Sleep fragmentation delays wound healing in a mouse model of type 2 diabetes

Sleep, Fatigue, and Inflammatory Biomarkers in Older Adults with Chronic Venous Leg Ulcers Receiving Intensive Outpatient Wound Care

Objective: Chronic venous ulcers are a relatively common and distressing condition that disproportionately affects older individuals. Along with multiple concomitant issues such as wound drainage, pain, and mobility impairments, individuals with chronic venous leg ulcers (CVLUs) commonly report sleep disturbances and fatigue; however, limited research has examined these symptoms in relation to inflammatory biomarkers in this population over the intensive wound care treatment trajectory. This study aimed at describing the symptoms of sleep and fatigue in older adults with CVLUs receiving intensive wound treatment with weekly debridement and exploring the relationships between these symptoms and tumor necrosis factor-alpha (TNF-α), c-reactive protein (CRP), and interleukin (IL)-6. Approach: Demographics, clinical characteristics, Pittsburgh Sleep Quality Index (PSQI) scores, Brief Fatigue Inventory (BFI), TNF-α, CRP, and IL-6 levels were collected from 84 older adults with CVLUs at three time points (baseline, week 4, and week 8). Data analysis included descriptive statistics and Bayesian estimation of associations. Results: Findings showed a consistent pattern of poor sleep quality and mild fatigue among these individuals. Lower IL-6 levels at week 4 and higher CRP levels at week 8 were linked to poor sleep quality. Higher CRP levels were linked to greater fatigue at baseline and week 8. Sleep and fatigue were correlated at all time points. Innovation and Conclusion: This study highlights the importance of clinicians evaluating sleep and fatigue in those with CVLUs. Further research is needed to validate circulating inflammatory biomarkers to enhance our understanding of sleep and fatigue's role in wound healing.

Lifestyle Medicine Approach to Wound Management

Chronic wounds impact 4.5% of the US population, necessitating a comprehensive understanding of their types and underlying mechanisms. Diabetic foot ulcers (DFUs), prevalent in 25% of individuals with diabetes, contribute significantly to lower limb amputations. The pathophysiology involves neuropathy, peripheral arterial disease, impaired immunity, glycemic control, and mechanical stress. Lifestyle medicine emerges as a pivotal aspect of care, offering both prevention and treatment by integrating plant-predominant nutrition, physical activity, stress management, avoidance of harmful substances, restful sleep, and social connectedness. These interventions impact gene interactions, immune function, and tissue regeneration, playing a crucial role in chronic wound management. The standard of care involves a multidisciplinary approach, emphasizing infection and vascular management, pressure offloading, conducive wound healing environments, and lifestyle adjustments. As diabetes prevalence rises, a proactive integration of lifestyle interventions is crucial, offering a promising avenue to alleviate the growing healthcare burden associated with chronic wounds.

Potential effects of shift work on skin autoimmune diseases

Shift work is associated with systemic chronic inflammation, impaired host and tumor defense and dysregulated immune responses to harmless antigens such as allergens or auto-antigens. Thus, shift workers are at higher risk to develop a systemic autoimmune disease and circadian disruption with sleep impairment seem to be the key underlying mechanisms. Presumably, disturbances of the sleep-wake cycle also drive skin-specific autoimmune diseases, but epidemiological and experimental evidence so far is scarce. This review summarizes the effects of shift work, circadian misalignment, poor sleep, and the effect of potential hormonal mediators such as stress mediators or melatonin on skin barrier functions and on innate and adaptive skin immunity. Human studies as well as animal models were considered. We will also address advantages and potential pitfalls in animal models of shift work, and possible confounders that could drive skin autoimmune diseases in shift workers such as adverse lifestyle habits and psychosocial influences. Finally, we will outline feasible countermeasures that may reduce the risk of systemic and skin autoimmunity in shift workers, as well as treatment options and highlight outstanding questions that should be addressed in future studies.

Consequences of Sleep Deprivation in Adult Diabetes Mellitus Type 2 Patients: An Integrative Review

BACKGROUND: Sleep deprivation in individuals with diabetes mellitus type 2 is more prevalent than in ordinary people. At present, the adverse effects of diabetes type 2 people with sleep disorders and sleep deprivation on blood sugar control are irrefutable. Thorough assessments covering the whole structure should be of concern in health-care treatment. It is precipitated and delivered to the physical, mental health, and social environment, but no systematic review or minimal data were published. Furthermore, it may significantly affect the system more than existing research. AIM: An integrative review aims to clarify the results or consequences of sleep disturbance/deprivation or insomnia symptoms among diabetes mellitus type 2 patients. METHODS: The writers implemented a literature search in PubMed, CINAHL, and Medline using the terms DM type 2, insomnia, adult, effect, DM, sleep disturbance, sleep disorder, and a consequence between 2012 and 2022. Inclusion criteria selected through considering the entire article, and providing an abstract, were 20 articles. RESULTS: Integrative data extraction and information were analyzed thematically. Identified were nine ideas: Association with blood sugar control, blood pressure control, risk of CVD, diabetes self-care behavior, weight gained and Obstructive Sleep Apnea (OSA), lifestyle and physical activity, mood/depression and anxiety symptoms, daily calories distribution, cholesterol/triglyceride, and liver enzyme levels. CONCLUSION: The adverse effects of sleep deprivation in type 2 diabetes significantly affect all pathophysiologically, mentally, and lifestyle modifications, including diabetes self-care. Therefore, to highlight the importance of promoting optimum sleep in diabetes type2 patients, a health-care system is inevitably as necessary as diet and exercise management.

