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Agustiningsih D, Wibawa T. Demystifying roles of exercise in immune response regulation against acute respiratory infections: A narrative review. SPORTS MEDICINE AND HEALTH SCIENCE 2024; 6:139-153. [PMID: 38708320 PMCID: PMC11067861 DOI: 10.1016/j.smhs.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 01/09/2024] [Accepted: 01/19/2024] [Indexed: 05/07/2024] Open
Abstract
The benefits of physical activity and exercise, especially those classified as moderate-to-vigorous activity (MVPA), have been well-established in preventing non-communicable diseases and mental health problems in healthy adults. However, the relationship between physical activity and exercise and the prevention and management of acute respiratory infection (ARI), a global high-burden disease, has been inconclusive. There have been debates and disagreements among scientific publications regarding the relationship between exercise and immune response against the causative agents of ARI. This narrative review aims to explore the theory that sufficiently explains the correlation between exercise, immune response, and ARI. The potential root causes of discrepancies come from research associated with the "open window" hypothesis. The studies have several limitations, and future improvements to address them are urgently needed in the study design, data collection, exercise intervention, subject recruitment, biomarkers for infection and inflammation, nutritional and metabolism status, and in addressing confounding variables. In conclusion, data support the clinical advantages of exercise have a regulatory contribution toward improving the immune response, which in turn potentially protects humans fromARI. However, the hypothesis related to its negative effect must be adopted cautiously.
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Affiliation(s)
- Denny Agustiningsih
- Department of Physiology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
| | - Tri Wibawa
- Department of Microbiology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
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Curry G, Cheung T, Zhang SD, Logue S, McAnena L, Price R, Sittlington JJ. Repeated electrical vestibular nerve stimulation (VeNS) reduces severity in moderate to severe insomnia; a randomized, sham-controlled trial; The Modius Sleep Study. Brain Stimul 2024:S1935-861X(24)00092-5. [PMID: 38797370 DOI: 10.1016/j.brs.2024.05.010] [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: 02/01/2024] [Revised: 04/26/2024] [Accepted: 05/20/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Insomnia is a prevalent health concern in the general population associated with a range of adverse health effects. New, effective, safe and low-cost treatments, suitable for long-term use, are urgently required. Previous studies have shown the potential of electrical vestibular nerve stimulation (VeNS) in improving insomnia symptoms, however only one sham-controlled trial has been conducted on people with chronic insomnia. OBJECTIVES /Hypothesis: Repeated VeNS delivered by the Modius Sleep device prior to sleep onset will show superior improvement in Insomnia Severity Index (ISI) scores over a 4-week period compared to sham stimulation. METHODS In this double-blinded, multi-site, randomised, sham-controlled study, 147 participants with moderate to severe insomnia (ISI≥15) were recruited and allocated a VeNS or a sham device (1:1 ratio) which they were asked to use at home for 30 minutes daily (minimum 5 days per week) for 4 weeks. RESULTS After 4 weeks, mean ISI score reduction was 2.26 greater in the VeNS treatment group than the sham group (p=0.002). In the per protocol analysis, the treatment group had a mean ISI score decrease of 5.8 (95% CI [-6.8, -4.81], approaching the clinically meaningful threshold of a 6-point reduction, with over half achieving a clinically significant decrease. Furthermore, the treatment group showed superior improvement to the sham group in the SF-36 (Quality of Life) energy/fatigue component (PP p=0.004, effect size 0.26; ITT p=0.006, effect size 0.22). CONCLUSIONS Modius sleep has the potential to provide a viable, non-invasive and safe clinically meaningful alternative treatment option for insomnia.
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Affiliation(s)
- Grace Curry
- School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine, BT52 1SA, United Kingdom.
| | - Teris Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China; The Mental Health Research Centre, The Hong Kong Polytechnic University, Hong Kong SAR, China.
| | - Shu-Dong Zhang
- School of Medicine, Ulster University, Londonderry, BT48 7JL, United Kingdom.
| | - Susan Logue
- School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine, BT52 1SA, United Kingdom.
| | - Liadhan McAnena
- School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine, BT52 1SA, United Kingdom.
| | - Ruth Price
- School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine, BT52 1SA, United Kingdom.
| | - Julie J Sittlington
- School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine, BT52 1SA, United Kingdom.
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Schilling C, Nieters A, Schredl M, Peter RS, Rothenbacher D, Brockmann SO, Göpel S, Kindle G, Merle U, Steinacker JM, Kern W. Pre-existing sleep problems as a predictor of post-acute sequelae of COVID-19. J Sleep Res 2024; 33:e13949. [PMID: 37227000 DOI: 10.1111/jsr.13949] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/13/2023] [Accepted: 05/08/2023] [Indexed: 05/26/2023]
Abstract
Several months after COVID-19 many individuals still report persisting symptoms, the so-called 'post-COVID-19 syndrome'. An immunological dysfunction is one of the main pathophysiological hypotheses. As sleep is central to the functioning of the immune system, we investigated whether self-reported pre-existing sleep disturbance might be an independent risk factor for the development of post-COVID-19 syndrome. A total of 11,710 participants of a cross-sectional survey (all tested positive for severe acute respiratory syndrome coronavirus-2) were classified into probable post-COVID-19 syndrome, an intermediate group, and unaffected participants at an average of 8.5 months after infection. The case definition was based on newly occurring symptoms of at least moderate severity and ≥20% reduction in health status and/or working capacity. Unadjusted and adjusted odds ratios were calculated to investigate the association between pre-existing sleep disturbances and subsequent development of post-COVID-19 syndrome while controlling for a variety of demographic, lifestyle, and health factors. Pre-existing sleep disturbances were found to be an independent predictor of subsequent probable post-COVID-19 syndrome (adjusted odds ratio 2.7, 95% confidence interval 2.27-3.24). Sleep disturbances as part of the post-COVID-19 syndrome were reported by more than half of the participants and appeared to be a new symptom and to occur independent of a mood disorder in most cases. Recognition of disturbed sleep as an important risk factor for post-COVID-19 syndrome should promote improved clinical management of sleep disorders in the context of COVID-19. Further, it may stimulate further research on the effect of improving sleep on the prognosis of COVID-19 long-term sequelae and other post-viral conditions.
