respiratory and Critical Care Medicine, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi City, China
| | - Peijun Liu
- Department of Respiratory and Critical Care Medicine, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi City, China
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Fank F, Artismo RS, de Santana MG, Esteves AM, Matte DL, Mazo GZ. Effects of combined exercise training with sleep education in older adults with obstructive sleep apnea: protocol for a randomized clinical trial. Front Psychol 2024; 15:1322545. [PMID: 38425564 PMCID: PMC10902716 DOI: 10.3389/fpsyg.2024.1322545] [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: 10/16/2023] [Accepted: 01/22/2024] [Indexed: 03/02/2024] Open
Abstract
Background Obstructive sleep apnea (OSA) is a common disorder that affects approximately 1 billion people worldwide. Advanced age is a significant risk factor. Various treatment options have been explored to reduce the severity of OSA symptoms and physical exercise has emerged as a potential alternative therapy. Therefore, this study aims to investigate the effects of a combined exercise program with sleep education on sleep quality and on the severity of OSA in older adults. Methods This is a randomized clinical trial with two parallel groups that will involve individuals of both genders aged between 60 and 79 years who have an apnea-hypopnea index (AHI) of more than 15 events per hour and who have not received or are currently undergoing treatment for OSA. Older adults who have engaged in regular exercise in the last six months and individuals with contraindications to exercise will be excluded. The study will assess outcomes related to OSA, including AHI, oxygen desaturation index, minimum and mean oxyhemoglobin saturation, sleep efficiency, sleep latency, and the type of respiratory events. Additionally, sleep quality-related outcomes, daytime sleepiness, physical activity, physical fitness, aerobic capacity, cognitive status, anthropometric measures, and health-related quality of life will be analyzed. Participants will be randomized to two groups: a combined exercise group (involving both resistance and aerobic training) with sleep education, and a control group that will receive only educational recommendations for managing OSA. The intervention will last 12 weeks and will consist of three sessions per week, totaling 36 exercise sessions. Sample size calculation indicates a minimum number of 36 participants. Discussion If the hypothesis is confirmed, this clinical trial will indicate an effective non-pharmacological intervention for treating OSA in older adults. This intervention could be used as an adjunct to existing approaches designed to improve OSA management. Clinical trail registration Brazil Clinical Trials Registry (ReBEC), identifier RBR-9hk6pgz.
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Affiliation(s)
- Felipe Fank
- Laboratory of Gerontology, Health and Sports Sciences Center, Santa Catarina State University, Florianopolis, Brazil
| | - Regiana Santos Artismo
- Teaching, Research and Extension Center in Physiotherapy in the Pre- and Post-Operation of Major Surgeries, Health and Sports Sciences Center, Santa Catarina State University, Florianopolis, Brazil
| | | | - Andrea Maculano Esteves
- Laboratory of Sleep and Exercise, School of Applied Sciences, State University of Campinas, Campinas, Brazil
| | - Darlan Laurício Matte
- Teaching, Research and Extension Center in Physiotherapy in the Pre- and Post-Operation of Major Surgeries, Health and Sports Sciences Center, Santa Catarina State University, Florianopolis, Brazil
| | - Giovana Zarpellon Mazo
- Laboratory of Gerontology, Health and Sports Sciences Center, Santa Catarina State University, Florianopolis, Brazil
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7
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Dimulescu C, Donle L, Cakan C, Goerttler T, Khakimova L, Ladenbauer J, Flöel A, Obermayer K. Improving the detection of sleep slow oscillations in electroencephalographic data. Front Neuroinform 2024; 18:1338886. [PMID: 38375447 PMCID: PMC10875054 DOI: 10.3389/fninf.2024.1338886] [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: 11/15/2023] [Accepted: 01/19/2024] [Indexed: 02/21/2024] Open
Abstract
Study objectives We aimed to build a tool which facilitates manual labeling of sleep slow oscillations (SOs) and evaluate the performance of traditional sleep SO detection algorithms on such a manually labeled data set. We sought to develop improved methods for SO detection. Method SOs in polysomnographic recordings acquired during nap time from ten older adults were manually labeled using a custom built graphical user interface tool. Three automatic SO detection algorithms previously used in the literature were evaluated on this data set. Additional machine learning and deep learning algorithms were trained on the manually labeled data set. Results Our custom built tool significantly decreased the time needed for manual labeling, allowing us to manually inspect 96,277 potential SO events. The three automatic SO detection algorithms showed relatively low accuracy (max. 61.08%), but results were qualitatively similar, with SO density and amplitude increasing with sleep depth. The machine learning and deep learning algorithms showed higher accuracy (best: 99.20%) while maintaining a low prediction time. Conclusions Accurate detection of SO events is important for investigating their role in memory consolidation. In this context, our tool and proposed methods can provide significant help in identifying these events.
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Affiliation(s)
- Cristiana Dimulescu
- Department of Software Engineering and Theoretical Computer Science, Technical University Berlin, Berlin, Germany
- Bernstein Center for Computational Neuroscience Berlin, Berlin, Germany
| | - Leonhard Donle
- Department of Software Engineering and Theoretical Computer Science, Technical University Berlin, Berlin, Germany
| | - Caglar Cakan
- Department of Software Engineering and Theoretical Computer Science, Technical University Berlin, Berlin, Germany
- Bernstein Center for Computational Neuroscience Berlin, Berlin, Germany
| | - Thomas Goerttler
- Department of Software Engineering and Theoretical Computer Science, Technical University Berlin, Berlin, Germany
| | - Lilia Khakimova
- Department of Neurology, University Medicine, Greifswald, Germany
| | - Julia Ladenbauer
- Department of Neurology, University Medicine, Greifswald, Germany
| | - Agnes Flöel
- Department of Neurology, University Medicine, Greifswald, Germany
- German Center for Neurodegenerative Diseases, Greifswald, Germany
| | - Klaus Obermayer
- Department of Software Engineering and Theoretical Computer Science, Technical University Berlin, Berlin, Germany
- Bernstein Center for Computational Neuroscience Berlin, Berlin, Germany
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8
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Hardin L. Hypoglossal nerve stimulation for adults with obstructive sleep apnea. JAAPA 2023; 36:24-29. [PMID: 37989167 DOI: 10.1097/01.jaa.0000991392.37494.b6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
ABSTRACT Obstructive sleep apnea (OSA) is a common chronic condition in which upper airway collapse interferes with breathing during sleep, reducing sleep quality. Untreated OSA can impair a patient's health and quality of life. The recommended first-line treatment for OSA in adults is positive airway pressure, but difficulty tolerating this device limits adherence to treatment for many patients. Treatment with an implanted hypoglossal nerve stimulation (HNS) device is a relatively new second-line option for these patients, and is gaining more widespread use. Clinicians who treat OSA or provide other healthcare services to patients with HNS implants should be familiar with these devices. This article reviews HNS technology and relevant OSA pathophysiology, along with device candidacy criteria, efficacy, risks, and considerations related to use of other medical technologies for patients with HNS implants.
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Affiliation(s)
- Laura Hardin
- Laura Hardin practices in otolaryngology at Texas ENT Specialists in Houston, Tex. The author has disclosed no potential conflicts of interest, financial or otherwise
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Full KM, Johnson DA, Kaufmann CN, Malhotra A. An Update on Sleep Duration, Obesity, and Mortality Risk in Women. Sleep Med Clin 2023; 18:415-422. [PMID: 38501514 PMCID: PMC10969361 DOI: 10.1016/j.jsmc.2023.06.015] [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] [Indexed: 03/20/2024]
Abstract
Sleep health is an essential component to overall health. Because of numerous societal, economic, and biological factors, obtaining adequate sleep poses a unique challenge to aging women. Yet, women have been traditionally understudied in sleep research. An increasing body of research supports abnormal sleep duration as a risk factor for obesity, cardiovascular disease, and mortality. This review focuses specifically on 3 areas of the discussion of insufficient sleep in women: (1) the mysterious poor health of long sleepers, (2) the potential underlying mechanisms linking abnormal sleep duration and cardiometabolic health, and (3) the need to investigate multiple levels of social determinants driving sleep disparities.
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Affiliation(s)
- Kelsie M Full
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 600, Nashville, TN 37203, USA.
| | - Dayna A Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, Georgia, 30322, USA
| | - Christopher N Kaufmann
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, Florida, 32603, USA
| | - Atul Malhotra
- Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, California, 92093, USA
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10
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Lavender I, McCartney D, Marshall N, Suraev A, Irwin C, D'Rozario AL, Gordon CJ, Saini B, Grunstein RR, Yee B, McGregor I, Hoyos CM. Cannabinol (CBN; 30 and 300 mg) effects on sleep and next-day function in insomnia disorder ('CUPID' study): protocol for a randomised, double-blind, placebo-controlled, cross-over, three-arm, proof-of-concept trial. BMJ Open 2023; 13:e071148. [PMID: 37612115 PMCID: PMC10450062 DOI: 10.1136/bmjopen-2022-071148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 08/07/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVE Insomnia is the most prevalent sleep disorder, with few effective pharmacotherapies. Anecdotal reports and recent preclinical research suggest that cannabinol (CBN), a constituent of Cannabis sativa derived from delta-9-tetrahydrocannabinol, could be an effective treatment. Despite this, the isolated effects of CBN on sleep have yet to be systematically studied in humans. METHODS The present protocol paper describes a randomised, double-blind, placebo-controlled, single-dose, three-arm, cross-over, proof-of-concept study which investigates the effects of CBN on sleep and next-day function in 20 participants with clinician-diagnosed insomnia disorder and an Insomnia Severity Index Score ≥15. Participants receive a single fixed oral liquid dose of 30 mg CBN, 300 mg CBN and matched placebo, in random order on three treatment nights; each separated by a 2-week wash-out period. Participants undergo overnight sleep assessment using in-laboratory polysomnography and next-day neurobehavioural function tests. The primary outcome is wake after sleep onset minutes. Secondary outcomes include changes to traditional sleep staging, sleep-onset latency and absolute spectral power during non-rapid eye movement (NREM) sleep. Tertiary outcomes include changes to sleep spindles during NREM sleep, arousal indices, absolute spectral power during REM sleep and subjective sleep quality. Safety-related and exploratory outcomes include changes to next-day simulated driving performance, subjective mood and drug effects, postural sway, alertness and reaction time, overnight memory consolidation, pre and post-sleep subjective and objective sleepiness; and plasma, urinary, and salivary cannabinoid concentrations. The study will provide novel preliminary data on CBN efficacy and safety in insomnia disorder, which will inform larger clinical trials. ETHICS AND DISSEMINATION Human Research Ethics Committee approval has been granted by Bellberry (2021-08-907). Study findings will be disseminated in a peer-reviewed journal and at academic conferences. TRIAL REGISTRATION NUMBER NCT05344170.
