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Cao W, Li X, Yan Y, Zhou J, Ye J, Lv Q. Changes in sleep patterns in primary care workers during the first wave of the COVID-19 pandemic in 2022 in Shanghai: a cross-sectional study. Sci Rep 2024; 14:12373. [PMID: 38811616 PMCID: PMC11137069 DOI: 10.1038/s41598-024-61311-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 05/03/2024] [Indexed: 05/31/2024] Open
Abstract
The coronavirus disease (COVID-19) pandemic has significantly affected the sleep health of healthcare workers (HCWs); however, no studies have assessed this effect in primary HCWs. This cross-sectional, web-based study explored the prevalence and factors associated with sleep disorders among primary HCWs during the first COVID-19 outbreak in Shanghai from 12 July to 15 August 2022. Sociodemographic and work-related characteristics, various sleep dimensions, and exposure to patients with COVID-19 were assessed. They were screened for common mental disorders (depression, burnout, and stress). Overall, 313 primary HCWs were recruited. At least one sleep dimension in 84% of respondents deteriorated compared with that observed pre-pandemic; sleep quality (decline of 66%) and daytime sleepiness (increase of 56%) were the most affected domains. After excluding 145 primary HCWs with pre-pandemic 'poor sleep', depression (odds ratio [OR] 3.08; 95% confidence interval [CI] 1.59-5.98), weekly burnout symptoms (OR 2.57; 95% CI 1.32-5.03), and high psychological stress (OR 4.51; 95% CI 2.09-9.72) were associated with poor sleep patterns during the pandemic. After adjusting for significant differences between groups, for every 1-point increase in the Perceived Stress Scale score, an associated 12% increased risk of poor sleep (adjusted OR 1.12; 95% CI 1.05-1.21; p = 0.002) was observed. Most primary HCWs showed significant worsening of sleep quality, with increases in daytime sleepiness during the first wave of the COVID-19 pandemic in Shanghai. HCWs with high stress levels were at greater risks of sleep disorders.
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Affiliation(s)
- Wenshu Cao
- Tianlin Community Health Center of Xuhui District, 500 Liuzhou Road, Shanghai, China
| | - Xiaoting Li
- Nanhui New Town Community Health Service Center of Pudong New Area, 280 Chaohe Road, Shanghai, China
| | - Yini Yan
- Tianlin Community Health Center of Xuhui District, 500 Liuzhou Road, Shanghai, China
| | - Jianfeng Zhou
- Tianlin Community Health Center of Xuhui District, 500 Liuzhou Road, Shanghai, China
| | - Jizhong Ye
- Tianlin Community Health Center of Xuhui District, 500 Liuzhou Road, Shanghai, China.
| | - Qiwei Lv
- Tianlin Community Health Center of Xuhui District, 500 Liuzhou Road, Shanghai, China.
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2
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Hu H, Wu Y, Zhao M, Liu J, Xie P. Sleep duration time and human papillomavirus infection risk: The U-shaped relationship revealed by NHANES data. PLoS One 2024; 19:e0301212. [PMID: 38578744 PMCID: PMC10997073 DOI: 10.1371/journal.pone.0301212] [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: 12/13/2023] [Accepted: 03/12/2024] [Indexed: 04/07/2024] Open
Abstract
PURPOSE This study aims to investigate the relationship between sleep factors (sleep duration time [SDT] and obstructive sleep apnea [OSA]) and human papillomavirus (HPV)/high-risk HPV(HR-HPV) infection, utilizing data from the National Health and Nutrition Examination Survey (NHANES). METHODS We conducted a cross-sectional analysis using NHANES data, focusing on SDT and OSA's association with HPV/HR-HPV infection. The primary statistical methods included weighted multivariate linear regression and logistic regression to assess the association between SDT, OSA, and HPV/HR-HPV infection. The study employed restricted cubic splines (RCS) for evaluating potential non-linear relationships between SDT and HPV/HR-HPV infection. Subgroup analyses were conducted. Interaction terms were used to examine the heterogeneity in associations across different subgroups. RESULTS The study identified a U-shaped relationship between SDT and HPV infection. Specifically, 7 hours of sleep was associated with the lowest risk of HPV infection. In comparison, SDT less than 7 hours resulted in a 26.3% higher risk of HPV infection (Odds Ratio [OR] = 1.26, 95% Confidence Interval [CI]: 1.029, 1.549), and more than 9 hours of sleep showed a 57.4% increased risk (OR = 1.574, 95% CI: 1.116, 2.220). The relationship between SDT and HR-HPV infection was significant in the first two models, but not in the fully adjusted model. No significant interaction was found between sleep duration and other covariates. There was no association between OSA and HPV/HR-HPV infection. CONCLUSION The study underscores the complex relationship between sleep duration and HPV infection risk, suggesting both very short and very long sleep durations may increase HPV infection likelihood. The findings highlight the need for further research to explore the biological mechanisms underpinning this association and to consider broader population groups and more precise sleep assessment methods in future studies.
