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de Faria RR, de Siqueira SF, Haddad FA, Del Monte Silva G, Spaggiari CV, Martinelli M. The Six Pillars of Lifestyle Medicine in Managing Noncommunicable Diseases - The Gaps in Current Guidelines. Arq Bras Cardiol 2024; 120:e20230408. [PMID: 38198361 PMCID: PMC10735241 DOI: 10.36660/abc.20230408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/29/2023] [Accepted: 10/25/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Noncommunicable diseases (NCDs), also known as chronic diseases that are long-lasting, are considered the major cause of death and disability worldwide, and the six pillars of lifestyle medicine (nutrition, exercise, toxic control, stress management, restorative sleep, and social connection) play an important role in a holistic management of their prevention and treatment. In addition, medical guidelines are the most accepted documents with recommendations to manage NCDs. OBJECTIVE The present study aims to analyze the lack of lifestyle pillars concerning the major Brazilian medical guidelines for NCDs and identify evidence in the literature that could justify their inclusion in the documents. METHOD Brazilian guidelines were selected according to the most relevant causes of death in Brazil, given by the Mortality Information System, published by the Brazilian Ministry of Health in 2019. Journals were screened in the PUBMED library according to the disease and non-mentioned pillars of lifestyle. RESULTS Relevant causes of deaths in Brazil are acute myocardial infarction (AMI), diabetes mellitus (DM), and chronic obstructive pulmonary diseases (COPD). Six guidelines related to these NCDs were identified, and all address aspects of lifestyle, but only one, regarding cardiovascular prevention, highlights all six pillars. Despite this, a literature search involving over 50 articles showed that there is evidence that all the pillars can help control each of these NCDs. CONCLUSION Rarely are the six pillars of lifestyle contemplated in Brazilian guidelines for AMI, DM, and COPD. The literature review identified evidence of all lifestyle pillars to offer a holistic approach for the management and prevention of NCDs.
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Affiliation(s)
- Rafaella Rogatto de Faria
- Cultivare Prevenção e Promoção da SaúdePesquisa e DesenvolvimentoSão PauloSPBrasilCultivare Prevenção e Promoção da Saúde – Pesquisa e Desenvolvimento, São Paulo, SP – Brasil
- Hospital das Clínicas da FMUSPMedicina do EsporteSão PauloSPBrasilMedicina do Esporte – Hospital das Clínicas da FMUSP, São Paulo, SP – Brasil
| | - Sergio Freitas de Siqueira
- Cultivare Prevenção e Promoção da SaúdePesquisa e DesenvolvimentoSão PauloSPBrasilCultivare Prevenção e Promoção da Saúde – Pesquisa e Desenvolvimento, São Paulo, SP – Brasil
- Hospital das Clínicas da FMUSPInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor), Hospital das Clínicas da FMUSP, São Paulo, SP – Brasil
| | - Francisco Aguerre Haddad
- Cultivare Prevenção e Promoção da SaúdePesquisa e DesenvolvimentoSão PauloSPBrasilCultivare Prevenção e Promoção da Saúde – Pesquisa e Desenvolvimento, São Paulo, SP – Brasil
- Pontifícia Universidade Católica de São PauloSão PauloSPBrasilPontifícia Universidade Católica de São Paulo, São Paulo, SP – Brasil
| | - Gustavo Del Monte Silva
- Cultivare Prevenção e Promoção da SaúdePesquisa e DesenvolvimentoSão PauloSPBrasilCultivare Prevenção e Promoção da Saúde – Pesquisa e Desenvolvimento, São Paulo, SP – Brasil
- Pontifícia Universidade Católica de São PauloSão PauloSPBrasilPontifícia Universidade Católica de São Paulo, São Paulo, SP – Brasil
| | - Caio Vitale Spaggiari
- Hospital das Clínicas da FMUSPInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor), Hospital das Clínicas da FMUSP, São Paulo, SP – Brasil
| | - Martino Martinelli
- Cultivare Prevenção e Promoção da SaúdePesquisa e DesenvolvimentoSão PauloSPBrasilCultivare Prevenção e Promoção da Saúde – Pesquisa e Desenvolvimento, São Paulo, SP – Brasil
- Hospital das Clínicas da FMUSPInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração (InCor), Hospital das Clínicas da FMUSP, São Paulo, SP – Brasil