Association of sleep-disordered breathing and wound healing in patients with diabetic foot ulcers

STUDY OBJECTIVES

Sleep-disordered breathing (SDB) is prevalent and associated with an increased risk of morbidity and mortality. However, whether SDB has an adverse impact on wound healing in patients with diabetic foot ulcers (DFUs) is uncertain. The purpose of this study was to investigate the association of SDB with wound healing in patients with DFUs.

METHODS

A total of 167 patients with DFUs were enrolled between July 2013 and June 2019 at West China Hospital (Chengdu, China) to assess the association of SDB with wound healing, ulcer recurrence, and all-cause mortality.

RESULTS

Whereas there was no significant association between apnea-hypopnea index (AHI) and wound healing, total sleep time (per hour: hazard ratio [HR], 1.15; 95% confidence interval [CI], 1.01-1.30; P = .029), sleep efficiency (per 10%: HR, 1.20; 95% CI, 1.04-1.37; P = .012), and wakefulness after sleep onset (per 30 minutes: HR, 0.89; 95% CI, 0.82-0.97; P = .008) were associated with wound healing. Total sleep time (per hour: odds ratio, 0.71; 95% CI, 0.51-0.97; P = .035) and sleep efficiency (per 10%: odds ratio, 0.68; 95% CI, 0.47-0.97; P = .033) were also associated with ulcer recurrence. Mean oxygen saturation (per 3%: HR, 0.68; 95% CI, 0.49-0.94; P = .021) and percentage of sleep time with oxygen saturation < 90% (per 10%: HR, 1.25; 95% CI, 1.03-1.53; P = .026) were significantly associated with mortality.

CONCLUSIONS

SDB is highly prevalent in patients with DFUs but its severity, as conventionally measured by AHI, is not associated with wound healing. Sleep fragmentation and hypoxemia are stronger predictors of poor wound healing, high ulcer recurrence, and increased risk of death in patients with DFUs.

Acute postoperative pain experiences and satisfaction with its management among patients with elective surgery: An observational study

BACKGROUND AND AIM

There is a paucity of regional data on acute postoperative pain. The present study was conducted with an aim to assess the acute postoperative pain experiences, its interference with ADLs, emotions, sleep, IPR and satisfaction with pain management among patients who had undergone elective surgeries.

METHODS

In this observational study, 200 postoperative adult patients; who had undergone elective surgery were interviewed using American Pain Society's Patient Outcome and Satisfaction Survey Questionnaire. Pain perception and interference of pain with ADLs, emotions, sleep, and IPR was measured on 0-10 numerical scale and satisfaction on 6 point Likert scale, i.e., very satisfied to very dissatisfied.

RESULTS

There was high incidence (82.5%) of acute postoperative pain experience and mean score for worst episodes of pain was significantly high, i.e., 7.6 ± 1.5, which had significant interference with ADLs (5.6 ± 2.1), sleep (3.6 ± 1.7), and emotions (3.6 ± 1.6). Majority of patients reported that pain was assessed only once (17%) or twice (48.5%) in each shift. Despite of poor pain control, a large number of patients were satisfied with overall pain treatment (69%), and response of physicians (81%) and nurses (62%) for their pain complaints. Acute pain score was directly associated with the duration of postoperative hospital stay (P = 0.001).

CONCLUSION

Acute postoperative pain was inadequately assessed and undertreated but still a large number of participants were satisfied with acute postoperative pain management probably because patients expects that pain is inevitable after surgery. Postoperative pain had significant interference with ADLs, emotions and sleep of patients, which may affect postoperative comfort and recovery.

The Interlinked Rising Epidemic of Insufficient Sleep and Diabetes Mellitus

For healthy existence, humans need to spend one-third of their time sleeping. Any qualitative or quantitative disturbances in sleep would result in an increased prevalence of obesity, metabolic disorders, diabetes, cardiovascular diseases, and hypertension. The paper aims to highlight the growing global problem of insufficient sleep and its significant impact on the rising incidence of diabetes mellitus. An extensive literature search was done in all major databases for "insufficient sleep" and "Diabetes Mellitus" for this review. Shorter (<6 h) and longer (>9 h) durations of sleep have been adversely related to insulin resistance. Though the relation between insufficient sleep and diabetes mellitus is more or less understood, little is known about how oversleeping or hypersomnia (10⁻12 h) increases the risk of diabetes. The relationship between sleep disturbances and diabetes is dual-sided, as chronic sleep disturbances would elevate the risk of developing insulin resistance, while diabetes would worsen the quality of sleep. Both the qualitative and quantitative disturbances in sleep significantly increase the risk of developing diabetes, which is supported by numerous community-based and hospital-based epidemiological studies discussed in this review. Obstructive sleep apnea is one of the most common sleep disorders and is characterized by chronic intermittent hypoxia and increased sympathetic activity, thus leading to a higher prevalence of diabetes. Sleep therapy may serve as a low-cost method for fighting against the rising epidemic of diabetes.