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Kokkali M, Pinioti E, Lappas AS, Christodoulou N, Samara MT. Effects of Trazodone on Sleep: A Systematic Review and Meta-analysis. CNS Drugs 2024; 38:753-769. [PMID: 39123094 DOI: 10.1007/s40263-024-01110-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND AND OBJECTIVES Sleep problems and insomnia are common, challenging to treat, and transcend specific diagnoses. Although trazodone is a popular choice, robust meta-analytic evidence is lacking. This systematic review and meta-analysis investigates the efficacy and safety of trazodone for sleep disturbances, reflecting recent updates in insomnia diagnosis and treatment. METHODS We searched Medline, Embase, APA PsycINFO, the Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) up to 1 May 2024, for Randomized Controlled Trials (RCTs) comparing trazodone with placebo and reporting sleep-related outcomes. The minimum pharmacotherapy duration was 5 days. Included were all RCTs regardless of blinding (open-label or single- or double-blind), while quasi-randomized studies were excluded. The Cochrane Risk of Bias Tool for Randomized Trials assessed bias. Analyses used a random-effects model on an intention-to-treat (ITT) basis. Risk ratio (RR) was used for dichotomous outcomes and weighted mean difference (WMD) for continuous outcomes. When different units or scales were used, Hedge's adjusted g standardized mean difference (SMD) was calculated. Subgroup and preplanned sensitivity analyses explored heterogeneity and evaluated findings' strength and consistency. RESULTS In total, 44 RCTs with 3935 participants were included. Trazodone did not significantly impact subjective total sleep time (TST) [WMD = 0.73 min, 95% confidence interval (CI) - 24.62; 26.07, p = 0.96] but improved sleep quality (SQ) (SMD = - 0.58, 95% CI - 0.87; - 0.28, p < 0.01) and secondary outcomes. These included the number of nocturnal awakenings (SMD = - 0.57, 95% CI - 0.85; - 0.30], p < 0.01), nocturnal time awake after sleep onset (WMD = - 13.47 min, 95% CI - 23.09; - 3.86], p < 0.01), objective TST by polysomnography (WMD = 27.98 min, 95% CI 4.02; 51.95, p = 0.02), and sleep efficiency (WMD = 3.32, 95% CI 0.53; 1.57, p = 0.02). Tolerability issues included more dropouts owing to adverse effects (RR = 2.30, 95% CI 1.45; 3.64, p < 0.01), any sleep-related adverse effects (RR = 3.67, 95% CI 1.07; 12.47, p = 0.04), more adverse effects in general (RR = 1.18, 95% CI 1.03; 1.33, p = 0.02), and more sleep-related adverse effects (RR = 4.31, 95% CI 2.29; 8.13, p < 0.01). CONCLUSION Trazodone extends total sleep time but does not affect perceived sleep duration. It may improve sleep quality and continuity but has minor effects on sleep latency, efficiency, and daytime impairment. Trazodone is associated with adverse effects, necessitating a careful risk-benefit assessment. Limited data restrict generalizability, underscoring the need for more research. REGISTRATION PROSPERO registration number,CRD42022383121.
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Affiliation(s)
- Maria Kokkali
- Department of Psychiatry, School of Medicine, University of Thessaly, 41334, Larissa, Greece
| | - Elisavet Pinioti
- Department of Psychiatry, School of Medicine, University of Thessaly, 41334, Larissa, Greece
| | - Andreas S Lappas
- Department of Psychiatry, School of Medicine, University of Thessaly, 41334, Larissa, Greece
- Aneurin Bevan University Health Board, Wales, UK
| | - Nikolaos Christodoulou
- Department of Psychiatry, School of Medicine, University of Thessaly, 41334, Larissa, Greece
- Medical School, University of Nottingham, Nottingham, UK
| | - Myrto T Samara
- Department of Psychiatry, School of Medicine, University of Thessaly, 41334, Larissa, Greece.
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de Oliveira ACS, Zacarias LC, de Souza CCC, Bezerra JPDS, Viana-Junior AB, Sobreira-Neto MA, Leite CF. Validity, reliability, and responsiveness of the Brazilian version of the instrument World Health Organization Disability Assessment Schedule (WHODAS 2.0) for individuals with obstructive sleep apnoea. Heart Lung 2024; 67:183-190. [PMID: 38848628 DOI: 10.1016/j.hrtlng.2024.05.010] [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: 03/01/2024] [Revised: 04/26/2024] [Accepted: 05/28/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is a disabling health condition, and there is no disease-specific patient-reported outcome instrument to assess individuals with OSA. OBJECTIVES To evaluate the psychometric properties of the Brazilian version of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) in individuals with OSA. METHODS One hundred individuals with OSA responded to the WHODAS 2.0 version of 36 items, the Epworth Sleepiness Scale (ESS), the Pittsburgh Sleep Quality Index (PSQI), and the 12-item health survey (SF-12). Internal consistency, convergent and discriminative validity, and responsiveness to continuous positive airway pressure (CPAP) were the psychometric properties tested. RESULTS Cronbach's α values indicate good internal consistency (0.91 - 0.73), except for the self-care domain (α = 0.52). Convergent validity indicated an excellent correlation (r = -0.80) between the domains of functioning and quality of life. Discriminative validity showed no association between OSA severity and functioning (p = 0.90). The responsiveness to CPAP treatment showed a large effect size (r = 0.82; p < 0.05) CONCLUSIONS: The WHODAS 2.0 instrument is valid, reliable, and responsive for assessing individuals with OSA.
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Affiliation(s)
- Ana Cecília Silva de Oliveira
- Master Program in Physiotherapy and Functioning, Federal University of Ceara, Fortaleza, Ceara, Brazil, Rua Coronel Nunes Melo, 1127, Rodolfo Teófilo, Campus Porangabussu, ZIP Code:60.430-275
| | - Laíla Cândida Zacarias
- Graduate Program in Cardiovascular Sciences, Federal University of Ceara, Fortaleza, CE, Brazil, Rua Papi Júnior, 1232, sala 209, Rodolfo Teófilo, ZIP Code: 60430-235
| | - Clarice Cristina Cunha de Souza
- Graduate Program in Cardiovascular Sciences, Federal University of Ceara, Fortaleza, CE, Brazil, Rua Papi Júnior, 1232, sala 209, Rodolfo Teófilo, ZIP Code: 60430-235
| | - João Paulo da Silva Bezerra
- Department of Physical Therapy, Federal University of Ceara, Fortaleza, Ceara, Brazil, Rua Major Weyne, 1440, Campus do Porangabussu, Rodolfo Teófilo, ZIP Code: 60430-160
| | - Antônio Brazil Viana-Junior
- Clinical Research Unit of Hospital Universitario Walter Cantidio, Federal University of Ceara - EBSERH, Fortaleza, Brazil, Rua Coronel Nunes de Melo, Rodolfo Teófilo, ZIP Code: 60430-275
| | - Manoel Alves Sobreira-Neto
- Department of Clinical Medicine, Federal University of Ceara, Fortaleza, Ceara, Brazil. R. Alexandre Baraúna, 949, Rodolfo Teófilo, ZIP Code: 60430-160
| | - Camila Ferreira Leite
- Master Program in Physiotherapy and Functioning, Federal University of Ceara, Fortaleza, Ceara, Brazil, Rua Coronel Nunes Melo, 1127, Rodolfo Teófilo, Campus Porangabussu, ZIP Code:60.430-275; Graduate Program in Cardiovascular Sciences, Federal University of Ceara, Fortaleza, CE, Brazil, Rua Papi Júnior, 1232, sala 209, Rodolfo Teófilo, ZIP Code: 60430-235.
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Durtette A, Dargent B, Gierski F, Barbe C, Deslée G, Perotin JM, Henry A, Launois C. Impact of continuous positive airway pressure on cognitive functions in adult patients with obstructive sleep apnea: A systematic review and meta-analysis. Sleep Med 2024; 123:7-21. [PMID: 39226674 DOI: 10.1016/j.sleep.2024.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 07/26/2024] [Accepted: 08/16/2024] [Indexed: 09/05/2024]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is associated with the impairment of a range of cognitive functions. Whether treatment with continuous positive airway pressure (CPAP) improves these cognitive functions is still a matter of debate. METHODS We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) that included OSA patients (apnea hypopnea index, AHI >10/h), naive to CPAP treatment, with a cognitive assessment before and after CPAP initiation. We compared CPAP versus sham-CPAP or placebo tablet or dietary rules or no treatment. This systematic review and meta-analysis were registered in PROSPERO (ID CRD42021275214). RESULTS Eleven RCTs encompassing 923 OSA patients were included. For most of them, CPAP initiation was ≤3 months. A significant post-treatment improvement was found for the Trail Making Test part B (TMT-B; SMD = -0.93, 95 % CI = [-1.60, -0.25], Z = -2.70, p = 0.007), but not for the other neuropsychological assessments. No global effects on other cognitive domains (information processing speed, executive functions, working memory) were found. CONCLUSION The significant improvement in the TMT-B supports a short-term enhancement in cognitive flexibility with CPAP treatment. Further studies that take into account OSA comorbidities, cognitive profiles, a more diverse range of cognition assessments and include long-term evaluations are needed.
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Affiliation(s)
- Apolline Durtette
- Université de Reims Champagne Ardenne, Laboratoire C2S (Cognition, Santé, Société), UR 6291, France
| | - Barbara Dargent
- Service des Maladies Respiratoires, Centre Hospitalier Universitaire de Reims, 45, Rue de Cognacq-Jay, CEDEX, 51092, Reims, France
| | - Fabien Gierski
- Université de Reims Champagne Ardenne, Laboratoire C2S (Cognition, Santé, Société), UR 6291, France
| | - Coralie Barbe
- Université de Reims Champagne Ardenne, Laboratoire C2S (Cognition, Santé, Société), UR 6291, France; Comité Universitaire de Ressources pour La Recherche en Santé, Université de Reims Champagne-Ardenne, UFR Médecine, 51 Rue Cognacq Jay, 51100, REIMS, France
| | - Gaétan Deslée
- Service des Maladies Respiratoires, Centre Hospitalier Universitaire de Reims, 45, Rue de Cognacq-Jay, CEDEX, 51092, Reims, France; INSERM UMRS 1250, Université de Reims Champagne Ardenne, 51100, Reims, France
| | - Jeanne-Marie Perotin
- Service des Maladies Respiratoires, Centre Hospitalier Universitaire de Reims, 45, Rue de Cognacq-Jay, CEDEX, 51092, Reims, France; INSERM UMRS 1250, Université de Reims Champagne Ardenne, 51100, Reims, France
| | - Audrey Henry
- Université de Reims Champagne Ardenne, Laboratoire C2S (Cognition, Santé, Société), UR 6291, France
| | - Claire Launois
- Service des Maladies Respiratoires, Centre Hospitalier Universitaire de Reims, 45, Rue de Cognacq-Jay, CEDEX, 51092, Reims, France; INSERM UMRS 1250, Université de Reims Champagne Ardenne, 51100, Reims, France.
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Chan WS, Cheng WY, Lok SHC, Cheah AKM, Lee AKW, Ng ASY, Kowatsch T. Assessing the Short-Term Efficacy of Digital Cognitive Behavioral Therapy for Insomnia With Different Types of Coaching: Randomized Controlled Comparative Trial. JMIR Ment Health 2024; 11:e51716. [PMID: 39110971 PMCID: PMC11339566 DOI: 10.2196/51716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 03/07/2024] [Accepted: 05/25/2024] [Indexed: 08/25/2024] Open
Abstract
BACKGROUND Digital cognitive behavioral therapy for insomnia (dCBTi) is an effective intervention for treating insomnia. The findings regarding its efficacy compared to face-to-face cognitive behavioral therapy for insomnia are inconclusive but suggest that dCBTi might be inferior. The lack of human support and low treatment adherence are believed to be barriers to dCBTi achieving its optimal efficacy. However, there has yet to be a direct comparative trial of dCBTi with different types of coaching support. OBJECTIVE This study examines whether adding chatbot-based and human coaching would improve the treatment efficacy of, and adherence to, dCBTi. METHODS Overall, 129 participants (n=98, 76% women; age: mean 34.09, SD 12.05 y) whose scores on the Insomnia Severity Index [ISI] were greater than 9 were recruited. A randomized controlled comparative trial with 5 arms was conducted: dCBTi with chatbot-based coaching and therapist support (dCBTi-therapist), dCBTi with chatbot-based coaching and research assistant support, dCBTi with chatbot-based coaching only, dCBTi without any coaching, and digital sleep hygiene and self-monitoring control. Participants were blinded to the condition assignment and study hypotheses, and the outcomes were self-assessed using questionnaires administered on the web. The outcomes included measures of insomnia (the ISI and the Sleep Condition Indicator), mood disturbances, fatigue, daytime sleepiness, quality of life, dysfunctional beliefs about sleep, and sleep-related safety behaviors administered at baseline, after treatment, and at 4-week follow-up. Treatment adherence was measured by the completion of video sessions and sleep diaries. An intention-to-treat analysis was conducted. RESULTS Significant condition-by-time interaction effects showed that dCBTi recipients, regardless of having any coaching, had greater improvements in insomnia measured by the Sleep Condition Indicator (P=.003; d=0.45) but not the ISI (P=.86; d=-0.28), depressive symptoms (P<.001; d=-0.62), anxiety (P=.01; d=-0.40), fatigue (P=.02; d=-0.35), dysfunctional beliefs about sleep (P<.001; d=-0.53), and safety behaviors related to sleep (P=.001; d=-0.50) than those who received digital sleep hygiene and self-monitoring control. The addition of chatbot-based coaching and human support did not improve treatment efficacy. However, adding human support promoted greater reductions in fatigue (P=.03; d=-0.33) and sleep-related safety behaviors (P=.05; d=-0.30) than dCBTi with chatbot-based coaching only at 4-week follow-up. dCBTi-therapist had the highest video and diary completion rates compared to other conditions (video: 16/25, 60% in dCBTi-therapist vs <3/21, <25% in dCBTi without any coaching), indicating greater treatment adherence. CONCLUSIONS Our findings support the efficacy of dCBTi in treating insomnia, reducing thoughts and behaviors that perpetuate insomnia, reducing mood disturbances and fatigue, and improving quality of life. Adding chatbot-based coaching and human support did not significantly improve the efficacy of dCBTi after treatment. However, adding human support had incremental benefits on reducing fatigue and behaviors that could perpetuate insomnia, and hence may improve long-term efficacy. TRIAL REGISTRATION ClinicalTrials.gov NCT05136638; https://www.clinicaltrials.gov/study/NCT05136638.
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Affiliation(s)
- Wai Sze Chan
- Department of Psychology, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Wing Yee Cheng
- Department of Psychology, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Samson Hoi Chun Lok
- Department of Psychology, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Amanda Kah Mun Cheah
- Department of Psychology, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Anna Kai Win Lee
- Department of Psychology, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Albe Sin Ying Ng
- Department of Psychology, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Tobias Kowatsch
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- School of Medicine, University of St.Gallen, St. Gallen, Switzerland
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, Eidgenössische Technische Hochschule Zürich, Zurich, Switzerland
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Woods TJ, Kaambwa B. An empirical comparison of sleep-specific versus generic quality of life instruments among Australians with sleep disorders. Qual Life Res 2024; 33:2261-2274. [PMID: 38913275 PMCID: PMC11286652 DOI: 10.1007/s11136-024-03686-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 06/25/2024]
Abstract
PURPOSE In Australian adults diagnosed with a sleep disorder(s), this cross-sectional study compares the empirical relationships between two generic QoL instruments, the EuroQoL 5-dimension 5-level (EQ-5D-5L) and ICEpop CAPability measure for Adults (ICECAP-A), and three sleep-specific metrics, the Epworth Sleepiness Scale (ESS), 10-item Functional Outcomes of Sleep Questionnaire (FOSQ-10), and Pittsburgh Sleep Quality Index (PSQI). METHODS Convergent and divergent validity between item/dimension scores was examined using Kendall's Tau-B correlation, with correlations below 0.30 considered weak, between 0.30 and 0.50 moderate and those above 0.50 strong (indicating that instruments were measuring similar constructs). Exploratory factor analysis (EFA) was conducted to identify shared underlying constructs. RESULTS A total of 1509 participants (aged 18-86 years) were included in the analysis. Convergent validity between dimensions/items of different instruments was weak to moderate. A 5-factor EFA solution, representing 'daytime dysfunction', 'fatigue', 'wellbeing', 'physical health', and 'perceived sleep quality', was simplest with close fit and fewest cross-loadings. Each instrument's dimensions/items primarily loaded onto their own factor, except for the EQ-5D-5L and PSQI. Nearly two-thirds of salient loadings were of excellent magnitude (0.72 to 0.91). CONCLUSION Moderate overlap between the constructs assessed by generic and sleep-specific instruments indicates that neither can fully capture the complexity of QoL alone in general disordered sleep populations. Therefore, both are required within economic evaluations. A combination of the EQ-5D-5L and, depending on context, ESS or PSQI offers the broadest measurement of QoL in evaluating sleep health interventions.