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Affiliation(s)
- Huangyu Hu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture School of Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yue Wu
- Sichuan University West China Second University Hospital, Chengdu, China
| | - Min Zhao
- Acupuncture School of Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jiaqi Liu
- Acupuncture School of Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ping Xie
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Schilling C, Nieters A, Schredl M, Peter RS, Rothenbacher D, Brockmann SO, Göpel S, Kindle G, Merle U, Steinacker JM, Kern W. Pre-existing sleep problems as a predictor of post-acute sequelae of COVID-19. J Sleep Res 2024; 33:e13949. [PMID: 37227000 DOI: 10.1111/jsr.13949] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/13/2023] [Accepted: 05/08/2023] [Indexed: 05/26/2023]
Abstract
Several months after COVID-19 many individuals still report persisting symptoms, the so-called 'post-COVID-19 syndrome'. An immunological dysfunction is one of the main pathophysiological hypotheses. As sleep is central to the functioning of the immune system, we investigated whether self-reported pre-existing sleep disturbance might be an independent risk factor for the development of post-COVID-19 syndrome. A total of 11,710 participants of a cross-sectional survey (all tested positive for severe acute respiratory syndrome coronavirus-2) were classified into probable post-COVID-19 syndrome, an intermediate group, and unaffected participants at an average of 8.5 months after infection. The case definition was based on newly occurring symptoms of at least moderate severity and ≥20% reduction in health status and/or working capacity. Unadjusted and adjusted odds ratios were calculated to investigate the association between pre-existing sleep disturbances and subsequent development of post-COVID-19 syndrome while controlling for a variety of demographic, lifestyle, and health factors. Pre-existing sleep disturbances were found to be an independent predictor of subsequent probable post-COVID-19 syndrome (adjusted odds ratio 2.7, 95% confidence interval 2.27-3.24). Sleep disturbances as part of the post-COVID-19 syndrome were reported by more than half of the participants and appeared to be a new symptom and to occur independent of a mood disorder in most cases. Recognition of disturbed sleep as an important risk factor for post-COVID-19 syndrome should promote improved clinical management of sleep disorders in the context of COVID-19. Further, it may stimulate further research on the effect of improving sleep on the prognosis of COVID-19 long-term sequelae and other post-viral conditions.
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Affiliation(s)
- Claudia Schilling
- Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Sleep Laboratory, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Alexandra Nieters
- Institute for Immunodeficiency, Medical Centre and Faculty of Medicine, Albert-Ludwigs-University, Freiburg, Germany
| | - Michael Schredl
- Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Sleep Laboratory, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Raphael S Peter
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | - Stefan O Brockmann
- Department of Health Protection, Infection Control and Epidemiology, Baden-Wuerttemberg Federal State Health Office, Ministry of Social Affairs, Health and Integration Stuttgart, Stuttgart, Germany
| | - Siri Göpel
- Division of Infectious Diseases, Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany
| | - Gerhard Kindle
- Institute for Immunodeficiency, Medical Centre and Faculty of Medicine, Albert-Ludwigs-University, Freiburg, Germany
| | - Uta Merle
- Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany
| | - Jürgen M Steinacker
- Division of Sports and Rehabilitation Medicine, Department of Medicine, Ulm University Hospital, Ulm, Germany
| | - Winfried Kern
- Division of Infectious Diseases, Department of Medicine II, Medical Centre and Faculty of Medicine, Albert-Ludwigs-University, Freiburg, Germany
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Bjorvatn B, Waage S, Emberland KE, Litleskare S, Rebnord IK, Forthun I, Rortveit G. The associations between different types of infections and circadian preference and shift work. Chronobiol Int 2024; 41:259-266. [PMID: 38221779 DOI: 10.1080/07420528.2024.2303986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/05/2024] [Indexed: 01/16/2024]
Abstract
Disturbed sleep and circadian disruption are reported to increase the risk of infections. People with an evening circadian preference and night workers typically report insufficient sleep, and the aims of the present study were to investigate possible associations between various types of infections and circadian preference and shift work status. Data were collected from an online cross-sectional survey of 1023 participants recruited from the Norwegian practice-based research network in general practice - PraksisNett. The participants completed questions about circadian preference (morning type, intermediate type, evening type), work schedule (day work, shift work without nights, shift work with night shifts), and whether they had experienced infections during the last three months (common cold, throat infection, ear infection, sinusitis, pneumonia/bronchitis, COVID-19, influenza-like illness, skin infection, gastrointestinal infection, urinary infection, venereal disease, eye infection). Data were analyzed with chi-square tests and logistic regression analyses with adjustment for relevant confounders (gender, age, marital status, country of birth, children living at home, and educational level). Results showed that evening types more often reported venereal disease compared to morning types (OR = 4.01, confidence interval (CI) = 1.08-14.84). None of the other infections were significantly associated with circadian preference. Shift work including nights was associated with higher odds of influenza-like illness (OR = 1.97, CI = 1.10-3.55), but none of the other infections. In conclusion, neither circadian preference nor shift work seemed to be strongly associated with risk of infections, except for venereal disease (more common in evening types) and influenza-like illness (more common in night workers). Longitudinal studies are needed for causal inferences.