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Affiliation(s)
- Isobel Lavender
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, New South Wales, Australia
- Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Danielle McCartney
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, New South Wales, Australia
- Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Nathaniel Marshall
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, New South Wales, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Anastasia Suraev
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, New South Wales, Australia
- Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Chris Irwin
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Angela L D'Rozario
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, New South Wales, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Christopher J Gordon
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, New South Wales, Australia
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, New South Wales, Australia
| | - Bandana Saini
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, New South Wales, Australia
| | - Ronald R Grunstein
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, New South Wales, Australia
- CPC-RPA clinic, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Brendon Yee
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, New South Wales, Australia
- CPC-RPA clinic, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Iain McGregor
- Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Camilla M Hoyos
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, New South Wales, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
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Sanders AE, Wallace ED, Ehrmann BM, Soma PS, Shaikh SR, Preisser JS, Ohrbach R, Fillingim RB, Slade GD. Non-esterified erythrocyte linoleic acid, arachidonic acid, and subjective sleep outcomes. Prostaglandins Leukot Essent Fatty Acids 2023; 195:102580. [PMID: 37451068 PMCID: PMC10529142 DOI: 10.1016/j.plefa.2023.102580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 07/03/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE This study investigated whether non-esterified erythrocyte omega-6 PUFAs were associated with subjective assessment of sleep quality and duration, and risk for obstructive sleep apnea. METHODS In this secondary analysis of the cross-sectional OPPERA-II study, 538 adults completed the Pittsburgh Sleep Quality Index (PSQI), reported their usual hours of sleep, and answered STOP screening questions for obstructive sleep apnea. Circulating non-esterified erythrocyte concentrations of omega-6 PUFA linoleic acid and arachidonic acid were quantified by liquid chromatography tandem mass spectroscopy. Sleep outcomes were dichotomized as poor (PSQI ≤5) vs good (PSQI ≥6) sleep quality, insufficient or excessive (≤6 or >9 h) vs good (7-9 h) sleep duration, and high (≥2 affirmative responses) vs low (<2 affirmative responses) risk for obstructive sleep apnea. Non-esterified omega-6 PUFAs and the continuous covariates of body mass index, Short Form (SF) 12 Health Survey Physical and Mental Component scores and resting measures of systolic and diastolic blood pressure were standardized for multivariable analysis. Categorical covariates were study site, age, sex, and race/ethnicity. Multivariable-adjusted logistic regression first estimated odds ratios (OR) and 95% confidence limits (CL) for sleep outcomes using linoleic acid as the main exposure. Analysis was then repeated using arachidonic acid as the main exposure. RESULTS In the multivariable-adjusted model, each standard deviation increase in non-esterified erythrocyte linoleic acid was associated with higher odds of poor sleep quality (OR=1.2, 95% CL: 1.1, 1.5), insufficient or excessive sleep (OR= 1.3, 95% CL: 1.1, 1.6) and high-risk for obstructive sleep apnea (OR=1.3, 95% CL: 1.1, 1.6). Likewise, for each standard deviation increase in non-esterified erythrocyte arachidonic acid, odds increased of poor sleep quality (OR=1.2, 95% CL: 1.1, 1.5), and insufficient or excessive sleep (OR=1.2, 95% CL: 1.1, 1.5). Odds of being high risk for obstructive sleep apnea increased with greater circulating arachidonic acid, but the association did not reach statistical significance (OR=1.1, 95% CL: 0.9, 1.4). CONCLUSION Non-esterified erythrocyte linoleic acid and arachidonic acid were associated with poor sleep quality and insufficient or excessive sleep duration. Linoleic acid, but not arachidonic acid, was also associated with high risk for obstructive sleep apnea.
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Affiliation(s)
- Anne E Sanders
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - E Diane Wallace
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Brandie M Ehrmann
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Paul S Soma
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Saame R Shaikh
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - John S Preisser
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Richard Ohrbach
- Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, NY 14260, USA
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL 32611, USA; Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL 32611, USA
| | - Gary D Slade
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Piccirillo F, Crispino SP, Buzzelli L, Segreti A, Incalzi RA, Grigioni F. A State-of-the-Art Review on Sleep Apnea Syndrome and Heart Failure. Am J Cardiol 2023; 195:57-69. [PMID: 37011555 DOI: 10.1016/j.amjcard.2023.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/19/2023] [Accepted: 02/25/2023] [Indexed: 04/05/2023]
Abstract
Heart failure (HF) affects many patients worldwide every year. It represents a leading cause of hospitalization and still, today, mortality remains high, albeit the progress in treatment strategies. Several factors contribute to the development and progression of HF. Among these, sleep apnea syndrome represents a common but still underestimated factor because its prevalence is substantially higher in patients with HF than in the general population and is related to a worse prognosis. This review summarizes the current knowledge about sleep apnea syndrome coexisting with HF in terms of morbidity and mortality to provide actual and future perspectives about the diagnosis, evaluation, and treatment of this association.
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Affiliation(s)
- Francesco Piccirillo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy; Research Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy.
| | - Simone Pasquale Crispino
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy; Research Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
| | - Lorenzo Buzzelli
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy; Research Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
| | - Andrea Segreti
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy; Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy; Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Raffaele Antonelli Incalzi
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy; Research Unit of Geriatrics, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
| | - Francesco Grigioni
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy; Research Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
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Full KM, Huang T, Shah NA, Allison MA, Michos ED, Duprez DA, Redline S, Lutsey PL. Sleep Irregularity and Subclinical Markers of Cardiovascular Disease: The Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc 2023; 12:e027361. [PMID: 36789869 PMCID: PMC10111477 DOI: 10.1161/jaha.122.027361] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/02/2022] [Indexed: 02/16/2023]
Abstract
Background Sleep irregularity has been linked to incident cardiovascular disease. Less is known about associations of sleep regularity with atherosclerosis. We examined cross-sectional associations of actigraphy-assessed sleep duration and sleep timing regularity with subclinical atherosclerosis in the community-based MESA (Multi-Ethnic Study of Atherosclerosis). Methods and Results MESA Sleep Ancillary Study participants (N=2032; mean age, 68.6±9.2 years; 37.9% White) completed 7-day wrist actigraphy. Participants underwent assessments of coronary artery calcium, carotid plaque presence, carotid intima-media thickness, and the ankle-brachial index. Sleep regularity was quantified by the 7-day with-in person SD of sleep duration and sleep onset timing. Relative risk regression models were used to calculate prevalence ratios and 95% CIs. Models are adjusted for demographics, cardiovascular disease risk factors, and other objectively assessed sleep characteristics including obstructive sleep apnea, sleep duration, and sleep fragmentation. After adjustment, compared with participants with more regular sleep durations (SD ≤60 minutes), participants with greater sleep duration irregularity (SD >120 minutes) were more likely to have high coronary artery calcium burden (>300; prevalence ratio, 1.33 [95% CI, 1.03-1.71]) and abnormal ankle-brachial index (<0.9; prevalence ratio, 1.75 [95% CI, 1.03-2.95]). Compared with participants with more regular sleep timing (SD ≤30 minutes), participants with irregular sleep timing (SD >90 minutes) were more likely to have high coronary artery calcium burden (prevalence ratio, 1.39 [95% CI, 1.07-1.82]). Associations persisted after adjustment for cardiovascular disease risk factors and average sleep duration, obstructive sleep apnea, and sleep fragmentation. Conclusions Sleep irregularity, particularly sleep duration irregularity, was associated with several measures of subclinical atherosclerosis. Sleep regularity may be a modifiable target for reducing atherosclerosis risk. Future investigation into cardiovascular risk reduction interventions targeting sleep irregularity may be warranted.
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Affiliation(s)
- Kelsie M. Full
- Division of Epidemiology and Community HealthUniversity of Minnesota School of Public HealthMinneapolisMN
| | - Tianyi Huang
- Channing Division of Network Medicine, Brigham and Women’s HospitalHarvard UniversityBostonMA
- Division of Sleep MedicineHarvard Medical SchoolBostonMA
| | - Neomi A. Shah
- Division of Pulmonary, Critical Care and Sleep MedicineIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Matthew A. Allison
- Division of Preventive MedicineUniversity of California San DiegoSan DiegoCA
| | - Erin D. Michos
- Division of CardiologyJohns Hopkins School of MedicineBaltimoreMD
| | - Daniel A. Duprez
- Cardiovascular DivisionUniversity of Minnesota School of MedicineMinneapolisMN
| | - Susan Redline
- Division of Sleep MedicineHarvard Medical SchoolBostonMA
- Brigham and Women’s Hospital, Division of Sleep and Circadian DisordersHarvard Medical SchoolBostonMA
| | - Pamela L. Lutsey
- Division of Epidemiology and Community HealthUniversity of Minnesota School of Public HealthMinneapolisMN
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Holzer DW, Counts CJ, Ashmore EP, Hammock C, John-Henderson N. Childhood environments and their relationship with sleep and ambulatory blood pressure in college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:190-199. [PMID: 33759718 PMCID: PMC8460682 DOI: 10.1080/07448481.2021.1885414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 12/23/2020] [Accepted: 01/31/2021] [Indexed: 06/12/2023]
Abstract
Objective: Investigate whether psychosocial risk in the childhood family environment moderates the relationship between childhood socioeconomic status (SES) and sleep, and the relationship between childhood SES and ambulatory blood pressure (ABP) in college students, two factors that are linked to future risk for cardiovascular disease. Participants: 124 American college students. Methods: Childhood SES and psychosocial risk in childhood family environments were measured by self-report instruments. Sleep was measured with self-report and actigraphy (over 5 days) and ABP over a 2-day period. Results: Linear regressions adjusting for age, sex, current SES, and current depressive symptoms indicated that SES and psychosocial risk in family environments during childhood interact to inform sleep quality, actigraphy derived wake after sleep onset (WASO), actigraphy derived Sleep Efficiency (SE) and ABP. Conclusions: Psychosocial risk in the childhood family environment may offset previously documented relationships between childhood SES and health-relevant outcomes in college students.
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Mochón-Benguigui S, Carneiro-Barrera A, Dote-Montero M, Castillo MJ, Amaro-Gahete FJ. Sleep and Anabolic/Catabolic Hormonal Profile in Sedentary Middle-Aged Adults: The FIT-AGEING Study. Int J Mol Sci 2022; 23:ijms232314709. [PMID: 36499035 PMCID: PMC9739476 DOI: 10.3390/ijms232314709] [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: 10/21/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022] Open
Abstract
Sleep quality plays an important role in the modulation of several aging markers. This influence could be explained by aging-induced hormonal changes. Indeed, poor sleep quality has been associated with the development of several endocrine-related health complications. This study examined the relationship of both subjective and objective sleep quantity and quality, with basal levels of selected plasma anabolic and catabolic hormones in sedentary middle-aged adults. A total of 74 volunteers (52.7% women; aged 53.7 ± 5.1) were recruited for this study. Subjective sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI; higher scores indicate worse sleep quality), and objective sleep quality parameters (total sleep time [TST], wake after sleep onset [WASO], and sleep efficiency [SE]) were measured using a wrist-worn accelerometer. Basal levels of plasma dehydroepiandrosterone sulphate (DHEAS), total testosterone, sex hormone binding globulin (SHBG), somatotropin, and cortisol levels, were determined. Free testosterone was calculated from the total testosterone and SHBG levels. No associations of global PSQI score, TST, WASO, and SE with DHEAS, free testosterone, and somatotropin plasma levels were found, neither in men nor in women (all p ≥ 0.05). Global PSQI score was inversely related to cortisol plasma levels in women (p = 0.043). WASO was positively associated with cortisol plasma levels, while SE was negatively associated with cortisol plasma levels in women (all p ≤ 0.027). Sleep quality is not related to levels of plasma anabolic hormones, but to levels of catabolic hormones, in sedentary middle-aged adults. Therefore, these results suggest that potential changes in aging biomarkers associated with sleep disturbances, could be mediated by age-related changes in the catabolic endocrine system.