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Affiliation(s)
- Taylor-Jade Woods
- Health Economics Unit, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.
| | - Billingsley Kaambwa
- Health Economics Unit, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
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Golombek DA, Eyre H, Spiousas I, Casiraghi LP, Hartikainen KM, Partonen T, Pyykkö M, Reynolds CF, Hynes WM, Bassetti CLA, Berk M, Hu K, Ibañez A. Sleep Capital: Linking Brain Health to Wellbeing and Economic Productivity Across the Lifespan. Am J Geriatr Psychiatry 2024:S1064-7481(24)00405-6. [PMID: 39117505 DOI: 10.1016/j.jagp.2024.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 07/12/2024] [Accepted: 07/13/2024] [Indexed: 08/10/2024]
Abstract
INTRODUCTION AND FRAMEWORK Sleep capital contributes to individual and societal wellbeing, productivity, and economic outcomes and involves a novel aspect of brain capital. It encompasses the quality and quantity of sleep as integral components that influence cognitive abilities, mental and brain health, and physical health, affecting workplace productivity, learning, decision-making, and overall economic performance. Here, we bring a framework to understand the complex relationship between sleep quality, health, wellbeing, and economic productivity. Then we outline the multilevel impact of sleep on cognitive abilities, mental/brain health, and economic indicators, providing evidence for the substantial returns on investment in sleep health initiatives. Moreover, sleep capital is a key factor when considering brain health across the lifespan, especially for the aging population. DISCUSSION We propose specific elements and main variables to develop specific indexes of sleep capital to address its impacts on health, wellbeing and productivity. CONCLUSION Finally, we suggest policy recommendations, workplace interventions, and individual strategies to promote sleep health and brain capital. Investing in sleep capital is essential for fostering a healthier, happier, fairer and more productive society.
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Affiliation(s)
- Diego A Golombek
- Laboratorio Interdisciplinario del Tiempo (LITERA) (DAG, IS, LPC), Universidad de San Andrés/CONICET, Buenos Aires, Argentina.
| | - Harris Eyre
- Baker Institute for Public Policy (HE), Rice University, Houston, TX, USA; Global Brain Health Institute (HE), University of California San Francisco (UCSF), San Francisco, CA, USA; Department of Psychiatry and Behavioral Science (HE), (UCSF), San Francisco, CA, USA; Department of Psychiatry and Behavioral Science (HE), Baylor College of Medicine, Houston, TX, USA; Department of Psychiatry and Behavioral Science (HE), Houston Methodist, Houston, TX, USA; Department of Psychiatry and Behavioral Science (HE), The University of Texas Health Sciences Center at Houston, Houston, TX, USA; Institute for Mental and Physical Health and Clinical Translation (IMPACT) (HE), Deakin University, Geelong, Victoria, Australia; Euro-Mediterranean Economists Association (HE), Barcelona, Spain; Meadows Mental Health Policy Institute (HE), Dallas, TX, USA; Frontier Technology Lab, School of Engineering (HE), Stanford University, Palo Alto, CA, USA
| | - Ignacio Spiousas
- Laboratorio Interdisciplinario del Tiempo (LITERA) (DAG, IS, LPC), Universidad de San Andrés/CONICET, Buenos Aires, Argentina
| | - Leandro P Casiraghi
- Laboratorio Interdisciplinario del Tiempo (LITERA) (DAG, IS, LPC), Universidad de San Andrés/CONICET, Buenos Aires, Argentina
| | - Kaisa M Hartikainen
- Faculty of Medicine and Health Technology (KMH), Tampere University, Tampere, Finland; Behavioral Neurology Research Group (KMH), Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland; National Brain Health Programme (KMH), Helsinki, Finland
| | - Timo Partonen
- Finnish Institute for Health and Welfare (TP), Helsinki, Finland; Department of Psychiatry (TP), University of Helsinki, Helsinki, Finland
| | - Mika Pyykkö
- Finnish Brain Association and Finnish Centre for Health Promotion (MP), Helsinki, Finland
| | - Charles F Reynolds
- Graduate School of Public Health, University of Pittsburgh School of Medicine (CFR), Pittsburgh, PA, USA
| | - William M Hynes
- Institute for Global Prosperity (MH), University College London, London, UK; Santa Fe Institute (MH), Santa Fe, NM, USA; World Bank (MH), Washington, DC, USA
| | - Claudio L A Bassetti
- Neurology Department, Inselspital (CLAB), University of Bern, Bern, Switzerland; Swiss Brain Health Plan (CLAB), Bern, Switzerland
| | - Michael Berk
- School of Medicine (MB), Deakin University and Barwon Health. Institute for Mental and Physical Health and Clinical Translation (IMPACT), Victoria, Australia
| | - Kun Hu
- Division of Sleep Medicine (KH), Harvard Medical School, Boston, MA, USA; Medical Biodynamics Center (KH), Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Agustín Ibañez
- Latin American Brain Health institute (Brainlat) (CSCN) (AI), Universidad Adolfo Ibanez, Santiago, Chile; ChileGlobal Brain Health Institute, Trinity College Dublin, Ireland; Center for Social and Cognitive Neuroscience (CSCN) (AI), Universidad Adolfo Ibanez, Santiago, Chile; Universidad de San Andrés (AI), Buenos Aires, Argentina
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Luo X, Zhou B, Shi J, Li G, Zhu Y. Effects of gender and age on sleep EEG functional connectivity differences in subjects with mild difficulty falling asleep. Front Psychiatry 2024; 15:1433316. [PMID: 39045546 PMCID: PMC11264056 DOI: 10.3389/fpsyt.2024.1433316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 06/17/2024] [Indexed: 07/25/2024] Open
Abstract
Introduction Difficulty falling asleep place an increasing burden on society. EEG-based sleep staging is fundamental to the diagnosis of sleep disorder, and the selection of features for each sleep stage is a key step in the sleep analysis. However, the differences of sleep EEG features in gender and age are not clear enough. Methods This study aimed to investigate the effects of age and gender on sleep EEG functional connectivity through statistical analysis of brain functional connectivity and machine learning validation. The two-overnight sleep EEG data of 78 subjects with mild difficulty falling asleep were categorized into five sleep stages using markers and segments from the "sleep-EDF" public database. First, the 78 subjects were finely grouped, and the mutual information of the six sleep EEG rhythms of δ, θ, α, β, spindle, and sawtooth wave was extracted as a functional connectivity measure. Then, one-way analysis of variance (ANOVA) was used to extract significant differences in functional connectivity of sleep rhythm waves across sleep stages with respect to age and gender. Finally, machine learning algorithms were used to investigate the effects of fine grouping of age and gender on sleep staging. Results and discussion The results showed that: (1) The functional connectivity of each sleep rhythm wave differed significantly across sleep stages, with delta and beta functional connectivity differing significantly across sleep stages. (2) Significant differences in functional connections among young and middle-aged groups, and among young and elderly groups, but no significant difference between middle-aged and elderly groups. (3) Female functional connectivity strength is generally higher than male at the high-frequency band of EEG, but no significant difference in the low-frequency. (4) Finer group divisions based on gender and age can indeed improve the accuracy of sleep staging, with an increase of about 3.58% by using the random forest algorithm. Our results further reveal the electrophysiological neural mechanisms of each sleep stage, and find that sleep functional connectivity differs significantly in both gender and age, providing valuable theoretical guidance for the establishment of automated sleep stage models.
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Affiliation(s)
- Xiaodong Luo
- Psychiatry Department, The Second Hospital of Jinhua, Jinhua, China
| | - Bin Zhou
- College of Mathematical Medicine, Zhejiang Normal University, Jinhua, China
| | - Jilong Shi
- College of Engineering, Zhejiang Normal University, Jinhua, China
| | - Gang Li
- College of Mathematical Medicine, Zhejiang Normal University, Jinhua, China
| | - Yixia Zhu
- Psychiatry Department, The Second Hospital of Jinhua, Jinhua, China
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Wang L, Liu H, Zhou L, Zheng P, Li H, Zhang H, Liu W. Association of Obstructive Sleep Apnea with Nonalcoholic Fatty Liver Disease: Evidence, Mechanism, and Treatment. Nat Sci Sleep 2024; 16:917-933. [PMID: 39006248 PMCID: PMC11244635 DOI: 10.2147/nss.s468420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 06/22/2024] [Indexed: 07/16/2024] Open
Abstract
Obstructive sleep apnea (OSA), a common sleep-disordered breathing condition, is characterized by intermittent hypoxia (IH) and sleep fragmentation and has been implicated in the pathogenesis and severity of nonalcoholic fatty liver disease (NAFLD). Abnormal molecular changes mediated by IH, such as high expression of hypoxia-inducible factors, are reportedly involved in abnormal pathophysiological states, including insulin resistance, abnormal lipid metabolism, cell death, and inflammation, which mediate the development of NAFLD. However, the relationship between IH and NAFLD remains to be fully elucidated. In this review, we discuss the clinical correlation between OSA and NAFLD, focusing on the molecular mechanisms of IH in NAFLD progression. We meticulously summarize clinical studies evaluating the therapeutic efficacy of continuous positive airway pressure treatment for NAFLD in OSA. Additionally, we compile potential molecular biomarkers for the co-occurrence of OSA and NAFLD. Finally, we discuss the current research progress and challenges in the field of OSA and NAFLD and propose future directions and prospects.
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Affiliation(s)
- Lingling Wang
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Huiguo Liu
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Ling Zhou
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Pengdou Zheng
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Hai Li
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
- Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Huojun Zhang
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Wei Liu
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
- Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
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9
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Katmeh T, Gardner DM, Kiepek N, Macdonald M, Murphy AL. Sleep should not be this difficult: An interpretive descriptive study of older adults' perspectives on behaviour change elements in Sleepwell and experiences with benzodiazepine discontinuation. J Sleep Res 2024:e14282. [PMID: 38945830 DOI: 10.1111/jsr.14282] [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: 02/10/2024] [Revised: 05/07/2024] [Accepted: 06/18/2024] [Indexed: 07/02/2024]
Abstract
Benzodiazepine receptor agonists are often used for insomnia in older adults contrary to current evidence. The harms outweigh the benefits, which are limited. Cognitive behavioural therapy for insomnia is the first-line recommended treatment. Sleepwell was created as a repository of evidence-based resources to promote cognitive behavioural therapy for insomnia and limit benzodiazepine receptor agonist use. This qualitative study uses an interpretive description design and reflexive thematic analysis to explore older adults' perspectives on behavioural change techniques used in Sleepwell resources. It also explores challenges and opportunities towards benzodiazepine receptor agonist discontinuation and cognitive behavioural therapy for insomnia use. Participants were recruited from the Sleepwell arm of a randomized controlled trial. Data were collected from 15 older adults using semi-structured interviews. Two main themes were developed: (1) sleep should not be this difficult; and (2) whether you know it, or learn it, drugs are bad. Two sub-themes were created within the first theme: (1) justification of benzodiazepine receptor agonist use to achieve sleep goals; (2) efforts of committing to cognitive behavioural therapy for insomnia. Several behavioural change techniques (e.g. information about consequences, anticipated regret, salience of consequences) were enablers of benzodiazepine receptor agonist-related behaviour change. For committing to cognitive behavioural therapy for insomnia, several behavioural change techniques (e.g. self-monitoring of behaviour, distraction, stimulus substitution) were beneficial, but social support, which was perceived as useful, was absent. Older adults experienced tension with benzodiazepine receptor agonist use and deprescribing, despite knowing or learning the potential consequences of benzodiazepine receptor agonists. Cognitive behavioural therapy for insomnia implementation was challenging. Embedded behavioural change techniques in the Sleepwell booklets were identified as helpful, but more (e.g. social support) are needed to optimize cognitive behavioural therapy for insomnia use.
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Affiliation(s)
- Tulayla Katmeh
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - David M Gardner
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Niki Kiepek
- School of Occupational Therapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Marilyn Macdonald
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrea L Murphy
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
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Kikuti-Koyama KA, Lemes ÍR, de Morais LC, Monteiro HL, Turi-Lynch BC, Fernandes RA, Codogno JS. Combined association of insufficient physical activity and sleep problems with healthcare costs: a longitudinal study. SAO PAULO MED J 2024; 142:e2023241. [PMID: 38896745 PMCID: PMC11185864 DOI: 10.1590/1516-3180.2023.0241.r2.25032024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 02/26/2023] [Accepted: 03/25/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND The magnitude of economic losses attributed to sleep problems and insufficient physical activity (PA) remains unclear. This study aimed to investigate the association between insufficient PA, sleep problems, and direct healthcare costs. OBJECTIVE To investigate the association between insufficient physical activity (PA), sleep problems, and direct healthcare costs among adults. DESIGN AND SETTING Adults aged ≥ 50 years attended by the Brazilian National Health Service were tracked from 2010 to 2014. METHODS Direct healthcare costs were assessed using medical records and expressed in US$. Insufficient PA and sleep problems were assessed through face-to-face interviews. Differences were identified using the analysis of covariance and variance for repeated measures. RESULTS In total, 454 women and 166 men were enrolled. Sleep problems were reported by 28.9% (95%CI: 25.2% to 32.4%) of the sample, while insufficient PA was reported by 84.8% (95%CI: 82.1% to 87.6%). The combination of sleep problems and insufficient PA explained 2.3% of all healthcare costs spent on these patients from 2010 to 2014, which directly accounts for approximately US$ 4,765.01. CONCLUSION The combination of sleep problems and insufficient PA plays an important role in increasing direct healthcare costs in adults. Public health stakeholders, policymakers, and health professionals can use these results to reinforce the need for strategies to improve sleep quality and increase PA, especially in nations that finance their National Health Systems.