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Affiliation(s)
- Claudia Schilling
- Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Sleep Laboratory, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Alexandra Nieters
- Institute for Immunodeficiency, Medical Centre and Faculty of Medicine, Albert-Ludwigs-University, Freiburg, Germany
| | - Michael Schredl
- Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Sleep Laboratory, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Raphael S Peter
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | - Stefan O Brockmann
- Department of Health Protection, Infection Control and Epidemiology, Baden-Wuerttemberg Federal State Health Office, Ministry of Social Affairs, Health and Integration Stuttgart, Stuttgart, Germany
| | - Siri Göpel
- Division of Infectious Diseases, Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany
| | - Gerhard Kindle
- Institute for Immunodeficiency, Medical Centre and Faculty of Medicine, Albert-Ludwigs-University, Freiburg, Germany
| | - Uta Merle
- Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany
| | - Jürgen M Steinacker
- Division of Sports and Rehabilitation Medicine, Department of Medicine, Ulm University Hospital, Ulm, Germany
| | - Winfried Kern
- Division of Infectious Diseases, Department of Medicine II, Medical Centre and Faculty of Medicine, Albert-Ludwigs-University, Freiburg, Germany
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Bjorvatn B, Rørtveit G, Rebnord I, Waage S, Emberland KE, Forthun I. Self-reported short and long sleep duration, sleep debt and insomnia are associated with several types of infections: Results from the Norwegian practice-based research network in general practice - PraksisNett. Sleep Med X 2023; 5:100074. [PMID: 37223609 PMCID: PMC10200965 DOI: 10.1016/j.sleepx.2023.100074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 05/25/2023] Open
Abstract
Objective The objective was to assess the association between self-reported infections and sleep duration, sleep debt, chronic insomnia, and insomnia severity. Methods In total, 1023 participants were recruited from the Norwegian practice-based research network in general practice to a cross-sectional online survey with validated questions about sleep habits and insomnia symptoms (Bergen Insomnia Scale (BIS) and Insomnia Severity Index (ISI)), and whether they had experienced various infections during the last three months. Data were analyzed with chi-square tests and logistic regressions with adjustment for relevant confounders. Results Self-reported short sleep duration (<6 h) was significantly associated with increased odds of throat infection (OR = 1.60), ear infection (OR = 2.92), influenzalike illness (OR = 1.81) and gastrointestinal infection (OR = 1.91) whereas long sleep duration (>9 h) was associated with increased odds of throat (OR = 3.33) and ear infections (OR = 5.82), compared to sleep duration of 6-9 h, respectively. Sleep debt of >2 h was associated with increased odds of the common cold (OR = 1.67), throat infection (OR = 2.58), ear infection (OR = 2.84), sinusitis (OR = 2.15), pneumonia/bronchitis (OR = 3.97), influenzalike illness (OR = 2.66), skin infection (OR = 2.15), and gastrointestinal infection (OR = 2.80), compared to no sleep debt. Insomnia (based on BIS and ISI) was associated with throat infection (OR = 2.06, 2.55), ear infection (OR = 2.43, 2.45), sinusitis (OR = 1.82, 1.80), pneumonia/bronchitis (OR = 2.23, 3.59), influenzalike illness (OR = 1.77, 1.90), skin infection (OR = 1.64, 2.06), gastrointestinal infection (OR = 1.94, 3.23), and eye infection (OR = 1.99, 2.95). Conclusions These novel findings support the notion that people who have insufficient sleep or sleep problems are at increased risk of infections.
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Affiliation(s)
- Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Guri Rørtveit
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Ingrid Rebnord
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Siri Waage
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Knut Erik Emberland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Ingeborg Forthun
- Department of Disease Burden, Norwegian Institute of Public Health, Bergen, Norway
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Jones SE, Maisha FI, Strausz SJ, Lammi V, Cade BE, Tervi A, Helaakoski V, Broberg ME, Lane JM, Redline S, Saxena R, Ollila HM. The public health impact of poor sleep on severe COVID-19, influenza and upper respiratory infections. EBioMedicine 2023; 93:104630. [PMID: 37301713 PMCID: PMC10248098 DOI: 10.1016/j.ebiom.2023.104630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 05/02/2023] [Accepted: 05/11/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Poor sleep is associated with an increased risk of infections and all-cause mortality but the causal direction between poor sleep and respiratory infections has remained unclear. We examined if poor sleep contributes as a causal risk factor to respiratory infections. METHODS We used data on insomnia, influenza and upper respiratory infections (URIs) from primary care and hospital records in the UK Biobank (N ≈ 231,000) and FinnGen (N ≈ 392,000). We computed logistic regression to assess association between poor sleep and infections, disease free survival hazard ratios, and performed Mendelian randomization analyses to assess causality. FINDINGS Utilizing 23 years of registry data and follow-up, we discovered that insomnia diagnosis associated with increased risk for infections (FinnGen influenza Cox's proportional hazard (CPH) HR = 4.34 [3.90, 4.83], P = 4.16 × 10-159, UK Biobank influenza CPH HR = 1.54 [1.37, 1.73], P = 2.49 × 10-13). Mendelian randomization indicated that insomnia causally predisposed to influenza (inverse-variance weighted (IVW) OR = 1.65, P = 5.86 × 10-7), URI (IVW OR = 1.94, P = 8.14 × 10-31), COVID-19 infection (IVW OR = 1.08, P = 0.037) and risk of hospitalization from COVID-19 (IVW OR = 1.47, P = 4.96 × 10-5). INTERPRETATION Our findings indicate that chronic poor sleep is a causal risk factor for contracting respiratory infections, and in addition contributes to the severity of respiratory infections. These findings highlight the role of sleep in maintaining sufficient immune response against pathogens. FUNDING Instrumentarium Science Foundation, Academy of Finland, Signe and Ane Gyllenberg Foundation, National Institutes of Health.