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Affiliation(s)
- Sol Mochón-Benguigui
- EFFECTS-262 Research Group, Department of Medical Physiology, School of Medicine, University of Granada, 18016 Granada, Spain
| | - Almudena Carneiro-Barrera
- Department of Psychology, Universidad Loyola Andalucía, 41704 Seville, Spain
- Sleep and Health Promotion Laboratory, Mind, Brain and Behavior Research Centre, University of Granada, 18011 Granada, Spain
- PROmoting FITness and Health through Physical Activity Research Group (PROFITH), Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18071 Granada, Spain
| | - Manuel Dote-Montero
- EFFECTS-262 Research Group, Department of Medical Physiology, School of Medicine, University of Granada, 18016 Granada, Spain
- PROmoting FITness and Health through Physical Activity Research Group (PROFITH), Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18071 Granada, Spain
| | - Manuel J. Castillo
- EFFECTS-262 Research Group, Department of Medical Physiology, School of Medicine, University of Granada, 18016 Granada, Spain
| | - Francisco J. Amaro-Gahete
- EFFECTS-262 Research Group, Department of Medical Physiology, School of Medicine, University of Granada, 18016 Granada, Spain
- PROmoting FITness and Health through Physical Activity Research Group (PROFITH), Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18071 Granada, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence:
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Gordon NP, Yao JH, Brickner LA, Lo JC. Prevalence of sleep-related problems and risks in a community-dwelling older adult population: a cross-sectional survey-based study. BMC Public Health 2022; 22:2045. [PMID: 36348296 PMCID: PMC9644466 DOI: 10.1186/s12889-022-14443-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022] Open
Abstract
Background Despite evidence of adverse health consequences of inadequate restorative sleep for older adults, assessment of sleep quantity, quality, and use of sleep aids is not routinely done. We aimed to characterize sleep problems, sleep risks, and advice received about sleep in a community-dwelling older adult population, overall and in subgroups with health conditions and functional difficulties. Methods This cross-sectional study used weighted self-report data for 5074 Kaiser Permanente Northern California members aged 65-79y who responded to a 2017 or 2020 Member Health Survey. We estimated usual amount of sleep (< 6, 6 to < 7, ≥7 hours) and prevalence of sleep problems (frequent insomnia, frequent daytime fatigue, poor quality sleep, and potential sleep apnea (OSA) symptoms (frequent very loud snoring, apnea episodes)) for older adults overall, by self-rated health, and in subgroups reporting hypertension, diabetes, heart disease, frequent problems with balance/walking, and frequent memory problems. We also estimated percentages who regularly used sleep aids and had discussed sleep adequacy with a healthcare professional in the past year. Results Approximately 30% of older adults usually got less than the recommended ≥7 hours sleep per day, and 9% experienced frequent daytime fatigue, 13% frequent insomnia, 18% frequent insomnia/poor quality sleep, and 8% potential OSA symptoms. Prevalence of frequent insomnia was higher among women than men (16% vs. 11%). Higher percentages of those in fair/poor health and those with frequent balance/walking and memory problems reported sleeping < 6 hours per day and having all four types of sleep problems. Nearly 20% of all older adults (22% of women vs. 17% of men) and 45% of those with frequent insomnia (no sex difference) reported regular sleep aid use. Only 10% of older adults reported discussing sleep with a healthcare professional whereas > 20% reported discussing diet and exercise. Conclusions Large percentages of older adults experience sleep problems or get less sleep than recommended for optimal sleep health. Older patients should routinely be assessed on multiple components of sleep health (sleep hygiene, quantity, quality, problems, and sleep aid use) and educated about sleep hygiene and the importance of getting adequate restorative sleep for their overall health and wellbeing.
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Murniati N, Al Aufa B, Kusuma D, Kamso S. A Scoping Review on Biopsychosocial Predictors of Mental Health among Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10909. [PMID: 36078627 PMCID: PMC9518331 DOI: 10.3390/ijerph191710909] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/26/2022] [Accepted: 08/27/2022] [Indexed: 06/15/2023]
Abstract
This review aims to map the available evidence on biopsychosocial predictors of elderly mental health. The articles were independently screened in three selected databases, namely Pubmed, Proquest and Google Scholar. The stages consist of identifying the research questions, seeking and selecting relevant evidence, mapping data, and concluding and reporting results. The PRISMA flowchart was used to show the PEOS evidence search flow. A total of 23,722 articles were obtained from all databases during the initial search, where 458 titles fulfilled the eligibility criteria at the title screening stage. Furthermore, 383 articles passed through abstract screening, where 75 met the inclusion criteria and were included for full-text screening. Based on the full-text screening stage, 28 articles were excluded and the remaining 47 articles that matched the search process were included for data extraction. This review creates biopsychosocial variables related to the mental health of the elderly. The biological factors consist of age, biomarkers, female, health conditions, chronic diseases, and physical function. Variables related to psychological factors are affect, personality traits, and subjective well-being. Meanwhile, social factors include smoking, sleep quality, physical activity, daily living, social support, marital status, loneliness, religiosity, spirituality, and early life conditions.
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Affiliation(s)
- Nia Murniati
- Doctoral Program in Public Health, Faculty of Public Health, Universitas Indonesia, Depok 16424, Indonesia
- Applied Health Science Department, Vocational Education Program, Universitas Indonesia, Depok 16424, Indonesia
| | - Badra Al Aufa
- Applied Health Science Department, Vocational Education Program, Universitas Indonesia, Depok 16424, Indonesia
| | - Dian Kusuma
- Centre for Health Economics & Policy Innovation, Imperial College Business School, London, SW7 2AZ, UK
| | - Sudijanto Kamso
- Department of Biostatistics, Faculty of Public Health, Universitas Indonesia, Depok 16424, Indonesia
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Sleep health in later life: interviews exploring experiences, attitudes and behaviours of older people. AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x22000447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Sleep is vital for health and wellbeing across the lifecourse. Ethnic differences have been observed with regards to the prevalence and predictors of self-reported sleep problems. An understanding of sleep experiences with ageing and across ethnicities is required to better support older people. Open-ended interviews were conducted with 23 people living in Aotearoa/New Zealand aged 61–92 years (12 Māori and 11 non-Māori) concerning current sleep status, changes over their lifecourse and personal strategies for supporting good sleep. Participants typically expressed satisfaction with current sleep (usually pertaining to duration) or feelings that sleep was compromised (usually pertaining to waking function). Comparisons to a socially perceived ‘ideal’ sleep were common, with sleep transitions presented as a gradual and accepted part of ageing. Participants resisted medicalising sleep disruptions in older age. While participants were aware of ways to enhance their sleep, many acknowledged engaging in practices that undermined it. Unique insights from some Māori participants indicated that sleep disruptions were not so readily pathologised compared to Western views and that sleeplessness could provide opportunity for cultural or spiritual connection. Common narratives underpinning the themes were: ‘You don't need as much sleep when you're older’, ‘Sleep just fits in’ and ‘Having the time of my life’. Findings provide personal experiences and cultural interpretations relating to sleep and ageing. This provides the foundation for future participatory research to co-design sleep health messages which are meaningful for ageing well across ethnicities.
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Mjelle KES, Lehmann S, Saxvig IW, Gulati S, Bjorvatn B. Association of Excessive Sleepiness, Pathological Fatigue, Depression, and Anxiety With Different Severity Levels of Obstructive Sleep Apnea. Front Psychol 2022; 13:839408. [PMID: 35432136 PMCID: PMC9008507 DOI: 10.3389/fpsyg.2022.839408] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThe aim of this study was to investigate possible associations between obstructive sleep apnea and fatigue. This naturally led to considering the association between OSA and excessive sleepiness, depression, and anxiety.BackgroundOSA is a highly prevalent sleep disorder, associated with a risk of hypertension, cardiovascular events, daytime sleepiness, poor cognitive function, and sudden death during sleep. Both excessive sleepiness, fatigue, and symptoms of depression are frequently reported.Method5,464 patients referred to a university hospital for obstructive sleep apnea underwent standard respiratory polygraphy. The severity of OSA was defined as either mild, moderate, or severe, using the apnea–hypopnea index. Validated questionnaires were used to assess excessive sleepiness, pathological fatigue, depression, and anxiety.ResultsNearly 70% of the patients were men, and median age was 50 (range: 16–89) years. One in three had moderate-to-severe OSA (AHI ≥ 15). Excessive sleepiness and pathological fatigue were present in 43 and 39%, respectively. The prevalence of possible depression and anxiety was 19 and 28%, respectively. The proportion of patients with male sex, obesity, and excessive sleepiness increased with the severity of OSA. In contrast, the proportion of patients with pathological fatigue did not increase with OSA severity, and there was a decrease in depression and anxiety with increasing OSA severity.ConclusionOur study reports that pathological fatigue, as well as anxiety and depression, did not increase with OSA severity, whereas excessive sleepiness did. Knowledge concerning conditions related to OSA severity may be indicative of pretest probability of OSA and thus change the priority for polygraphy. Furthermore, the high prevalence rates of fatigue, anxiety, and depression among these patients warrant further investigations.
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Affiliation(s)
- Karin Elisabeth Sundt Mjelle
- Department of Otorhinolaryngology and Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
- *Correspondence: Karin Elisabeth Sundt Mjelle,
| | - Sverre Lehmann
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
- Department of Thoracic Medicine, Clinical Center for Sleep Medicine, Haukeland University Hospital, Bergen, Norway
| | - Ingvild West Saxvig
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
- Department of Thoracic Medicine, Clinical Center for Sleep Medicine, Haukeland University Hospital, Bergen, Norway
| | - Shashi Gulati
- Department of Otorhinolaryngology and Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Bjørn Bjorvatn
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Raphelson J, Feldman E, Malhotra A. Obstructive Sleep Apnea: Diagnosis with Polysomnography and Portable Monitors. Respir Med 2022. [DOI: 10.1007/978-3-030-93739-3_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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How can light be used to optimize sleep and health in older adults? PROGRESS IN BRAIN RESEARCH 2022; 273:331-355. [DOI: 10.1016/bs.pbr.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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22
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Vadakkan Devassy T, Ps N, Sharma D, Thomas AM. Sleep disorders in elderly population suffering from TB and respiratory diseases. Indian J Tuberc 2022; 69 Suppl 2:S272-S279. [PMID: 36400523 DOI: 10.1016/j.ijtb.2022.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022]
Abstract
Sleep disorders (SD) are more frequent in the elderly population than younger counterparts. The underlying SD has a more severe impact on cardiorespiratory fitness. In elderly population with respiratory disorders, incidence and baneful influence of sleep disorders are extremely high. Insomnia in elderly is very common probably due to age related changes, underlying co morbidities and multiple medications. With aging there is decrease in duration of slow wave sleep and increase in NREM stage 1 and 2 sleep, which increases number of spontaneous arousals. Compared to younger people, elderly individuals tend to sleep earlier and wake up earlier due to changes in their normal circadian rhythm. Poor sleep quality and restless leg syndrome are higher in Tuberculosis patients. Disturbances in immune regulation due to chronic insomnia may exacerbate chronic infections like TB. Because many respiratory diseases and medications are known to cause sleep disturbances, it is important to assess treatable medical conditions and insomnia inducing medications before initiating hypnotics. Diagnosing sleep disordered breathing (SDB) in ILD patients is particularly important as nocturnal oxygen desaturation is associated with poor prognosis and could possibly be a cause of pulmonary hypertension. In patients with pulmonary hypertension (PH) and underlying obstructive sleep apnoea, CPAP therapy may help to reduce the PH. Addressing sleep disorders will be highly beneficial in elderly COPD patients with sleep disorders. This article reviews different SD, its effects and the treatment benefits in improving the quality of life and reducing the risk of progression of respiratory dysfunction in elderly population with TB and respiratory diseases.
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Affiliation(s)
| | - Nishanth Ps
- DM Pulmonary Medicine Resident, Department of Pulmonary Medicine, Amala Institute of Medical Sciences, India
| | - Daksh Sharma
- DM Pulmonary Medicine Resident, Department of Pulmonary Medicine, Amala Institute of Medical Sciences, India
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Kim M, Um YH, Kim TW, Kim SM, Seo HJ, Jeong JH, Lee J, Kim S, Cho IH, Kim SY, Hong SC. Association Between Age and Sleep Quality: Findings From a Community Health Survey. SLEEP MEDICINE RESEARCH 2021. [DOI: 10.17241/smr.2021.01158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background and Objective This study aimed to investigate the changes in sleep quality with increasing age and the effect of age on the components of the Pittsburgh Sleep Quality Index (PSQI).Methods We used data from the Community Health Survey conducted by the Korea Center for Disease Control and Prevention in 2018. A total of 228340 participants in this nationwide survey. Sleep quality was assessed using the PSQI. Adults aged ≥ 19 years were divided into six age groups and one-way analysis of variance (one-way ANOVA) was used to compare the mean values of PSQI of each group. By comparing the scores for each PSQI component in those aged ≥ 65 years and < 65 years, we aimed to reveal the differences in special components according to age group.Results In total, 223334 respondents were included in the study. Based on a one-way ANOVA, the PSQI score generally increased with age. Although the average PSQI score of patients in their 40s was lower than that of patients in their 30s, there was no significant difference between the two groups (p = 0.11). When the PSQI component was compared between the population aged over and under 65 years, the population aged ≥ 65 years scored higher in most components. In contrast, daytime dysfunction scored higher in the population aged < 65 years.Conclusions Sleep quality tends to decrease with increasing age. Several factors, including physiological changes, underlying physical conditions, and psychosocial factors, may contribute to a decrease in sleep quality with age.