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Affiliation(s)
- Kelly Akemi Kikuti-Koyama
- Student, Department of Physical Education, Laboratory of InVestigation in Exercise (LIVE), Universidade Estadual Paulista (UNESP), Presidente Prudente (SP), Brazil
| | - Ítalo Ribeiro Lemes
- Assistant Professor, Physiotherapy Department, Universidade Estadual Paulista (UNESP), Presidente Prudente (SP), Brazil; Assistant Professor, Physiotherapy Department, Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE), São Paulo (SP), Brazil
| | - Luana Carolina de Morais
- Student, Laboratory of InVestigation in Exercise (LIVE), Department of Physical Education, Universidade Estadual Paulista (UNESP), Presidente Prudente (SP), Brazil
| | - Henrique Luiz Monteiro
- Assistant Professor, Department of Physical Education, Universidade Estadual Paulista (UNESP), Bauru (SP), Brazil
| | - Bruna Camilo Turi-Lynch
- Assistant Professor, Physical Education and Exercise Science Department, Lander University, Greenwood, United States
| | - Rômulo Araújo Fernandes
- Associate Professor, Laboratory of InVestigation in Exercise – LIVE, Department of Physical Education, Universidade Estadual Paulista (UNESP), Presidente Prudente (SP), Brazil
| | - Jamile Sanches Codogno
- Assistant Professor, Laboratory of InVestigation in Exercise – LIVE, Department of Physical Education, Universidade Estadual Paulista (UNESP), Presidente Prudente (SP), Brazil
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11
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Pendharkar SR, Kaambwa B, Kapur VK. The Cost-Effectiveness of Sleep Apnea Management: A Critical Evaluation of the Impact of Therapy on Health Care Costs. Chest 2024:S0012-3692(24)00660-3. [PMID: 38815624 DOI: 10.1016/j.chest.2024.04.024] [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: 04/24/2023] [Revised: 04/01/2024] [Accepted: 04/11/2024] [Indexed: 06/01/2024] Open
Abstract
TOPIC IMPORTANCE OSA is a widespread condition that significantly affects both health and health-related quality of life (HRQoL). If left untreated, OSA can lead to accidents, decreased productivity, and medical complications, resulting in significant economic burdens including the direct costs of managing the disorder. Given the constraints on health care resources, understanding the cost-effectiveness of OSA management is crucial. A key factor in cost-effectiveness is whether OSA therapies reduce medical costs associated with OSA-related complications. REVIEW FINDINGS Treatments for OSA have been shown to enhance HRQoL, particularly for symptomatic patients with moderate or severe disease. Economic studies also have demonstrated that these treatments are highly cost-effective. However, although substantial empirical evidence shows that untreated OSA is associated with increased medical costs, uncertainty remains about the impact of OSA treatment on these costs. Randomized controlled trials of positive airway pressure (PAP) therapy have failed to demonstrate cost reductions, but the studies have had important limitations. Observational studies suggest that PAP therapy may temper increases in costs, but only among patients who are highly adherent to treatment. However, the healthy adherer effect is an important potential source of bias in these studies. SUMMARY OSA management is cost-effective, although uncertainties persist regarding the therapy's impact on medical costs. Future studies should focus on reducing bias, particularly the healthy adherer effect, and addressing other confounding factors to clarify potential medical cost savings. Promising avenues to further understanding include using quasiexperimental designs, incorporating more sophisticated characterization of OSA severity and symptoms, and leveraging newer technologies (eg, big data, wearables, and artificial intelligence).
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Affiliation(s)
- Sachin R Pendharkar
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Billingsley Kaambwa
- Health Economics, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, SA, Australia
| | - Vishesh K Kapur
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA.
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Kaambwa B, Woods TJ, Natsky A, Bulamu N, Mpundu-Kaambwa C, Loffler KA, Sweetman A, Catcheside PG, Reynolds AC, Adams R, Eckert DJ. Content Comparison of Quality-of-Life Instruments Used in Economic Evaluations of Sleep Disorder Interventions: A Systematic Review. PHARMACOECONOMICS 2024; 42:507-526. [PMID: 38340220 PMCID: PMC11039546 DOI: 10.1007/s40273-023-01349-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND Assessment of quality of life (QoL) in people living with sleep disorders using questionnaires is necessary to compare intervention benefits. Knowledge of the content and concepts covered by specific QoL instruments is essential to determine which instruments are best suited for conducting economic evaluations of sleep-related interventions. OBJECTIVES This review aims to identify the QoL instruments that have been applied in economic evaluations of sleep disorder interventions and compare their conceptual overlap and content coverage using the framework of the International Classification of Functioning, Disability and Health (ICF). METHODS A systematic review of full economic evaluations in sleep published in peer-reviewed journals from conception to 30 May, 2023 was conducted. MEDLINE, PsychInfo, ProQuest, Cochrane, Scopus, CINAHL, Web of Science and Emcare were searched for eligible studies. Studies incorporating either generic or sleep-specific QoL instruments as the primary or secondary measures of effectiveness within a full economic evaluation were included. Quality appraisal against the JBI Critical Appraisal Checklist for Economic Evaluations and EURONHEED checklists and mapping of QoL items to ICF categories were performed by two reviewers, with a third helping settle any potential differences. RESULTS Sixteen instruments were identified as having been used in sleep health economic evaluations. The EQ-5D-3L, Epworth Sleepiness Scale, and Insomnia Severity Index were the most widely used, but the latter two are predominantly diagnostic tools and not specifically designed to guide economic evaluations. Other instruments with broader ICF content coverage have been least used, and these include the Sleep Apnea Quality of Life Index, Functional Outcomes of Sleep Questionnaire, 15 Dimensions, Short-Form 6 Dimensions, 12-item Short Form Survey, 36-item Short Form Survey and the GRID Hamilton Rating Scale for Depression. CONCLUSIONS This study provides an overview of current QoL instruments used in economic evaluations of sleep with respect to their content coverage. A combination of generic and sleep-specific instruments with broader ICF content coverage is recommended for such evaluations.
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Affiliation(s)
- Billingsley Kaambwa
- Health Economics Unit, College of Medicine and Public Health, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, SA, 5042, Australia.
| | - Taylor-Jade Woods
- Health Economics Unit, College of Medicine and Public Health, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, SA, 5042, Australia
| | - Andrea Natsky
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Norma Bulamu
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Christine Mpundu-Kaambwa
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Kelly A Loffler
- Health Data and Clinical Trials, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Alexander Sweetman
- Flinders Health and Medical Research Institute (Sleep Health)/formerly Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
| | - Peter G Catcheside
- Flinders Health and Medical Research Institute (Sleep Health)/formerly Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
| | - Amy C Reynolds
- Flinders Health and Medical Research Institute (Sleep Health)/formerly Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
| | - Robert Adams
- Flinders Health and Medical Research Institute (Sleep Health)/formerly Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
| | - Danny J Eckert
- Flinders Health and Medical Research Institute (Sleep Health)/formerly Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
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Huang Y, Fleury J. Socially-supported sleep in older adults aged 50 and older: a concept analysis. Front Public Health 2024; 12:1364639. [PMID: 38645458 PMCID: PMC11027164 DOI: 10.3389/fpubh.2024.1364639] [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: 01/02/2024] [Accepted: 03/25/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction The population of older adults is growing disproportionately, constituting 13% of the global population in 2022, and is expected to double by 2050. One of public health's priorities is healthy aging, the maintenance of functional ability aligned with well-being. As many as 50% of older adults report poor sleep quality, leading to an increased risk of morbidity and mortality. The quality and quantity of social relationships may broadly benefit sleep in older adults. However, the concept of socially-supported sleep is underdeveloped as a basis for intervention. Methods Existing literature was searched without time restriction in PubMed, CINAHL, PsycINFO, and Scopus ending in August 2022. Thematic analysis was used to determine the defining attributes, antecedents, and consequences of socially-supported sleep guided by Rodgers' evolutionary concept analysis. Results Twenty-nine articles written in English, peer-reviewed, and examined social support and sleep in participants aged ≥50 were included. The defining attributes reflect dimensions of sleep quality. The antecedents are safe and secure, belonging and connection, and warmth and comfort. The consequences of socially-supported sleep include improved regulatory capabilities, physical and emotional well-being, and quality of life. Conclusion Socially-supported sleep has the potential to inform interventions that promote sleep in older adults. Ongoing research is needed to address the antecedents and mechanisms through which socially-supported sleep may promote sleep quality for healthy aging.
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Affiliation(s)
- Yingyan Huang
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
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14
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Yan X, Han F, Wang H, Li Z, Kawachi I, Li X. Years of life lost due to insufficient sleep and associated economic burden in China from 2010-18. J Glob Health 2024; 14:04076. [PMID: 38574358 PMCID: PMC10994670 DOI: 10.7189/jogh.14.04076] [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: 04/06/2024] Open
Abstract
Background Research on the health and economic costs due to insufficient sleep remains scant in developing countries. In this study we aimed to estimate the years of life lost (YLLs) due to short sleep and quantify its economic burden in China. Methods We estimated both individual and aggregate YLLs due to short sleep (ie, ≤6 hours) among Chinese adults aged 20 years or older by sex and five-year age groups in 2010, 2014, and 2018. YLL estimates were derived from 1) the prevalence of short sleep using three survey waves of the China Family Panel Studies, 2) relative mortality risks from meta-analyses, and 3) life tables in China. YLL was the difference between the estimated life expectancy of an individual in the short sleep category vs in the recommended sleep category. We estimated the economic cost using the human capital approach. Results The sample sizes of the three survey waves were 31 393, 31 207, and 28 618. Younger age groups and men had more YLLs due to short sleep compared to their counterparts. For individuals aged 20-24, men had an average YLL of nearly 0.95, in contrast to the approximate 0.75 in women across the observed years of 2010, 2014, and 2018. The trend in individual YLLs remained consistent over these years. In aggregate, China experienced a rise from 66.75 million YLLs in 2010 to 95.29 million YLLs in 2014, and to 115.05 million YLLs in 2018. Compared to 2010 (USD 191.83 billion), the associated economic cost in 2014 increased to USD 422.24 billion, and the cost in 2018 more than tripled (USD 628.15 billion). The percentage of cost to Chinese gross domestic product in corresponding years was 3.23, 4.09, and 4.62%. Conclusions Insufficient sleep is associated with substantial YLLs in China, potentially impacting the population's overall life expectancy. The escalating economic toll attributed to short sleep underscores the urgent need for public health interventions to improve sleep health at the population level.
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Affiliation(s)
- Xumeng Yan
- Department of Sociology, Tsinghua University, Beijing, China
- Department of Community Health Sciences, University of California, Los Angeles, California, USA
| | - Fang Han
- Division of Sleep Medicine, Beijing University People’s Hospital, Beijing, China
| | - Haowei Wang
- Department of Sociology and Aging Studies Institute, Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, New York, USA
| | - Zhihui Li
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Ichiro Kawachi
- Department of Social and Behavioural Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Xiaoyu Li
- Department of Sociology, Tsinghua University, Beijing, China
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15
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Chaabane S, Chaabna K, Khawaja S, Aboughanem J, Mittal D, Mamtani R, Cheema S. Sleep disorders and associated factors among medical students in the Middle East and North Africa: a systematic review and meta-analysis. Sci Rep 2024; 14:4656. [PMID: 38409132 PMCID: PMC10897338 DOI: 10.1038/s41598-024-53818-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 02/05/2024] [Indexed: 02/28/2024] Open
Abstract
Sleep disturbances like poor and insufficient sleep are common among medical students in the Middle East and North Africa (MENA) countries; however, the extent of medically defined sleep disorders (SDs) remains unclear. This meta-analysis determines SD prevalence and identifies associated factors among medical students in the MENA. PubMed, Web of Science, Google Scholar, and reference lists of included studies were searched (latest search: June 2022). Meta-analyses included 22 studies and were performed using random-effect models. Included studies used self-reported screening tools for assessing SDs and then estimated the proportion of participants at high risk of developing a SD. Central disorders of hypersomnolence were the most prevalent SD [prevalencepooled range: 30.9% (Jordan) to 62.5% (Saudi Arabia)], followed by insomnia disorders [prevalencepooled range: 30.4% (Jordan) to 59.1% (Morocco)], circadian rhythm sleep-wake disorders [prevalencepooled range: 13.5% (Jordan) to 22.4% (Saudi Arabia)], sleep-related breathing disorders [prevalencepooled range: 12.2% (Jordan) to 22.5% (Pakistan)], sleep-related movement disorders [prevalencepooled range: 5.9% (Egypt) to 30.6% (Saudi Arabia)], and parasomnias [prevalencepooled range: 5.6% (Jordan) to 17.4% (Saudi Arabia)]. Female sex, studying in the latter academic years, having anxiety, excessive internet use, and poor academic performance were significantly associated with SDs. SDs are prevalent among MENA medical students. Implementing student-centered interventions targeting high risk groups in medical schools should be considered to improve students' health and wellbeing.
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Affiliation(s)
- Sonia Chaabane
- Institute for Population Health, Weill Cornell Medicine - Qatar, Education City, Qatar Foundation, P.O. Box. 24144, Doha, Qatar.
| | - Karima Chaabna
- Institute for Population Health, Weill Cornell Medicine - Qatar, Education City, Qatar Foundation, P.O. Box. 24144, Doha, Qatar
| | - Salina Khawaja
- Institute for Population Health, Weill Cornell Medicine - Qatar, Education City, Qatar Foundation, P.O. Box. 24144, Doha, Qatar
| | - Jasmine Aboughanem
- Institute for Population Health, Weill Cornell Medicine - Qatar, Education City, Qatar Foundation, P.O. Box. 24144, Doha, Qatar
| | - Dhruv Mittal
- Intern, Institute for Population Health, Weill Cornell Medicine - Qatar, Education City, Qatar Foundation, P.O. Box. 24144, Doha, Qatar
| | - Ravinder Mamtani
- Institute for Population Health, Weill Cornell Medicine - Qatar, Education City, Qatar Foundation, P.O. Box. 24144, Doha, Qatar
| | - Sohaila Cheema
- Institute for Population Health, Weill Cornell Medicine - Qatar, Education City, Qatar Foundation, P.O. Box. 24144, Doha, Qatar
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Nie Q, Shen Y, Luo M, Sheng Z, Zhou R, Li G, Huang W, Chen S. Analysis of sleep for the American population: Result from NHANES database. J Affect Disord 2024; 347:134-143. [PMID: 37995924 DOI: 10.1016/j.jad.2023.11.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/08/2023] [Accepted: 11/20/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVES To assess the contemporary prevalence and decade-long trends of sleep duration, sleep disorders and trouble sleeping among adults in the United States, as well as their risk factors, from 2005 to 2018. MATERIALS AND METHODS We used National Health and Nutrition Examination Survey data to calculate the sleep duration and weighted prevalence of sleep disorders and trouble sleeping in adults aged 20 years or older. Sleep duration, sleep disorders and trouble sleeping were assessed by questionnaire. RESULTS A total of 27,399 people were included in the survey on sleep duration, with a weighted percentage of normal sleep (7-8 h/night) of 56.33 % (95 % CI, 53.06-59.60 %) and a weighted percentage of short sleep (5-6 h/night) of 31.73 %. In stratified descriptions, participants aged 40-49 years were more likely to sleep less than five hours, while women aged 80 years and older were more likely to sleep longer and blacks were more likely to sleep shorter. A total of 27,406 participants were included in the survey for sleep disorders. The weighted proportion of the population with sleep disorders was 8.44 % (95 % CI, 7.79-9.8 %). Independent risk factors for sleep disorders were being 40-69 years old, being white, having a high education level, smoking, having hypertension, diabetes, heart disease, and BMI ≥ 25. From 2005 to 2014, the prevalence of sleep disorders increased year by year, from 7.44 % in 2005-2006 to 10.40 % in 2013-2014 (P for Trend<0.001). A total of 38,165 participants were included in the survey on trouble sleeping. The weighted proportion of the population with troubled sleeping was 27.30 % (25.70-28.90 %). Independent risk factors for troubled sleeping were being 30-79 years old, being white, having a high education level, smoking, drinking, having hypertension, diabetes, heart disease and BMI ≥ 25. From 2005 to 2018, the prevalence of trouble sleeping increased annually, from 24.44 % in 2005-2006 to 30.58 % in 2017-2018 (P for trend<0.001). CONCLUSION Adults in the United States are likely to have abnormal sleep durations, and the prevalence of sleep disorders and troubled sleeping is on the rise.
