Evening intake of alcohol, caffeine, and nicotine: night-to-night associations with sleep duration and continuity among African Americans in the Jackson Heart Sleep Study

Association between alcohol consumption and sleep traits: observational and mendelian randomization studies in the UK biobank

Previous studies have shown that excessive alcohol consumption is associated with poor sleep. However, the health risks of light-to-moderate alcohol consumption in relation to sleep traits (e.g., insomnia, snoring, sleep duration and chronotype) remain undefined, and their causality is still unclear in the general population. To identify the association between alcohol consumption and multiple sleep traits using an observational and Mendelian randomization (MR) design. Observational analyses and one-sample MR (linear and nonlinear) were performed using clinical and individual-level genetic data from the UK Biobank (UKB). Two-sample MR was assessed using summary data from genome-wide association studies from the UKB and other external consortia. Phenotype analyses were externally validated using data from the National Health and Nutrition Examination Survey (2017-2018). Data analysis was conducted from January 2022 to October 2022. The association between alcohol consumption and six self-reported sleep traits (short sleep duration, long sleep duration, chronotype, snoring, waking up in the morning, and insomnia) were analysed. This study included 383,357 UKB participants (mean [SD] age, 57.0 [8.0] years; 46% male) who consumed a mean (SD) of 9.0 (10.0) standard drinks (one standard drink equivalent to 14 g of alcohol) per week. In the observational analyses, alcohol consumption was significantly associated with all sleep traits. Light-moderate-heavy alcohol consumption was linearly linked to snoring and the evening chronotype but nonlinearly associated with insomnia, sleep duration, and napping. In linear MR analyses, a 1-SD (14 g) increase in genetically predicted alcohol consumption was associated with a 1.14-fold (95% CI, 1.07-1.22) higher risk of snoring (P < 0.001), a 1.28-fold (95% CI, 1.20-1.37) higher risk of evening chronotype (P < 0.001) and a 1.24-fold (95% CI, 1.13-1.36) higher risk of difficulty waking up in the morning (P < 0.001). Nonlinear MR analyses did not reveal significant results after Bonferroni adjustment. The results of the two-sample MR analyses were consistent with those of the one-sample MR analyses, but with a slightly attenuated overall estimate. Our findings suggest that even low levels of alcohol consumption may affect sleep health, particularly by increasing the risk of snoring and evening chronotypes. The negative effects of alcohol consumption on sleep should be made clear to the public in order to promote public health.

Poor Subjective Sleep Quality Predicts Symptoms in Irritable Bowel Syndrome Using the Experience Sampling Method

INTRODUCTION

Sleep quality may affect symptom experience in irritable bowel syndrome (IBS). Our aim was to investigate the relationship between sleep quality and gastrointestinal (GI) symptoms using actigraphy and the experience sampling method.

METHODS

Patients with IBS were recruited from a tertiary Neurogastroenterology clinic and the community. GI symptoms and mood were recorded on a smartphone application, 10 times per day, over 7 consecutive days. Subjective sleep quality was recorded every morning to reflect the night before. Objective measures of sleep quality were estimated from wrist-worn actigraphy. Cross-lagged structural equation models were built to assess the directionality of sleep-symptom relationships over time.

RESULTS

Eighty patients with IBS completed the study (mean age: 37 years [range 20-68], 89% female, 78% community). Approximately 66% had a Pittsburgh Sleep Quality Index score ≥ 8, indicating a clinically significant sleep disturbance. Approximately 82% (95% CI: 72-90) screened positive for a sleep disorder, most commonly insomnia. In cross-lagged analysis, poor subjective sleep quality predicted next-day abdominal pain (0.036 < P < 0.040) and lower GI symptoms (0.030 < P < 0.032), but not vice versa. No significant relationship with GI symptoms was found for any objective sleep measure using actigraphy.

DISCUSSION

Poor subjective sleep quality was associated with higher next-day lower GI symptom levels, but not vice versa. Objective sleep measures did not predict next-day abdominal symptoms, potentially supporting the conclusion that it is the perception of sleep quality that is most influential. This study may be used to guide future research into the effect of sleep interventions on GI symptoms.

Psychosocial determinants of healthy sleep habits in adults with type 1 and type 2 diabetes

Background

Many adults with type 1 (T1D) and type 2 diabetes (T2D) have inadequate sleep increasing their risk of hyperglycemia and developing complications. The objective was to identify psychosocial determinants of healthy sleep habits (HSH) among adults with T1D and T2D.

Methods

The two HSH were: avoiding screen use in bed and having sleep regularity. Adults (≥18 years) with T1D and T2D were invited to complete an anonymous online survey. The questionnaires were based on the Reasoned Action Approach and formative qualitative research previously conducted in 56 adults with T1D and T2D. Habit was included as an additional variable for screen use in bed.