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Zhang W, Gao X. A Cone Beam CT Study of Upper Airway Morphology in Perimenopausal and Postmenopausal Women. Int J Womens Health 2021; 13:1129-1137. [PMID: 34853538 PMCID: PMC8627894 DOI: 10.2147/ijwh.s335728] [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: 08/24/2021] [Accepted: 11/11/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Menopause is accompanied by a decline in estrogen and progesterone. Several studies have demonstrated that upper airway patency decreases in women after menopause, while morphology changes are still a lack of evidence. This study aimed to explore upper airway morphology changes in perimenopausal and postmenopausal women. Methods This retrospective cross-sectional study included 367 consecutive Chinese female patients over 25 years old who had routinely taken large-field cone beam computed tomography in the imaging library of Peking University School and Hospital of Stomatology from October 2016 to September 2020. A total of 283 males were screened as sex controls according to the same age group. Upper airway morphology, hyoid position and facial pattern were measured. The association between perimenopausal and postmenopausal years and upper airway morphology in both sexes was analyzed. Results Perimenopausal women (aged 45-54 years) showed a significant decrease in the volume (3172.91mm3, 95% CI = 653.86-5691.96) and minimum cross-sectional area (37.08 mm2, 95% CI = 5.36-68.80), and a significant increase in the length (-1.96mm, 95% CI = -3.62 to -0.29) of upper airway compared to adjacent reproductive years (aged 35-44), while this difference was neither seen in other adjacent two reproductive age groups of females nor in the same age groups of males. In postmenopausal women (55 years and older), hyoid position was significantly lower (-2.74mm, 95% CI = -4.42 to -1.07) than either age group, while no similar changes were seen in men. Conclusion Women had smaller airway volume, reduced upper airway cross-sectional area and longer airway length in perimenopausal years, and a significantly lower hyoid position in postmenopausal years. These changes may be related to menopause itself and independent of the changes associated with aging.
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Affiliation(s)
- Wanxin Zhang
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, People's Republic of China
| | - Xuemei Gao
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, People's Republic of China
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Zhang Q, Wu Y, Liu E. Longitudinal associations between sleep duration and cognitive function in the elderly population in China: A 10-year follow-up study from 2005 to 2014. Int J Geriatr Psychiatry 2021; 36:1878-1890. [PMID: 34378823 DOI: 10.1002/gps.5615] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 08/05/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Sleep duration is increasingly recognized as an important determinant of cognitive function among elderly. However, longitudinal studies on the relationship between sleep duration and cognitive function in Chinese elderly are rare. We sought to investigate the longitudinal association between sleep duration and cognitive function in Chinese elderly during a 10-year follow-up. METHOD This longitudinal study analyzed 2148 elderly (the baseline including 43.16% aged 70%-79%, 23.79% aged 80 and over) who had participated in four waves of the Chinese Longitudinal Healthy Longevity Survey during 2005-2014. Cognitive function (including global functioning and cognitive domains) was assessed using the Chinese version of the Mini-Mental State Examination. Sleep duration was assessed via self-reports. Mixed model analysis was used to evaluate the association between sleep duration and cognitive function, adjusting for sociodemographic variables and risk factors for cognitive function. RESULTS There is an inverted U-shaped relationship between sleep duration and global cognition and cognitive domains, with the highest cognitive scores observed for sleep durations between 6 and 9 h and the curve shifting from smooth to steeper from 2005 to 2014. The regression model showed that long sleep duration (>9 h) is significantly associated with global cognition and four cognitive domains: orientation, attention and calculation, immediate recall and visual construction. Both long and short sleep durations are significantly associated with delayed recall and not significantly associated with category fluency, language or the ability to follow a three-stage command. The five cognitive domains related to sleep duration are the domains that exhibited a rapid rate of decline. CONCLUSIONS Sleep duration can be identified as a modifiable risk factor for cognitive decline, as long or short sleep duration is associated with the five cognitive domains that exhibit cognitive decline. These findings suggest the need for intervention measures to maintain healthy sleep durations among Chinese elderly people.
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Affiliation(s)
- Qilin Zhang
- Center for Social Security Studies, Wuhan University, Wuhan, China
| | - Yanli Wu
- Center for Social Security Studies, Wuhan University, Wuhan, China
| | - Erpeng Liu
- Institute of Income Distribution and Public Finance, Zhongnan University of Economics and Law, Wuhan, China
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26
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Orr JE, Edwards BA, Schmickl CN, Karris M, DeYoung PN, Darquenne C, Theilmann R, Jain S, Malhotra A, Hicks CB, Owens RL. Pathogenesis of obstructive sleep apnea in people living with HIV. J Appl Physiol (1985) 2021; 131:1671-1678. [PMID: 34672765 PMCID: PMC8714978 DOI: 10.1152/japplphysiol.00591.2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/04/2021] [Accepted: 10/18/2021] [Indexed: 11/22/2022] Open
Abstract
Obstructive sleep apnea (OSA) is highly prevalent in people living with human immunodeficiency virus (HIV) (PLWH), and it might contribute to frequently reported symptoms and comorbidities. Traditional risk factors for OSA are often absent in PLWH, suggesting that HIV or HIV medications might predispose to OSA. Therefore, we measured the anatomical and nonanatomical traits important for OSA pathogenesis in those with and without HIV. We recruited virally suppressed PLWH who had been previously diagnosed with OSA (PLWH + OSA) adherent to positive airway pressure (PAP) therapy, along with age-, sex-, and body mass index (BMI)-matched OSA controls. All participants underwent a baseline polysomnogram to assess OSA severity and a second overnight research sleep study during which the airway pressure was adjusted slowly or rapidly to measure the OSA traits. Seventeen PLWH + OSA and 17 OSA control participants were studied [median age = 58 (IQR = 54-65) yr, BMI = 30.7 (28.4-31.8) kg/m2, apnea-hypopnea index = 46 (24-74)/h]. The groups were similar, although PLWH + OSA demonstrated greater sleepiness (despite PAP) and worse sleep efficiency on baseline polysomnography. On physiological testing during sleep, there were no statistically significant differences in OSA traits (including Veupnea, Varousal, Vpassive, Vactive, and loop gain) between PLWH + OSA and OSA controls, using mixed-effects modeling to account for age, sex, and BMI and incorporating each repeated measurement (range = 72-334 measures/trait). Our data suggest that well-treated HIV does not substantially impact the pathogenesis of OSA. Given similar underlying physiology, existing available therapeutic approaches are likely to be adequate to manage OSA in PLWH, which might improve symptoms and comorbidities.NEW & NOTEWORTHY Clinical data suggest an increased risk of obstructive sleep apnea (OSA) in people living with HIV (PLWH), while OSA might account for chronic health issues in this population. We characterized the anatomical and nonanatomical OSA traits in PLWH + OSA compared with OSA controls, using detailed physiological measurements obtained during sleep. Our data suggest against a major impact of HIV on OSA pathogenesis. Available OSA management strategies should be effective to address this potentially important comorbidity in PLWH.
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Affiliation(s)
- Jeremy E Orr
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, San Diego, California
| | - Bradley A Edwards
- Sleep and Circadian Medicine Laboratory, Department of Physiology, Biomedicine Discovery Institute, Monash University, Melbourne, Australia
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Christopher N Schmickl
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, San Diego, California
| | - Maile Karris
- Division of Infectious Disease, University of California San Diego, San Diego, California
| | - Pamela N DeYoung
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, San Diego, California
| | - Chantal Darquenne
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, San Diego, California
| | - Rebecca Theilmann
- Department of Radiology, University of California San Diego, San Diego, California
| | - Sonia Jain
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, California
| | - Atul Malhotra
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, San Diego, California
| | - Charles B Hicks
- Division of Infectious Disease, University of California San Diego, San Diego, California
| | - Robert L Owens
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, San Diego, California
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The association of changes of sleep architecture related to donepezil: A systematic review and meta-analysis. J Formos Med Assoc 2021; 121:1466-1477. [PMID: 34753629 DOI: 10.1016/j.jfma.2021.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 10/02/2021] [Accepted: 10/18/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Donepezil had been recognized to have impact on sleep quality in demented patients. However, there was insufficient evidences about the actual effect of donepezil in the sleep architectures. Our meta-analysis aimed to evaluate the changes of sleep architectures related to donepezil use. METHODS Followed the PRISMA2020 and AMSTAR2 guidelines, electronic search had been performed on the databases of PubMed, Embase, ScienceDirect, ClinicalKey, Cochrane CENTRAL, ProQuest, Web of Science, and ClinicalTrials.gov. The outcome measurement was changes of sleep parameters detected by polysomnography. A random-effects meta-analysis was conducted. RESULTS Total twelve studies had been involved. The percentage of REM sleep would significantly increase after donepezil treatment (Hedges' g = 0.694, p < 0.001). Compared to placebo/controls, subjects with donepezil would had significantly increased percentage of REM sleep stage (Hedges' g = 0.556, p = 0.018). Furthermore, donepezil was also associated with the decreased stage 2 sleep percentage, sleep efficiency, or total sleep time in different analysis conditions. CONCLUSION Our meta-analysis provided detailed changes of sleep architectures related to donepezil treatment. Further larger sample size studies with stricter control of potential moderators are needed to clarify these issues.
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Lee J, Jung HY, Lee SI, Youn H, Kim SG. Smartphone Addiction Proneness Is Associated With Subjective-Objective Sleep Discrepancy in Patients With Insomnia Disorder. Psychiatry Investig 2021; 18:1035-1043. [PMID: 34732032 PMCID: PMC8600213 DOI: 10.30773/pi.2020.0360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 06/09/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Subjective reports of patients with insomnia often show a discrepancy with their objective assessments of sleep. We aimed to assess subjective-objective sleep discrepancy in subjects with insomnia disorder as well as the psychological factors associated with the discrepancy. METHODS This study is a secondary analysis of the baseline data of a randomized controlled study on 110 adults aged 18 years to 59 years with insomnia disorder. Subjective reports on sleep and the objective measures acquired by an overnight polysomnography were used to measure the sleep discrepancy. Smartphone Addiction Proneness Scale (SAPS), Center for Epidemiologic Studies Depression Scale (CES-D), beck anxiety inventory (BAI), and Global Assessment of Recent Stress (GARS) were used to evaluate the psychological factors associated with the sleep discrepancy. RESULTS Mean total sleep time (TST) discrepancy of the participants was -81.65±97.41 minutes. Multivariable logistic regression analyses revealed that age (adjusted OR=1.07, 95% CI=1.01-1.13, p=0.027), years of education (adjusted OR=0.69, 95% CI=0.48-0.91, p=0.017), and smartphone addiction proneness (adjusted OR=1.14, 95% CI=1.04-1.27, p=0.008) were independent predictors of TST misperception. Mean sleep onset latency (SOL) discrepancy of the participants was 41.28±45.01 minutes. Only anxiety was an independent predictor of SOL misperception (adjusted OR=1.16, 95% CI=1.05-1.31, p=0.006). CONCLUSION The present study provides empirical evidence to increase our understanding of the various factors that are associated with subjective-objective sleep discrepancy. Screening insomnia patients with smartphone addiction proneness may help predict the potential discrepancy between the patients' subjective reports and objective measures of sleep duration.