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Affiliation(s)
- Qiurui Nie
- Department of Gerontology, Nanchang first hospital, Nanchang, China
| | - Yu Shen
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Mengqin Luo
- Department of Health Management Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zhiyong Sheng
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Rui Zhou
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Guangmin Li
- Department of Gerontology, Nanchang first hospital, Nanchang, China
| | - Wei Huang
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
| | - Shenjian Chen
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
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François C, Bonafé I, Carra MC, Bertrand C, Micoulaud-Franchi JA, d'Incau E. Dental sleep medicine education among undergraduate dental students in France. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2024; 28:148-153. [PMID: 37353975 DOI: 10.1111/eje.12931] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/29/2023] [Accepted: 06/10/2023] [Indexed: 06/25/2023]
Abstract
INTRODUCTION Dental sleep medicine (DSM) is an emerging discipline that studies the oral and maxillofacial causes and consequences of sleep-related problems. DSM is of upmost importance given the major medical challenge it represents. Therefore, to verify whether the future generation of dentists would be ready to face this challenge, the main objective of this study was to assess the degree of involvement of the French dental schools in teaching DSM at the undergraduate level. MATERIALS AND METHODS All 16 dental schools in France were asked to participate in the study by answering to an online survey concerning the DSM curriculum during the 2018-2019 academic year. The survey was addressed to the head of the dental school and/or to relevant course coordinators and contained 10 questions related to the type, content and amount of DSM teaching to undergraduate dental students. RESULTS Nine of the 16 (56.2%) French dental schools responded to the questionnaire. All these nine reported the inclusion of DSM in their undergraduate curriculum. The total average hours dedicated to teaching DSM was 5.6 h (SD 4.2; range 1-15 h). Seven of the 9 dental schools spent most of their DSM curriculum teaching time in the fifth year. All of them reviewed obstructive sleep apnoea and sleep-related bruxism and covered some topics related to therapies for sleep-related breathing disorders, such as the use of oral appliance. CONCLUSION The results of this survey showed that, although the average hourly volume is relatively high, the DSM teaching in French dental schools appeared to be non-standardised, heterogeneous and often lacunar. It is therefore essential to develop a common curriculum and implement it in all dental schools to provide undergraduate students a comprehensive and updated teaching in DSM.
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Affiliation(s)
- Cindy François
- PhyMedExp, INSERM U1046, CNRS UMR9214, Université de Montpellier, Montpellier, France
- UFR of Odontology, Université de Montpellier, Montpellier, France
- Centre de Soins, d'Enseignement et de Recherche Dentaires, CHU de Montpellier, Montpellier, France
| | - Isabelle Bonafé
- UFR of Odontology, Université de Montpellier, Montpellier, France
- Centre de Soins, d'Enseignement et de Recherche Dentaires, CHU de Montpellier, Montpellier, France
- Unité de recherche «Aide à la décision médicale personnalisée» EA 2415, Université de Montpellier, Montpellier, France
| | - Maria Clotilde Carra
- INSERM - Sorbonne Paris Cité Epidemiology and Statistics Research Centre, Paris, France
- UFR of Odontology, Université Paris Cité, Paris, France
- Department of Periodontology, Service of Odontology, Rothschild Hospital (AP-HP), Paris, France
| | - Caroline Bertrand
- Univ. Bordeaux, CNRS, ICMCB, UMR 5026, Talence, France
- UFR of Odontological Sciences, Univ. Bordeaux, Bordeaux, France
- Service of Oral Medicine, University Hospital of Bordeaux, Bordeaux, France
| | - Jean-Arthur Micoulaud-Franchi
- Univ. Bordeaux, CNRS, SANPSY, UMR 6033, Bordeaux, France
- UFR of Medical Sciences, Univ. Bordeaux, Bordeaux, France
- University Sleep Clinic, University Hospital of Bordeaux, Bordeaux, France
| | - Emmanuel d'Incau
- UFR of Odontological Sciences, Univ. Bordeaux, Bordeaux, France
- Service of Oral Medicine, University Hospital of Bordeaux, Bordeaux, France
- Univ. Bordeaux, CNRS, SANPSY, UMR 6033, Bordeaux, France
- University Sleep Clinic, University Hospital of Bordeaux, Bordeaux, France
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Reynolds AC, Loffler KA, Grivell N, Brown BW, Adams RJ. Diagnosis and management of sleep disorders in shift workers, with patient informed solutions to improve health services research and practice. Sleep Med 2024; 113:131-141. [PMID: 38016359 DOI: 10.1016/j.sleep.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND The combination of shift work and an unmanaged sleep disorder carries health and safety risks. Yet, diagnosis rates for sleep disorders are low in shift workers. The aim of this study was to understand the experience of sleep disorder diagnosis and treatment in shift workers, and consider patient informed solutions to improve access to health services. METHODS Semi-structured interviews were conducted with 16 Australian shift workers with a diagnosed sleep disorder. Patient journey mapping and reflexive thematic analysis were used to understand diagnosis and management experiences. RESULTS There were highly variable experiences with diagnosis and management, often taking >5 years to seek help from a health care provider (HCP) after noticing symptoms of a sleep disorder. Three themes were constructed, including 'the cause of the problem', 'prioritising work', and '(dis)satisfaction and (dis)connection'. Extent of patient and HCP awareness of sleep disorders, and a prevailing attitude of shift work being 'the problem' impacted diagnosis, as did organisational needs (including rostering, which had both positive and negative influences on help seeking). Relationships with HCPs were important, and living on non-standard time was both a barrier and an enabler to sleep disorder care. Participants identified the need for education and awareness, prompts and easy access to screening and referral pathways, and tailored models of care. CONCLUSION Education and awareness initiatives for shift workers, their employers and HCPs, together with development of a model of care for shift workers with sleep disorders may address some of the unique barriers to diagnosis and management.
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Affiliation(s)
- Amy C Reynolds
- Flinders Health and Medical Research Institute (Sleep Health) / Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia.
| | - Kelly A Loffler
- Flinders Health and Medical Research Institute (Sleep Health) / Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia; Health Data and Clinical Trials, Flinders University, Bedford Park, SA, Australia
| | - Nicole Grivell
- Flinders Health and Medical Research Institute (Sleep Health) / Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia
| | - Brandon Wj Brown
- Flinders Health and Medical Research Institute (Sleep Health) / Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia
| | - Robert J Adams
- Flinders Health and Medical Research Institute (Sleep Health) / Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia
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Yang R, Chen J, Wang R, Li D, Hu J, Wan Y, Fang J, Zhang S. The effect of bullying victimization on sleep quality among Chinese medical students: Timing, duration, and patterns. J Affect Disord 2024; 344:25-32. [PMID: 37802327 DOI: 10.1016/j.jad.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/02/2023] [Accepted: 10/03/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Bullying victimization (BV) is a potential factor to sleep quality, but the role of BV characteristics in this association remains unclear. This study aimed to investigate correlation between the timing, duration, and patterns of BV and sleep quality among Chinese medical students. METHODS 4035 participants (mean age of 19.2 ± 1.0) were recruited. BV patterns from pre-school to college were estimated using latent class analysis. Multinomial logistic regression was conducted to evaluate the odds ratio (OR) and 95 % confidence interval (CI) between sleep quality and BV. E values were used to assess unmeasured confounding. RESULTS Three patterns of BV were identified as follows: persistent BV (6.2 %), moderate BV (10.5 %), and low BV (83.3 %). BV during pre-school, elementary school, junior high school, senior high school, and college were all positively associated with poor sleep quality. The ORs were 2.30 (1.43-3.70), 3.00 (2.28-3.95), 2.71 (2.14-3.43), 3.34 (2.57-4.33) and 4.13 (3.19-5.36), respectively. The E value were 4.03 (2.21-NA), 5.45 (3.99-NA), 4.86 (3.70-NA), 6.14 (4.58-NA), 7.73 (5.83-NA), respectively. Those who experienced more periods of BV were more strongly associated with poor sleep quality, presenting a dose-response relationship [OR = 1.78, 95 % CI: 1.63-1.95, E value: 2.96 (2.64-NA)]. Those who experienced moderate BV [OR = 2.58, 95 % CI: 1.99-3.35; E value: 4.60 (3.39-NA)] and persistent BV [OR = 4.01, 95 % CI: 2.95-5.46; E value: 7.48(5.35-NA)] had higher odds of poor sleep quality. LIMITATIONS Retrospective design may introduce recall bias. CONCLUSION BV was positively related to poor sleep quality and chronic exposure to BV had a cumulative effect on poor sleep quality.
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Affiliation(s)
- Rong Yang
- School of Public Health, Anhui Medical University, 81th Meishan Road, Hefei 230032, Anhui Province, PR China
| | - Jin Chen
- School of Medical Technology, Anhui Medical College, 632th Furong Road, Hefei 230601, Anhui Province, PR China
| | - Rong Wang
- Community Health Service Center of Xiyuan Street, 77th Hezuohua South Road, Hefei 230031, Anhui Province, PR China
| | - Danlin Li
- School of Public Health, Anhui Medical University, 81th Meishan Road, Hefei 230032, Anhui Province, PR China
| | - Jie Hu
- School of Public Health, Anhui Medical University, 81th Meishan Road, Hefei 230032, Anhui Province, PR China
| | - Yuhui Wan
- School of Public Health, Anhui Medical University, 81th Meishan Road, Hefei 230032, Anhui Province, PR China
| | - Jun Fang
- School of Public Health, Anhui Medical University, 81th Meishan Road, Hefei 230032, Anhui Province, PR China; Faculty of Pharmaceutical Science, Sojo University, Ikeda 4-22-1, Kumamoto 860-0082, Japan; Department of Preventive Medicine, School of Public Health and Health Management, Anhui Medical College, 632th Furong Road, Hefei 230601, Anhui Province, PR China.
| | - Shichen Zhang
- Department of Preventive Medicine, School of Public Health and Health Management, Anhui Medical College, 632th Furong Road, Hefei 230601, Anhui Province, PR China; MOE Key Laboratory of Population Health Across Life Cycle, 81th Meishan Road, Hefei 230032, Anhui Province, PR China.
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20
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De Simone M, De Feo R, Choucha A, Ciaglia E, Fezeu F. Enhancing Sleep Quality: Assessing the Efficacy of a Fixed Combination of Linden, Hawthorn, Vitamin B1, and Melatonin. Med Sci (Basel) 2023; 12:2. [PMID: 38249078 PMCID: PMC10801487 DOI: 10.3390/medsci12010002] [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: 10/03/2023] [Revised: 11/24/2023] [Accepted: 12/18/2023] [Indexed: 01/23/2024] Open
Abstract
Sleep is essential for overall health, yet various sleep disorders disrupt normal sleep patterns, affecting duration, quality, and timing. This pilot study investigate the impact of a food supplement (SPINOFF®) on both sleep quality and mental well-being in 41 participants (mean age: 45.3 years). Initial assessments revealed sleep disturbances (Pittsburgh Sleep Quality Index-PSQ-mean score: 8.2) and insomnia symptoms (Insomnia Severity Index-ISI- mean score: 12.7). Mental health assessments showed psychological distress (Dass-21 Depression mean score: 4.2, Anxiety mean score: 6.9, Stress mean score: 11.6, Total mean score: 22.7). This study assessed sleep continuity using Awakenings per Night (ApN) via a smartwatch (HELO HEALTH®) and conducted the study in two phases: baseline (T0) and after 30 days of treatment (T1) (Phase A). No placebo-control was used in this study. After 30 days (Phase B), 21 patients were selected for reassessment. Eleven continued treatment for another 30 days (T2), while ten discontinued. Following the intervention, we observed remarkable improvements in sleep quality and mental distress. The SPINOFF® supplement significantly reduced the PSQI scores (22.4%), indicating enhanced sleep quality. Additionally, there was a 19.6% decrease in ISI scores, demonstrating a reduction in insomnia symptoms. Moreover, overall psychological distress decreased by 19.5% signifying improved psychological well-being. In the second phase, participants who continued treatment experienced more substantial improvements, with a mean decrease of 0.8 points in PSQI scores (±0.9) and a mean decrease of 0.9 points in ISI scores. Our findings suggest that the SPINOFF® supplement has the potential to effectively address both sleep disturbances and psychological distress in our study population.
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Affiliation(s)
- Matteo De Simone
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Via Salvatore Allende, 84081 Baronissi, Italy; (R.D.F.); (E.C.)
| | - Rosario De Feo
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Via Salvatore Allende, 84081 Baronissi, Italy; (R.D.F.); (E.C.)
| | - Anis Choucha
- Department of Neurosurgery, Aix Marseille University, APHM, UH Timone, 13005 Marseille, France;
| | - Elena Ciaglia
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Via Salvatore Allende, 84081 Baronissi, Italy; (R.D.F.); (E.C.)
| | - Francis Fezeu
- Department of Neurology & Neurological Surgery, Brain Global, 27659 Arabian Drive, Salisbury, MD 21801, USA;
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21
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Davis-Cheshire R, Bennington S, Hartsek A, Kelly T, Marinelli J, Perez A. The Impact of Weighted Blanket Use on Adults with Sensory Sensitivity and Insomnia. Occup Ther Int 2023; 2023:3109388. [PMID: 38152339 PMCID: PMC10752672 DOI: 10.1155/2023/3109388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 11/29/2023] [Accepted: 12/07/2023] [Indexed: 12/29/2023] Open
Abstract
Purpose This study's purpose was to determine the impact of weighted blanket use on moderate to severe insomnia in adults with sensory sensitivity greater than the average population. Methods For this study, a four-week, single-case, multiple-participant ABA study design was used. Through convenience sampling, four participants scoring 15 or greater on the Insomnia Severity Index (ISI), which categorizes them as having moderate to severe insomnia, and much more than most people in sensory sensitivity on the Adolescent/Adult Sensory Profile were recruited. First, seven-day baseline sleep data was gathered, followed by two weeks of weighted blanket use, concluding with a seven-day withdrawal phase. Additional outcome measures included: Tuck and Snooze Survey, Consensus Sleep Diary Morning, and Additional Sleep Diary Questions. Data analysis included visual analysis, mean comparisons, Tau-U calculations, and pre- to post-ISI category comparisons. Results All participants' ISI scores were categorized as one level less severe postintervention. All participants demonstrated increased sleep quality, and three participants showed an increase in sleep duration based on individual mean comparisons between baseline and intervention phases. Conclusion Weighted blankets appear beneficial in reducing insomnia severity in adults with much more than the average population sensory sensitivity. In addition, those with self-reported anxiety may have increased benefit from this intervention.
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Affiliation(s)
| | | | - Allison Hartsek
- Kettering College, 3737 Southern Blvd, Kettering, OH 45429, USA
| | - Teresa Kelly
- Kettering College, 3737 Southern Blvd, Kettering, OH 45429, USA
| | | | - Amanda Perez
- Kettering College, 3737 Southern Blvd, Kettering, OH 45429, USA
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22
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Lee J, Oh J, Park H, Sim J, Lee J, Kim Y, Yun B. Exploring the relationship between work-family conflict and sleep disturbance: a study on stratification and interaction. Front Psychol 2023; 14:1257233. [PMID: 38144977 PMCID: PMC10740203 DOI: 10.3389/fpsyg.2023.1257233] [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: 07/12/2023] [Accepted: 11/22/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction Despite several studies on the association between work-family conflict (WFC) and sleep disturbances, a more comprehensive approach considering occupational factors is lacking. We aimed to analyze this association among Korean workers and the combined effects of WFC and job-related factors on sleep disturbance. Methods Data on paid workers from the sixth Korean Working Conditions Survey were analyzed. Odds ratios (ORs) with 95% confidence intervals (CIs) for sleep disturbances with WFC were calculated using a multiple logistic regression model among Korean workers. Furthermore, stratification and interaction analyses were conducted between WFC and socioeconomic factors related to sleep disturbance. Results Among the 24,923 workers (male: 11,752, female: 13,171) examined, 35.40% of males and 39.95% of females experienced sleep disturbances. In both sexes, the WFC group was significantly associated with sleep disturbance [adjusted OR (95% CI): male, 2.90 [2.67-3.16]; female, 2.54 [2.35-2.74]]. According to the stratification analysis, the association between sleep disturbance and WFC was prominent among younger and highly educated individuals, those engaged in quick returns, and larger companies in both sexes. In the interactions between WFC, quick return, occupation, and company size on sleep disturbance, there were significant additive associations, except between WFC and occupation among female workers. Conclusion This study highlights the association between WFC and sleep disturbances in male and female workers and emphasizes the importance of maintaining work-life balance.