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Affiliation(s)
- Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Siri Waage
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Knut Erik Emberland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Sverre Litleskare
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - Ingrid K Rebnord
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Ingeborg Forthun
- Department of Disease Burden, Norwegian Institute of Public Health, Bergen, Norway
| | - Guri Rortveit
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Li N, Liu C, Qiu L, Shen C, Zhang F, Lu Z, Zhou M, Sheng D, Liu Z. Study on the correlation between lifestyle and negative conversion time in patients diagnosed with coronavirus disease (COVID-19): a retrospective cohort study. BMC Public Health 2023; 23:2410. [PMID: 38049851 PMCID: PMC10696701 DOI: 10.1186/s12889-023-17163-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/06/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND As of early December 2022, China eased the coronavirus disease (COVID-19) restriction, affecting over 80% of the country's population and posing a severe threat to public health. Previous studies mostly focused factors on the severity/mortality rate of hospitalized COVID-19 patients, but limited studies explored factors associated with virus-negative conversion, particularly lifestyles. Therefore, the aim of our study was to analyze the correlation between lifestyle factors and the negative conversion time in COVID-19 patients. METHODS We recruited individuals aged 18 years or older who had a clear time record for both the diagnosis and negative conversion of COVID-19 and completed the electronic questionnaire with no missing data. Dietary data collected from the questionnaire was analyzed using exploratory factor analysis to establish dietary patterns. Age segmentation was performed using restricted cubic spline (RCS) plots. The association between lifestyle factors and the time to negative conversion in different age groups, was assessed using Kaplan-Meier plots and Cox regression analysis. RESULT Out of 514 participants, all achieved viral negative conversion within a median time of 11 days. Based on nutrient intake, we identified four dietary patterns. The relationship between age and negative conversion rate, as depicted by RCS plots, exhibited an inverted "U" shape. We categorized age into three segments: <35 years, 35-45 years, and ≥ 45 years. For individuals under 35, our study indicated that a higher protein intake was linked to a faster recovery among COVID-19 patients, while medical staff or those receiving prescription treatments exhibited a slower recovery rate (P < 0.05). The 35 ~ 45 age group showed that adequate sleep and physical exercise were associated with a shorter time to negative conversion, whereas southern regions and a higher intake of carbohydrates were related with a longer conversion time (P < 0.05). Among individuals aged ≥ 45 years, the negative conversion time was primarily associated with physical exercise and being a medical staff member(P < 0.05). CONCLUSION Our research suggests that adequate sleep, physical exercise and a higher protein intake can help alleviate COVID-19 symptoms, while a higher level of carbohydrates intake may hinder recovery from COVID-19.
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Affiliation(s)
- Nan Li
- Health Management Center, The First Affiliated Hospital of Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, Shangcheng District, China
| | - Chenbing Liu
- Health Management Center, The First Affiliated Hospital of Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, Shangcheng District, China
| | - Lihong Qiu
- Health Management Center, The First Affiliated Hospital of Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, Shangcheng District, China
| | - Chao Shen
- Health Management Center, The First Affiliated Hospital of Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, Shangcheng District, China
| | - Feng Zhang
- Health Management Center, The First Affiliated Hospital of Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, Shangcheng District, China
| | - Zhangfan Lu
- Health Management Center, The First Affiliated Hospital of Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, Shangcheng District, China
| | - Menghao Zhou
- Health Management Center, The First Affiliated Hospital of Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, Shangcheng District, China
| | - Di Sheng
- Health Management Center, The First Affiliated Hospital of Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, Shangcheng District, China
| | - Zhong Liu
- Health Management Center, The First Affiliated Hospital of Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, Shangcheng District, China.
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6
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Bjorvatn B, Rørtveit G, Rebnord I, Waage S, Emberland KE, Forthun I. Self-reported short and long sleep duration, sleep debt and insomnia are associated with several types of infections: Results from the Norwegian practice-based research network in general practice - PraksisNett. Sleep Med X 2023; 5:100074. [PMID: 37223609 PMCID: PMC10200965 DOI: 10.1016/j.sleepx.2023.100074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 05/25/2023] Open
Abstract
Objective The objective was to assess the association between self-reported infections and sleep duration, sleep debt, chronic insomnia, and insomnia severity. Methods In total, 1023 participants were recruited from the Norwegian practice-based research network in general practice to a cross-sectional online survey with validated questions about sleep habits and insomnia symptoms (Bergen Insomnia Scale (BIS) and Insomnia Severity Index (ISI)), and whether they had experienced various infections during the last three months. Data were analyzed with chi-square tests and logistic regressions with adjustment for relevant confounders. Results Self-reported short sleep duration (<6 h) was significantly associated with increased odds of throat infection (OR = 1.60), ear infection (OR = 2.92), influenzalike illness (OR = 1.81) and gastrointestinal infection (OR = 1.91) whereas long sleep duration (>9 h) was associated with increased odds of throat (OR = 3.33) and ear infections (OR = 5.82), compared to sleep duration of 6-9 h, respectively. Sleep debt of >2 h was associated with increased odds of the common cold (OR = 1.67), throat infection (OR = 2.58), ear infection (OR = 2.84), sinusitis (OR = 2.15), pneumonia/bronchitis (OR = 3.97), influenzalike illness (OR = 2.66), skin infection (OR = 2.15), and gastrointestinal infection (OR = 2.80), compared to no sleep debt. Insomnia (based on BIS and ISI) was associated with throat infection (OR = 2.06, 2.55), ear infection (OR = 2.43, 2.45), sinusitis (OR = 1.82, 1.80), pneumonia/bronchitis (OR = 2.23, 3.59), influenzalike illness (OR = 1.77, 1.90), skin infection (OR = 1.64, 2.06), gastrointestinal infection (OR = 1.94, 3.23), and eye infection (OR = 1.99, 2.95). Conclusions These novel findings support the notion that people who have insufficient sleep or sleep problems are at increased risk of infections.
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Affiliation(s)
- Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Guri Rørtveit
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Ingrid Rebnord
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Siri Waage
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Knut Erik Emberland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Ingeborg Forthun
- Department of Disease Burden, Norwegian Institute of Public Health, Bergen, Norway
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7
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Lin YN, Zhou LN, Liu ZR, Wang Y, Li SQ, Lu FY, Zhang L, Li QY. Short Sleep Duration is Associated with Prolonged Virus Shedding in SARS-CoV-2 Omicron-Infected Patients. Nat Sci Sleep 2023; 15:547-554. [PMID: 37441268 PMCID: PMC10335320 DOI: 10.2147/nss.s411677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
Purpose Sleep disturbance has been implicated in poor prognosis of coronavirus disease 2019 (COVID-19), but less is known about the influence of short sleep duration on COVID-19 outcomes. We aim to investigate whether short sleep duration is associated with prolonged virus shedding duration in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron-infected patients. Patients and Methods A total of 270 patients with a laboratory confirmed COVID-19 diagnosis during SARS-CoV-2 Omicron-predominant period were recruited. Self-reported sleep duration of the patients was collected. The two-way analysis of variance (ANOVA) was used to determine the interactions between sleep duration and variables, and multivariate logistic regression analysis was used to analyze the effect of independent variables on longer virus shedding duration. Results The two-way ANOVA revealed a significant sleep duration × snoring interaction effect for virus shedding duration, and a sleep duration × sex interaction effect for virus shedding duration. Multivariate logistic regression model illustrated that patients sleeping <6 h were at greater risk of prolonged virus shedding duration compared to those sleeping ≥6 hours (OR = 1.80, 95% CI = 1.01-3.26), independent of age, sex, co-existing diseases, vaccination condition, and antiviral treatment. Conclusion Short sleep duration (<6 h) was associated with increased virus shedding in SARS-CoV-2 Omicron-infected patients.