Results

In total, 320 adults with diabetes (T1D: 39%; T2D: 61%) completed the questionnaires (screen use in bed: 174; sleep timing: 146). Close to 75% of participants reported screen use in bed and close to 90% reported sleep timing variability in the last month. Perceived behavioral control (PBC) to avoid screen use in bed (β = -0.4486, p < 0.0001), habit of using screens in bed (β = 0.4002; p < 0.0001), and age (β = -0.0202; p = 0.0086) were determinants of screen use in bed, and this model explained 71% of the variance. PBC for sleep regularity (β = -0.2909; p = 0.0004) and being female (β = 0.5057; p = 0.0069) were determinants of sleep timing variability, and this model explained 28% of the variance. The most important beliefs associated with each HSH were identified to obtain information to design targeted interventions.

Conclusions

Few adults with diabetes have HSH. Screen use in bed was strongly influenced by habit and the results suggest that both HSH are not easy to adopt among adults with diabetes. Younger adults with diabetes should be prioritized for screen use in bed, while females with diabetes should be prioritized for sleep timing variability. Adults with diabetes should have access to behavior change interventions to encourage them to adopt HSH.

Nighttime ambient temperature and sleep in community-dwelling older adults

This longitudinal study examines the association between bedroom nighttime temperature and sleep quality in a sample of community dwelling older adults. Using wearable sleep monitors and environmental sensors, we assessed sleep duration, efficiency, and restlessness over an extended period within participants' homes while controlling for potential confounders and covariates. Our findings demonstrated that sleep was most efficient and restful when nighttime ambient temperature ranged between 20 and 25 °C, with a clinically relevant 5-10 % drop in sleep efficiency when the temperature increased from 25 °C to 30 °C. The associations were primarily nonlinear, and substantial between-subject variations were observed. These results highlight the potential to enhance sleep quality in older adults by optimizing home thermal environments and emphasize the importance of personalized temperature adjustments based on individual needs and circumstances. Additionally, our study underscores the potential impact of climate change on sleep quality in older adults, particularly those with lower socioeconomic status, and supports increasing their adaptive capacity in the face of a changing climate.

Prevalence and Factors Associated With Poor Sleep Quality Among Visitors of Primary Healthcare Centers in Al-Ahsa, Kingdom of Saudi Arabia: An Analytical Cross-Sectional Study

Introduction Poor sleep quality can predict poor health and is associated with mortality risk. Many factors are associated with sleep quality such as gender, health, education, socioeconomic status, and stress. The objective of this study was to estimate the magnitude of poor sleep quality among visitors of Primary Healthcare Centers (PHCCs) in Al-Ahsa and to identify factors associated with poor sleep quality. Methods This is an analytical cross-sectional study. A multistage cluster sampling technique was used to recruit 461 visitors to PHCCs in Al-Ahsa Governorate in the Eastern Province of Saudi Arabia. A structured questionnaire was administered through face-to-face interviews. The questionnaire includes demographics, a validated Arabic version of the Pittsburgh Sleep Quality Index (PSQI), the Arabic version of the International Physical Activity Questionnaire (IPAQ), the Arabic version of the Patient Health Questionnaire-2 (PHQ-2), the Arabic version of the Generalized Anxiety Disorder-2 (GAD-2), the Arabic version of Perceived Stress Scale-10 (PSS-10), and a translated Mobile Related Sleep Risk Factors (MRSRF). Univariate analysis was performed using the Mann-Whitney U test for continuous data, the chi-square test (χ²) or Fishers's exact test (as appropriate) for categorical data, and logistic regression for multivariable analysis. A P-value of less than or equal to 0.05 was considered significant. Results The study included 433 participants, with 72.5% of them being poor sleepers (PSQI global score of over 5). The highest percentage of poor sleepers was found among those aged 18 - 28 years (81.7%), with no significant difference between genders (p = 0.676). The study's multivariable logistic regression analysis revealed that poor sleep is associated with smoking four hours before bedtime (OR = 2.9, CI = 1.2 - 6.7), consuming caffeine (drinks or pills) three hours before sleep (OR = 2.3, CI = 1.23 - 4.12) or immediately before bedtime (OR = 3.2, CI = 1.02 - 9.9), using mobile phones right before bedtime (OR = 2.6, CI = 1.5 - 4.5), having anxiety (OR = 5.8, CI = 1.3 - 26.2), and depression symptoms (OR = 6.5, CI = 2.9 - 14.5), among other risk factors. Conclusion The prevalence of poor sleep quality in our sample was notably high at 72.5%. Many factors are strongly associated with poor sleep quality including experiencing symptoms of anxiety and depression. Longitudinal studies are needed to explore this crucial health issue further. Healthcare providers in Al-Ahsa should pay particular attention while assessing patients who suffer from sleep disturbance by screening them for depression and anxiety and raising public awareness of the importance of good quality sleep and the factors that affect it.