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Affiliation(s)
- Samuel E Jones
- Institute for Molecular Medicine Finland, HiLIFE, University of Helsinki, Finland
| | - Fahrisa I Maisha
- Department of Neurology, School of Medicine, Yale University, New Haven, CT, USA; Broad Institute of MIT and Harvard, Cambridge, MA, USA; Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Satu J Strausz
- Institute for Molecular Medicine Finland, HiLIFE, University of Helsinki, Finland; Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Vilma Lammi
- Institute for Molecular Medicine Finland, HiLIFE, University of Helsinki, Finland
| | - Brian E Cade
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Anniina Tervi
- Institute for Molecular Medicine Finland, HiLIFE, University of Helsinki, Finland
| | - Viola Helaakoski
- Institute for Molecular Medicine Finland, HiLIFE, University of Helsinki, Finland
| | - Martin E Broberg
- Institute for Molecular Medicine Finland, HiLIFE, University of Helsinki, Finland
| | - Jacqueline M Lane
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Broad Institute of MIT and Harvard, Cambridge, MA, USA; Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Richa Saxena
- Broad Institute of MIT and Harvard, Cambridge, MA, USA; Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA; Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Hanna M Ollila
- Institute for Molecular Medicine Finland, HiLIFE, University of Helsinki, Finland; Broad Institute of MIT and Harvard, Cambridge, MA, USA; Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA; Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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Quan SF, Weaver MD, Czeisler MÉ, Barger LK, Booker LA, Howard ME, Jackson ML, Lane RI, McDonald CF, Ridgers A, Robbins R, Varma P, Wiley JF, Rajaratnam SMW, Czeisler CA. Insomnia, Poor Sleep Quality and Sleep Duration and Risk for COVID-19 Infection and Hospitalization. Am J Med 2023:S0002-9343(23)00248-6. [PMID: 37075878 PMCID: PMC10108572 DOI: 10.1016/j.amjmed.2023.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/31/2023] [Accepted: 04/02/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Medical comorbidities increase the risk of severe acute COVID-19 illness. Although sleep problems are common after COVID-19 infection, it is unclear whether insomnia, poor sleep quality and extremely long or short sleep increase risk of developing COVID-19 infection or hospitalization. METHODS Cross-sectional survey of a diverse sample of 19,926 U.S. adults RESULTS: COVID-19 infection and hospitalization prevalence rates were 40.1% and 2.9% respectively. Insomnia and poor sleep quality were reported in 19.8% and 40.1% respectively. In logistic regression models adjusted for comorbid medical conditions and sleep duration but excluding participants who reported COVID-19 associated sleep problems, poor sleep quality but not insomnia was associated with COVID-19 infection (aOR: 1.16, 95%CI: 1.07-1.26) and COVID-19 hospitalization (aOR: 1.50, 95% CI: 1.18-1.91). In comparison to habitual sleep duration of 7-8 hours, sleep durations less than 7 hours (aOR: 1.14, 95% CI: 1.06-1.23) and sleep duration of 12 hours (aOR: 1.61, 95% CI: 1.12-2.31) were associated with increased odds of COVID-19 infection. Overall, the relationship between COVID-19 infection and hours of sleep followed a quadratic (U shaped) pattern. No association between sleep duration and COVID-19 hospitalization was observed. CONCLUSION In a general population sample, poor sleep quality and extremes of sleep duration are associated with greater odds of having had a COVID-19 infection; poor sleep quality was associated with an increased requirement of hospitalization for severe COVID-19 illness. These observations suggest that inclusion of healthy sleep practices in public health messaging may reduce the impact of the COVID-19 pandemic.
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Affiliation(s)
- Stuart F Quan
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA; Division of Sleep Medicine, Harvard Medical School, Boston, MA.
| | - Matthew D Weaver
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA; Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Mark É Czeisler
- Francis Weld Peabody Society, Harvard Medical School, Boston, MA; School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Laura K Barger
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA; Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Lauren A Booker
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; University Department of Rural Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Mark E Howard
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia; Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Melinda L Jackson
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Rashon I Lane
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
| | - Christine F McDonald
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia; Faculty of Medicine, Monash University, Melbourne, Australia
| | - Anna Ridgers
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia; Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rebecca Robbins
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA; Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Prerna Varma
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Joshua F Wiley
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Shantha M W Rajaratnam
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA; School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Charles A Czeisler
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA; Division of Sleep Medicine, Harvard Medical School, Boston, MA
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Forthun I, Eliassen KER, Emberland KE, Bjorvatn B. The association between self-reported sleep problems, infection, and antibiotic use in patients in general practice. Front Psychiatry 2023; 14:1033034. [PMID: 36937728 PMCID: PMC10017838 DOI: 10.3389/fpsyt.2023.1033034] [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: 10/03/2022] [Accepted: 01/30/2023] [Indexed: 03/06/2023] Open
Abstract
Objectives There is emerging evidence that sleep problems and short sleep duration increase the risk of infection. We aimed to assess whether chronic insomnia disorder, chronic sleep problems, sleep duration and circadian preference based on self-report were associated with risk of infections and antibiotic use among patients visiting their general practitioner (GP). Methods We conducted a cross-sectional study of 1,848 unselected patients in Norway visiting their GP during 2020.The patients completed a one-page questionnaire while waiting for the consultation, that included the validated Bergen Insomnia Scale (BIS), questions on self-assessed sleep problem, sleep duration and circadian preference and whether they have had any infections or used antibiotics in the last 3 months. Relative risks (RR) were estimated using modified Poisson regression models. Results The risk of infection was 27% (95% CI RR 1.11-1.46) and 44% higher (95% CI 1.12-1.84) in patients sleeping < 6 h and >9 h, respectively, compared to those sleeping 7-8 h. The risk was also increased in patients with chronic insomnia disorder or a chronic sleep problem. For antibiotic use, the risk was higher for patients sleeping < 6 h, and for those with chronic insomnia disorder or a chronic sleep problem. Conclusions Among patients visiting their GP, short sleep duration, chronic insomnia and chronic sleep problem based on self-report were associated with higher prevalence of infection and antibiotic use. These findings support the notion of a strong association between sleep and infection.