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Affiliation(s)
- Ying Ni Lin
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 20025, People’s Republic of China
- Institute of Respiratory Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People’s Republic of China
| | - Li Na Zhou
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 20025, People’s Republic of China
- Institute of Respiratory Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People’s Republic of China
| | - Zhuo Ran Liu
- Department of Thyroid and Vascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People’s Republic of China
| | - Yi Wang
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 20025, People’s Republic of China
- Institute of Respiratory Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People’s Republic of China
| | - Shi Qi Li
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 20025, People’s Republic of China
- Institute of Respiratory Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People’s Republic of China
| | - Fang Ying Lu
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 20025, People’s Republic of China
- Institute of Respiratory Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People’s Republic of China
| | - Liu Zhang
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 20025, People’s Republic of China
- Institute of Respiratory Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People’s Republic of China
| | - Qing Yun Li
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 20025, People’s Republic of China
- Institute of Respiratory Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People’s Republic of China
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Jones SE, Maisha FI, Strausz SJ, Lammi V, Cade BE, Tervi A, Helaakoski V, Broberg ME, Lane JM, Redline S, Saxena R, Ollila HM. The public health impact of poor sleep on severe COVID-19, influenza and upper respiratory infections. EBioMedicine 2023; 93:104630. [PMID: 37301713 PMCID: PMC10248098 DOI: 10.1016/j.ebiom.2023.104630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 05/02/2023] [Accepted: 05/11/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Poor sleep is associated with an increased risk of infections and all-cause mortality but the causal direction between poor sleep and respiratory infections has remained unclear. We examined if poor sleep contributes as a causal risk factor to respiratory infections. METHODS We used data on insomnia, influenza and upper respiratory infections (URIs) from primary care and hospital records in the UK Biobank (N ≈ 231,000) and FinnGen (N ≈ 392,000). We computed logistic regression to assess association between poor sleep and infections, disease free survival hazard ratios, and performed Mendelian randomization analyses to assess causality. FINDINGS Utilizing 23 years of registry data and follow-up, we discovered that insomnia diagnosis associated with increased risk for infections (FinnGen influenza Cox's proportional hazard (CPH) HR = 4.34 [3.90, 4.83], P = 4.16 × 10-159, UK Biobank influenza CPH HR = 1.54 [1.37, 1.73], P = 2.49 × 10-13). Mendelian randomization indicated that insomnia causally predisposed to influenza (inverse-variance weighted (IVW) OR = 1.65, P = 5.86 × 10-7), URI (IVW OR = 1.94, P = 8.14 × 10-31), COVID-19 infection (IVW OR = 1.08, P = 0.037) and risk of hospitalization from COVID-19 (IVW OR = 1.47, P = 4.96 × 10-5). INTERPRETATION Our findings indicate that chronic poor sleep is a causal risk factor for contracting respiratory infections, and in addition contributes to the severity of respiratory infections. These findings highlight the role of sleep in maintaining sufficient immune response against pathogens. FUNDING Instrumentarium Science Foundation, Academy of Finland, Signe and Ane Gyllenberg Foundation, National Institutes of Health.
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Affiliation(s)
- Samuel E Jones
- Institute for Molecular Medicine Finland, HiLIFE, University of Helsinki, Finland
| | - Fahrisa I Maisha
- Department of Neurology, School of Medicine, Yale University, New Haven, CT, USA; Broad Institute of MIT and Harvard, Cambridge, MA, USA; Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Satu J Strausz
- Institute for Molecular Medicine Finland, HiLIFE, University of Helsinki, Finland; Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Vilma Lammi
- Institute for Molecular Medicine Finland, HiLIFE, University of Helsinki, Finland
| | - Brian E Cade
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Anniina Tervi
- Institute for Molecular Medicine Finland, HiLIFE, University of Helsinki, Finland
| | - Viola Helaakoski
- Institute for Molecular Medicine Finland, HiLIFE, University of Helsinki, Finland
| | - Martin E Broberg
- Institute for Molecular Medicine Finland, HiLIFE, University of Helsinki, Finland
| | - Jacqueline M Lane
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Broad Institute of MIT and Harvard, Cambridge, MA, USA; Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Richa Saxena
- Broad Institute of MIT and Harvard, Cambridge, MA, USA; Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA; Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Hanna M Ollila
- Institute for Molecular Medicine Finland, HiLIFE, University of Helsinki, Finland; Broad Institute of MIT and Harvard, Cambridge, MA, USA; Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA; Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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9
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Taylor L, Von Lendenfeld F, Ashton A, Sanghani H, Di Pretoro S, Usselmann L, Veretennikova M, Dallmann R, McKeating JA, Vasudevan S, Jagannath A. Sleep and circadian rhythm disruption alters the lung transcriptome to predispose to viral infection. iScience 2023; 26:105877. [PMID: 36590897 PMCID: PMC9788990 DOI: 10.1016/j.isci.2022.105877] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 10/11/2022] [Accepted: 12/21/2022] [Indexed: 12/26/2022] Open
Abstract
Sleep and circadian rhythm disruption (SCRD), as encountered during shift work, increases the risk of respiratory viral infection including SARS-CoV-2. However, the mechanism(s) underpinning higher rates of respiratory viral infection following SCRD remain poorly characterized. To address this, we investigated the effects of acute sleep deprivation on the mouse lung transcriptome. Here we show that sleep deprivation profoundly alters the transcriptional landscape of the lung, causing the suppression of both innate and adaptive immune systems, disrupting the circadian clock, and activating genes implicated in SARS-CoV-2 replication, thereby generating a lung environment that could promote viral infection and associated disease pathogenesis. Our study provides a mechanistic explanation of how SCRD increases the risk of respiratory viral infections including SARS-CoV-2 and highlights possible therapeutic avenues for the prevention and treatment of respiratory viral infection.