Food insecurity and sleep health by race/ethnicity in the United States

Food insecurity, poised to increase with burgeoning concerns related to climate change, may influence sleep, yet few studies examined the food security-sleep association among racially/ethnically diverse populations with multiple sleep dimensions. We determined overall and racial/ethnic-specific associations between food security and sleep health. Using National Health Interview Survey data, we categorised food security as very low, low, marginal and high. Sleep duration was categorised as very short, short, recommended and long. Sleep disturbances included trouble falling/staying asleep, insomnia symptoms, waking up feeling unrested and using sleep medication (all ≥3 d/times in the previous week). Adjusting for socio-demographic characteristics and other confounders, we used Poisson regression with robust variance to estimate prevalence ratios (PRs) and 95 % confidence intervals (95 % CIs) for sleep dimensions by food security. Among 177 435 participants, the mean age of 47⋅2 ± 0⋅1 years, 52⋅0 % were women, and 68⋅4 % were non-Hispanic (NH)-White. A higher percent of NH-Black (7⋅9 %) and Hispanic/Latinx (5⋅1 %) lived in very low food security households than NH-White (3⋅1 %) participants. Very low v. high food security was associated with a higher prevalence of very short (PR = 2⋅61 [95 % CI 2⋅44-2⋅80]) sleep duration as well as trouble falling asleep (PR = 2⋅21 [95 % CI 2⋅12-2⋅30]). Very low v. high food security was associated with a higher prevalence of very short sleep duration among Asian (PR = 3⋅64 [95 % CI 2⋅67-4⋅97]) and NH-White (PR = 2⋅73 [95 % CI 2⋅50-2⋅99]) participants compared with NH-Black (PR = 2⋅03 [95 % CI 1⋅80-2⋅31]) and Hispanic/Latinx (PR = 2⋅65 [95 % CI 2⋅30-3⋅07]) participants. Food insecurity was associated with poorer sleep in a racially/ethnically diverse US sample.

Nicotine use and non-pathological alcohol use and their relationship to affective symptoms and sleep disturbances in bipolar disorder

BACKGROUND

The use of alcohol and nicotine can negatively impact the course of bipolar disorder (BD), but there is limited knowledge about how symptoms and sleep disturbances are related to concurrent nicotine use and non-pathological use of alcohol.

METHODS

We investigated how nicotine use and non-pathological use of alcohol relates to affective symptoms and sleep disturbances in 453 participants with BD without substance use disorders. Manic symptoms were assessed with the Young Mania Rating Scale, and depressive symptoms with The Inventory of Depressive Symptomatology, Clinician-Rated (IDS-C). Sleep-related questions from IDS-C were used to create proxy variables for sleep disturbances, including Insomnia and Hypersomnia. Multinomial regression analysis was conducted to investigate the associations between nicotine use and sleep disturbances, controlling for possible confounders such as current use of illicit drugs and psychopharmacological treatment.

RESULTS

Depressive and manic symptoms were not associated with the concurrent level of alcohol or nicotine use. Individuals with medium and high levels of daily nicotine use had higher risk of insomnia than those without. Non-pathological alcohol use was not associated with sleep disturbances.

LIMITATIONS

Sleep disturbances were based on items from the IDS-C questionnaire.

CONCLUSION

We found an elevated risk for insomnia in individuals with BD and medium or high levels of daily nicotine use. We found no association between the level of affective symptoms and the level of use of alcohol or nicotine. The direction of the relationship between nicotine use and insomnia needs clarification, as it is highly relevant for treatment planning.

Beliefs about Healthy Sleep Habits in Adults with Diabetes Compared to Adults without Diabetes: A Reasoned Action Approach Elicitation Study

Objective  Sleep is part of a healthy lifestyle and in adults with diabetes, inadequate sleep is associated with risks of developing complications. The objective was to compare beliefs about healthy sleep habits (HSHs) in adults with versus without diabetes based on the Reasoned Action Approach. Methods  A total of 56 adults with and 98 without diabetes answered open-ended questions regarding their beliefs about: avoiding screen use in bed; having a regular sleep schedule; or avoiding caffeine, alcohol, and cigarettes before bedtime. A qualitative content analysis was used to identify the most important beliefs, similarities, and differences between both groups. Results  Both groups reported that adopting HSHs could improve sleep. Having a regular sleep schedule was perceived to facilitate diabetes management in adults with diabetes. Negative consequences specific to adopting each HSH were identified in both groups. Adopting HSHs was associated with mainly negative emotions (e.g., stress, anxiety, fear) in both groups. Avoiding screen use in bed was associated with anxiety of not knowing blood glucose levels at night in adults with diabetes. Partners, parents, and friends were considered the most important individuals who would approve of adopting HSHs, but they were often perceived as unlikely to adopt HSHs themselves in both groups. Adults with diabetes perceived more barriers to adopting HSHs. Facilitating factors for both groups included removing triggers of unhealthy sleep habits, behavior substitution, using reminders, time management, and social support. Discussion  These beliefs can guide the development of behavioral sleep interventions, including interventions specifically for adults with diabetes.

Association between use of electronic vaping products and insufficient sleep among adolescents: Findings from the 2017 and 2019 YRBS

BACKGROUND AND OBJECTIVE

Although studies have investigated the association between cigarette smoking and sleep outcomes among adolescents in the United States, few studies have examined the association between electronic vaping products (EVPs) use and insufficient sleep among adolescents. The objective of this study was to investigate the cross-sectional association between the use of EVPs and insufficient sleep among adolescents.