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Affiliation(s)
- Ingeborg Forthun
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Disease Burden, Norwegian Institute of Public Health, Bergen, Norway
| | | | - Knut Erik Emberland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
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Cheung T, Lam JYT, Fong KH, Cheng CPW, Ho A, Sittlington J, Xiang YT, Li TMH. Evaluating the Efficacy of Electrical Vestibular Stimulation (VeNS) on Insomnia Adults: Study Protocol of a Double-Blinded, Randomized, Sham-Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3577. [PMID: 36834268 PMCID: PMC9964781 DOI: 10.3390/ijerph20043577] [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: 12/29/2022] [Revised: 01/27/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
Insomnia is a common health problem in the general population. There are different ways to improve sleeping habits and quality of sleep; however, there is no clinical trial using transdermal neurostimulation to treat individuals with symptoms of insomnia in Asia. This gives us the impetus to execute the first study in Asia which aims to evaluate the efficacy of Electrical Vestibular Stimulation (VeNS) on individuals with insomnia in Hong Kong. This study proposes a two-armed, double-blinded, randomized, sham-controlled trial including the active VeNS and sham VeNS group. Both groups will be measured at baseline (T1), immediately after the intervention (T2), and at the 1-month (T3) and 3-month follow-up (T4). A total of 60 community-dwelling adults aged 18 to 60 years, with insomnia symptoms will be recruited in this study. All subjects will be computer randomized into either the active VeNS group or the sham VeNS group on a 1:1 ratio. All subjects in each group will receive twenty 30-min VeNS sessions during weekdays, which will be completed in a 4-week period. Baseline measurements and post-VeNS evaluation of the psychological outcomes (i.e., insomnia severity, sleep quality and quality of life) will also be conducted on all participants. The 1-month and 3-month follow-up period will be used to assess the short-and long-term sustainability of the VeNS intervention. For statistical analysis, a mixed model will be used to analyze the repeated measures data. Missing data will be managed by multiple imputations. The level of significance will be set to p < 0.05. Significance of the study: The results of this study will be used to determine whether this VeNS device can be considered as a self-help technological device to reduce the severity of insomnia in the community setting. We registered this clinical trial with the Clinical trial government, identifier: NCT04452981.
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Affiliation(s)
- Teris Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
- The Mental Health Research Centre, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Joyce Yuen Ting Lam
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Kwan Hin Fong
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | | | - Alex Ho
- Integrated Services for Persons with Disabilities, Christian Family Service Centre, Hong Kong SAR, China
| | - Julie Sittlington
- School of Biomedical Sciences, Ulster University, Coleraine BT52 1SA, UK
| | - Yu-Tao Xiang
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macau SAR, China
| | - Tim Man Ho Li
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China
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9
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Kumar N, Goyal A, Hussain A, Saini LK, Chawla O, Arora P, Daga R, Tikka SK, Goyal SK, Kanchan S, Desai S, Ahmed S, Das S, Dubey V, Gupta R. SARS-CoV-2 infection is associated with increased odds of insomnia, RLS and dream enactment behavior. Indian J Psychiatry 2022; 64:354-363. [PMID: 36060721 PMCID: PMC9435609 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_586_21] [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: 07/11/2021] [Revised: 12/08/2021] [Accepted: 05/05/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Literature suggests that the COVID-19 pandemic has resulted in poor sleep quality, especially among the infected population. However, literature regarding the effect of COVID-19 pandemic and SARS-CoV-2 infection on occurrence of insomnia, restless legs syndrome and dream enactment behavior is either scarce or unavailable. METHODS This study was planned to assess the effect of SARS-CoV-2 infection on the occurrence of insomnia, restless legs syndrome (RLS) and dream enactment behavior (DEB). For this cross-sectional study, a questionnaire comprising of items related to demographic details, past medical history, and information related to SARS-CoV-2 infection was distributed through social media. Insomnia was diagnosed using clinical criteria. RLS, DEB, sleep quality, depression and anxiety were assessed using a validated questionnaire. Information regarding the use of hypnotic medications was also gathered. RESULTS Of the 1596 respondents, 37.2% reported disturbed sleep while insomnia was reported by 22.6% respondents. 27.3% of respondents reported RLS and 17.4% suffered DEB. The odds of insomnia were greater among males (OR = 1.27; 95% CI: 1.03-1.58; P < 0.02) and among those who had SARS-CoV-2 infection (OR = 1.76; 95% CI = 1.42-2.19; P < 0.001). Similarly, SARS-CoV-2 infection was also associated with increased odds of RLS (OR = 2.48; 95% CI = 1.98-3.11; P < 0.001) and DEB (OR = 1.58; 95%CI = 1.21-2.06; P < 0.001). Insomnia, RLS and DEB were more frequent among respondents who required oxygen therapy, those who experienced loss of taste and/or smell, depression and anxiety. Prevalence of insomnia, DEB and RLS was higher than said prevalence among respondents with no history of SARS-CoV-2 infection, but lower than that of those with positive history of SARS-CoV-2 infection. 5.3% of respondents reported taking hypnotic medications before infection, 7% during infection and 5.3% after infection. CONCLUSION SARS-CoV-2-infection-related factors in association with environmental factors have increased the prevalence of insomnia, DEB and RLS among subjects having infection. SARS-CoV-2-associated immunological changes, hypoxia and neurotropism may play a role in occurrence of insomnia, DEB and RLS.