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Affiliation(s)
- Jeewon Lee
- Department of Psychiatry, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Republic of Korea
| | - Han-Yong Jung
- Department of Psychiatry, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Republic of Korea
| | - Soyoung Irene Lee
- Department of Psychiatry, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Republic of Korea
| | - HyunChul Youn
- Department of Psychiatry, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Republic of Korea
| | - Shin-Gyeom Kim
- Department of Psychiatry, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Republic of Korea
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29
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Osorio RS, Martínez-García MÁ, Rapoport DM. Sleep apnoea in the elderly: a great challenge for the future. Eur Respir J 2021; 59:13993003.01649-2021. [PMID: 34561285 DOI: 10.1183/13993003.01649-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/25/2021] [Indexed: 11/05/2022]
Abstract
Due in part to overall improvements in health, the population of elderly individuals is increasing rapidly. Similarly, obstructive sleep apnoea (OSA) is both gaining increased recognition and also increasing due to the worldwide obesity epidemic. The overlap of OSA and aging is large, but there is strong plausibility for causation in both directions: OSA is associated with pathological processes that may accelerate aging and aging related processes; aging may cause physical and neurological changes that predispose to obstructive (and central) apnoea. In addition, the common symptoms (e.g. excessive daytime somnolence, defects in memory and cognition), possible physiological consequences of OSA (e.g. accelerated cardiovascular and cerebrovascular atherosclerosis), and changes in metabolic and inflammatory markers overlap with the symptoms and associated conditions seen in aging. There is also the possibility of synergy in the effects of these symptoms and conditions on quality of life, as well as a need to separate treatable consequences of OSA from age-related complaints. Taken together, the above make it essential to review the interaction of OSA and aging, both proven and suspected. The present review examines some aspects of what is known and points to the need for further investigation of the relationships, given the large number of potentially affected subjects.
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Affiliation(s)
- Ricardo S Osorio
- Department of Psychiatry, New York University (NYU) Grossman School of Medicine, New York, New York, USA.,Clinical Research Division, Nathan Kline Institute (NKI), Orangeburg, New York, USA
| | - Miguel Ángel Martínez-García
- Respirology Department, University and Politechnic la Fe Hospital, Valencia, Valencian Community, Spain .,CIBERES de Enfermedades Respiratorias, Madrid, Spain
| | - David M Rapoport
- Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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30
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Changes in Locomotor Activity and Oxidative Stress-Related Factors after the Administration of an Amino Acid Mixture by Generation and Age. Int J Mol Sci 2021; 22:ijms22189822. [PMID: 34575986 PMCID: PMC8466552 DOI: 10.3390/ijms22189822] [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: 06/30/2021] [Revised: 07/16/2021] [Accepted: 07/23/2021] [Indexed: 12/05/2022] Open
Abstract
Amino acids, as nutrients, are expected to improve sleep disorders. This study aimed to evaluate the generation- and age-dependent sleep-improving effects of γ-aminobutyric acid (GABA) and 5-hydroxytryptophan (5-HTP) coadministration. The differentially expressed genes and generation-related behavior after the administration of a GABA/5-HTP mixture were measured in a Drosophila model, while age-related changes in gene expression and oxidative stress-related parameters were measured in a mouse model. The GABA/5-HTP-treated group showed significant behavioral changes compared to the other groups. Sequencing revealed that the GABA/5-HTP mixture influenced changes in nervous system-related genes, including those involved in the regulation of the expression of behavioral and synaptic genes. Additionally, total sleep time increased with age, and nighttime sleep time in the first- and third-generation flies was significantly different from that of the control groups. The GABA/5-HTP mixture induced significant changes in the expression of sleep-related receptors in both models. Furthermore, the GABA/5-HTP mixture reduced levels of ROS and ROS reaction products in an age-dependent manner. Therefore, the increase in behavioral changes caused by GABA/5-HTP mixture administration was effective in eliminating ROS activity across generations and ages.
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31
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Obstructive Sleep Apnea and Arrhythmias in the Elderly. CURRENT SLEEP MEDICINE REPORTS 2021. [DOI: 10.1007/s40675-021-00212-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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32
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Hyde J, Eidels A, van Amelsvoort T, Myin-Germeys I, Campbell L. Gene Deletion and Sleep Depletion: Exploring the Relationship Between Sleep and Affect in 22q11.2 Deletion Syndrome. The Journal of Genetic Psychology 2021; 182:304-316. [PMID: 34114933 DOI: 10.1080/00221325.2021.1930995] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
22q11.2 deletion syndrome (22q11DS) is a neurodevelopmental disorder caused by a microdeletion on the long arm of chromosome 22. Sleep problems have been reported in this population, and psychiatric disorders and affect dysregulation are common to the behavioral phenotype of 22q11DS. Sleep and affect have been consistently linked across multiple studies, yet despite this very little research has investigated sleep problems in 22q11DS, or the link between sleep and affect in this population. The Experience Sampling Method was used to track daily reports of sleep quality and affect in a total of 29 individuals with 22q11DS and 21 control subjects. Measurements were recorded during a 6-day period using an electronic device that prompted daily response with audio cues. Participants with 22q11DS were found to experience a longer sleep onset latency and a greater amount, and duration, of night wakings compared with control subjects. Despite this, no significant between-group difference was found for subjective sleep quality. 22q11DS participants reported more experiences of negative affect and less positive affect than control subjects. A bidirectional relationship was found between sleep measures and affect. Sleep problems can cause a wide range of negative health effects, and individuals with 22q11DS are particularly vulnerable to deficits of sleep. To ensure high standards of care, healthcare providers should be aware of the possibility and impact of sleep problems in this population.
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Affiliation(s)
- Justyn Hyde
- School of Psychology, College of Engineering, Science and Environment, University of Newcastle, Callaghan, Australia
| | - Ami Eidels
- School of Psychology, College of Engineering, Science and Environment, University of Newcastle, Callaghan, Australia
| | - Therese van Amelsvoort
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Inez Myin-Germeys
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Linda Campbell
- School of Psychology, College of Engineering, Science and Environment, University of Newcastle, Callaghan, Australia
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Mireku MO, Rodriguez A. Sleep Duration and Waking Activities in Relation to the National Sleep Foundation's Recommendations: An Analysis of US Population Sleep Patterns from 2015 to 2017. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6154. [PMID: 34200277 PMCID: PMC8201191 DOI: 10.3390/ijerph18116154] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 12/02/2022]
Abstract
The objective was to investigate the association between time spent on waking activities and nonaligned sleep duration in a representative sample of the US population. We analysed time use data from the American Time Use Survey (ATUS), 2015-2017 (N = 31,621). National Sleep Foundation (NSF) age-specific sleep recommendations were used to define recommended (aligned) sleep duration. The balanced, repeated, replicate variance estimation method was applied to the ATUS data to calculate weighted estimates. Less than half of the US population had a sleep duration that mapped onto the NSF recommendations, and alignment was higher on weekdays (45%) than at weekends (33%). The proportion sleeping longer than the recommended duration was higher than those sleeping shorter on both weekdays and weekends (p < 0.001). Time spent on work, personal care, socialising, travel, TV watching, education, and total screen time was associated with nonalignment to the sleep recommendations. In comparison to the appropriate recommended sleep group, those with a too-short sleep duration spent more time on work, travel, socialising, relaxing, and leisure. By contrast, those who slept too long spent relatively less time on each of these activities. The findings indicate that sleep duration among the US population does not map onto the NSF sleep recommendations, mostly because of a higher proportion of long sleepers compared to short sleepers. More time spent on work, travel, and socialising and relaxing activities is strongly associated with an increased risk of nonalignment to NSF sleep duration recommendations.
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Affiliation(s)
- Michael Osei Mireku
- School of Psychology, University of Lincoln, Lincoln LN6 7TS, UK
- Lincoln Sleep Research (LiSReC), University of Lincoln, Lincoln LN6 7TS, UK
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, UK;
| | - Alina Rodriguez
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, UK;
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK
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34
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Yoon JE, Oh D, Hwang I, Park JA, Im HJ, Lee SK, Jung KY, Park SH, Thomas RJ, Shin C, Yun CH. Sleep structure and electroencephalographic spectral power of middle-aged or older adults: Normative values by age and sex in the Korean population. J Sleep Res 2021; 30:e13358. [PMID: 33949014 DOI: 10.1111/jsr.13358] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 03/23/2021] [Accepted: 03/29/2021] [Indexed: 11/28/2022]
Abstract
The fine structure of sleep electrocortical activity reflects health and disease. The current study provides normative data for sleep structure and electroencephalography (EEG) spectral power measures derived from overnight polysomnography (PSG) and examines the effect of age and sex among Korean middle-aged and older adults with or without obstructive sleep apnea (OSA). We analysed home PSG data from 1,153 adult participants of an ongoing population-based cohort study, the Korean Genome and Epidemiology Study. Sleep stages were visually scored and spectral power was measured on a single-channel EEG (C4-A1). We computed spectral power for five frequency ranges. The EEG power was reported in relative (%) and log-transformed absolute values (µV2 ). With ageing, the proportion of N1 sleep increased, whereas N3 decreased, which is more noticeable in men than in women. The amount of N3 was relatively low in this cohort. With ageing, relative delta power decreased and alpha and sigma power increased for the whole sleep period, which was more pronounced during REM sleep in non-OSA. For men compared with women, relative theta power was lower during REM and sigma and beta were higher during N1 sleep. The differences of relative powers by age and sex in OSA were comparable to those in non-OSA. In a community-based Korean population, we present normative data of sleep structure and spectral power for middle-aged or older adults of a non-Caucasian ethnicity. The values varied with age and sex and were not influenced by sleep apnea.
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Affiliation(s)
- Jee-Eun Yoon
- Department of Neurology, Uijeongbu Eulji Medical Center, Uijeongbu, Korea
| | - Dana Oh
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - Inha Hwang
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung Ah Park
- Department of Neurology, School of Medicine, Catholic University of Daegu, Daegu, Korea
| | - Hee-Jin Im
- Department of Neurology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Seung Ku Lee
- Institute of Human Genomic Study, Korea University Ansan Hospital, Ansan, Korea
| | - Ki-Young Jung
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seong-Ho Park
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Robert J Thomas
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, USA
| | - Chol Shin
- Institute of Human Genomic Study, Korea University Ansan Hospital, Ansan, Korea.,Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Chang-Ho Yun
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
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35
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Parker JL, Appleton SL, Melaku YA, Stevens D, Wittert GA, Martin S, Adams RJ, Vakulin A. Sleep macroarchitecture but not obstructive sleep apnea is independently associated with cognitive function in only older men of a population-based cohort. J Sleep Res 2021; 30:e13370. [PMID: 33890335 DOI: 10.1111/jsr.13370] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 12/20/2022]
Abstract
Evidence linking obstructive sleep apnea with cognitive dysfunction predominantly comes from clinical or select community samples. We investigated the independent cross-sectional association of obstructive sleep apnea and sleep macroarchitecture parameters with cognitive function in unselected community-dwelling middle-aged and older men. Four hundred and seventy-seven Florey Adelaide Male Ageing Study participants underwent successful home-based polysomnography. They also completed cognitive testing, including the inspection time task, Fuld object memory evaluation, trail-making test A and B, and mini-mental state examination. Multivariable regression models examined independent cross-sectional associations of obstructive sleep apnea and sleep macroarchitecture parameters with cognitive function. In univariable analyses, a higher apnea-hypopnea index and percentage of total sleep time with oxygen saturation <90% were associated with worse trail-making test A performance (both p < .05). A higher apnea-hypopnea index was also associated with worse trail-making test B performance and slower inspection time (both p < .05). In adjusted analyses, obstructive sleep apnea and sleep macroarchitecture parameters were not associated with cognitive function (all p > .05). In age-stratified analysis in men ≥65 years, greater stage 1 sleep was independently associated with worse trail-making test A performance, whereas greater stage 3 sleep was independently associated with better trail-making test A performance (both p < .05). Our findings suggest that obstructive sleep apnea is not independently associated with cognitive function. In older, but not younger, men, light sleep was associated with worse attention, whereas deep sleep was associated with better attention. Longitudinal population-based cohort studies are needed to determine if obstructive sleep apnea and disrupted sleep macroarchitecture independently predict prospective cognitive dysfunction and decline.