METHODS

Data were pooled from the 2017 and 2019 Youth Risk Behavior Survey. An analytic sample of 28,135 adolescents (51.2% female) was analyzed using binary logistic regression. The dependent variable investigated was insufficient sleep, and the main independent variable was the use of EVPs.

RESULTS

Of the 28,135 adolescents, 22.6%, 19.2%, and 58.2% were current, former, and never users of EVPs, respectively. More than three in four adolescents (76.5%) did not obtain the recommended 8 h of sleep on an average school night. Controlling for demographic factors and other covariates, adolescents who currently used EVPs had 1.33 times higher odds of having insufficient sleep (AOR = 1.33, p < .001, 95% CI = 1.16-1.52), and adolescents who previously used EVPs had 1.29 times higher odds of having insufficient sleep (AOR = 1.29, p < .001, 95% CI = 1.15-1.44) when compared to adolescents who had never used EVPs. Adolescents were more likely to get insufficient sleep if they were older, non-Hispanic Black, had symptoms of depression, experienced suicidal ideation, engaged in excessive screen-time behaviors, or currently used alcohol. Physical activity had a protective effect on insufficient sleep.

CONCLUSION

This study found that EVPs use was associated with insufficient sleep among adolescents over and above demographic and other covariates. As EVP use increases among adolescents, it is important to consider the potential impact on multiple domains, including sleep. Future studies that employ longitudinal designs may offer additional insight into the mechanisms underlying the association between EVPs use and insufficient sleep.

Overall diet quality and proinflammatory diet in relation to risk of obstructive sleep apnea in 3 prospective US cohorts

BACKGROUND

Inflammation-related mechanisms may be important in the development of obstructive sleep apnea (OSA), and diet plays a crucial role in modulating inflammation. Current epidemiologic evidence for the associations between dietary patterns and OSA risk is limited to cross-sectional studies.

OBJECTIVES

We investigated prospectively the associations of overall diet quality and proinflammatory diet with OSA risk.

METHODS

We followed 145,801 participants in the Nurses' Health Study (NHS) (2002-2012), NHS II (1995-2013), and Health Professionals Follow-up Study (1996-2012). Alternative Healthy Eating Index 2010 (AHEI) and Empirical Dietary Inflammatory Pattern (EDIP) scores were calculated based on validated FFQs administered every 4 y. Cox models were used to estimate HRs and 95% CIs.

RESULTS

We documented 8856 incident OSA cases during follow-up. In pooled analyses adjusted for potential confounders, higher diet quality (higher AHEI scores) was associated with lower OSA risk (HR comparing the highest with the lowest quintile of AHEI: 0.76; 95% CI: 0.71, 0.82; P-trend < 0.001), and higher dietary inflammatory potential (higher EDIP scores) was associated with significantly increased risk (HR comparing the highest with the lowest quintile of EDIP: 1.94; 95% CI: 1.81, 2.08; P-trend < 0.001). Additional adjustment for metabolic factors attenuated both associations. The association with AHEI score was no longer statistically significant (comparable HR: 0.98; 95% CI: 0.91, 1.05; P-trend = 0.54), whereas the association with EDIP score remained statistically significant (comparable HR: 1.31; 95% CI: 1.22, 1.41; P-trend < 0.001).

CONCLUSIONS

A healthier diet, particularly one with anti-inflammatory potential, was associated with lower OSA risk.

Nutritional Elements in Sleep

Sleep comprises one-third of our day and plays an integral role in human health and well-being. Many factors influence sleep, with nutrition being a key element that impacts various sleep parameters. Meal-timing through strategies like chrono-nutrition leads to positive sleep outcomes. In addition, consuming a high-protein diet with essential amino acids, low-glycemic-index foods, and certain fruits rich in antioxidants can all contribute to better sleep quality. Other facets of nutrition that can affect sleep outcomes include weight loss and limiting certain nutritional elements such as caffeine, nicotine, and alcohol. In this article, we will shed some light on how some of these factors can play a vital role in sleep quality.

The roles of the circadian hormone melatonin in drug addiction

Given the devastating social and health consequences of drug addiction and the limitations of current treatments, a new strategy is needed. Circadian system disruptions are frequently associated with drug addiction. Correcting abnormal circadian rhythms and improving sleep quality may thus be beneficial in the treatment of patients with drug addiction. Melatonin, an essential circadian hormone that modulates the biological clock, has anti-inflammatory, analgesic, anti-depressive, and neuroprotective effects via gut microbiota regulation and epigenetic modifications. It has attracted scientists' attention as a potential solution to drug abuse. This review summarized scientific evidence on the roles of melatonin in substance use disorders at the cellular, circuitry, and system levels, and discussed its potential applications as an intervention strategy for drug addiction.