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Affiliation(s)
- Niraj Kumar
- Department of Neurology and Division of Sleep Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Abhishek Goyal
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Arshad Hussain
- Department of Psychiatry, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Lokesh Kumar Saini
- Department of Pulmonary Medicine and Division of Sleep Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Omna Chawla
- Department of Physiology, Seema Dental College and Hospital, Rishikesh, Uttarakhand, India
| | | | - Ritu Daga
- Vivekananda Institute of Mental Health and Neurosciences, Jaipur, Rajasthan, India
| | - Sai Krishna Tikka
- Department of Psychiatry, All India Institute of Medical Sciences, Bibinagar, Telangana, India
| | | | - Shweta Kanchan
- Harispandan Heart Care Centre, Gomti Nagar, Lucknow, Uttar Pradesh, India
| | - Soaham Desai
- Department of Neurology, Shree Krishna Hospital and Pramukhswami Medical College, Bhaikaka University, Karamasad, Anand, Gujarat, India
| | - Sohaib Ahmed
- Department of Medicine, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Sourav Das
- Consultant Psychiatrist, Somnos Sleep Clinic, Kolkata, West Bengal, India
| | - Vaibhav Dubey
- Department of Psychiatry, People's College of Medical Sciences and Research Centre, Bhopal, Madhya Pradesh, India
| | - Ravi Gupta
- Department of Psychiatry and Division of Sleep Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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10
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Besedovsky L, Dang R, Engert LC, Goldstein MR, Devine JK, Bertisch SM, Mullington JM, Simpson N, Haack M. Differential effects of an experimental model of prolonged sleep disturbance on inflammation in healthy females and males. PNAS NEXUS 2022; 1:pgac004. [PMID: 36380854 PMCID: PMC9648610 DOI: 10.1093/pnasnexus/pgac004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/04/2022] [Accepted: 01/19/2022] [Indexed: 11/29/2022]
Abstract
Sleep disturbances, including disrupted sleep and short sleep duration, are highly prevalent and are prospectively associated with an increased risk for various widespread diseases, including cardiometabolic, neurodegenerative, chronic pain, and autoimmune diseases. Systemic inflammation, which has been observed in populations experiencing sleep disturbances, may mechanistically link disturbed sleep with increased disease risks. To determine whether sleep disturbances are causally responsible for the inflammatory changes reported in population-based studies, we developed a 19-day in-hospital experimental model of prolonged sleep disturbance inducing disrupted and shortened sleep. The model included delayed sleep onset, frequent nighttime awakenings, and advanced sleep offset, interspersed with intermittent nights of undisturbed sleep. This pattern aimed at providing an ecologically highly valid experimental model of the typical sleep disturbances often reported in the general and patient populations. Unexpectedly, the experimental sleep disturbance model reduced several of the assessed proinflammatory markers, namely interleukin(IL)-6 production by monocytes and plasma levels of IL-6 and C-reactive protein (CRP), presumably due to intermittent increases in the counterinflammatory hormone cortisol. Striking sex differences were observed with females presenting a reduction in proinflammatory markers and males showing a predominantly proinflammatory response and reductions of cortisol levels. Our findings indicate that sleep disturbances causally dysregulate inflammatory pathways, with opposing effects in females and males. These results have the potential to advance our mechanistic understanding of the pronounced sexual dimorphism in the many diseases for which sleep disturbances are a risk factor.
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Affiliation(s)
- Luciana Besedovsky
- Harvard Medical School, Boston, MA 02115, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Dana 779, Boston, MA 02215, USA
- Institute of Medical Psychology, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
| | - Rammy Dang
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Dana 779, Boston, MA 02215, USA
| | - Larissa C Engert
- Harvard Medical School, Boston, MA 02115, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Dana 779, Boston, MA 02215, USA
| | - Michael R Goldstein
- Harvard Medical School, Boston, MA 02115, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Dana 779, Boston, MA 02215, USA
| | - Jaime K Devine
- Institutes for Behavior Resources, Inc., Baltimore, MD 21218, USA
| | - Suzanne M Bertisch
- Harvard Medical School, Boston, MA 02115, USA
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Janet M Mullington
- Harvard Medical School, Boston, MA 02115, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Dana 779, Boston, MA 02215, USA
| | - Norah Simpson
- Stanford Sleep Heath and Insomnia Program, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Monika Haack
- Harvard Medical School, Boston, MA 02115, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Dana 779, Boston, MA 02215, USA
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11
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Jones SE, Maisha FI, Strausz SJ, Cade BE, Tervi AM, Helaakoski V, Broberg ME, Lammi V, Lane JM, Redline S, Saxena R, Ollila HM. The public health impact of poor sleep on severe COVID-19, influenza and upper respiratory infections. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.02.16.22271055. [PMID: 35194621 PMCID: PMC8863167 DOI: 10.1101/2022.02.16.22271055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Poor sleep is associated with an increased risk of infections and all-cause mortality, and acute sleep loss and disruption have been linked with inflammation and poorer immune control. Previous studies, however, have been unable to evidence causality between the chronic effects of poor sleep and respiratory infection risk. In light of the ongoing COVID-19 pandemic and potential future disease outbreaks, understanding the risk factors for these infections is of great importance. Aim Our goal was to understand if chronic poor sleep could be identified as a causal risk factor for respiratory infections including influenza, upper respiratory infections and COVID-19. Methods We used population cohorts from the UK Biobank (N ≈ 231,000) and FinnGen (N ≈ 327,000) with ICD-10 based electronic health records and obtained diagnoses of insomnia, influenza and upper respiratory infections (URIs) from primary care and hospital settings. We computed logistic regression to assess association between poor sleep and infections, disease free survival hazard ratios, and used summary statistics from genome-wide association studies of insomnia, influenza, URI and COVID-19 to perform Mendelian randomization analyses and assess causality. Findings Utilizing 23 years of registry data and follow-up, we saw that insomnia diagnosis associated with increased risk for infections in FinnGen and in UK Biobank (FinnGen influenza HR = 5.32 [4.09, 6.92], P = 1.02×10-35, UK Biobank influenza HR = 1.54 [1.37, 1.73], P = 2.49×10-13). Mendelian randomization indicated that insomnia causally predisposed to influenza (OR = 1.59, P = 6.23×10-4), upper respiratory infections (OR = 1.71, P = 7.60×10-13), COVID-19 infection (OR = 1.08, P = 0.037) and risk of hospitalization from COVID-19 (OR = 1.47, P = 4.96×10-5). Conclusions Our findings indicate that chronic poor sleep is a causal risk factor for contracting respiratory infections, and in addition contributes to the severity of respiratory infections. These findings highlight the role of sleep in maintaining sufficient immune response against pathogens as suggested by earlier work. As the current COVID-19 pandemic has increased the number of people suffering from poor sleep, safe interventions such as sleep management and treating individuals with insomnia could be promoted to reduce infections and save lives.