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Affiliation(s)
- Jian Lee
- Department of Health Administration, Yonsei University, Wonju-si, Republic of Korea
| | - Juyeon Oh
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Heejoo Park
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Juho Sim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jongmin Lee
- Department of Occupational Health, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
| | - Yangwook Kim
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Byungyoon Yun
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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23
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Alakörkkö I, Törmälehto S, Leppänen T, McNicholas WT, Arnardottir ES, Sund R. The economic cost of obstructive sleep apnea: A systematic review. Sleep Med Rev 2023; 72:101854. [PMID: 37939650 DOI: 10.1016/j.smrv.2023.101854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 11/10/2023]
Abstract
Obstructive sleep apnea (OSA) is a common disease associated with a high prevalence of costly comorbidities and accidents that add to the disease's economic impact. Although more attention has been focused on OSA in recent years, no previous systematic reviews have synthesized findings from existing studies that provide estimates of the economic cost of OSA. This study aims to summarize the findings of existing studies that provide estimates of the cost of OSA. Two bibliographic databases, PubMed and Scopus, were used to identify articles on the costs of OSA. The systematic literature review identified 5,938 publications, of which 31 met the inclusion criteria. According to the results, adjusted for inflation and converted to euros, the annual cost per patient ranged from €236 (the incremental cost of OSA) for New Zealand to €28,267 for the United States. The total annual cost per patient in Europe ranged from €1,669 to €5,186. OSA causes a significant burden on society, and OSA-related costs increase many years before the diagnosis and remain elevated for a long time after the diagnosis. Despite some well-conducted studies, the cost estimates for OSA are uncertain and specific to the context in which the study was conducted.
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Affiliation(s)
- Ida Alakörkkö
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
| | - Soili Törmälehto
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - Timo Leppänen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland; School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Walter T McNicholas
- Department of Respiratory and Sleep Medicine, St. Vincent's Hospital Group, School of Medicine, University College Dublin, Dublin, Ireland
| | - Erna S Arnardottir
- Reykjavik University Sleep Institute, School of Technology, Reykjavik University, Reykjavik, Iceland
| | - Reijo Sund
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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24
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Guo J, Redline S, Stone KL, Xiao Y. Redefining Comorbid Insomnia and Sleep Apnea: The Association of Sleep Breathing Impairment and Insomnia with Incident Diabetes. Ann Am Thorac Soc 2023; 20:1791-1800. [PMID: 37695743 PMCID: PMC10704235 DOI: 10.1513/annalsats.202302-171oc] [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: 02/23/2023] [Accepted: 09/08/2023] [Indexed: 09/13/2023] Open
Abstract
Rationale: Obstructive sleep apnea (OSA) is a prevalent sleep disorder that is frequently comorbid with insomnia and often accompanied by metabolic diseases such as type 2 diabetes. Although the apnea-hypopnea index (AHI) is currently the diagnostic criterion for gauging the severity of OSA, the AHI has not consistently predicted incident diabetes. Objectives: To test whether a combined insomnia-OSA (COMISA) phenotype based on comorbid insomnia and sleep breathing impairment index (COMISA-SBII) predicts incident diabetes and to compare the association with an AHI definition of COMISA (COMISA-AHI) in the MrOS (Osteoporotic Fractures in Men) study. Methods: The study samples came from participants in the MrOS sleep study without diabetes at their baseline examination. The SBII was derived as the product of the duration of each respiratory event (apnea and hypopnea) and the accompanying desaturation area from baseline unattended polysomnography. A subgroup of individuals classified as having comorbid insomnia (difficulties falling asleep, waking up in the middle of the night and/or early morning awakenings >15 times per month, and daytime impairments) and sleep breathing impairment (greater than 50th percentile of SBII) were identified at baseline. The primary outcome was incident diabetes during the follow-up visits. Cox proportional models were built to assess the adjusted hazard ratios of COMISA-AHI and COMISA-SBII. Prediction model performances of incident diabetes were compared across different models. Results: A total of 2,365 men (mean age, 76 yr) without diabetes at baseline were included. During a median follow-up of 10.0 years, diabetes developed in 181. After adjusting for demographic characteristics, comorbidities, and behavioral risk factors, participants with COMISA-SBII had a higher risk of incident diabetes (hazard ratio, 1.82; 95% confidence interval, 1.15-2.89) than those without sleep disorders (those with an SBII ⩽13.17 and no insomnia). The result remained significant in the risk competing model. Compared with COMISA-AHI, the addition of COMISA-SBII to a crude model with established risk factors significantly improved the predictive value of incident diabetes. Conclusions: COMISA-SBII, but not COMISA-AHI, predicted incident diabetes after accounting for multiple covariates in a cohort of older men. A comorbid insomnia phenotype based on SBII plus insomnia symptoms may be an important clinical subtype.
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Affiliation(s)
- Junwei Guo
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; and
| | - Katie L. Stone
- Research Institute, California Pacific Medical Center, San Francisco, California
| | - Yi Xiao
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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25
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Sultan P, Guo N, Kawai M, Barwick FH, Carvalho B, Mackey S, Kallen MA, Gould CE, Butwick AJ. Prevalence and predictors for postpartum sleep disorders: a nationwide analysis. J Matern Fetal Neonatal Med 2023; 36:2170749. [PMID: 36710393 DOI: 10.1080/14767058.2023.2170749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To describe the prevalence and predictors of postpartum sleep disorders. DESIGN A retrospective cohort study. SETTING Postpartum. POPULATION Commercially insured women delivering in California (USA) between 2011 and 2014. METHODS Using the Optum Clinformatics Datamart Database. MAIN OUTCOME MEASURES Prevalence of a postpartum sleep disorder diagnosis with and without a depression diagnosis up to 12 months following hospital discharge for inpatient delivery. We also identified predictors of a postpartum sleep disorder diagnosis using multivariable logistic regression. RESULTS We identified 3535 (1.9%) women with a postpartum sleep disorder diagnosis. The prevalence of sleep disorder diagnoses was insomnia (1.3%), sleep apnea (0.25%), and other sleep disorder (0.25%). The odds of a postpartum sleep disorder were highest among women with a history of drug abuse (adjusted odds ratio (aOR): 2.70, 95% confidence interval (CI): 1.79-4.09); a stillbirth delivery (aOR: 2.15, 95% CI: 1.53-3.01); and chronic hypertension (aOR: 1.82; 95% CI: 1.57-2.11). A comorbid diagnosis of a postpartum sleep disorder and depression occurred in 1182 women (0.6%). These women accounted for 33.4% of all women with a postpartum sleep disorder. The strongest predictors of a comorbid diagnosis were a history of drug abuse (aOR: 4.13; 95% CI: 2.37-7.21) and a stillbirth delivery (aOR: 2.93; 95% CI: 1.74-4.92). CONCLUSIONS Postpartum sleep disorders are underdiagnosed conditions, with only 2% of postpartum women in this cohort receiving a sleep diagnosis using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. Insomnia was the most common disorder and one-third of women diagnosed with a postpartum sleep disorder had a co-morbid diagnosis of depression. Future studies are needed to improve the screening and diagnostic accuracy of postpartum sleep disorders.
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Affiliation(s)
- P Sultan
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - N Guo
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - M Kawai
- Department of Psychiatry and Behavioral Sciences, Division of Sleep Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - F H Barwick
- Department of Psychiatry and Behavioral Sciences, Division of Sleep Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - B Carvalho
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - S Mackey
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - M A Kallen
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - C E Gould
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - A J Butwick
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
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26
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Ohn M, McArdle N, Khan RN, von Ungern-Sternberg BS, Eastwood PR, Walsh JH, Wilson AC, Maddison KJ. Early life predictors of obstructive sleep apnoea in young adults: Insights from a longitudinal community cohort (Raine study). Sleep Med 2023; 110:76-81. [PMID: 37544276 DOI: 10.1016/j.sleep.2023.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/24/2023] [Accepted: 07/27/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE Early-life obstructive sleep apnoea (OSA) predictors are unavailable for young adults. This study identifies early-life factors predisposing young adults to OSA. METHODS This retrospective study included 923 young adults and their mothers from the Western Australian Pregnancy Raine Study Cohort. OSA at 22 years was determined from in-laboratory polysomnography. Logistic regression was used to identify maternal and neonatal factors associated with OSA in young adulthood. RESULTS OSA was observed in 20.8% (192) participants. Maternal predictors of OSA included gestational diabetes mellitus (odds ratio (OR) 9.54, 95% confidence interval (CI) 1.7, 58.5, P = 0.011), preterm delivery (OR 3.18, 95%CI 1.1,10.5, P = 0.043), preeclampsia (OR 2.95, 95%CI 1.1,8.0, P = 0.034), premature rupture of membranes (OR 2.46, 95%CI 1.2, 5.2, P = 0.015), age ≥35 years (OR 2.28, 95%CI 1.2,4.4, P = 0.011), overweight and obesity (pregnancy BMI≥25 kg/m2) (OR 2.00, 95%CI 1.2,3.2, P = 0.004), pregnancy-induced hypertension (OR 1.89, 95%CI 1.1,3.2, P = 0.019), and Chinese ethnicity (OR 2.36,95%CI 1.01,5.5, P = 0.047). Neonatal predictors included male child (OR 2.10, 95%CI 1.5,3.0, P < 0.0001), presence of meconium-stained liquor during delivery (OR 1.60, 95%CI 1.0,2.5, P = 0.044) and admission to special care nursery (OR 1.51 95%CI 1.0,2.2, P = 0.040). Higher birth lengths reduced OSA odds by 7% for each centimetre (OR 0.93, 95%CI 0.87, 0.99, P = 0.033). CONCLUSIONS A range of maternal and neonatal factors predict OSA in young adults, including those related to poor maternal metabolic health, high-risk pregnancy and stressful perinatal events. This information could assist in the early identification and management of at-risk individuals and indicates that better maternal health may reduce the likelihood of young adults developing OSA.
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Affiliation(s)
- Mon Ohn
- Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, WA, Australia; Division of Pediatrics, Medical School, The University of Western Australia, Crawley, WA, Australia; Perioperative Medicine Team, Telethon Kids Institute, Nedlands, WA, Australia.
| | - Nigel McArdle
- Centre for Sleep Science, School of Human Sciences, The University of Western Australia, Crawley, WA, Australia; West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.
| | - R Nazim Khan
- Department of Mathematics and Statistics, The University of Western Australia, Crawley, WA, Australia.
| | - Britta S von Ungern-Sternberg
- Perioperative Medicine Team, Telethon Kids Institute, Nedlands, WA, Australia; Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Crawley, WA, Australia; Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Nedlands, WA, Australia.
| | - Peter R Eastwood
- Health Futures Institute, Murdoch University, Perth, WA, Australia.
| | - Jennifer H Walsh
- Centre for Sleep Science, School of Human Sciences, The University of Western Australia, Crawley, WA, Australia; West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.
| | - Andrew C Wilson
- Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, WA, Australia; Division of Pediatrics, Medical School, The University of Western Australia, Crawley, WA, Australia; Wal-yan Respiratory Research Centre, Telethon Kids Institute, Nedlands, WA, Australia.
| | - Kathleen J Maddison
- Centre for Sleep Science, School of Human Sciences, The University of Western Australia, Crawley, WA, Australia; West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.
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27
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Thomas E, Micic G, Adams R, Eckert DJ. Pharmacological management of co-morbid obstructive sleep apnoea and insomnia. Expert Opin Pharmacother 2023; 24:1963-1973. [PMID: 38099435 DOI: 10.1080/14656566.2023.2292186] [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: 09/29/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024]
Abstract
INTRODUCTION Clinical presentation of both insomnia and obstructive sleep apnea (COMISA) is common. Approximately 30% of clinical cohorts with OSA have insomnia symptoms and vice versa. The underlying pathophysiology of COMISA is multifactorial. This poses a complex clinical challenge. Currently, there are no clinical guidelines or recommendations outside of continuous positive airway pressure (CPAP) therapy and cognitive behavioral therapy for insomnia (CBTi). Clinically translatable precision medicine approaches to characterize individual causes or endotypes may help optimize future pharmacological management of COMISA. AREAS COVERED This review article provides an up-to-date account of COMISA and its consequences, the underlying pathophysiology of sleep apnea, insomnia and COMISA, current treatment approaches and limitations, pharmacotherapy targets and future priorities. EXPERT OPINION There are multiple promising emerging therapies, but clinical trial data specifically in COMISA populations are lacking. This is a priority for future investigation to inform development of evidence-based guidelines. Pharmacotherapies, particularly for insomnia, do not target the underlying causes of the disorder thus, are indicated for short-term use only and should remain second line. Future multidisciplinary research should be directed toward the multifactorial nature of COMISA and the challenges of adapting COMISA treatment in clinical practice and overcoming the practical barriers that health-care providers and consumers encounter.
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Affiliation(s)
- Emma Thomas
- Flinders Health and Medical Research Institute (FHMRI) Sleep Health/Adelaide Institute for Sleep Health (AISH), College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Gorica Micic
- Flinders Health and Medical Research Institute (FHMRI) Sleep Health/Adelaide Institute for Sleep Health (AISH), College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Robert Adams
- Flinders Health and Medical Research Institute (FHMRI) Sleep Health/Adelaide Institute for Sleep Health (AISH), College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, Australia
| | - Danny J Eckert
- Flinders Health and Medical Research Institute (FHMRI) Sleep Health/Adelaide Institute for Sleep Health (AISH), College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
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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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Lal U, Mathavu Vasanthsena S, Hoblidar A. Temporal Feature Extraction and Machine Learning for Classification of Sleep Stages Using Telemetry Polysomnography. Brain Sci 2023; 13:1201. [PMID: 37626557 PMCID: PMC10452545 DOI: 10.3390/brainsci13081201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
Accurate sleep stage detection is crucial for diagnosing sleep disorders and tailoring treatment plans. Polysomnography (PSG) is considered the gold standard for sleep assessment since it captures a diverse set of physiological signals. While various studies have employed complex neural networks for sleep staging using PSG, our research emphasises the efficacy of a simpler and more efficient architecture. We aimed to integrate a diverse set of feature extraction measures with straightforward machine learning, potentially offering a more efficient avenue for sleep staging. We also aimed to conduct a comprehensive comparative analysis of feature extraction measures, including the power spectral density, Higuchi fractal dimension, singular value decomposition entropy, permutation entropy, and detrended fluctuation analysis, coupled with several machine-learning models, including XGBoost, Extra Trees, Random Forest, and LightGBM. Furthermore, data augmentation methods like the Synthetic Minority Oversampling Technique were also employed to rectify the inherent class imbalance in sleep data. The subsequent results highlighted that the XGBoost classifier, when used with a combination of all feature extraction measures as an ensemble, achieved the highest performance, with accuracies of 87%, 90%, 93%, 96%, and 97% and average F1-scores of 84.6%, 89%, 90.33%, 93.5%, and 93.5% for distinguishing between five-stage, four-stage, three-stage, and two distinct two-stage sleep configurations, respectively. This combined feature extraction technique represents a novel addition to the body of research since it achieves higher performance than many recently developed deep neural networks by utilising simpler machine-learning models.