Characterisation of the genetic relationship between the domains of sleep and circadian-related behaviours with substance use phenotypes

Sleep problems and substance use frequently co-occur. While substance use can result in specific sleep deficits, genetic pleiotropy could explain part of the relationship between sleep and substance use and use disorders. Here we use the largest publicly available genome-wide summary statistics of substance use behaviours (N = 79,729-632,802) and sleep/activity phenotypes to date (N = 85,502-449,734) to (1) assess the genetic overlap between substance use behaviours and both sleep and circadian-related activity measures, (2) estimate clusters from genetic correlations and (3) test processes of causality versus genetic pleiotropy. We found 31 genetic correlations between substance use and sleep/activity after Bonferroni correction. These patterns of overlap were represented by two genetic clusters: (1) tobacco use severity (age of first regular tobacco use and smoking cessation) and sleep health (sleep duration, sleep efficiency and chronotype) and (2) substance consumption/problematic use (drinks per day and cigarettes per day, cannabis use disorder, opioid use disorder and problematic alcohol use) and sleep problems (insomnia, self-reported short sleep duration, increased number of sleep episodes, increased sleep duration variability and diurnal inactivity) and measures of circadian-related activity (L5, M10 and sleep midpoint). Latent causal variable analyses determined that horizontal pleiotropy (rather than genetic causality) underlies a majority of the associations between substance use and sleep/circadian related measures, except one plausible genetically causal relationship for opioid use disorder on self-reported long sleep duration. Results show that shared genetics are likely a mechanism that is at least partly responsible for the overlap between sleep and substance use traits.

Long Working Hours Indirectly Affect Psychosomatic Stress Responses via Complete Mediation by Irregular Mealtimes and Shortened Sleep Duration: A Cross-Sectional Study

BACKGROUND

Long working hours are detrimental to physical and mental health. However, the association between long working hours and psychosomatic symptoms have remained controversial, possibly because of the existence of mediators between working hours and psychosomatic stress responses. We hypothesized that lifestyle habits, regarding sleep and mealtimes, act as mediators, and analyzed the associations between long working hours, sleep duration, mealtime regularity, and psychosomatic stress responses in office workers.

METHODS

From April 2017 to March 2018, an online cross-sectional survey regarding overtime work hours, work-related stress, sleep, and eating habits was conducted with employees of 17 companies located in Tokyo, Japan. Answers were obtained from 3559 employees, and 3100 provided written consent for the academic use of their answers, and were included in the analysis. A path analysis was conducted to assess the effect of overtime work on psychosomatic stress via shortened sleep or irregular mealtimes.

RESULTS

Overtime work hours had no direct effect on psychosomatic stress responses and depressive symptoms. However, overtime work hours affected sleep duration and the regularity of mealtimes. The effects of overtime work hours on psychosomatic stress responses and depressive symptoms were completely mediated by sleep duration and the regularity of mealtimes.

CONCLUSION

Long working hours do not affect mental health directly; however, shortened sleep duration and irregular mealtimes mediate the effect of long working hours on psychosomatic stress responses and depressive symptoms.

The impact of cigarette smoking on the quality of sleep in Polish men

Quality of sleep directly impacts quality of life, whilst lifestyle significantly impacts night rest. Cigarette smoking is a serious threat to overall health, including sleep. Nicotine in cigarettes affects the nervous system, whilst the respiratory system is impacted by carcinogenic substances, such as dusts and tarred substances, inhaled with smoke. Cigarettes are assumed to be a risk factor in sleep disorders, including breathing sleep disorders.

This study’s aim was to analyze the impact of cigarette smoking on adult men’s polysomnographic parameters.

Polysomnographic records for 94 adult men were obtained from the polysomnography laboratory in Opolskie Province, Poland. Additionally co-morbidities, height, weight and frequency of smoking were also noted. Three groups of men were categorised according to the frequency with which they smoked: non-smokers, smoking less than a pack a day, smoking more than a pack a day.

Compared to non-smokers and mild smokers, men who were heavy smokers also exhibited the longest sleepless time (H=8.11; p=0.017), the maximum waking time following the onset of sleep (H=7.99; p= 0.018), the lowest sleep efficiency across the three groups (H=7.96; p=0.019), the greatest number of apnea events per hour of sleep (H=6.23; p= 0.045), the lowest Oxygen Level Nadir (H=11.44; p= 0.003) and the highest rate of limb movements per hour of sleep (H=9.81; p=0.007).

The dose effect was identified, which correlated more cigarettes men smoked per day with lower sleep quality.

Beliefs of women of childbearing age on healthy sleep habits: a reasoned action approach elicitation study

There is little information on the determinants of healthy sleep habits (HSH) among women of childbearing age (WOCBA). The objective was to identify WOCBA's beliefs on HSH based on the Reasoned Action Approach. Thirty WOCBA (18-41 years) were randomly assigned to answer questions regarding one of three HSH: avoiding screen use in bed; avoiding caffeine, alcohol and cigarettes before bedtime; and having a regular bedtime and wake up time even on weekends. A content analysis was performed independently by two experts to identify the most important beliefs using a 75% cumulative frequency of mention. Participants reported that adopting the HSH would improve sleep, avoid side effects, help them relax before bedtime and make them feel like they were missing out on things. Adopting the HSH was associated with feeling relaxed and satisfied, but also qualified as unpleasant and abnormal. WOCBA mentioned their parents, partner, siblings and children would approve/disapprove if they adopted the HSH and were the most/least likely to adopt them. Barriers were having activities in the evening and social situations. Facilitating factors were putting their electronic devices away from bed, having alternatives and a regular schedule. These results can guide the development of interventions promoting HSH among WOCBA.