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Affiliation(s)
- Samuel E Jones
- Institute for Molecular Medicine, HiLIFE, University of Helsinki, Finland
| | - Fahrisa I Maisha
- Department of Immunology and Dermatology, Yale University, School of Medicine, New Haven, Connecticut, USA
| | - Satu J Strausz
- Institute for Molecular Medicine, HiLIFE, University of Helsinki, Finland
| | - Brian E Cade
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Anniina M Tervi
- Institute for Molecular Medicine, HiLIFE, University of Helsinki, Finland
| | - Viola Helaakoski
- Institute for Molecular Medicine, HiLIFE, University of Helsinki, Finland
| | - Martin E Broberg
- Institute for Molecular Medicine, HiLIFE, University of Helsinki, Finland
| | - Vilma Lammi
- Institute for Molecular Medicine, HiLIFE, University of Helsinki, Finland
| | - Jacqueline M Lane
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Richa Saxena
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Hanna M Ollila
- Institute for Molecular Medicine, HiLIFE, University of Helsinki, Finland
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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12
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Shu Z, Wang J, Sun H, Xu N, Lu C, Zhang R, Li X, Liu B, Zhou X. Diversity and molecular network patterns of symptom phenotypes. NPJ Syst Biol Appl 2021; 7:41. [PMID: 34848731 PMCID: PMC8632989 DOI: 10.1038/s41540-021-00206-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 11/01/2021] [Indexed: 11/08/2022] Open
Abstract
Symptom phenotypes have continuously been an important clinical entity for clinical diagnosis and management. However, non-specificity of symptom phenotypes for clinical diagnosis is one of the major challenges that need be addressed to advance symptom science and precision health. Network medicine has delivered a successful approach for understanding the underlying mechanisms of complex disease phenotypes, which will also be a useful tool for symptom science. Here, we extracted symptom co-occurrences from clinical textbooks to construct phenotype network of symptoms with clinical co-occurrence and incorporated high-quality symptom-gene associations and protein-protein interactions to explore the molecular network patterns of symptom phenotypes. Furthermore, we adopted established network diversity measure in network medicine to quantify both the phenotypic diversity (i.e., non-specificity) and molecular diversity of symptom phenotypes. The results showed that the clinical diversity of symptom phenotypes could partially be explained by their underlying molecular network diversity (PCC = 0.49, P-value = 2.14E-08). For example, non-specific symptoms, such as chill, vomiting, and amnesia, have both high phenotypic and molecular network diversities. Moreover, we further validated and confirmed the approach of symptom clusters to reduce the non-specificity of symptom phenotypes. Network diversity proposes a useful approach to evaluate the non-specificity of symptom phenotypes and would help elucidate the underlying molecular network mechanisms of symptom phenotypes and thus promotes the advance of symptom science for precision health.
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Affiliation(s)
- Zixin Shu
- Institute of Medical Intelligence, School of Computer and Information Technology, Beijing Jiaotong University, Beijing, 100063, China
| | - Jingjing Wang
- Institute of Medical Intelligence, School of Computer and Information Technology, Beijing Jiaotong University, Beijing, 100063, China
| | - Hailong Sun
- Institute of Medical Intelligence, School of Computer and Information Technology, Beijing Jiaotong University, Beijing, 100063, China
| | - Ning Xu
- The First Affiliated Hospital of Henan University of Chinese Medicine (Co-construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan, Henan University of Chinese Medicine), Zhengzhou, 450046, China
| | - Chenxia Lu
- Hubei Provincial Hospital of Traditional Chinese Medicine (Affiliated Hospital of Hubei University of Traditional Chinese Medicine, Hubei Academy of Traditional Chinese Medicine), Wuhan, 430061, China
| | - Runshun Zhang
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Xiaodong Li
- Hubei Provincial Hospital of Traditional Chinese Medicine (Affiliated Hospital of Hubei University of Traditional Chinese Medicine, Hubei Academy of Traditional Chinese Medicine), Wuhan, 430061, China
| | - Baoyan Liu
- China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Xuezhong Zhou
- Institute of Medical Intelligence, School of Computer and Information Technology, Beijing Jiaotong University, Beijing, 100063, China.
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13
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The Prospective Association Between Physical Activity, Insomnia Symptoms and Productivity in an Australian Population-based Cohort. J Occup Environ Med 2021; 64:183-189. [PMID: 34817462 DOI: 10.1097/jom.0000000000002439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate the joint, prospective associations of physical inactivity and insomnia symptoms and productivity using the 2013 and 2014 Household Income and Labor Dynamics in Australia Survey panel data. METHODS The association between i) presenteeism (yes/no, n=5864) and ii) absenteeism (sick leave days, n = 4324) and the mutually exclusive groups "active without insomnia", "active with insomnia", "inactive without insomnia" and "inactive with insomnia" was assessed. RESULTS Participants "active with insomnia" or "inactive with insomnia" had greater odds of presenteeism than those "active without insomnia" (OR = 1.41, 95%CI: 1.07-1.85 and OR=1.44, 95%CI: 1.14-1.83 respectively). Participants "inactive with insomnia" had a greater incidence of absenteeism than participants "active without insomnia" (IRR=1.28, 95%CI: 1.07-1.54). CONCLUSIONS Findings suggest improving physical activity levels and insomnia symptoms concurrently may improve productivity by reducing presenteeism and sick leave.