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Affiliation(s)
- Lewis Taylor
- Sleep and Circadian Neuroscience Institute (SCNi), Nuffield Department of Clinical Neurosciences, New Biochemistry Building, University of Oxford, South Parks Road, Oxford OX1 3QU, UK
| | - Felix Von Lendenfeld
- Sleep and Circadian Neuroscience Institute (SCNi), Nuffield Department of Clinical Neurosciences, New Biochemistry Building, University of Oxford, South Parks Road, Oxford OX1 3QU, UK
| | - Anna Ashton
- Sleep and Circadian Neuroscience Institute (SCNi), Nuffield Department of Clinical Neurosciences, New Biochemistry Building, University of Oxford, South Parks Road, Oxford OX1 3QU, UK
| | - Harshmeena Sanghani
- Department of Pharmacology, University of Oxford, Mansfield Road, Oxford OX1 3QT, UK
| | - Simona Di Pretoro
- Sleep and Circadian Neuroscience Institute (SCNi), Nuffield Department of Clinical Neurosciences, New Biochemistry Building, University of Oxford, South Parks Road, Oxford OX1 3QU, UK
| | - Laura Usselmann
- Division of Biomedical Sciences, Warwick Medical School, Interdisciplinary Biomedical Research Building, Gibbet Hill Campus, University of Warwick, Coventry CV4 7AL, UK
| | - Maria Veretennikova
- Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, Department of Mathematics, Mathematical Sciences Building, University of Warwick, Coventry CV4 7AL, UK
| | - Robert Dallmann
- Division of Biomedical Sciences, Warwick Medical School, Interdisciplinary Biomedical Research Building, Gibbet Hill Campus, University of Warwick, Coventry CV4 7AL, UK
| | - Jane A. McKeating
- Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford OX3 7BN, UK
- Chinese Academy of Medical Sciences (CAMS) Oxford Institute (COI), University of Oxford, Old Road Campus, Oxford OX3 7BN, UK
| | - Sridhar Vasudevan
- Department of Pharmacology, University of Oxford, Mansfield Road, Oxford OX1 3QT, UK
| | - Aarti Jagannath
- Sleep and Circadian Neuroscience Institute (SCNi), Nuffield Department of Clinical Neurosciences, New Biochemistry Building, University of Oxford, South Parks Road, Oxford OX1 3QU, UK
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10
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Knapik JJ, Caldwell JA, Steelman RA, Trone DW, Farina EK, Lieberman HR. Short sleep duration is associated with a wide variety of medical conditions among United States military service members. Sleep Med 2023; 101:283-295. [PMID: 36470164 DOI: 10.1016/j.sleep.2022.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This cross-sectional study investigated self-reported sleep duration and its association with a comprehensive range of clinically-diagnosed medical condition categories (CDMCs), as well as the relationship between short sleep duration (≤6 h) and demographic/lifestyle factors, among United States military service members (SMs). METHODS A stratified random sample of SMs (n = 20,819) completed an online questionnaire on usual daily hours of sleep and demographic/lifestyle characteristics. CDMCs for a six-month period prior to questionnaire completion were obtained from a comprehensive military electronic medical surveillance system and grouped into 33 CDMCs covering both broad and specific medical conditions. Prevalence of CDMCs was compared among three sleep duration categories (≤4, 5-6 and ≥7 h). RESULTS SMs reported a mean ± standard deviation of 6.3 ± 1.4 h of sleep per day. After adjustment for demographic/lifestyle characteristics, shorter sleep duration was associated with higher odds of a medical condition in 25 of 33 CDMCs, with most (n = 20) demonstrating a dose-response relationship. The five CDMCs with the largest differences between ≤4 vs ≥ 7 h sleep were: diseases of the nervous system (odds ratio [OR] = 2.9, 95% confidence interval [95%CI] = 2.4-3.4), mental/behavioral diseases (OR = 2.7, 95%CI = 2.3-3.2), diseases of the musculoskeletal system (OR = 1.9, 95%CI = 1.6-2.1), diseases of the circulatory system (OR = 1.7, 95%CI = 1.3-2.2), and diseases of the digestive system (OR = 1.6, 95%CI = 1.2-2.0). Six hours of sleep or less was independently associated with older age, less formal education, race, Hispanic ethnicity, higher body mass index, smoking, and military service branch. CONCLUSIONS In this young, physically active population, reporting shorter sleep duration was associated with a higher risk of multiple CDMCs.