COVID-19: Sleep, Circadian Rhythms and Immunity - Repurposing Drugs and Chronotherapeutics for SARS-CoV-2

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has affected nearly 28 million people in the United States and has caused more than five hundred thousand deaths as of February 21, 2021. As the novel coronavirus continues to take its toll in the United States and all across the globe, particularly among the elderly (>65 years), clinicians and translational researchers are taking a closer look at the nexus of sleep, circadian rhythms and immunity that may contribute toward a more severe coronavirus disease-19 (COVID-19). SARS-CoV-2-induced multi-organ failure affects both central and peripheral organs, causing increased mortality in the elderly. However, whether differences in sleep, circadian rhythms, and immunity between older and younger individuals contribute to the age-related differences in systemic dysregulation of target organs observed in SARS-CoV-2 infection remain largely unknown. Current literature demonstrates the emerging role of sleep, circadian rhythms, and immunity in the development of chronic pulmonary diseases and respiratory infections in human and mouse models. The exact mechanism underlying acute respiratory distress syndrome (ARDS) and other cardiopulmonary complications in elderly patients in combination with associated comorbidities remain unclear. Nevertheless, understanding the critical role of sleep, circadian clock dysfunction in target organs, and immune status of patients with SARS-CoV-2 may provide novel insights into possible therapies. Chronotherapy is an emerging concept that is gaining attention in sleep medicine. Accumulating evidence suggests that nearly half of all physiological functions follow a strict daily rhythm. However, healthcare professionals rarely take implementing timed-administration of drugs into consideration. In this review, we summarize recent findings directly relating to the contributing roles of sleep, circadian rhythms and immune response in modulating infectious disease processes, and integrate chronotherapy in the discussion of the potential drugs that can be repurposed to improve the treatment and management of COVID-19.

The relationship between sleep and physical activity: The moderating role of daily alcohol consumption

STUDY OBJECTIVES

Studies have demonstrated a daily, bidirectional relationship between sleep and physical activity. However, little is known about how other health behaviors, such as alcohol consumption affect this relationship. This study examined how daily and average alcohol consumption affects the relationships between sleep and physical activity.

METHODS

Participants included 70 men and women, ages 18-50 with sleep duration >6.5 h. Participants wore an actigraph, physical activity monitor and recorded number of alcoholic drinks by daily food logs for 7 days. Results were analyzed using multi-level models to evaluate the 7-day average (i.e., between-person effects) and daily effects (i.e., within-person effects) simultaneously.

RESULTS

Those with more average (7 day) minutes of vigorous physical activity had less wake after sleep onset (WASO). Furthermore, a higher number of alcoholic drinks was associated with longer sleep duration and higher WASO over 7 days. Days with a higher number of alcoholic drinks were associated with higher WASO and sleep fragmentation that night. Alcohol intake moderated the average (7 day) and daily relationships between sleep and physical activity such that high average (7 days) WASO was associated with shorter average total physical activity duration, but only for those with higher alcohol intake. In addition, longer physical activity duration during the day was associated with lower sleep fragmentation that night, but only for those with lower alcohol intake.

CONCLUSIONS

These data demonstrate that in a naturalistic setting, alcohol intake negatively impacts sleep and diminishes the benefits of physical activity on sleep.

Differences in sleep timing and related effects between African Americans and non-Hispanic Whites

STUDY OBJECTIVES

Prior studies have shown a morning chronotype for African Americans compared with non-Hispanic Whites, yet self-reported sleep timing is delayed in African Americans compared with Whites.

METHODS

We analyzed data from the Multi-Ethnicity Study of Atherosclerosis, a multisite community-based cohort. Self-reported and actigraphic sleep timing, chronotype measured by the modified Horne-Östberg Morningness-Eveningness Questionnaire, and risk of depression measured by the Center for Epidemiologic Studies Depression scale were examined using nonparametric approaches and linear or logistic regression while comparing between African Americans and Whites and evaluating the effects of delayed sleep phase.

RESULTS

In 1,401 participants, there was no difference in chronotype between African Americans and Whites. African Americans were 80% more likely to report a delayed sleep phase (defined as bedtime after midnight) on weekdays and 50% more likely on weekends than were Whites. Actigraphic data showed similar results. Actigraphic midsleep time was delayed 38 minutes on weekdays and 24 minutes on weekends in African Americans compared with Whites. Stratified analysis by chronotype showed that African Americans with a morning or intermediate chronotype had a significantly delayed sleep phase compared with Whites, but there was no difference between African Americans and Whites with an evening chronotype. Delayed sleep phase was associated with depression, but this relationship was only significant in White participants.