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14
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Occurrence and Long-term Prognosis of Insomnia Disorder among Survivors of Acute Respiratory Distress Syndrome in South Korea. Ann Am Thorac Soc 2021; 19:1022-1029. [PMID: 34793689 DOI: 10.1513/annalsats.202107-851oc] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE As a most common type of sleep disorder, insomnia disorder can develop as a sequela among acute respiratory distress syndrome (ARDS) survivors. However, insomnia prevalence, its associated factors, and its impact on long-term survival remain controversial. OBJECTIVES This study aimed to investigate insomnia prevalence and its associated factors among ARDS survivors. We also examined the association between insomnia and 2-year all-cause mortality. METHODS The National Health Insurance Database of South Korea was used for this nationwide cohort study. We included adult patients (≥18 years old) admitted to intensive care units for ARDS treatment from January 1, 2010, to December 31, 2018, and survived for ≥1 year after diagnosis, defined as ARDS survivors. ARDS survivors diagnosed with insomnia disorder before ARDS diagnosis were defined as the pre-ARDS insomnia disorder group, whereas those who had no history of insomnia disorder but were newly diagnosed with insomnia disorder within 1 year of diagnosis of ARDS were defined as the post-ARDS insomnia disorder group. RESULTS A total of 4,452 ARDS survivors were included in this study, with 895 patients (20.1%) in the pre-ARDS insomnia disorder group and 536 (12.6%) patients in the post-ARDS insomnia disorder group. In the multivariable logistic regression analysis, delirium occurrence (odds ratio [OR]:1.61, 95% confidence interval [CI]: 1.24-2.10; P<0.001), underlying anxiety disorder (OR:1.34, 95% CI: 1.08-1.66; P=0.007), depression (OR: 1.48, 95% CI: 1.17-1.86; P=0.001), and substance abuse (OR:1.51, 95% CI: 1.01-2.26; P=0.042) were associated with a higher prevalence of post-ARDS insomnia disorder. In multivariable Cox regression analysis, the pre-ARDS insomnia disorder and post-ARDS insomnia disorder groups were associated with 1.33-fold (hazard ratio [HR]:1.33, 95% CI: 1.08-1.64; P=0.007) and 1.36-fold (HR:1.36, 95% CI: 1.06-1.74; P=0.016) increased prevalence of 2-year all-cause mortality among ARDS survivors, respectively. CONCLUSIONS At 1 year after diagnosis of ARDS, 12.6% of ARDS survivors were newly diagnosed with insomnia disorder in South Korea. Delirium and underlying psychiatric illness (anxiety disorder, depression, and substance abuse) were potential risk factors for the diagnosis of post-ARDS insomnia disorder. Moreover, both pre-and post-ARDS insomnia disorders were associated with 2-year all-cause mortality among ARDS survivors.
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15
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Yun S, Jo S. Understanding insomnia as systemic disease. Yeungnam Univ J Med 2021; 38:267-274. [PMID: 34510866 PMCID: PMC8688785 DOI: 10.12701/yujm.2021.01424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 08/29/2021] [Indexed: 11/25/2022] Open
Abstract
Sleep plays a critical role in homeostasis of the body and mind. Insomnia is a disease that causes disturbances in the initiation and maintenance of sleep. Insomnia is known to affect not only the sleep process itself but also an individual’s cognitive function and emotional regulation during the daytime. It increases the risk of various neuropsychiatric diseases such as depression, anxiety disorder, and dementia. Although it might appear that insomnia only affects the nervous system, it is also a systemic disease that affects several aspects of the body, such as the cardiovascular, endocrine, and immune systems; therefore, it increases the risk of various diseases such as hypertension, diabetes mellitus, and infection. Insomnia has a wide range of effects on our bodies because sleep is a complex and active process. However, a high proportion of patients with insomnia do not seek treatment, which results in high direct and indirect costs. This is attributed to the disregard of many of the negative effects of insomnia. Therefore, we expect that understanding insomnia as a systemic disease will provide an opportunity to understand the condition better and help prevent secondary impairment due to insomnia.
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Affiliation(s)
- Seokho Yun
- Department of Psychiatry, Yeungnam University Hospital, Daegu, Korea
| | - Sohye Jo
- Department of Psychiatry, Yeungnam University Hospital, Daegu, Korea
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16
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Ollila HM. Narcolepsy type 1: what have we learned from genetics? Sleep 2021; 43:5842137. [PMID: 32442260 PMCID: PMC7658635 DOI: 10.1093/sleep/zsaa099] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 04/22/2020] [Indexed: 01/12/2023] Open
Abstract
Type-1 narcolepsy is a severe neurological disorder with distinct characteristic of loss of hypocretin neurotransmitter. Genetic analysis in type-1 narcolepsy have revealed a unique signal pointing toward autoimmune, rather than psychiatric origin. While type-1 narcolepsy has been intensively studied, the other subtypes of hypersomnolence, narcolepsy, and hypersomnia are less thoroughly understood. This review summarizes the latest breakthroughs in the field in narcolepsy. The goal of this article is to help the reader to understand better the risk from genetic factors and their interplay with immune, genetic, and epidemiological aspects in narcolepsy.