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Affiliation(s)
- Joseph J Knapik
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA, 01760, USA.
| | - John A Caldwell
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA, 01760, USA; Laulima Government Solutions, 5301 Buckystown Pike, STE 460, Frederick, MD, 21704, USA
| | - Ryan A Steelman
- U.S. Army Public Health Center, 8252 Blackhawk Rd, Aberdeen Proving Ground, MD, 21010, USA
| | - Daniel W Trone
- Naval Health Research Center, Building 329, Ryne Rd, San Diego, CA, 92152, USA
| | - Emily K Farina
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA, 01760, USA
| | - Harris R Lieberman
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA, 01760, USA
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11
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Bjorvatn B, Merikanto I, Reis C, Korman M, Bjelajac AK, Holzinger B, De Gennaro L, Wing YK, Morin CM, Espie CA, Benedict C, Landtblom AM, Matsui K, Hrubos-Strøm H, Mota-Rolim S, Nadorff MR, Plazzi G, Chan RNY, Partinen M, Dauvilliers Y, Chung F, Forthun I. Shift workers are at increased risk of severe COVID-19 compared with day workers: Results from the international COVID sleep study (ICOSS) of 7141 workers. Chronobiol Int 2022; 40:114-122. [PMID: 36412198 DOI: 10.1080/07420528.2022.2148182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The present study had two main aims. First, to investigate whether shift/night workers had a higher prevalence and severity of COVID-19 compared with day workers. Second, to investigate whether people regularly working in face-to-face settings during the pandemic exhibited a higher prevalence and severity of COVID-19 compared with those having no need to be in close contact with others at work. Data consisted of 7141 workers from 15 countries and four continents who participated in the International COVID Sleep Study-II (ICOSS-II) between May and December 2021. The associations between work status and a positive COVID-19 test and several indications of disease severity were tested with chi-square tests and logistic regressions adjusted for relevant confounders. In addition, statistical analyses were conducted for the associations between face-to-face work and COVID-19 status. Results showed that shift/night work was not associated with an increased risk of COVID-19 compared to day work. Still, shift/night workers reported higher odds for moderate to life-threatening COVID-19 (adjusted odds ratio (aOR) = 2.71, 95%-confidence interval = 1.23-5.95) and need for hospital care (aOR = 5.66, 1.89-16.95). Face-to-face work was associated with an increased risk of COVID-19 (aOR = 1.55, 1.12-2.14) but not with higher disease severity. In conclusion, shift/night work was not associated with an increased risk of COVID-19, but when infected, shift/night workers reported more severe disease. Impaired sleep and circadian disruption commonly seen among shift/night workers may be mediating factors. Working face-to-face increased the risk of COVID-19, likely due to increased exposure to the virus. However, face-to-face work was not associated with increased disease severity.
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Affiliation(s)
- Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway and Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Ilona Merikanto
- SleepWell Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland and Orton Orthopaedics Hospital, Helsinki, Finland
| | - Catia Reis
- Universidade Católica Portuguesa, Católica Research Centre for Psychological, Family and Social Wellbeing, Lisbon, Portugal and Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina de Lisboa, Lisboa, Portugal
| | - Maria Korman
- Department of Occupational Therapy, Faculty of Health Sciences, Ariel University, Ariel, Israel
| | | | - Brigitte Holzinger
- Institute for Consciousness and Dream Research, Medical University of Vienna, Wien, Postgraduate, Sleep Coaching, Vienna, Austria
| | - Luigi De Gennaro
- Department of Psychology, Sapienza University of Rome, Roma, Lazio, Italy and IRCCS Fondazione Santa Lucia, Roma, Italy
| | - Yun Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Charles M. Morin
- Centre de recherche CERVO/Brain Research Center, École de psychologie, Université Laval, Quebec, Quebec, Canada
| | - Colin A. Espie
- Sir Jules Thorn Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Christian Benedict
- Department of Pharmaceutical Biosciences, Molecular Neuropharmacology, Uppsala University, Uppsala, Sweden
| | - Anne-Marie Landtblom
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Kentaro Matsui
- Department of Clinical Laboratory, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Harald Hrubos-Strøm
- Department of Otorhinolaryngology, Akershus University Hospital, Lørenskog, Norway and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sérgio Mota-Rolim
- Brain Institute, Physiology and Behavior Department and Onofre Lopes University Hospital, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Michael R. Nadorff
- Department of Psychology, Mississippi State University, Mississippi, Mississippi, USA
| | - Giuseppe Plazzi
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy; and Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Rachel Ngan Yin Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Markku Partinen
- Department of Clinical Neurosciences, University of Helsinki Clinicum Unit, Helsinki, Finland and Helsinki Sleep Clinic, Terveystalo Healthcare Services, Helsinki, Finland
| | - Yves Dauvilliers
- Sleep-Wake Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, Institute for Neurosciences of Montpellier INM, INSERM, University of Montpellier, Montpellier, France
| | - Frances Chung
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Ingeborg Forthun
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway and Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
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12
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Orysiak J, Młynarczyk M, Piec R, Jakubiak A. Lifestyle and environmental factors may induce airway and systemic inflammation in firefighters. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:73741-73768. [PMID: 36094704 PMCID: PMC9465149 DOI: 10.1007/s11356-022-22479-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/07/2022] [Indexed: 06/15/2023]
Abstract
Health status depends on multiple genetic and non-genetic factors. Nonheritable factors (such as lifestyle and environmental factors) have stronger impact on immune responses than genetic factors. Firefighters work is associated with exposure to air pollution and heat stress, as well as: extreme physical effort, mental stress, or a changed circadian rhythm, among others. All these factors can contribute to both, short-term and long-term impairment of the physical and mental health of firefighters. Increased levels of some inflammatory markers, such as pro-inflammatory cytokines or C-reactive protein (CRP) have been observed in firefighters, which can lead to local, acute inflammation that promotes a systemic inflammatory response. It is worth emphasizing that inflammation is one of the main hallmarks of cancer and also plays a key role in the development of cardiovascular and respiratory diseases. This article presents possible causes of the development of an inflammatory reaction in firefighters, with particular emphasis on airway inflammation caused by smoke exposure.