CONCLUSIONS

African Americans had a delayed sleep phase compared with Whites that was more pronounced in individuals with a morning or intermediate chronotype. Consequences of delayed sleep phase may vary by race and ethnicity.

Effects of ambulatory blood pressure monitoring on sleep in healthy, normotensive men and women

OBJECTIVES

To determine the effect of ambulatory blood pressure monitoring (ABPM) on sleep quality among healthy adults and to explore possible effect modification by demographics.

METHODS

We examined data from 192 relatively healthy young (median age: 31; 33% men, 18% with clinic BP >130/80 mmHg) participants in an observational study of sleep and arterial stiffness. Demographic/health questionnaires were completed. A wrist-based accelerometer assessed sleep for seven nights, and sleep duration, wakefulness after sleep onset (WASO), fragmentation (physical restlessness), midpoint, and efficiency were estimated. ABPM was conducted for one 36-h period, including one actigraphy night.

RESULTS

Within-subject comparisons indicated that WASO and fragmentation were higher, midpoint was later, and efficiency was lower on the ABPM night (Ps < 0.001-0.038). Neither age nor sex moderated these associations. Among older adults, a later midpoint and worse fragmentation were observed with ABPM (Ps = 0.002-0.010). There was also a main effect of sex: men demonstrated shorter sleep duration, greater WASO and fragmentation, and less efficiency than women (Ps = 0.002-0.046). With ABPM, women had worse fragmentation and a later midpoint (Ps = 0.002-0.049); for men, WASO and fragmentation were worse (Ps = 0.003-0.023). Importantly, this study does not address whether the effect of wearing ABPM on sleep in turn affects BP during sleep.

CONCLUSIONS

ABPM appears to modestly disturb actigraphy-assessed sleep among healthy adults. Researchers and clinicians should consider the downstream effects of performing ABPM and whether these effects are more pronounced in those who typically experience sleep disturbance.

Smoke at night and sleep worse? The associations between cigarette smoking with insomnia severity and sleep duration

OBJECTIVE

Insomnia is a clinically verified nicotine withdrawal symptom. As nicotine is a stimulant, it is plausible that smoking at night could disturb sleep more than smoking at earlier times of the day, but this remains empirically unclear. This study examined smoking status and its associations with insomnia severity and sleep duration while considering the potential role of smoking time.

METHODS

Data were derived from the Sleep and Healthy Activity Diet Environment and Socialization study, a community-based study of 1007 adults (nnonsmokers = 818; nsmokers = 189) aged 22-60 from the Philadelphia area. Smoking status and time of smoking were self-reported. Insomnia was assessed with the Insomnia Severity Index and categorized as none, mild, and moderate-to-severe. Sleep duration was assessed with one item from the National Health and Nutrition Examination Survey and categorized as very short, short, normal, and long. Ordinal and multinomial logistic regressions were used to determine the association of smoking status including smoking time with insomnia severity and sleep duration controlling for sociodemographic covariates.

RESULTS

Compared to nonsmoking, smoking was associated with experiencing increased insomnia (odds ratio = 2.5, 95% confidence interval [CI] 1.9, 3.4, P < .001) as well as very short (relative risk ratio = 1.9, 95% CI 1.1, 3.3) and short (relative risk ratio = 1.5, 95% CI 1.0, 2.3) sleep (vs normal sleep duration). Night-time smoking was significantly associated with greater insomnia and shorter sleep duration.

CONCLUSIONS

Findings provide evidence that smoking is associated with increased insomnia severity and shorter sleep duration, particularly nightly smoking. Sleep health should be considered in smoking cessation efforts.

Sleep and physical activity in university students: A systematic review and meta-analysis

University students have low levels of physical activity and report disturbances to sleep, which are independently associated with poor health outcomes. Some research suggests that there is a bi-directional relationship between sleep and physical activity in adults. However, the relationship between sleep and physical activity in university students has not yet been evaluated. Therefore, the aim of this systematic review and meta-analysis was to qualitatively synthesise and quantitatively evaluate the evidence for the association between sleep and physical activity in university students. Twenty-nine eligible studies were included, with a total of 141,035 participants (43% men and 57% women). Only four studies used device-based measures of sleep and/or physical activity, with the remainder including self-report measures. Qualitative synthesis found that the majority of studies did not find any association between sleep and physical activity in university students. However, random-effects meta-analysis showed that moderate-to-high intensity physical activity was associated with lower PSQI scores (e.g., better sleep quality) [r = -0.18, 95% CI (-0.37, 0.03), p = 0.100]. Further, a weak negative association between moderate-to-vigorous physical activity level and sleep duration was also found [r = -0.02, 95% CI (-0.16, 0.12), p = 0.760]. As the findings of this review are predominantly derived from cross-sectional investigations, with limited use of device-based measurement tools, further research is needed to investigate the relationship between sleep and physical activity in university students. Future studies should employ longitudinal designs, with self-report and device-based measures, and consider the intensity and time of physical activity as well as records of napping behaviour.