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Affiliation(s)
- Jesse L Parker
- Flinders Health and Medical Research Institute - Sleep Health, Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Sarah L Appleton
- Flinders Health and Medical Research Institute - Sleep Health, Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,Freemasons Foundation Centre for Men's Health, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Yohannes A Melaku
- Flinders Health and Medical Research Institute - Sleep Health, Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - David Stevens
- Flinders Health and Medical Research Institute - Sleep Health, Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Gary A Wittert
- Freemasons Foundation Centre for Men's Health, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Sean Martin
- Freemasons Foundation Centre for Men's Health, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Robert J Adams
- Flinders Health and Medical Research Institute - Sleep Health, Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,Freemasons Foundation Centre for Men's Health, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,Respiratory and Sleep Services, Southern Adelaide Local Health Network, Bedford Park, Adelaide, SA, Australia
| | - Andrew Vakulin
- Flinders Health and Medical Research Institute - Sleep Health, Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,NeuroSleep - NHMRC Centre of Research Excellence, and Centre for Sleep and Chronobiology (CIRUS), Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
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Hermans LWA, van Gilst MM, Regis M, van den Heuvel LCE, Langen H, van Mierlo P, Krijn R, Hoondert B, Maass H, van Dijk JP, Leufkens TRM, Overeem S. Modeling sleep onset misperception in insomnia. Sleep 2021; 43:5721963. [PMID: 32016410 DOI: 10.1093/sleep/zsaa014] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/06/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To extend and validate a previously suggested model of the influence of uninterrupted sleep bouts on sleep onset misperception in a large independent data set. METHODS Polysomnograms and sleep diaries of 139 insomnia patients and 92 controls were included. We modeled subjective sleep onset as the start of the first uninterrupted sleep fragment longer than Ls minutes, where parameter Ls reflects the minimum length of a sleep fragment required to be perceived as sleep. We compared the so-defined sleep onset latency (SOL) for various values of Ls. Model parameters were compared between groups, and across insomnia subgroups with respect to sleep onset misperception, medication use, age, and sex. Next, we extended the model to incorporate the length of wake fragments. Model performance was assessed by calculating root mean square errors (RMSEs) of the difference between estimated and perceived SOL. RESULTS Participants with insomnia needed a median of 34 minutes of undisturbed sleep to perceive sleep onset, while healthy controls needed 22 minutes (Mann-Whitney U = 4426, p < 0.001). Similar statistically significant differences were found between sleep onset misperceivers and non-misperceivers (median 40 vs. 20 minutes, Mann-Whitney U = 984.5, p < 0.001). Model outcomes were similar across other subgroups. Extended models including wake bout lengths resulted in only marginal improvements of model outcome. CONCLUSIONS Patients with insomnia, particularly sleep misperceivers, need larger continuous sleep bouts to perceive sleep onset. The modeling approach yields a parameter for which we coin the term Sleep Fragment Perception Index, providing a useful measure to further characterize sleep state misperception.
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Affiliation(s)
- Lieke W A Hermans
- Department of Electrical Engineering, Eindhoven University of Technology, De Zaale, Eindhoven, The Netherlands
| | - Merel M van Gilst
- Department of Electrical Engineering, Eindhoven University of Technology, De Zaale, Eindhoven, The Netherlands.,Center for Sleep Medicine, Kempenhaeghe Foundation, Heeze, Noord Brabant, The Netherlands
| | - Marta Regis
- Department of Mathematics and Computer Science, Eindhoven University of Technology, De Zaale, Eindhoven, The Netherlands
| | | | - Hanneke Langen
- Center for Sleep Medicine, Kempenhaeghe Foundation, Heeze, Noord Brabant, The Netherlands
| | - Petra van Mierlo
- Center for Sleep Medicine, Kempenhaeghe Foundation, Heeze, Noord Brabant, The Netherlands
| | - Roy Krijn
- Center for Sleep Medicine, Kempenhaeghe Foundation, Heeze, Noord Brabant, The Netherlands
| | - Bertram Hoondert
- Center for Sleep Medicine, Kempenhaeghe Foundation, Heeze, Noord Brabant, The Netherlands
| | | | - Johannes P van Dijk
- Department of Electrical Engineering, Eindhoven University of Technology, De Zaale, Eindhoven, The Netherlands.,Center for Sleep Medicine, Kempenhaeghe Foundation, Heeze, Noord Brabant, The Netherlands.,Department of Orthodontics, University of Ulm, Ulm, Germany
| | - Tim R M Leufkens
- Philips Research, Eindhoven, The Netherlands.,Department of Industrial Design, Eindhoven University of Technology, De Zaale, Eindhoven, The Netherlands
| | - Sebastiaan Overeem
- Department of Electrical Engineering, Eindhoven University of Technology, De Zaale, Eindhoven, The Netherlands.,Center for Sleep Medicine, Kempenhaeghe Foundation, Heeze, Noord Brabant, The Netherlands.,Department of Industrial Design, Eindhoven University of Technology, De Zaale, Eindhoven, The Netherlands
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Changes in sleep EEG with aging in humans and rodents. Pflugers Arch 2021; 473:841-851. [PMID: 33791849 PMCID: PMC8076123 DOI: 10.1007/s00424-021-02545-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 02/17/2021] [Accepted: 02/19/2021] [Indexed: 12/18/2022]
Abstract
Sleep is one of the most ubiquitous but also complex animal behaviors. It is regulated at the global, systems level scale by circadian and homeostatic processes. Across the 24-h day, distribution of sleep/wake activity differs between species, with global sleep states characterized by defined patterns of brain electric activity and electromyography. Sleep patterns have been most intensely investigated in mammalian species. The present review begins with a brief overview on current understandings on the regulation of sleep, and its interaction with aging. An overview on age-related variations in the sleep states and associated electrophysiology and oscillatory events in humans as well as in the most common laboratory rodents follows. We present findings observed in different studies and meta-analyses, indicating links to putative physiological changes in the aged brain. Concepts requiring a more integrative view on the role of circadian and homeostatic sleep regulatory mechanisms to explain aging in sleep are emerging.
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38
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Evaluation and Management of Adults with Obstructive Sleep Apnea Syndrome. Lung 2021; 199:87-101. [PMID: 33713177 DOI: 10.1007/s00408-021-00426-w] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 02/09/2021] [Indexed: 02/08/2023]
Abstract
Obstructive sleep apnea syndrome (OSAS) is a common and underdiagnosed medical condition characterized by recurrent sleep-dependent pauses and reductions in airflow. While a narrow, collapsible oropharynx plays a central role in the pathophysiology of OSAS, there are other equally important nonanatomic factors including sleep-stage dependent muscle tone, arousal threshold, and loop gain that drive obstructive apneas and hypopneas. Through mechanisms of intermittent hypoxemia, arousal-related sleep fragmentation, and intrathoracic pressure changes, OSAS impacts multiple organ systems. Risk factors for OSAS include obesity, male sex, age, specific craniofacial features, and ethnicity. The prevalence of OSAS is rising due to increasing obesity rates and improved sensitivity in the tools used for diagnosis. Validated questionnaires have an important but limited role in the identification of patients that would benefit from formal testing for OSA. While an in-laboratory polysomnography remains the gold standard for diagnosis, the widespread availability and accuracy of home sleep apnea testing modalities increase access and ease of OSAS diagnosis for many patients. In adults, the most common treatment involves the application of positive airway pressure (PAP), but compliance continues to be a challenge. Alternative treatments including mandibular advancement device, hypoglossal nerve stimulator, positional therapies, and surgical options coupled with weight loss and exercise offer possibilities of an individualized personal approach to OSAS. Treatment of symptomatic patients with OSAS has been found to be beneficial with regard to sleep-related quality of life, sleepiness, and motor vehicle accidents. The benefit of treating asymptomatic OSA patients, particularly with regard to cardiovascular outcomes, is controversial and more data are needed.
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Luongo A, Lukowski A, Protho T, Van Vorce H, Pisani L, Edgin J. Sleep's role in memory consolidation: What can we learn from atypical development? ADVANCES IN CHILD DEVELOPMENT AND BEHAVIOR 2021; 60:229-260. [PMID: 33641795 DOI: 10.1016/bs.acdb.2020.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Research conducted over the last century has suggested a role for sleep in the processes guiding healthy cognition and development, including memory consolidation. Children with intellectual and developmental disabilities (IDDs) tend to have higher rates of sleep disturbances, which could relate to behavior issues, developmental delays, and learning difficulties. While several studies examine whether sleep exacerbates daytime difficulties and attention deficits in children with IDDs, this chapter focuses on the current state of knowledge regarding sleep and memory consolidation in typically developing (TD) groups and those at risk for learning difficulties. In particular, this chapter summarizes the current literature on sleep-dependent learning across developmental disabilities, including Down syndrome, Williams syndrome, Autism Spectrum Disorder, and Learning Disabilities (Attention-Deficit/Hyperactivity Disorder and Dyslexia). We also highlight the gaps in the current literature and identify challenges in studying sleep-dependent memory in children with different IDDs. This burgeoning new field highlights the importance of considering the role of sleep in memory retention across long delays when evaluating children's memory processes. Further, an understanding of typical and atypical development can mutually inform recent theories of sleep's role in memory.
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Affiliation(s)
- A Luongo
- Department of Psychology, University of Arizona, Tucson, AZ, Unites States
| | - A Lukowski
- Department of Psychological Sciences, University of California Irvine, Irvine, CA, United States
| | - T Protho
- Department of Psychology, University of Arizona, Tucson, AZ, Unites States
| | - H Van Vorce
- Department of Psychology, University of Arizona, Tucson, AZ, Unites States
| | - L Pisani
- Department of Psychology, University of Arizona, Tucson, AZ, Unites States
| | - J Edgin
- Department of Psychology, University of Arizona, Tucson, AZ, Unites States; University of Arizona Sonoran UCEDD, Tucson, AZ, United States.
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40
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Chen CY, Chen CL, Yu CC. Trazodone improves obstructive sleep apnea after ischemic stroke: a randomized, double-blind, placebo-controlled, crossover pilot study. J Neurol 2021; 268:2951-2960. [PMID: 33625584 DOI: 10.1007/s00415-021-10480-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Low arousal threshold plays a part in the pathogenesis of obstructive sleep apnea (OSA) and may be improved by sedatives. Sedative antidepressants are frequently prescribed for stroke patients due to their high prevalence of insomnia and depression. However, the effect of sedative antidepressants on the severity of OSA in stroke patients has not been studied well. METHODS In a double-blinded randomized crossover pilot study, 22 post-acute ischemic stroke patients (mean age, 61.7 ± 10.6 y) with OSA received 100 mg of trazodone or a placebo just before polysomnography, with approximately 1 week between measures. The study also measured baseline heart rate variability and 24-h ambulatory blood pressure. RESULTS Administration of trazodone significantly increased the percentage time of slow-wave sleep (31.5 ± 13.2 vs. 18.4 ± 8.7%; P < 0.001) and improved almost all the parameters of OSA severity, including the apnea-hypopnea index (AHI, 25.4 ± 15.4 vs. 39.1 ± 18.4 events/h; P < 0.001), the respiratory arousal index (9.8 (5.8-11.95) vs. 14.1 (11.3-18.7) events/h; P < 0.001), and the minimum oxygen saturation (80.2 ± 9.1 vs. 77.1 ± 9.6%; P = 0.016). Responders to therapy (AHI reduced by > 50%; n = 7/22) had predominant OSA during rapid-eye-movement sleep and decreased sympathetic tone, as reflected in significantly lower mean blood pressure, diastolic blood pressure, and normalized low-frequency power. CONCLUSIONS Obstructive sleep apnea with comorbid ischemic stroke may be a distinctive phenotype which responds quite well to trazodone, decreasing OSA severity without increasing nocturnal hypoxia. TRIAL REGISTRATION Clinicaltrials.gov: NCT04162743, 2019/11/10.