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Affiliation(s)
- Joanna Orysiak
- Central Institute for Labour Protection - National Research Institute, Czerniakowska St. 16, 00-701, Warsaw, Poland.
| | - Magdalena Młynarczyk
- Central Institute for Labour Protection - National Research Institute, Czerniakowska St. 16, 00-701, Warsaw, Poland
| | - Robert Piec
- Institute of Internal Security, The Main School of Fire Service, Słowackiego St. 52/54, 01-629, Warsaw, Poland
| | - Agnieszka Jakubiak
- Department of Heart Failure and Cardiac Rehabilitation, Medical University of Warsaw, Żwirki and Wigury St. 61, 02-091, Warsaw, Poland
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13
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Walsh NP, Kashi DS, Edwards JP, Richmond C, Oliver SJ, Roberts R, Izard RM, Jackson S, Greeves JP. Good perceived sleep quality protects against the raised risk of respiratory infection during sleep restriction in young adults. Sleep 2022; 46:6702165. [PMID: 36112383 PMCID: PMC9832516 DOI: 10.1093/sleep/zsac222] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/09/2022] [Indexed: 01/14/2023] Open
Abstract
STUDY OBJECTIVES Prospectively examine the association between sleep restriction, perceived sleep quality (PSQ) and upper respiratory tract infection (URTI). METHODS In 1318 military recruits (68% males) self-reported sleep was assessed at the beginning and end of a 12-week training course. Sleep restriction was defined as an individualized reduction in sleep duration of ≥2 hours/night compared with civilian life. URTIs were retrieved from medical records. RESULTS On commencing training, approximately half of recruits were sleep restricted (52%; 2.1 ± 1.6 h); despite the sleep debt, 58% of recruits with sleep restriction reported good PSQ. Regression adjusted for covariates showed that recruits commencing training with sleep restriction were more likely to suffer URTI during the course (OR = 2.93, 95% CI 1.29-6.69, p = .011). Moderation analysis showed this finding was driven by poor PSQ (B = -1.12, SE 0.50, p = .023), as no significant association between sleep restriction and URTI was observed in recruits reporting good PSQ, despite a similar magnitude of sleep restriction during training. Associations remained in the population completing training, accounting for loss to follow-up. Recruits reporting poor PSQ when healthy at the start and end of training were more susceptible to URTI (OR = 3.16, 95% CI 1.31-7.61, p = .010, vs good PSQ). CONCLUSION Good perceived sleep quality was associated with protection against the raised risk of respiratory infection during sleep restriction. Studies should determine whether improvements in sleep quality arising from behavioral sleep interventions translate to reduced respiratory infection during sleep restriction.
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Affiliation(s)
- Neil P Walsh
- Corresponding author: Neil P. Walsh, Faculty of Science, Liverpool John Moores University, Liverpool, UK.
| | - Daniel S Kashi
- Faculty of Science, Liverpool John Moores University, Liverpool, UK
| | - Jason P Edwards
- Faculty of Science, Liverpool John Moores University, Liverpool, UK
| | - Claudia Richmond
- Faculty of Science, Liverpool John Moores University, Liverpool, UK
| | | | - Ross Roberts
- College of Human Sciences, Bangor University, Bangor, UK
| | | | - Sarah Jackson
- Army Health and Performance Research, Army HQ, Andover, UK
| | - Julie P Greeves
- Army Health and Performance Research, Army HQ, Andover, UK,Norwich Medical School, University of East Anglia, Norwich, UK
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14
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Shipley A, Fallows E. Juggling two pandemics: The simultaneous necessity and difficulty of practising lifestyle medicine during the COVID-19 era. LIFESTYLE MEDICINE 2022; 3:e68. [PMID: 37520338 PMCID: PMC9539232 DOI: 10.1002/lim2.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 06/23/2022] [Indexed: 11/13/2022] Open
Abstract
Since early 2020, COVID-19 has dominated headlines, claimed millions of lives, crippled global economies, overwhelmed health services, attracted multi-disciplinary scientific attention and transformed our daily lives. Unsurprisingly, the Lifestyle Medicine field has not been immune to the pandemic's wide-reaching influence. Although COVID-19 highlighted the necessity of maintaining healthy behaviours, the associated lockdowns and social distancing measures challenged our ability to do so. Attempts to mitigate the spread of COVID-19 may, therefore, have exacerbated the obesity pandemic and other diseases associated with unhealthy lifestyle habits. One hopes this devastating virus provides the impetus for policymakers, clinicians and patients to collaborate in tackling the diseases of modern life. This commentary explores how lifestyle-correlated conditions (which are closely intertwined with socioeconomic factors) rendered much of the UK population vulnerable to COVID-19 infection, morbidity and mortality. Subsequently, we consider the impact of lockdown measures on the accessibility of healthy living, focussing on eating behaviours, physical activity, relationships, sleep and substance abuse, as well as the social demographics particularly affected. Approaching the aftermath of this vicious cycle with optimism, we discuss why the post-Covid era presents a unique opportunity for Lifestyle Medicine, as an evidence-based approach to supporting patients to adopt and sustain healthy behaviours.