COVID-19 lockdown: Physical activity, sedentary behaviour and sleep in Italian medicine students

COVID-19 pandemic led many countries to implement lockdown measures. Italy declared lockdown from 9th March to 3rd May 2020, and universities shifted to online classes. Home confinement could prevent students from achieving the physical activity and sleep levels recommended for their psychophysical health, and medicine students are already known to be at risk of inactivity and reduced sleep due to their time-consuming curricula. This study aimed at describing medicine students' behaviours during lockdown and comparing them with pre-lockdown data and current recommendations. A cross-sectional questionnaire survey was conducted among 6th-year Italian medicine students (n = 714; age=25 ± 2 y; female: 62%; male: 38%) in October-November 2019. The same survey was repeated in 6th-year students during lockdown (n = 394; age=25 ± 2 y; female: 73%; male: 27%), and extended to 1st-5th year (total 1st-6th-year sample during lockdown: n = 1471; age=23 ± 2 y; female: 70%; male: 30%). International Physical Activity Questionnaire Short Form (IPAQ) and selected questions from Pittsburgh Sleep Quality Index were administered to evaluate physical activity, sitting and sleep time. Decreased physical activity, and increased sitting and sleep time were observed from pre- to during lockdown in 6th-year students (p<0.01). 1st-6th-year students featured 10 [8-12] hours sitting (median [Q1-Q3]) and an IPAQ score of 1170 [400-2348] MET-min/week. Even participants with higher physical activity featured high sitting time. Sleeping less than recommended (<7 h/night) was associated with more sitting time and less energies to perform daily activities. Strategies fostering compliance with current guidelines for physical activity, sedentary behaviour and sleep should be implemented, especially in case of a repeated or intermittent lockdown.Highlights During lockdown, medicine students reduced their total physical activity and increased sedentary behaviour.Walking time was reduced in favour of increased higher-intensity physical activity. However, total metabolic expenditure was lower than before lockdown.Before lockdown students slept less than the recommended 7 hours per night, but they increased sleep time during lockdown.Medical schools should promote education on physical activity and sleep, since it improves the health of students, doctors and patients. This is especially valuable in case of repeated lockdown.

REM sleep loss-induced elevated noradrenaline could predispose an individual to psychosomatic disorders: a review focused on proposal for prediction, prevention, and personalized treatment

Historically and traditionally, it is known that sleep helps in maintaining healthy living. Its duration varies not only among individuals but also in the same individual depending on circumstances, suggesting it is a dynamic and personalized physiological process. It has been divided into rapid eye movement sleep (REMS) and non-REMS (NREMS). The former is unique that adult humans spend the least time in this stage, when although one is physically asleep, the brain behaves as if awake, the dream state. As NREMS is a pre-requisite for appearance of REMS, the latter can be considered a predictive readout of sleep quality and health. It plays a protective role against oxidative, stressful, and psychopathological insults. Several modern lifestyle activities compromise quality and quantity of sleep (including REMS) affecting fundamental physiological and psychopathosomatic processes in a personalized manner. REMS loss-induced elevated brain noradrenaline (NA) causes many associated symptoms, which are ameliorated by preventing NA action. Therefore, we propose that awareness about personalized sleep hygiene (including REMS) and maintaining optimum brain NA level should be of paramount significance for leading physical and mental well-being as well as healthy living. As sleep is a dynamic, multifactorial, homeostatically regulated process, for healthy living, we recommend addressing and treating sleep dysfunctions in a personalized manner by the health professionals, caregivers, family, and other supporting members in the society. We also recommend that maintaining sleep profile, optimum level of NA, and/or prevention of elevation of NA or its action in the brain must be seriously considered for ameliorating lifestyle and REMS disturbance-associated dysfunctions.

Midday Napping and Successful Aging in Older People Living in the Mediterranean Region: The Epidemiological Mediterranean Islands Study (MEDIS)

The aim of the present study was to investigate the association between midday napping, sleeping hours, and successful aging among 2564 older (65+ years) individuals living in the insular Mediterranean region. Anthropometric, clinical, and socio-demographic characteristics, dietary habits, and lifestyle parameters were derived through standard procedures, while successful aging was evaluated using the validated Successful Aging Index (SAI; range 0-10). Of the 2564 participants, 74% reported midday napping. The SAI score was 2.9/10 for non-midday nappers vs. 3.5/10 for midday nappers (p = 0.001). Midday nappers were more likely to be physically active (p = 0.01) and to have higher adherence to the Mediterranean diet (p = 0.02) compared to non-midday nappers. In a fully adjusted model, midday nappers had 6.7% higher SAI score compared to the rest (p < 0.001), and the effect of midday napping was more prominent among males and participants 80+ years of age. Further analysis indicated a significant U-shaped trend between sleeping hours/day and SAI score (p < 0.001), with 8-9 h total of sleep/day, midday napping included, proposed as optimal in achieving the best SAI score. Midday napping seems to be a beneficial habit that should be promoted and encouraged in older people.