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Affiliation(s)
- Chung-Yao Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung, Taiwan. .,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Chia-Ling Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan.,Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Chieh Yu
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Pulmonary Critical Care and Sleep Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
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Reither EN, Barnet JH, Palta M, Liu Y, Hagen EW, Peppard PE. Polysomnographic indicators of restorative sleep and body mass trajectories in the Wisconsin Sleep Cohort Study. Sleep 2021; 44:6305987. [PMID: 34145899 DOI: 10.1093/sleep/zsab031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/27/2020] [Indexed: 12/12/2022] Open
Abstract
STUDY OBJECTIVES Previous research suggests that reductions in restorative, slow-wave (N3), and rapid eye movement (REM) sleep are associated with weight gain and obesity in mid-to-late life. We extend prior work by examining how within-person (WP) changes and between-person (BP) differences in restorative sleep over several years are associated with body mass trajectories among participants in the Wisconsin Sleep Cohort Study (WSCS). METHODS We used data from 4,862 polysomnographic (PSG) sleep studies and physical exams collected from 1,187 WSCS participants over an average duration of 14.9 years. Primary measures of interest included body mass index (BMI = kg/m2) and the percentages of time spent in N3 and REM sleep. We estimated a series of linear mixed regression models to examine how WP changes and BP differences in N3 and REM sleep affected BMI trajectories, controlling for other sleep measures, demographic characteristics, and health behaviors as potential confounders. RESULTS Women in the WSCS experienced more rapid BMI gain than men. With some variation by sex, we found that (1) below-average N3 and REM sleep is associated with above-average BMI, and (2) within-person decreases in N3 and REM sleep over time are associated with gains in BMI. These findings persisted after adjustment for sleep duration and other potential confounders. CONCLUSIONS Our findings highlight the importance of PSG indices of restorative sleep in mid-to-late life, suggesting that future clinical treatments and public health policies will benefit from heightened attention to sleep quality.
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Affiliation(s)
- Eric N Reither
- Department of Sociology, Social Work, and Anthropology, Utah State University, Logan, UT, USA
| | - Jodi H Barnet
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Mari Palta
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Yin Liu
- Department of Human Development and Family Studies, Utah State University, Logan, UT, USA
| | - Erika W Hagen
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Paul E Peppard
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
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Moradzadeh M, Mirmohammadkhani M, Tamadon MR, Mansori K, Malek F. Prevalence of Sleep Apnea and its Associated Factors in Chronic Kidney Disease Patients. TANAFFOS 2021; 20:116-125. [PMID: 34976082 PMCID: PMC8710220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 09/20/2020] [Indexed: 06/14/2023]
Abstract
BACKGROUND This study aimed to determine the prevalence of sleep apnea and its associated factors in patients with chronic kidney disease (CKD). MATERIALS AND METHODS This population-based cross-sectional study included 47 CKD patients, referred to the dialysis unit of Kosar Hospital in Semnan, Iran, in 2017. Two questionnaires were used for data collection. The first questionnaire included demographic and clinical variables, and the second questionnaire (STOP-BANG questionnaire) was used to measure sleep apnea in CKD patients. Also, the Apnea-Hypopnea Index (AHI) was calculated for all patients and was considered as the gold standard. To determine the factors associated with sleep apnea, univariate and multiple logistic regression models were used. Finally, the area under the receiver operating characteristic curve (ROC) was determined for assessing the discriminative ability of the model, as well as the accuracy of STOP-BANG questionnaire. STATA version 14 was used for data analysis. RESULTS The prevalence of sleep apnea in CKD patients was 53.2%. Also, its prevalence in women and men was 52% and 48%, respectively. In the multiple logistic regression model, body mass index (BMI) (OR: 1.21, 95% CI: 1.04-1.31) and blood urea nitrogen (BUN) (OR: 0.94, 95% CI: 0.91-0.98) had significant associations with sleep apnea in CKD patients; the area under the ROC curve was 0.7982 for this model. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the ROC curve of STOP-BANG questionnaire for AHI≥15 were 71.43, 61.54, 60, 72.73, and 0.6932, respectively. CONCLUSION This study showed that the prevalence of sleep apnea in CKD patients was high. Given the acceptable validity of STOP-BANG questionnaire, this scale can be used to screen sleep apnea in CKD patients.
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Affiliation(s)
- Maliheh Moradzadeh
- Department of Internal Medicine, Kosar Hospital, Semnan University of Medical Sciences, Semnan, Iran
| | - Majid Mirmohammadkhani
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Mohammad Reza Tamadon
- Department of Internal Medicine, Kosar Hospital, Semnan University of Medical Sciences, Semnan, Iran
| | - Kamyar Mansori
- Department of Biostatistics and Epidemiology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Farhad Malek
- Department of Internal Medicine, Kosar Hospital, Semnan University of Medical Sciences, Semnan, Iran
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Kozu Y, Kurosawa Y, Yamada S, Fukuda A, Hikichi M, Hiranuma H, Akahoshi T, Gon Y. Cluster analysis identifies a pathophysiologically distinct subpopulation with increased serum leptin levels and severe obstructive sleep apnea. Sleep Breath 2020; 25:767-776. [PMID: 32886313 PMCID: PMC8195782 DOI: 10.1007/s11325-020-02160-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/27/2020] [Accepted: 08/01/2020] [Indexed: 01/24/2023]
Abstract
PURPOSE To investigate the different pathophysiologies of obstructive sleep apnea (OSA) phenotypes using cluster analysis. Differences between leptin/adiponectin levels in the resulting OSA phenotypes were also examined. METHODS In total, 1057 OSA patients were selected, and a retrospective survey of clinical records, polysomnography results, and blood gas data was conducted. Patients were grouped into four clusters by their OSA severity, PaCO2, body mass index (BMI), and sleepiness. A k-means cluster analysis was performed, resulting in a division into four subpopulations. The Tukey or Games-Howell tests were used for intergroup comparisons. RESULTS Among the 20 clinical OSA items, four common factors (Epworth Sleepiness Scale [ESS], BMI, Apnea-Hypopnea Index [AHI], and PaCO2) were extracted by principal component analysis, and a cluster analysis was performed using the k-means method, resulting in four distinct phenotypes. The Clusters 1 (middle age, symptomatic severe OSA) and 4 (young, obese, symptomatic very severe OSA) exhibited high leptin levels. C-reactive protein levels were also elevated in Cluster 4, indicating a different pathophysiological background. No apparent differences between clusters were observed regarding adiponectin/leptin ratios and adiponectin levels. Classification into groups based on phenotype showed that Epworth Sleepiness Scale [ESS] score and disease severity were not correlated, suggesting that sleepiness is affected by multiple elements. CONCLUSIONS The existence of multiple clinical phenotypes suggests that different pathophysiological backgrounds exist such as systemic inflammation and metabolic disorder. This classification may be used to determine the efficacy of continuous positive airway pressure treatment that cannot be determined by the AHI.
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Affiliation(s)
- Yutaka Kozu
- Division of Respiratory Disease, Nihon University School of Medicine, 30-1 Ohyaguchi-Kamicho, Itabashiku, Tokyo, 173-8610, Japan.
| | - Yusuke Kurosawa
- Division of Respiratory Disease, Nihon University School of Medicine, 30-1 Ohyaguchi-Kamicho, Itabashiku, Tokyo, 173-8610, Japan
| | - Shiho Yamada
- Division of Respiratory Disease, Nihon University School of Medicine, 30-1 Ohyaguchi-Kamicho, Itabashiku, Tokyo, 173-8610, Japan
| | - Asami Fukuda
- Division of Respiratory Disease, Nihon University School of Medicine, 30-1 Ohyaguchi-Kamicho, Itabashiku, Tokyo, 173-8610, Japan
| | - Mari Hikichi
- Division of Respiratory Disease, Nihon University School of Medicine, 30-1 Ohyaguchi-Kamicho, Itabashiku, Tokyo, 173-8610, Japan
| | - Hisato Hiranuma
- Division of Respiratory Disease, Nihon University School of Medicine, 30-1 Ohyaguchi-Kamicho, Itabashiku, Tokyo, 173-8610, Japan
| | - Toshiki Akahoshi
- Division of Respiratory Disease, Nihon University School of Medicine, 30-1 Ohyaguchi-Kamicho, Itabashiku, Tokyo, 173-8610, Japan
| | - Yasuhiro Gon
- Division of Respiratory Disease, Nihon University School of Medicine, 30-1 Ohyaguchi-Kamicho, Itabashiku, Tokyo, 173-8610, Japan
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Tatineny P, Shafi F, Gohar A, Bhat A. Sleep in the Elderly. MISSOURI MEDICINE 2020; 117:490-495. [PMID: 33311760 PMCID: PMC7723148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Aging is associated with several changes in sleep patterns. Older adults have increased prevalence of primary sleep disorders including insomnia, sleep disordered breathing, restless legs syndrome, REM sleep behavior disorder, and circadian rhythm disturbances. These can be further compromised by sleep disturbances secondary to medical or psychiatric disorders, and medication side effects. This review discusses age-related changes in sleep architecture, etiology, clinical presentation, and treatment options of various sleep disorders in the elderly.
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Affiliation(s)
- Prathusha Tatineny
- Former Fellow, Sleep Medicine Fellowship Program, University of Missouri - Kansas City School of Medicine, Kansas City, Missouri
| | - Fariha Shafi
- MSMA member since 2020, Department of Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Ashraf Gohar
- Associate Professors, Department of Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Abid Bhat
- MSMA member since 2020, is Professor, Department of Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
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Abstract
Sleep maintains the function of the entire body through homeostasis. Chronic sleep deprivation (CSD) is a prime health concern in the modern world. Previous reports have shown that CSD has profound negative effects on brain vasculature at both the cellular and molecular levels, and that this is a major cause of cognitive dysfunction and early vascular ageing. However, correlations among sleep deprivation (SD), brain vascular changes and ageing have barely been looked into. This review attempts to correlate the alterations in the levels of major neurotransmitters (acetylcholine, adrenaline, GABA and glutamate) and signalling molecules (Sirt1, PGC1α, FOXO, P66shc, PARP1) in SD and changes in brain vasculature, cognitive dysfunction and early ageing. It also aims to connect SD-induced loss in the number of dendritic spines and their effects on alterations in synaptic plasticity, cognitive disabilities and early vascular ageing based on data available in scientific literature. To the best of our knowledge, this is the first article providing a pathophysiological basis to link SD to brain vascular ageing.