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15
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Jones SE, Maisha FI, Strausz SJ, Cade BE, Tervi AM, Helaakoski V, Broberg ME, Lammi V, Lane JM, Redline S, Saxena R, Ollila HM. The public health impact of poor sleep on severe COVID-19, influenza and upper respiratory infections. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.02.16.22271055. [PMID: 35194621 PMCID: PMC8863167 DOI: 10.1101/2022.02.16.22271055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Poor sleep is associated with an increased risk of infections and all-cause mortality, and acute sleep loss and disruption have been linked with inflammation and poorer immune control. Previous studies, however, have been unable to evidence causality between the chronic effects of poor sleep and respiratory infection risk. In light of the ongoing COVID-19 pandemic and potential future disease outbreaks, understanding the risk factors for these infections is of great importance. Aim Our goal was to understand if chronic poor sleep could be identified as a causal risk factor for respiratory infections including influenza, upper respiratory infections and COVID-19. Methods We used population cohorts from the UK Biobank (N ≈ 231,000) and FinnGen (N ≈ 327,000) with ICD-10 based electronic health records and obtained diagnoses of insomnia, influenza and upper respiratory infections (URIs) from primary care and hospital settings. We computed logistic regression to assess association between poor sleep and infections, disease free survival hazard ratios, and used summary statistics from genome-wide association studies of insomnia, influenza, URI and COVID-19 to perform Mendelian randomization analyses and assess causality. Findings Utilizing 23 years of registry data and follow-up, we saw that insomnia diagnosis associated with increased risk for infections in FinnGen and in UK Biobank (FinnGen influenza HR = 5.32 [4.09, 6.92], P = 1.02×10-35, UK Biobank influenza HR = 1.54 [1.37, 1.73], P = 2.49×10-13). Mendelian randomization indicated that insomnia causally predisposed to influenza (OR = 1.59, P = 6.23×10-4), upper respiratory infections (OR = 1.71, P = 7.60×10-13), COVID-19 infection (OR = 1.08, P = 0.037) and risk of hospitalization from COVID-19 (OR = 1.47, P = 4.96×10-5). Conclusions Our findings indicate that chronic poor sleep is a causal risk factor for contracting respiratory infections, and in addition contributes to the severity of respiratory infections. These findings highlight the role of sleep in maintaining sufficient immune response against pathogens as suggested by earlier work. As the current COVID-19 pandemic has increased the number of people suffering from poor sleep, safe interventions such as sleep management and treating individuals with insomnia could be promoted to reduce infections and save lives.
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Affiliation(s)
- Samuel E Jones
- Institute for Molecular Medicine, HiLIFE, University of Helsinki, Finland
| | - Fahrisa I Maisha
- Department of Immunology and Dermatology, Yale University, School of Medicine, New Haven, Connecticut, USA
| | - Satu J Strausz
- Institute for Molecular Medicine, HiLIFE, University of Helsinki, Finland
| | - Brian E Cade
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Anniina M Tervi
- Institute for Molecular Medicine, HiLIFE, University of Helsinki, Finland
| | - Viola Helaakoski
- Institute for Molecular Medicine, HiLIFE, University of Helsinki, Finland
| | - Martin E Broberg
- Institute for Molecular Medicine, HiLIFE, University of Helsinki, Finland
| | - Vilma Lammi
- Institute for Molecular Medicine, HiLIFE, University of Helsinki, Finland
| | - Jacqueline M Lane
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Richa Saxena
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Hanna M Ollila
- Institute for Molecular Medicine, HiLIFE, University of Helsinki, Finland
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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16
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Nie L, Pan XL, Zhang XB, Zhang S, Rao JX, Su ZF. Research on the correlation of immunity in patients with chronic insomnia. Front Psychiatry 2022; 13:1034405. [PMID: 36329922 PMCID: PMC9623272 DOI: 10.3389/fpsyt.2022.1034405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/23/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To investigate the changes in immunity and clinical infection events among patients with chronic insomnia. MATERIALS AND METHODS Forty-two patients with chronic insomnia (age = 64.44 ± 10.53) and 47 normal controls (age = 67.08 ± 7.822) were selected to determine differences in data, such as complete blood counts (CBCs), biochemical indices, lymphocyte subsets, immunoglobulin (Ig), complement C3 and C4 and interleukin-6 (IL-6), as well as to compare the incidence of clinical infection between the two groups. RESULTS There were significant differences in erythrocyte, hemoglobin, hematocrit, albumin, globulin, creatinine, IgG, IgG/IgM ratio, CD4+ T-lymphocytes, CD19-lymphocytes, CD4+/CD8+ ratio, platelet/lymphocyte ratio, CD19/CD3 ratio, and clinical infection events between the chronic insomnia group and the control group (p < 0.05). There was no significant difference in neutrophil, lymphocyte, monocyte, and platelet counts; lymphocyte subsets CD8+ T and CD56+; platelet-to-lymphocyte ratio (PLR); neutrophil-to-lymphocyte ratio (NLR); complement C3; complement C4; IgM; IgA; and IL-6 between the experimental group and their controls (p > 0.05). The systolic and diastolic blood pressures of the chronic insomnia group did not vary widely from those of the controls (p > 0.05). CONCLUSION Patients with chronic insomnia have immunological abnormalities, characterized by a higher incidence of clinical infection.
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Affiliation(s)
- Li Nie
- Department of General Medicine, Chaohu Hospital Affiliated with Anhui Medical University, Chaohu, China
| | - Xian-Li Pan
- Department of General Medicine, Chaohu Hospital Affiliated with Anhui Medical University, Chaohu, China
| | - Xiao-Bao Zhang
- Department of General Medicine, Chaohu Hospital Affiliated with Anhui Medical University, Chaohu, China
| | - Shan Zhang
- Department of General Medicine, Chaohu Hospital Affiliated with Anhui Medical University, Chaohu, China
| | - Ji-Xian Rao
- Department of General Medicine, Chaohu Hospital Affiliated with Anhui Medical University, Chaohu, China
| | - Zeng-Feng Su
- Department of General Medicine, Chaohu Hospital Affiliated with Anhui Medical University, Chaohu, China
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