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Affiliation(s)
- Utkarsh Lal
- Department of Computer Science and Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India;
| | - Suhas Mathavu Vasanthsena
- Department of Electronics and Communication Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India;
| | - Anitha Hoblidar
- Department of Electronics and Communication Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India;
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Reynolds AC, Coenen P, Lechat B, Straker L, Zabatiero J, Maddison KJ, Adams RJ, Eastwood P. Insomnia and workplace productivity loss among young working adults: a prospective observational study of clinical sleep disorders in a community cohort. Med J Aust 2023; 219:107-112. [PMID: 37357134 DOI: 10.5694/mja2.52014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE To examine associations between three clinically significant sleep disorders (chronic insomnia, obstructive sleep apnoea, restless legs syndrome) and workplace productivity losses among young Australian adults. DESIGN, SETTING Prospective, observational study; 22-year follow-up of participants in the longitudinal birth cohort Raine Study (Perth, Western Australia). PARTICIPANTS Currently employed 22-year-old Raine Study participants who underwent in-laboratory sleep disorder screening for moderate to severe obstructive sleep apnoea (apnoea-hypopnea index of more than fifteen events/hour or obstructive sleep apnoea syndrome) and were assessed for insomnia and restless legs syndrome using validated measures. MAIN OUTCOME MEASURES Total workplace productivity loss over twelve months, assessed with the World Health Organization Health and Work Performance Questionnaire. RESULTS Of 1235 contactable 22-year-old Raine Study cohort members, 554 people (44.9%; 294 women [53%]) underwent overnight polysomnography, completed the baseline sleep questionnaire, and completed at least three quarterly workplace productivity assessments. One or more clinically significant sleep disorders were identified in 120 participants (21.7%); 90 participants had insomnia (17%), thirty clinically significant obstructive sleep apnoea (5.4%), and two restless legs syndrome (0.4%). Seventeen people (14% of those with sleep disorders) had previously been diagnosed with a sleep disturbance by a health professional, including fourteen with insomnia. Median total workplace productivity loss was greater for participants with sleep disorders (164 hours/year; interquartile range [IQR], 0-411 hours/year) than for those without sleep disorders (30 hours/year; IQR, 0-202 hours/year); total workplace productivity loss was 40% greater for participants with sleep disorders (adjusted incidence rate ratio, 1.40; bias-corrected and accelerated 95% confidence interval, 1.10-1.76). The estimated population total productivity loss (weighted for disorder prevalence) was 28 644 hours per 1000 young workers per year, primarily attributable to insomnia (28 730 hours/1000 workers/year). CONCLUSION Insomnia is a risk factor for workplace productivity loss in young workers. Tailored interventions are needed to identify and manage sleep disorders, particularly as most of the sleep disorders detected in the Raine Study had not previously been diagnosed.
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Affiliation(s)
- Amy C Reynolds
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA
| | - Pieter Coenen
- Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Bastien Lechat
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA
| | | | | | - Kath J Maddison
- The University of Western Australia, Perth, WA
- West Australian Sleep Disorders Research Institute, Perth, WA
- Sir Charles Gairdner Hospital, Perth, WA
| | | | - Peter Eastwood
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA
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Lyons LC, Vanrobaeys Y, Abel T. Sleep and memory: The impact of sleep deprivation on transcription, translational control, and protein synthesis in the brain. J Neurochem 2023; 166:24-46. [PMID: 36802068 PMCID: PMC10919414 DOI: 10.1111/jnc.15787] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 01/31/2023] [Accepted: 02/07/2023] [Indexed: 02/20/2023]
Abstract
In countries around the world, sleep deprivation represents a widespread problem affecting school-age children, teenagers, and adults. Acute sleep deprivation and more chronic sleep restriction adversely affect individual health, impairing memory and cognitive performance as well as increasing the risk and progression of numerous diseases. In mammals, the hippocampus and hippocampus-dependent memory are vulnerable to the effects of acute sleep deprivation. Sleep deprivation induces changes in molecular signaling, gene expression and may cause changes in dendritic structure in neurons. Genome wide studies have shown that acute sleep deprivation alters gene transcription, although the pool of genes affected varies between brain regions. More recently, advances in research have drawn attention to differences in gene regulation between the level of the transcriptome compared with the pool of mRNA associated with ribosomes for protein translation following sleep deprivation. Thus, in addition to transcriptional changes, sleep deprivation also affects downstream processes to alter protein translation. In this review, we focus on the multiple levels through which acute sleep deprivation impacts gene regulation, highlighting potential post-transcriptional and translational processes that may be affected by sleep deprivation. Understanding the multiple levels of gene regulation impacted by sleep deprivation is essential for future development of therapeutics that may mitigate the effects of sleep loss.
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Affiliation(s)
- Lisa C Lyons
- Program in Neuroscience, Department of Biological Science, Florida State University, Tallahassee, Florida, USA
| | - Yann Vanrobaeys
- Department of Neuroscience and Pharmacology, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
- Iowa Neuroscience Institute, Iowa City, Iowa, USA
- Interdisciplinary Graduate Program in Genetics, University of Iowa, Iowa City, Iowa, USA
| | - Ted Abel
- Department of Neuroscience and Pharmacology, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
- Iowa Neuroscience Institute, Iowa City, Iowa, USA
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Turnbull CD, Stradling JR. Endotyping, phenotyping and personalised therapy in obstructive sleep apnoea: are we there yet? Thorax 2023; 78:726-732. [PMID: 37217289 DOI: 10.1136/thorax-2023-220037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/02/2023] [Indexed: 05/24/2023]
Abstract
Obstructive sleep apnoea (OSA) was traditionally thought to be mainly caused by obesity and upper airway crowding, and hence OSA management was not personalised according to particular characteristics, with most symptomatic patients receiving continuous positive airway pressure therapy. Recent advances in our understanding have identified additional potential and distinct causes of OSA (endotypes), and subgroups of patients (phenotypes) with increased risk of cardiovascular complications. In this review, we discuss the evidence to date as to whether there are distinct clinically useful endotypes and phenotypes of OSA, and the challenges to the field in moving towards delivering personalised therapy in OSA.
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Affiliation(s)
- Chris D Turnbull
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Oxford Centre for Respiratory Medicine, NIHR Oxford Biomedical Research Centre, Oxford, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - John R Stradling
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
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Ding X, Li Q, Tang YY. The thalamic clustering coefficient moderates the vigor-sleep quality relationship. Sleep Biol Rhythms 2023; 21:369-375. [PMID: 38476314 PMCID: PMC10899908 DOI: 10.1007/s41105-023-00456-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 03/06/2023] [Indexed: 03/28/2023]
Abstract
Sleep disorders affect more than one-quarter of the world's population, resulting in reduced daytime productivity, impaired immune function, and an increased risk of cardiovascular disease. It is important to identify the physiological and psychological factors related to sleep for the prevention and treatment of sleep disorders. In this study, we correlated measurements of emotional state, sleep quality, and some brain neural activity parameters to better understand the brain and psychological factors related to sleep. Resting-state functional magnetic resonance imaging (rs-fMRI) of 116 healthy undergraduates were analyzed using graph theory to assess regional topological characteristics. Among these, the left thalamic cluster coefficient proved to be the ablest to reflect the characteristics of the sleep neural graph index. The Profile of Mood States (POMS) was used to measure vigor, and the Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality. The results showed that the left thalamic clustering coefficient was negatively correlated with sleep quality and vigor. Further, the left thalamic clustering coefficient moderated the relationship between vigor and sleep quality. When the left thalamic clustering coefficient was very low, there was a significant positive correlation between vigor and sleep quality. However, when the left thalamic clustering coefficient was high, the correlation between vigor and sleep quality became insignificant. The relationship between vigor and sleep quality is heterogeneous. Analyzing the function of the left thalamic neural network could help understand the variation in the relationship between vigor and sleep quality in different populations. Such observations may help in the development of personalized interventions for sleep disorders.
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Affiliation(s)
- Xiaoqian Ding
- College of Psychology, Liaoning Normal University, Dalian, 116029 China
| | - Qingmin Li
- College of Psychology, Liaoning Normal University, Dalian, 116029 China
| | - Yi-Yuan Tang
- College of Health Solutions, Arizona State University, Tempe, AZ 85281 USA
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004 USA
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Hao Y, Liu S, Liu T, Huang X, Xie M, Wang D. Pulmonary Function Test and Obstructive Sleep Apnea Hypopnea Syndrome in Obese Adults: A Retrospective Study. Int J Chron Obstruct Pulmon Dis 2023; 18:1019-1030. [PMID: 37304766 PMCID: PMC10253010 DOI: 10.2147/copd.s409383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/28/2023] [Indexed: 06/13/2023] Open
Abstract
Objective We explore risk factors related to severe obstructive sleep apnea (OSA) in obese patients, including pulmonary ventilation function, diffusion function, and impulse oscillometry (IOS) data. Methods The medical records of 207 obese patients who were prepared to undergo bariatric surgery in a hospital from May 2020 to September 2021 were retrospectively reviewed. Polysomnography (PSG), pulmonary ventilation function, diffusion function, and IOS parameters were collected according to the ethical standards of the institutional research committee (registration number: KYLL-202008-144). Logistic regression analysis was used to analyze the related independent risk factors. Results There were significantly statistical difference in a number of pulmonary ventilation and diffusion function parameters among the non-OSAHS group, the mild-to-moderate OSA group, and the severe OSA group. However, only airway resistance parameters R5%, R10%, R15%, R20%, R25%, and R35% increased with increasing OSA severity and were positively correlated with apnea hypopnea index (AHI). Age (P = 0.012, 1.104 (1.022, 1.192)), body mass index (P< 0.0001, 1.12 (1.057, 1.187)), gender (P = 0.003, 4.129 (1.625, 10.49)), and R25% (P = 0.007, 1.018 (1.005, 1.031)) were independent risk factors for severe OSA. In patients aged 35 to 60, RV/TLC (P = 0.029, 1.272 (1.025, 1.577)) is an independent risk factor for severe OSA. Conclusion R25% was an independent risk factor for severe OSA in obese individuals, while RV/TLC was also an independent risk factor in those aged 35 to 60. Pulmonary function tests (PFTs), particularly IOS levels, are recommended to assess severe OSA in obese patients.
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Affiliation(s)
- Yijia Hao
- Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
| | - Shaozhuang Liu
- Division of Bariatric and Metabolic Surgery, Department of General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People’s Republic of China
| | - Teng Liu
- Division of Bariatric and Metabolic Surgery, Department of General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People’s Republic of China
| | - Xin Huang
- Division of Bariatric and Metabolic Surgery, Department of General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People’s Republic of China
| | - Mengshuang Xie
- Department of Geriatrics & Key Laboratory of Cardiovascular Proteomics of Shandong Province, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People’s Republic of China
| | - Dexiang Wang
- Department of Pulmonary and Critical Care Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People’s Republic of China
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Pelayo R, Bertisch SM, Morin CM, Winkelman JW, Zee PC, Krystal AD. Should Trazodone Be First-Line Therapy for Insomnia? A Clinical Suitability Appraisal. J Clin Med 2023; 12:jcm12082933. [PMID: 37109268 PMCID: PMC10146758 DOI: 10.3390/jcm12082933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/01/2023] [Accepted: 04/15/2023] [Indexed: 04/29/2023] Open
Abstract
Trazodone is one of the most commonly used prescription medications for insomnia; however, some recent clinical guidelines do not recommend its use for treating insomnia. This clinical appraisal critically reviews the scientific literature on trazodone as a first-line treatment for insomnia, with the focus statement "Trazodone should never be used as a first-line medication for insomnia." In addition, field surveys were sent to practicing physicians, psychiatrists, and sleep specialists to assess general support for this statement. Subsequently, a meeting with a seven-member panel of key opinion leaders was held to discuss published evidence in support and against the statement. This paper reports on the evidence review, the panel discussion, and the panel's and healthcare professionals' ratings of the statement's acceptability. While the majority of field survey responders disagreed with the statement, the majority of panel members agreed with the statement based on the limited published evidence supporting trazodone as a first-line agent as they understood the term "first-line agent".
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Affiliation(s)
- Rafael Pelayo
- Department of Psychiatry and Behavioral Sciences, Stanford University Sleep Medicine Center, Redwood City, CA 94063, USA
| | - Suzanne M Bertisch
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Charles M Morin
- Department of Psychology, Cervo Brain Research Centre, Laval University, Quebec, QC G1E 1T2, Canada
| | - John W Winkelman
- Department of Psychiatry and Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Phyllis C Zee
- Department of Neurology, Center for Circadian and Sleep Medicine, Northwestern University, Evanston, IL 60611, USA
| | - Andrew D Krystal
- Departments of Psychiatry and Neurology, UCSF Weill Institute for Neurosciences, San Francisco, CA 94158, USA
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Marquina C, Makarounas-Kirchmann K, Holden K, Sasse A, Ademi Z. The preventable productivity burden of sleep apnea in Australia: a lifetime modelling study. J Sleep Res 2023; 32:e13748. [PMID: 36303525 DOI: 10.1111/jsr.13748] [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: 08/07/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 11/29/2022]
Abstract
Obstructive sleep apnea (OSA) is a common disorder. OSA is associated with cardiovascular disease (CVD), type 2 diabetes mellitus (T2DM) and depression, among other comorbidities. We aim to determine the productivity burden of OSA in Australia using productivity-adjusted life-years (PALYs). Using life table modelling, we built a multistate Markov model to estimate the impact of moderate to severe OSA on the whole working-age Australian population in 2021 (aged 20-65 years) with OSA until retirement (aged 66 years). The model also captured the impact of OSA on CVD, T2DM, depression, and vehicle-related accidents. Data for OSA and comorbidities and Australian specific labour data, were extracted from published sources. A second cohort was then modelled to test the effect of a hypothetical intervention, assuming a 10% reduction in OSA prevalence and a 10% reduction in comorbidities in patients with OSA. The primary outcome of interest were PALYs accrued. All outcomes were discounted 5% annually. Over a lifetime, the Australian population with OSA accrued 193,713,441 years of life lived and 182,737,644 PALYs. A reduction of 10% in OSA prevalence and comorbidities would result in 45,401 extra years of life lived and 150,950 extra PALYs. This resulted in more than AU$25 billion of gained gross domestic product over the lifetime of the working population. Our study highlights the substantial burden of OSA on the Australian population and the need to tailor interventions at the population level to reduce the health and economic impacts.
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Affiliation(s)
- Clara Marquina
- Centre for Medicine Use and Safety (CMUS), Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kelly Makarounas-Kirchmann
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Snoretox Ltd., Melbourne, Victoria, Australia
| | - Karen Holden
- Snoretox Ltd., Melbourne, Victoria, Australia.,School of Health Sciences, Bundoora West Campus, RMIT University, Melbourne, Victoria, Australia
| | - Anthony Sasse
- Snoretox Ltd., Melbourne, Victoria, Australia.,School of Health Sciences, Bundoora West Campus, RMIT University, Melbourne, Victoria, Australia
| | - Zanfina Ademi
- Centre for Medicine Use and Safety (CMUS), Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
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Impact of Gender on Insomnia. Brain Sci 2023; 13:brainsci13030480. [PMID: 36979290 PMCID: PMC10046211 DOI: 10.3390/brainsci13030480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 03/16/2023] Open
Abstract
There is a distinct preponderance of female insomniacs when compared to male insomniacs. The aim of this study was to examine possible gender differences in the causes for insomnia, and the phenotypes of insomnia, and to investigate whether gender-specific insomnia diagnosis and treatment could be relevant in clinical practice. Data were collected from 121 insomniac patients by a medical specialist in the framework of normal clinical practice in Germany. The data consist of the patient’s medical history and various sleep-related patient questionnaires. Data from both genders were tested for independence using chi-square tests and Mann–Whitney U tests. We found a correlation between the gender of the patient and insomnia phenotypes in several aspects: concomitant lipometabolic disorders, diabetes mellitus, and high BMIs are more common in male insomniacs (p < 0.05). Frequency of insomnia occurrence in certain age groups, insomnia severity, distribution of SOI (sleep onset insomnia), SMI (sleep maintenance insomnia) and combined SOI + SMI, sleep duration, the time needed to seek medical consultation, trying out sleep-inducing drugs/techniques and the trigger, etiology and familial predisposition of the insomniac disorder were independent of the patient’s gender. We would like to re-evaluate the results with a larger number of patients in a further study.