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Liu Y, Zou J, Qian Y, Xu H, Zhu H, Meng L, Guan J, Yi H, Yin S. The association between obesity indices and obstructive sleep apnea is modified by age in a sex-specific manner. Sleep Breath 2020; 25:189-197. [PMID: 32367469 DOI: 10.1007/s11325-020-02083-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 04/01/2020] [Accepted: 04/06/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND The beneficial effects of weight reduction on obstructive sleep apnea (OSA) are highly variable. Whether or not the variability is associated with the effects of age and sex remains unclear. This study examined this issue with large cross-sectional data. METHOD Anthropometric measurements, polysomnographic variables, biochemical indicators, and medical history were collected for each participant. Multivariable linear regression with interaction terms was used to estimate the modification effect of age on the associations between OSA severity (assessed by apnea-hypopnea index, AHI) with obesity indices (body mass index, BMI; neck circumference, NC; waist circumference, WC; waist-to-hip ratio, WHR) in a sex-specific manner, and vice versa. To facilitate interpretation of the results, participants were further classified into six subpopulations according to both sex and age, and population-specific beta-coefficients were calculated and compared. RESULTS A total of 5756 adults (4600 men) with suspected OSA were included in the study. BMI, NC, WC, and WHR were all positively correlated with AHI after adjusting for potential confounders in all populations. In men, these associations were much stronger and more significant in younger than older individuals (P for interaction < 0.001). For example, a 10% increase in BMI was independently associated with a 32% increase in AHI for men < 40 years old, whereas the corresponding increases were 21% and 17% for men 40-60 and > 60 years old, respectively. By contrast, no modification effect of age was observed in women (P for interaction > 0.05). A 10% increase in BMI was associated with 26%, 27%, and 24% increases in AHI for women < 40, 40-60, and > 60 years old, respectively. CONCLUSIONS Age modifies the associations between obesity indices and OSA severity in a sex-specific manner. These findings may broaden the understanding of age- and sex-related heterogeneities in the pathogenic role of obesity in OSA, and may be beneficial for individualized risk evaluation and treatment management for patients with OSA.
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Affiliation(s)
- Yupu Liu
- Therapy Center of Obstructive Sleep Apnea, Department of Otorhinolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Xuhui District, Shanghai, China
- Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Jianyin Zou
- Therapy Center of Obstructive Sleep Apnea, Department of Otorhinolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Xuhui District, Shanghai, China
- Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Yingjun Qian
- Therapy Center of Obstructive Sleep Apnea, Department of Otorhinolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Xuhui District, Shanghai, China
- Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Huajun Xu
- Therapy Center of Obstructive Sleep Apnea, Department of Otorhinolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Xuhui District, Shanghai, China
- Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Huaming Zhu
- Therapy Center of Obstructive Sleep Apnea, Department of Otorhinolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Xuhui District, Shanghai, China
- Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Lili Meng
- Therapy Center of Obstructive Sleep Apnea, Department of Otorhinolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Xuhui District, Shanghai, China
- Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Jian Guan
- Therapy Center of Obstructive Sleep Apnea, Department of Otorhinolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Xuhui District, Shanghai, China.
- Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China.
| | - Hongliang Yi
- Therapy Center of Obstructive Sleep Apnea, Department of Otorhinolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Xuhui District, Shanghai, China.
- Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China.
| | - Shankai Yin
- Therapy Center of Obstructive Sleep Apnea, Department of Otorhinolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Xuhui District, Shanghai, China
- Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
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47
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Genome-wide association study reveals two novel risk alleles for incident obstructive sleep apnea in the EPISONO cohort. Sleep Med 2020; 66:24-32. [DOI: 10.1016/j.sleep.2019.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 08/02/2019] [Accepted: 08/07/2019] [Indexed: 01/25/2023]
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Full KM, Gallo LC, Malhotra A, Bellettiere J, Kerr J, Arredondo E, Stone KL, Zaslavsky O, Lewis CE, Lin X, Lacroix AZ. Modeling the cardiometabolic benefits of sleep in older women: exploring the 24-hour day. Sleep 2020; 43:zsz205. [PMID: 31553045 PMCID: PMC6955642 DOI: 10.1093/sleep/zsz205] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/15/2019] [Indexed: 12/31/2022] Open
Abstract
STUDY OBJECTIVES Activities throughout the day, including sleep, sedentary behavior (SB), light-intensity physical activity (LIPA), and moderate to vigorous physical activity (MVPA) are independently associated with cardiometabolic health. Few studies have examined interrelationships between sleep and 24-hour activity and associations with cardiometabolic risk. The objective of this study is to understand how replacing time in SB, LIPA, or MVPA with sleep impacts cardiometabolic risk. METHODS Women's Health Initiative OPACH Study participants (N = 3329; mean age = 78.5 ± 6) wore ActiGraph GT3X+ accelerometers 24 hours/7 days. Adjusted linear regression estimated the relationship between sleep duration and cardiometabolic markers. Separately for shorter (<8 hours) and longer (≥8 hours) sleepers, isotemporal substitution models estimated the cross-sectional associations with cardiometabolic markers with reallocating time in daytime activities to or from sleep. RESULTS Longer sleep duration was associated with higher insulin, HOMA-IR, glucose, total cholesterol, and triglycerides (all p < 0.05). The associations between sleep duration and C-reactive protein, waist circumference, and body mass index (BMI) were U-shaped (both p < 0.05). For shorter sleepers, reallocating 33 minutes of MVPA to sleep was associated with higher values of insulin, HOMA-IR, glucose, triglycerides, waist circumference, and BMI (0.7%-11.5%). Replacing 91 minutes of SB time with sleep was associated with lower waist circumference and BMI (-1.3%, -1.8%). For long sleepers, shifting 91 minutes of sleep to SB was associated with higher waist circumference and BMI (1.3%, 1.4%). CONCLUSIONS This is one of the first isotemporal analyses to include objectively measured sleep duration. Results illuminate possible cardiometabolic risks and benefits of reallocating time to or from sleep.
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Affiliation(s)
- Kelsie M Full
- Department of Family Medicine & Public Health, University of California, San Diego, La Jolla, CA
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, CA
- Division of Health Promotion and Behavioral Science, San Diego State University, San Diego, CA
| | - Atul Malhotra
- Division of Pulmonary & Critical Care Medicine, University of California, San Diego School of Medicine, La Jolla, CA
| | - John Bellettiere
- Department of Family Medicine & Public Health, University of California, San Diego, La Jolla, CA
| | - Jacqueline Kerr
- Department of Family Medicine & Public Health, University of California, San Diego, La Jolla, CA
| | - Elva Arredondo
- Division of Health Promotion and Behavioral Science, San Diego State University, San Diego, CA
| | - Katie L Stone
- California Pacific Medical Center Research Institute, University of California San Francisco, San Francisco, CA
| | - Oleg Zaslavsky
- School of Nursing, University of Washington, Seattle, WA
| | - Cora E Lewis
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Xiaochen Lin
- Department of Epidemiology, Brown University, Providence, RI
| | - Andrea Z Lacroix
- Department of Family Medicine & Public Health, University of California, San Diego, La Jolla, CA
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49
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Lusic Kalcina L, Pavlinac Dodig I, Pecotic R, Valic M, Dogas Z. Psychomotor Performance in Patients with Obstructive Sleep Apnea Syndrome. Nat Sci Sleep 2020; 12:183-195. [PMID: 32210650 PMCID: PMC7069561 DOI: 10.2147/nss.s234310] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 02/09/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Determinants of obstructive sleep apnea (OSA) are hypoxemia and hypercapnia, as well as (micro) arousals from sleep, resulting in chronic sleep fragmentation, sleep deprivation, and excessive daytime sleepiness (EDS). All of the above-mentioned factors might contribute to psychomotor impairment seen in OSA patients. Additionally, this study aimed to assess the contribution of BMI, age, EDS assessed with Epworth sleepiness scale (ESS), and severity of OSA assessed with apnea-hypopnea index (AHI) to the reaction time on chronometric tests in OSA patients and controls. It is hypothesized that moderate and severe OSA have adverse effects on reaction time of perception to visual stimulus, of solving simple arithmetic operations, and of psychomotor limbs coordination assessed by chronometric psychodiagnostic test battery. PATIENTS AND METHODS This study was conducted on 206 male participants; 103 of them had moderate or severe OSA diagnosed by whole-night polysomnography/polygraphy. Control participants (N=103), matched to patients with OSA by age and BMI, had no reported OSA in their medical history, no increased risk for OSA, nor EDS. All participants were assessed with three chronometric psychodiagnostic tests, measuring the reaction time of perception to visual stimulus, of solving simple arithmetic operations, and of psychomotor limbs coordination. RESULTS Participants from the OSA group achieved impaired results compared to control participants in minimum single task solving time in speed of solving simple arithmetic operations (3±0.9 and 2.6±0.6, P<0.001), and in minimum solving time of a single task in complex psychomotor limbs coordination (0.69±0.2 and 0.61±0.1, P=0.007). Regression analysis revealed no significant contribution of daytime sleepiness to the results achieved in each of the tests. CONCLUSION It is concluded that severe OSA impaired speed of perception, convergent, and operative thinking. Moreover, it is suggested that EDS did not contribute to poor psychomotor outcome in patients with OSA in this study, when age was controlled for.
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Affiliation(s)
- Linda Lusic Kalcina
- Department of Neuroscience, Split Sleep Medicine Center, University of Split School of Medicine, Split, Croatia
| | - Ivana Pavlinac Dodig
- Department of Neuroscience, Split Sleep Medicine Center, University of Split School of Medicine, Split, Croatia
| | - Renata Pecotic
- Department of Neuroscience, Split Sleep Medicine Center, University of Split School of Medicine, Split, Croatia
| | - Maja Valic
- Department of Neuroscience, Split Sleep Medicine Center, University of Split School of Medicine, Split, Croatia
| | - Zoran Dogas
- Department of Neuroscience, Split Sleep Medicine Center, University of Split School of Medicine, Split, Croatia
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50
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Chen L, Ma W, Tang W, Zha P, Wang C, Chen D, Lei F, Li T, Tang X, Ran X. Prevalence of Obstructive Sleep Apnea in Patients With Diabetic Foot Ulcers. Front Endocrinol (Lausanne) 2020; 11:416. [PMID: 32760345 PMCID: PMC7371781 DOI: 10.3389/fendo.2020.00416] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 05/26/2020] [Indexed: 02/05/2023] Open
Abstract
Objectives: Diabetic foot ulcers (DFUs) are a considerable burden on patients and the healthcare service system. Patients with DFUs have many risk factors that might contribute to obstructive sleep apnea (OSA). The purposes of this study were to assess the prevalence of OSA and associated features in patients with DFUs. Methods: Between July 2017 and June 2019, we recruited 245 consecutive patients who sought for treatment at West China Hospital because of DFUs. Polysomnography data from 127 Patients were included in the final analysis. Results: Of the 127 patients, with a median age of 64 years (interquartile range, 55-73 years; range, 36-86 years) and a mean body mass index (BMI) 24.09 ± 0.37 kg/m2, 91 (72%) were men. The prevalence of OSA [apnea-hypopnea index (AHI) ≧5/h] was 92% in men and 97% in women (P = 0.304). Moderate to severe OSA (AHI ≧15/h) was noted in 44 men (48%) and 26 women (72%) (P = 0.015). The risk factors associated with the severity of OSA were sex, age, smoking, alcohol use, and duration of diabetes. After multivariable adjustment, duration of diabetes and age were independent predictive factors of the severity of OSA. No significant association was observed between BMI, waist circumference, Epworth score, and the severity of OSA. There were no significant associations between OSA and ischemic heart disease, cerebral infarction, hypertension, diabetic retinopathy, diabetic kidney disease, and peripheral artery disease. Conclusions: The prevalence of OSA was high in patients with DFUs, with moderate to severe OSA accounting for more than half of the patients. Age and duration of diabetes were independent predictive factors of the severity of OSA.
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Affiliation(s)
- Lihong Chen
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, China
| | - Wanxia Ma
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, China
| | - Weiwei Tang
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, China
| | - Panpan Zha
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, China
| | - Chun Wang
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, China
| | - Dawei Chen
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, China
| | - Fei Lei
- State Key Laboratory of Biotherapy, Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
| | - Taomei Li
- State Key Laboratory of Biotherapy, Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiangdong Tang
- State Key Laboratory of Biotherapy, Sleep Medicine Center, Mental Health Center, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xingwu Ran
- Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Xingwu Ran
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