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Affiliation(s)
- Hanna M Ollila
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland.,Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA.,Program in Medical and Population Genetics, Broad Institute, Cambridge, MA.,Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA
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17
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Peter HH, Ochs HD, Cunningham-Rundles C, Vinh DC, Kiessling P, Greve B, Jolles S. Targeting FcRn for immunomodulation: Benefits, risks, and practical considerations. J Allergy Clin Immunol 2020; 146:479-491.e5. [PMID: 32896308 PMCID: PMC7471860 DOI: 10.1016/j.jaci.2020.07.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 02/08/2023]
Abstract
The neonatal fragment crystallizable (Fc) receptor (FcRn) functions as a recycling mechanism to prevent degradation and extend the half-life of IgG and albumin in the circulation. Several FcRn inhibitors selectively targeting IgG recycling are now moving rapidly toward clinical practice in neurology and hematology. These molecules accelerate the destruction of IgG, reducing pathogenic IgG and IgG immune complexes, with no anticipated effects on IgA, IgM, IgE, complement, plasma cells, B cells, or other cells of the innate or adaptive immune systems. FcRn inhibitors have potential for future use in a much wider variety of antibody-mediated autoimmune diseases. Given the imminent clinical use, potential for broader utility, and novel mechanism of action of FcRn inhibitors, here we review data from 4 main sources: (a) currently available activity, safety, and mechanism-of-action data from clinical trials of FcRn inhibitors; (b) other procedures and treatments that also remove IgG (plasma donation, plasma exchange, immunoadsorption); (c) diseases resulting in loss of IgG; and (d) primary immunodeficiencies with potential mechanistic similarities to those induced by FcRn inhibitors. These data have been evaluated to provide practical considerations for the assessment, monitoring, and reduction of any potential infection risk associated with FcRn inhibition, in addition to highlighting areas for future research.
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Affiliation(s)
- Hans-Hartmut Peter
- Freiburg University Hospital, Centre for Chronic Immunodeficiency, Freiburg, Germany
| | - Hans D Ochs
- Seattle Children's Research Institute, Seattle, Wash; Department of Pediatrics, University of Washington, Seattle, Wash
| | | | - Donald C Vinh
- Division of Infectious Diseases, Department of Medicine and Department of Medical Microbiology, McGill University Health Centre, Montreal, Quebec, Canada; Infectious Diseases & Immunity in Global Health Program, Research Institute-McGill University Health Centre, Montreal, Quebec, Canada
| | | | | | - Stephen Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, United Kingdom.
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18
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Holm LW, Bohman T, Lekander M, Magnusson C, Skillgate E. Risk of transition from occasional neck/back pain to long-duration activity limiting neck/back pain: a cohort study on the influence of poor work ability and sleep disturbances in the working population in Stockholm County. BMJ Open 2020; 10:e033946. [PMID: 32499260 PMCID: PMC7282292 DOI: 10.1136/bmjopen-2019-033946] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The prevalence of neck/back pain (NBP) is high worldwide. Limited number of studies have investigated workers with occasional NBP regarding the risk of developing long-duration activity limiting NBP (LNBP). The objectives were to assess (1) the effect of poor work ability and sleep disturbances in persons with occasional NBP on the risk of LNBP, and (2) the interaction effect of these exposures. DESIGN Cohort study based on three subsamples from the Stockholm Public Health Cohort. SETTINGS The working population in Stockholm County. PARTICIPANTS Persons aged 18-60 years, reporting occasional NBP the past 6 months at baseline year 2010 (n=16 460). MEASURES Work ability was assessed with items from the Work Ability Index, perceived mental and/or physical work ability. Sleep disturbances were self-reported current mild/severe disturbances. The outcome in year 2014 was reporting NBP the previous 6 months, occurring ≥couple of days per week and resulting in decreased work ability/restricted other daily activities. The additive effect of having both poor work ability and sleep disturbances was modelled with a dummy variable, including both exposures. Poisson log-linear regression was used to calculate risk ratios (RRs) and 95% CIs. RESULTS At follow-up, 9% had developed LNBP. Poor work ability and sleep disturbances were independent risk factors for LNBP; adjusted RR 1.7 (95% CI: 1.4 to 2.0) and 1.4 (95% CI: 1.2 to 1.5), respectively. No additive interaction was observed. CONCLUSION Workers with occasional NBP who have poor work ability and/or sleep disturbances are at risk of developing LNBP. Having both conditions does not exceed additive risk.
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Affiliation(s)
- Lena W Holm
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Tony Bohman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mats Lekander
- Stress Research Institute, Stockholm University, Stockholm, Sweden
- Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - C Magnusson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Eva Skillgate
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Sophiahemmet University, Stockholm, Sweden
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19
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[Self-reported infections in the German National Cohort (GNC) in the context of the current research landscape]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:404-414. [PMID: 32185449 DOI: 10.1007/s00103-020-03114-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Infectious diseases continue to play an important role for disease perception, health-economic considerations and public health in Germany. In recent years, infectious diseases have been linked to the development of non-communicable diseases. Analyses of the German National Cohort (GNC) may provide deeper insights into this issue and pave the way for new targeted approaches in disease prevention. OBJECTIVES The aim was to describe the tools used to assess infectious diseases and to present initial data on infectious disease frequencies, as well as to relate the GNC assessment tools to data collection methods in other studies in Germany. METHODS As part of the baseline examination, questions regarding infectious diseases were administered using both an interview and a self-administered touchscreen questionnaire. Data from the initial 101,787 GNC participants were analysed. RESULTS In the interview, 0.2% (HIV/AIDS) to 8.6% (shingles) of respondents reported ever having a medical diagnosis of shingles, postherpetic neuralgia (in cases where shingles was reported), hepatitis B/C, HIV/AIDS, tuberculosis or sepsis if treated in hospital. In the questionnaire, 12% (cystitis) to 81% (upper respiratory tract infections) of respondents reported having experienced at least one occurrence of upper or lower respiratory tract infections, gastrointestinal infections, cystitis or fever within the past 12 months. OUTLOOK The cross-sectional analyses of data and tools presented here - for example on determinants of susceptibility to self-reported infections - can be anticipated from the year 2021 onward. Beyond that, more extensive research into infectious disease epidemiology will follow, particularly once analyses of GNC biological materials have been performed.
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