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Efficacy of lifestyle medicine on sleep quality: A meta-analysis of randomized controlled trials. J Affect Disord 2023; 330:125-138. [PMID: 36863476 DOI: 10.1016/j.jad.2023.02.111] [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: 08/06/2022] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVES Randomized controlled trials (RCTs) on the efficacy of multicomponent lifestyle medicine (LM) interventions for improving sleep quality have yielded inconsistent findings. This study marks the first meta-analysis to evaluate the efficacy of multicomponent LM interventions in improving sleep quality. METHODS We searched six online databases for RCTs that compared multicomponent LM interventions to an active or inactive control group in an adult population and assessed subjective sleep quality as a primary or secondary outcome using validated sleep measures at any post-intervention time-point. RESULTS A total of 23 RCTs with 26 comparisons involving 2534 participants were included in the meta-analysis. After excluding outliers, the analysis revealed that multicomponent LM interventions significantly improved sleep quality at immediate post-intervention (d = 0.45) and at short-term follow-up (i.e., <three months) (d = 0.50) relative to an inactive control group. Regarding the comparison with active control, no significant between-group difference was found at any time-point. No meta-analysis was conducted at the medium- and long-term follow-up due to insufficient data. Subgroup analyses supported that multicomponent LM interventions had a more clinically relevant effect on improving sleep quality in participants with clinical levels of sleep disturbance (d = 1.02) relative to an inactive control at immediate post-intervention assessment. There was no evidence of publication bias. CONCLUSION Our findings provided preliminary evidence that multicomponent LM interventions were efficacious in improving sleep quality relative to an inactive control at immediate post-intervention and at short-term follow-up. Additional high-quality RCTs targeting individuals with clinically significant sleep disturbance and long-term follow-up are warranted.
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Guo J, Dai L, Luo J, Huang R, Xiao Y. Shorter respiratory event duration is related to prevalence of type 2 diabetes. Front Endocrinol (Lausanne) 2023; 14:1105781. [PMID: 36875453 PMCID: PMC9978406 DOI: 10.3389/fendo.2023.1105781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 02/03/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a heterogeneous sleep disorder often comorbid with metabolic diseases, and type 2 diabetes (T2DM) is one of them. Although apnea hypopnea index (AHI) is currently the diagnostic criteria for OSA severity, a controversial relationship between AHI and T2DM has been found. On the other hand, the duration of apnea-hypopnea events has been shown to be a useful metric for predicting mortality. This study aimed to test whether average respiratory event duration was associated with prevalence of T2DM. METHODS Patients referred to the sleep clinic were recruited in the study. Baseline clinical characteristics and polysomnography parameters including average respiratory event duration were collected. The association of average respiratory event duration with the prevalence of T2DM was evaluated by univariate and multivariate logistic regression analyses. RESULTS A total of 260 participants were enrolled, and 92 (35.4%) had T2DM. Univariate analysis revealed that age, body mass index (BMI), total sleep time, sleep efficiency, history of hypertension, and shorter average respiratory event duration were associated with T2DM. In multivariate analysis, only age and BMI remained significant. While average respiratory event duration was insignificant in multivariate analysis, subtype event analysis showed that shorter average apnea duration was both significant in univariate (OR, 0.95; 95% CI, 0.92-0.98) and multivariate analyses (OR, 0.95; 95% CI, 0.91-0.99). Neither average hypopnea duration nor AHI was associated with T2DM. Significant association (OR, 1.19; 95% CI, 1.12-1.25) was observed between shorter average apnea duration and lower respiratory arousal threshold after multivariate adjustment. However, causal mediation analysis revealed no mediating effect of arousal threshold on average apnea duration and T2DM. CONCLUSION The average apnea duration may be a useful metric in the diagnosis of OSA comorbidity. Shorter average apnea duration indicating poor sleep quality and augmented autonomic nervous system responses might be the potential pathological mechanisms leading to T2DM.
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Linz B, Hesselkilde EM, Skarsfeldt MA, Hertel JN, Sattler SM, Yan Y, Tfelt-Hansen J, Diness JG, Bentzen BH, Linz D, Jespersen T. Pharmacological inhibition of SK-channels with AP14145 prevents atrial arrhythmogenic changes in a porcine model for obstructive respiratory events. J Cardiovasc Electrophysiol 2023; 34:126-134. [PMID: 36482155 PMCID: PMC10107889 DOI: 10.1111/jce.15769] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 11/02/2022] [Accepted: 11/07/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) creates a complex substrate for atrial fibrillation (AF), which is refractory to many clinically available pharmacological interventions. We investigated atrial antiarrhythmogenic properties and ventricular electrophysiological safety of small-conductance Ca2+ -activated K+ (SK)-channel inhibition in a porcine model for obstructive respiratory events. METHODS In spontaneously breathing pigs, obstructive respiratory events were simulated by intermittent negative upper airway pressure (INAP) applied via a pressure device connected to the intubation tube. INAP was applied for 75 s, every 10 min, three times before and three times during infusion of the SK-channel inhibitor AP14145. Atrial effective refractory periods (AERP) were acquired before (pre-INAP), during (INAP) and after (post-) INAP. AF-inducibility was determined by a S1S2 atrial pacing protocol. Ventricular arrhythmicity was evaluated by heart rate adjusted QT-interval duration (QT-paced) and electromechanical window (EMW) shortening. RESULTS During vehicle infusion, INAP transiently shortened AERP (pre-INAP: 135 ± 10 ms vs. post-INAP 101 ± 11 ms; p = .008) and increased AF-inducibility. QT-paced prolonged during INAP (pre-INAP 270 ± 7 ms vs. INAP 275 ± 7 ms; p = .04) and EMW shortened progressively throughout INAP and post-INAP (pre-INAP 80 ± 4 ms; INAP 59 ± 6 ms, post-INAP 46 ± 10 ms). AP14145 prolonged baseline AERP, partially prevented INAP-induced AERP-shortening and reduced AF-susceptibility. AP14145 did not alter QT-paced at baseline (pre-AP14145 270 ± 7 ms vs. AP14145 268 ± 6 ms, p = .83) or QT-paced and EMW-shortening during INAP. CONCLUSION In a pig model for obstructive respiratory events, the SK-channel-inhibitor AP14145 prevented INAP-associated AERP-shortening and AF-susceptibility without impairing ventricular electrophysiology. Whether SK-channels represent a target for OSA-related AF in humans warrants further study.
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Affiliation(s)
- Benedikt Linz
- Faculty of Health and Medical Sciences, Department of Biomedical Sciences, Cardiac Physiology Laboratory, Panum Institutet, University of Copenhagen, Copenhagen, Denmark
| | - Eva M Hesselkilde
- Faculty of Health and Medical Sciences, Department of Biomedical Sciences, Cardiac Physiology Laboratory, Panum Institutet, University of Copenhagen, Copenhagen, Denmark
| | - Mark A Skarsfeldt
- Faculty of Health and Medical Sciences, Department of Biomedical Sciences, Cardiac Physiology Laboratory, Panum Institutet, University of Copenhagen, Copenhagen, Denmark.,Acesion Pharma, Copenhagen, Denmark
| | - Julie N Hertel
- Faculty of Health and Medical Sciences, Department of Biomedical Sciences, Cardiac Physiology Laboratory, Panum Institutet, University of Copenhagen, Copenhagen, Denmark
| | - Stefan M Sattler
- Faculty of Health and Medical Sciences, Department of Biomedical Sciences, Cardiac Physiology Laboratory, Panum Institutet, University of Copenhagen, Copenhagen, Denmark
| | - Yannan Yan
- Faculty of Health and Medical Sciences, Department of Biomedical Sciences, Cardiac Physiology Laboratory, Panum Institutet, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Bo H Bentzen
- Faculty of Health and Medical Sciences, Department of Biomedical Sciences, Cardiac Physiology Laboratory, Panum Institutet, University of Copenhagen, Copenhagen, Denmark.,Acesion Pharma, Copenhagen, Denmark
| | - Dominik Linz
- Faculty of Health and Medical Sciences, Department of Biomedical Sciences, Cardiac Physiology Laboratory, Panum Institutet, University of Copenhagen, Copenhagen, Denmark.,Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia.,Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Thomas Jespersen
- Faculty of Health and Medical Sciences, Department of Biomedical Sciences, Cardiac Physiology Laboratory, Panum Institutet, University of Copenhagen, Copenhagen, Denmark
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Torres-Granados GI, Santana-Miranda R, Barrera-Medina A, Cruz-Cruz C, Jiménez-Correa U, Rosenthal L, López-Naranjo F, Martínez-Núñez JM. The economic costs of insomnia comorbid with depression and anxiety disorders: an observational study at a sleep clinic in Mexico. Sleep Biol Rhythms 2023; 21:23-31. [PMID: 35975183 PMCID: PMC9372938 DOI: 10.1007/s41105-022-00412-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/28/2022] [Indexed: 01/07/2023]
Abstract
Significant advances documenting the costs associated with insomnia have been achieved. However, those related to insomnia associated with mood disorders remain understudied, even though insomnia is more severe in the presence of comorbid conditions such as depression and anxiety. The aim of this study was to determine the direct and indirect costs of insomnia associated with depression and anxiety disorders (DAD) from the perspective of the patient in a private healthcare system. This was an observational study of chronic insomnia associated with DAD at a private Sleep Disorders Clinic in Mexico City between 2019 and 2020. Patients were followed for up to one year. Healthcare resource utilization data were collected through clinical records. Direct and indirect costs associated with insomnia treatment were estimated through micro-costing. The estimated economic burden was projected to 5 years adjusting for inflation and discounting future costs. A deterministic sensitivity analysis was performed. The median cost of the first year of insomnia treatment associated with DAD was US$3537.57 per patient. The work productivity loss represented the highest economic burden (63.84%) followed by direct medical costs (28.32%), and the direct non-medical costs (7.85%). The estimated annual economic burden for patients treated in the private healthcare system in Mexico was US$293 million. The costs of insomnia associated with DAD at a private clinic in México were found to be high. The burden of the costs faced by these patients is substantial relative to the median income of the population. The economic costs at an individual and societal levels are substantial. Supplementary Information The online version contains supplementary material available at 10.1007/s41105-022-00412-6.
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Affiliation(s)
- Gustavo Ivan Torres-Granados
- Department of Biological Systems, Universidad Autónoma Metropolitana, Campus Xochimilco, Calzada del Hueso 1100, Col. Villa Quietud, 04960 Coyoacán, Mexico City, Mexico
| | - Rafael Santana-Miranda
- Clinic of Sleep Disorders, Research Division, School of Medicine, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | - Andrés Barrera-Medina
- Clinic of Sleep Disorders, Research Division, School of Medicine, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | - Copytzy Cruz-Cruz
- Department of Biological Systems, Universidad Autónoma Metropolitana, Campus Xochimilco, Calzada del Hueso 1100, Col. Villa Quietud, 04960 Coyoacán, Mexico City, Mexico
| | - Ulises Jiménez-Correa
- Clinic of Sleep Disorders, Research Division, School of Medicine, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico ,Postgraduate Program in Behavioral Neuroscience, Psychology Faculty, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | | | - Francisco López-Naranjo
- Department of Biological Systems, Universidad Autónoma Metropolitana, Campus Xochimilco, Calzada del Hueso 1100, Col. Villa Quietud, 04960 Coyoacán, Mexico City, Mexico
| | - Juan Manuel Martínez-Núñez
- Department of Biological Systems, Universidad Autónoma Metropolitana, Campus Xochimilco, Calzada del Hueso 1100, Col. Villa Quietud, 04960 Coyoacán, Mexico City, Mexico
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Cost-Effectiveness of Continuous Positive Airway Pressure Therapy Versus Other Treatments of Obstructive Sleep Apnea. Sleep Med Clin 2022; 17:559-567. [DOI: 10.1016/j.jsmc.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kim RE, Mabunga DF, Kim HJ, Han SH, Kim HY, Shin CY, Kwon KJ. Novel Therapeutics for Treating Sleep Disorders: New Perspectives on Maydis stigma. Int J Mol Sci 2022; 23:ijms232314612. [PMID: 36498940 PMCID: PMC9740493 DOI: 10.3390/ijms232314612] [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: 08/31/2022] [Revised: 10/26/2022] [Accepted: 11/05/2022] [Indexed: 11/24/2022] Open
Abstract
Sleep is a restorative period that plays a crucial role in the physiological functioning of the body, including that of the immune system, memory processing, and cognition. Sleep disturbances can be caused by various physical, mental, and social problems. Recently, there has been growing interest in sleep. Maydis stigma (MS, corn silk) is a female maize flower that is traditionally used as a medicinal plant to treat many diseases, including hypertension, edema, and diabetes. It is also used as a functional food in tea and other supplements. β-Sitosterol (BS) is a phytosterol and a natural micronutrient in higher plants, and it has a similar structure to cholesterol. It is a major component of MS and has anti-inflammatory, antidepressive, and sedative effects. However, the potential effects of MS on sleep regulation remain unclear. Here, we investigated the effects of MS on sleep in mice. The effects of MS on sleep induction were determined using pentobarbital-induced sleep and caffeine-induced sleep disruption mouse models. MS extracts decreased sleep latency and increased sleep duration in both the pentobarbital-induced sleep induction and caffeine-induced sleep disruption models compared to the positive control, valerian root extract. The butanol fraction of MS extracts decreased sleep latency time and increased sleep duration. In addition, β-sitosterol enhances sleep latency and sleep duration. Both MS extract and β-sitosterol increased alpha activity in the EEG analysis. We measured the mRNA expression of melatonin receptors 1 and 2 (MT1/2) using qRT-PCR. The mRNA expression of melatonin receptors 1 and 2 was increased by MS extract and β-sitosterol treatment in rat primary cultured neurons and the brain. In addition, MS extract increased the expression of clock genes including per1/2, cry1/2, and Bmal1 in the brain. MS extract and β-sitosterol increased the phosphorylation of ERK1/2 and αCaMKII. Our results demonstrate for the first time that MS has a sleep-promoting effect via melatonin receptor expression, which may provide new scientific evidence for its use as a potential therapeutic agent for the treatment and prevention of sleep disturbance.
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Affiliation(s)
- Ryeong-Eun Kim
- Department of Neuroscience, School of Medicine, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea
| | - Darine Froy Mabunga
- Department of Neuroscience, School of Medicine, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea
| | - Hee Jin Kim
- Department of Pharmacy, Uimyung Research Institute for Neuroscience, Sahmyook University, 815 Hwarangro, Nowon-gu, Seoul 01795, Republic of Korea
| | - Seol-Heui Han
- Department of Neurology, Konkuk Hospital Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, Republic of Korea
| | - Hahn Young Kim
- Department of Neurology, Konkuk Hospital Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, Republic of Korea
| | - Chan Young Shin
- Department of Pharmacology, School of Medicine, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea
| | - Kyoung Ja Kwon
- Department of Neuroscience, School of Medicine, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea
- Department of Neurology, Konkuk Hospital Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, Republic of Korea
- Correspondence: ; Tel.: +82-2-454-5630; Fax: +82-2030-7899
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A Combination of Rosa Multiflora and Zizyphus Jujuba Enhance Sleep Quality in Anesthesia-Induced Mice. Int J Mol Sci 2022; 23:ijms232214177. [PMID: 36430653 PMCID: PMC9696267 DOI: 10.3390/ijms232214177] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/15/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022] Open
Abstract
Sleep is an essential component of quality of life. The majority of people experience sleep problems that impact their quality of life. Melatonin is currently a representative sleep aid. However, it is classified as a prescription drug in most countries, and consumers cannot purchase it to improve their sleep. This sleep induction experiment in mice aimed to identify a natural combination product (NCP) that can create synergistic sleep-promoting effects. Based on the mechanism of action of sleep, we investigated whether phenomenological indicators of sleep quality change according to the intake of NCP. The sleep onset and sleep time of the mice that consumed the NCP found by this study were improved compared to the existing sleep aids. The mean melatonin level in the blood increased by 197% compared to the control. To our knowledge, this is the first study to demonstrate that Rosa multiflora Thunb. (Yeongsil) can promote sleep similarly to Zizyphus jujuba Miller (Sanjoin). The results indicate a preclinical study of NCPs containing Rosa multiflora Thunb and Zizyphus jujuba Miller developed by us showed significant differences in sleep incubation and duration depending on melatonin concentrations. Our results also suggest that increased melatonin concentrations in the blood are likely to improve sleep quality, especially regarding incubation periods.
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Jia Y, Guo D, Sun L, Shi M, Zhang K, Yang P, Zang Y, Wang Y, Liu F, Zhang Y, Zhu Z. Self-reported daytime napping, daytime sleepiness, and other sleep phenotypes in the development of cardiometabolic diseases: a Mendelian randomization study. Eur J Prev Cardiol 2022; 29:1982-1991. [PMID: 35707994 DOI: 10.1093/eurjpc/zwac123] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 01/11/2023]
Abstract
AIMS Sleep disorders are associated with an increased risk of cardiometabolic diseases in observational studies, but the causality remains unclear. In this study, we leveraged two-sample Mendelian randomization (MR) analyses to assess the causal associations of self-reported daytime napping, daytime sleepiness, and other sleep phenotypes with cardiometabolic diseases including ischaemic stroke (IS), coronary artery disease (CAD), heart failure (HF), and Type 2 diabetes mellitus (T2DM). METHODS AND RESULTS We selected genetic variants as instrumental variables for self-reported daytime napping, daytime sleepiness, morning person, insomnia, short sleep duration, and long sleep duration from European-descent genome-wide association studies (GWASs). Summary statistics for cardiometabolic diseases originated from four different GWASs with a total of 2 500 086 participants. We used the inverse-variance weighted method to explore the role of self-reported sleep phenotypes on the aetiology of cardiometabolic diseases in the main analyses, followed by several sensitivity analyses for robustness validation. Genetically predicted self-reported daytime napping [T2DM: OR, 1.56 (95% confidence interval, 1.21-2.02)], insomnia [IS: OR, 1.07 (1.04-1.11)]; CAD: OR, 1.13 (1.08-1.17); HF: OR, 1.10 (1.07-1.14); T2DM: OR, 1.16 (1.11-1.22); and short sleep duration [CAD: OR, 1.37 (1.21-1.55)] were causally associated with an elevated risk of cardiometabolic diseases. Moreover, genetically determined self-reported daytime sleepiness [CAD: OR, 2.05 (1.18-3.57); HF: OR, 1.82 (1.15-2.87)] and morning person [HF: 1.06 OR, (1.01-1.11)] had potential detrimental effect on cardiometabolic risks. CONCLUSION Self-reported daytime napping, insomnia, and short sleep duration had causal roles in the development of cardiometabolic diseases, while self-reported daytime sleepiness and morning person was the potential risk factor for cardiometabolic diseases.
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Affiliation(s)
- Yiming Jia
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, Jiangsu Province 215123, China
| | - Daoxia Guo
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, Jiangsu Province 215123, China.,School of Nursing, Medical College of Soochow University, Suzhou, Jiangsu Province 215006, China
| | - Lulu Sun
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, Jiangsu Province 215123, China
| | - Mengyao Shi
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, Jiangsu Province 215123, China
| | - Kaixin Zhang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, Jiangsu Province 215123, China
| | - Pinni Yang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, Jiangsu Province 215123, China
| | - Yuhan Zang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, Jiangsu Province 215123, China
| | - Yu Wang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, Jiangsu Province 215123, China
| | - Fanghua Liu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, Jiangsu Province 215123, China
| | - Yonghong Zhang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, Jiangsu Province 215123, China
| | - Zhengbao Zhu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, Jiangsu Province 215123, China
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Delgado-Floody P, Caamaño Navarrete F, Chirosa-Ríos L, Martínez-Salazar C, Vargas CA, Guzmán-Guzmán IP. Exercise Training Program Improves Subjective Sleep Quality and Physical Fitness in Severely Obese Bad Sleepers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13732. [PMID: 36360611 PMCID: PMC9658425 DOI: 10.3390/ijerph192113732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Sleep quality is an important modulator of neuroendocrine function, as sleep problems are related to metabolic and endocrine alterations. OBJECTIVE The main objective was to determine the effects of an exercise training program on the sleep quality of severely obese patients with sleep problems. The secondary objective was to determine the relationship between fitness and anthropometric parameters with sleep quality scores. METHODS Thirty severely obese patients participated in 16 weeks of PA intervention (age: 39.30 ± 11.62 y, BMI: 42.75 ± 5.27 kg/m2). Subjective sleep quality, anthropometric parameters, and fitness (i.e., handgrip strength and cardiorespiratory fitness) were measured. RESULTS Two groups were defined as good sleepers (n = 15, 38.06 ± 12.26, men = 1) and bad sleepers (n = 15, 40.53 ± 11.23, men = 3). The good sleeper group reported improvement in cardiorespiratory fitness (61.33 ± 68.75 m vs. 635.33 ± 98.91 m, p = 0.003) and handgrip strength (29.63 ± 9.29 kg vs. 31.86 ± 7.17 kg, p = 0.049). The bad sleeper group improved their cardiorespiratory fitness (472.66 ± 99.7 m vs. 611.33 ± 148.75 m, p = 0.001). In terms of sleep quality dimensions, the bad sleeper group improved their subjective sleep quality (p < 0.001), sleep latency (p = 0.045), sleep duration (p = 0.031), and habitual sleep efficiency (p = 0.015). Comparing the changes in both groups (∆), there were differences in subjective sleep quality scores (∆ = 2.23 vs. ∆ = -3.90, p = 0.002), where 86.6% of the bad sleeper group improved sleep quality (p = 0.030). An increase in handgrip strength was correlated to improving sleep quality scores (r = -0.49, p = 0.050). CONCLUSIONS Severely obese bad sleepers improved their subjective sleep quality, the components of sleep, and cardiorespiratory fitness through an exercise training program. Improvement in subjective sleep quality was linked to an increase in handgrip strength.
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Affiliation(s)
- Pedro Delgado-Floody
- Department of Physical Education, Sport and Recreation, Universidad de La Frontera, Temuco 4811230, Chile
- Department Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18011 Granada, Spain
- Strength & Conditioning Laboratory, CTS-642 Research Group, Department Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18011 Granada, Spain
| | | | - Luis Chirosa-Ríos
- Department Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18011 Granada, Spain
- Strength & Conditioning Laboratory, CTS-642 Research Group, Department Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18011 Granada, Spain
| | - Cristian Martínez-Salazar
- Department of Physical Education, Sport and Recreation, Universidad de La Frontera, Temuco 4811230, Chile
| | - Claudia Andrea Vargas
- Department of Physical Education, Sport and Recreation, Universidad de La Frontera, Temuco 4811230, Chile
| | - Iris Paola Guzmán-Guzmán
- Faculty of Chemical-Biological Sciences, Universidad Autónoma de Guerrero, Guerrero 39087, Mexico
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Bragazzi NL, Garbarino S, Puce L, Trompetto C, Marinelli L, Currà A, Jahrami H, Trabelsi K, Mellado B, Asgary A, Wu J, Kong JD. Planetary sleep medicine: Studying sleep at the individual, population, and planetary level. Front Public Health 2022; 10:1005100. [PMID: 36330122 PMCID: PMC9624384 DOI: 10.3389/fpubh.2022.1005100] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/20/2022] [Indexed: 01/27/2023] Open
Abstract
Circadian rhythms are a series of endogenous autonomous oscillators that are generated by the molecular circadian clock which coordinates and synchronizes internal time with the external environment in a 24-h daily cycle (that can also be shorter or longer than 24 h). Besides daily rhythms, there exist as well other biological rhythms that have different time scales, including seasonal and annual rhythms. Circadian and other biological rhythms deeply permeate human life, at any level, spanning from the molecular, subcellular, cellular, tissue, and organismal level to environmental exposures, and behavioral lifestyles. Humans are immersed in what has been called the "circadian landscape," with circadian rhythms being highly pervasive and ubiquitous, and affecting every ecosystem on the planet, from plants to insects, fishes, birds, mammals, and other animals. Anthropogenic behaviors have been producing a cascading and compounding series of effects, including detrimental impacts on human health. However, the effects of climate change on sleep have been relatively overlooked. In the present narrative review paper, we wanted to offer a way to re-read/re-think sleep medicine from a planetary health perspective. Climate change, through a complex series of either direct or indirect mechanisms, including (i) pollution- and poor air quality-induced oxygen saturation variability/hypoxia, (ii) changes in light conditions and increases in the nighttime, (iii) fluctuating temperatures, warmer values, and heat due to extreme weather, and (iv) psychological distress imposed by disasters (like floods, wildfires, droughts, hurricanes, and infectious outbreaks by emerging and reemerging pathogens) may contribute to inducing mismatches between internal time and external environment, and disrupting sleep, causing poor sleep quantity and quality and sleep disorders, such as insomnia, and sleep-related breathing issues, among others. Climate change will generate relevant costs and impact more vulnerable populations in underserved areas, thus widening already existing global geographic, age-, sex-, and gender-related inequalities.
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Affiliation(s)
- Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada,*Correspondence: Nicola Luigi Bragazzi
| | - Sergio Garbarino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences (DINOGMI), University of Genoa, Genoa, Italy
| | - Luca Puce
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences (DINOGMI), University of Genoa, Genoa, Italy
| | - Carlo Trompetto
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences (DINOGMI), University of Genoa, Genoa, Italy,Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genoa, Italy
| | - Lucio Marinelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences (DINOGMI), University of Genoa, Genoa, Italy,Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonio Currà
- Department of Medical-Surgical Sciences and Biotechnologies, Academic Neurology Unit, Ospedale A. Fiorini, Terracina, Italy,Sapienza University of Rome, Rome, Italy
| | - Haitham Jahrami
- Ministry of Health, Manama, Bahrain,College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Khaled Trabelsi
- High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia,Research Laboratory: Education, Motricity, Sport and Health, EM2S, LR19JS01, University of Sfax, Sfax, Tunisia
| | - Bruce Mellado
- School of Physics and Institute for Collider Particle Physics, University of the Witwatersrand, Johannesburg, South Africa,Subatomic Physics, iThemba Laboratory for Accelerator Based Sciences, Somerset West, South Africa
| | - Ali Asgary
- Disaster and Emergency Management Area and Advanced Disaster, Emergency and Rapid-Response Simulation (ADERSIM), School of Administrative Studies, York University, Toronto, ON, Canada
| | - Jianhong Wu
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada
| | - Jude Dzevela Kong
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada
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Magnavita N, Mele L, Meraglia I, Merella M, Vacca ME, Cerrina A, Gabriele M, Labella M, Soro MT, Ursino S, Matera C. The Impact of Workplace Violence on Headache and Sleep Problems in Nurses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13423. [PMID: 36294004 PMCID: PMC9603049 DOI: 10.3390/ijerph192013423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 10/14/2022] [Accepted: 10/16/2022] [Indexed: 06/16/2023]
Abstract
Workplace violence (WV) is a significant occupational hazard for nurses. Previous studies have shown that WV has a reciprocal relationship with occupational stress. Headaches and sleep problems are early neuropsychological signs of distress. This cross-sectional study aims to ascertain the frequency of physical or verbal assaults on nurses and to study the association of WV with headaches and sleep problems. During their regular medical examination in the workplace, 550 nurses and nursing assistants (105 males, 19.1%; mean age 48.02 ± 9.98 years) were asked to fill in a standardized questionnaire containing the Violent Incident Form (VIF) concerning the episodes of violence experienced, the Headache Impact Test (HIT-6) regarding headaches, and the Pittsburgh Sleep Quality Inventory (PSQI) on sleep quality. Occupational stress was measured using the Effort/Reward Imbalance questionnaire (ERI). Physical and non-physical violence experienced in the previous year was reported by 7.5% and 17.5% of workers, respectively. In the univariate logistic regression models, the workers who experienced violence had an increased risk of headaches and sleep problems. After adjusting for sex, age, job type, and ERI, the relationship between physical violence and headaches remained significant (adjusted odds ratio aOR = 2.25; confidence interval CI95% = 1.11; 4.57). All forms of WV were significantly associated with poor sleep in a multivariate logistic regression model adjusted for sex, age, job type, and ERI (aOR = 2.35 CI95% = 1.44; 3.85). WV was also associated with the impact of headaches and with sleep quality. WV prevention may reduce the frequency of lasting psychoneurological symptoms, such as headaches and poor sleep quality, that interfere with the ability to work.
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Affiliation(s)
- Nicola Magnavita
- Postgraduate School of Occupational Health, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
- Department of Woman, Child & Public Health Sciences, Fondazione A. Gemelli IRCCS, 00168 Roma, Italy
- Local Healthcare Unit Roma 4, 00053 Civitavecchia, Italy
| | - Luca Mele
- Postgraduate School of Occupational Health, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Igor Meraglia
- Postgraduate School of Occupational Health, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Marco Merella
- Postgraduate School of Occupational Health, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Maria Eugenia Vacca
- Postgraduate School of Occupational Health, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Anna Cerrina
- Local Healthcare Unit Roma 4, 00053 Civitavecchia, Italy
| | | | | | | | - Simona Ursino
- Local Healthcare Unit Roma 4, 00053 Civitavecchia, Italy
| | - Carmela Matera
- Local Healthcare Unit Roma 4, 00053 Civitavecchia, Italy
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49
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Chaput JP, Janssen I, Sampasa-Kanyinga H, Carney CE, Dang-Vu TT, Davidson JR, Robillard R, Morin CM. Economic burden of insomnia symptoms in Canada. Sleep Health 2022; 9:185-189. [PMID: 36319579 DOI: 10.1016/j.sleh.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/14/2022] [Accepted: 09/24/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To estimate health care and productivity costs associated with insomnia symptoms in Canadian adults. METHODS Three pieces of information were needed to calculate estimates based on a prevalence-based approach: (1) the pooled relative risk estimates of health outcomes consistently associated with insomnia symptoms obtained from recent meta-analyses of prospective cohort studies; (2) the direct (health care) and indirect (lost productivity due to premature mortality) costs of these health outcomes using the Economic Burden of Illness in Canada information; and (3) the prevalence of insomnia symptoms in Canadian men (18.1%) and women (29.5%) obtained from a nationally-representative survey. RESULTS The direct, indirect, and total costs of insomnia symptoms in Canada in 2021 were $1.9 billion, $12.6 million, and $1.9 billion, respectively. This value represents 1.9% of the overall burden of illness costs for 2021 in Canada. The 2 most expensive chronic diseases attributable to insomnia symptoms were type 2 diabetes ($754 million) and depression ($706 million). The main contributor to the costs for type 2 diabetes and depression was prescription drugs. A 5% decrease in insomnia symptoms (from 23.8% to 18.8%) would result in an estimated $353 million in avoided costs while a 5% increase in insomnia symptoms (from 23.8% to 28.8%) would result in an estimated $333 million in additional expenditures yearly. CONCLUSIONS Insomnia symptoms greatly contribute to the economic burden of illness in Canada. Reducing the prevalence of insomnia symptoms would reduce its societal burden.
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Affiliation(s)
- Jean-Philippe Chaput
- Healthy Active Living and Obesity Research Group, CHEO Research Institute, Ottawa, Ontario, Canada; Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Ian Janssen
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada; Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Hugues Sampasa-Kanyinga
- Healthy Active Living and Obesity Research Group, CHEO Research Institute, Ottawa, Ontario, Canada
| | - Colleen E Carney
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Thien Thanh Dang-Vu
- Institut Universitaire de Gériatrie de Montréal and CRIUGM, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada; PERFORM Centre, Center for Studies in Behavioral Neurobiology, Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Quebec, Canada
| | - Judith R Davidson
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Rebecca Robillard
- The University of Ottawa Institute of Mental Health Research at The Royal, Ottawa, Ontario, Canada; School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Charles M Morin
- School of Psychology, Laval University, Quebec City, Quebec, Canada
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Porosnicu Rodriguez KA, Salas RME, Schneider L. Insomnia. Neurol Clin 2022; 41:1-19. [DOI: 10.1016/j.ncl.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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