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Rainer MA, Palmer PH, Xie B. Sleep Duration and Chronic Disease Among Older Native Hawaiians or Other Pacific Islanders and Asians: Analysis of the Behavioral Risk Factor Surveillance System. J Racial Ethn Health Disparities 2023; 10:2302-2311. [PMID: 36109435 DOI: 10.1007/s40615-022-01409-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Older adults are particularly vulnerable to unhealthy sleep. This study examines the relationship between sleep duration and chronic diseases among older Native Hawaiians or Other Pacific Islanders (NHOPIs) and identifies variations with older Asians. METHODS In this cross-sectional study, data were analyzed using the 2016 Behavioral Risk Factor Surveillance System. The total sample of adults 50 years and older included 1277 NHOPIs and 4655 Asians. Weighted, survey logistic regressions were employed to analyze the relationship between sleep duration (i.e., short, healthy, and long) and seven chronic diseases: coronary heart disease, stroke, heart attack/myocardial infarction, pre-diabetes, diabetes, chronic obstructive pulmonary disease, and depressive disorder. Sleep duration was categorized into short sleep (SS; ≤ 6 h), healthy sleep (7-8 h), and long sleep (LS; ≥ 9 h), with healthy sleep as the reference group. RESULTS Among NHOPIs, SS and LS were significantly related to stroke (OR 3.19, 95% CI: 1.35-7.53 for SS and OR 9.52, 95% CI: 2.99-30.34 for LS) and SS was associated with pre-diabetes (OR 2.22 CI: 1.07-4.59), after adjusting for all covariates. In contrast, Asians with SS and LS reported higher odds of depression (OR 2.40, 95% CI: 1.20-4.79 and OR 5.03, 95% CI: 1.57-16.13, respectively). CONCLUSIONS Findings suggest older NHOPIs with SS or LS experience worse health. NHOPIs and Asians varied on the relationship between sleep and chronic disease, underscoring the need to disaggregate Asian/NHOPI data to understand health disparities.
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Affiliation(s)
- Michelle A Rainer
- School of Community and Global Health, Claremont Graduate University, 150 E 10th St, Claremont, CA, 91711, USA.
| | - Paula Healani Palmer
- School of Community and Global Health, Claremont Graduate University, 150 E 10th St, Claremont, CA, 91711, USA
| | - Bin Xie
- School of Community and Global Health, Claremont Graduate University, 150 E 10th St, Claremont, CA, 91711, USA
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Clinical and polysomnographic evaluation of sleep-related breathing disorders in patients with sarcoidosis. Sleep Breath 2022; 26:1847-1855. [DOI: 10.1007/s11325-021-02513-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 08/17/2021] [Accepted: 10/08/2021] [Indexed: 10/19/2022]
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4
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Multiple environmental and psychosocial work risk factors and sleep disturbances. Int Arch Occup Environ Health 2020; 93:623-633. [PMID: 31955238 DOI: 10.1007/s00420-020-01515-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 01/02/2020] [Indexed: 01/06/2023]
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The association between sleep disturbance and second-hand smoke exposure: a large-scale, nationwide, cross-sectional study of adolescents in Japan. Sleep Med 2018; 50:29-35. [DOI: 10.1016/j.sleep.2018.04.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 04/10/2018] [Accepted: 04/11/2018] [Indexed: 11/22/2022]
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Reis C, Dias S, Rodrigues AM, Sousa RD, Gregório MJ, Branco J, Canhão H, Paiva T. Sleep duration, lifestyles and chronic diseases: a cross-sectional population-based study. ACTA ACUST UNITED AC 2018; 11:217-230. [PMID: 30746039 PMCID: PMC6361301 DOI: 10.5935/1984-0063.20180036] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Adequate sleep is essential for health. Both, short and long sleep durations
are associated to worse quality of life and poor health outcomes. Portugal
represents a specific population model, since according to European
statistics it has high rates of chronic diseases like depression,
hypertension, diabetes and stroke; and low quality of life as well as low
index of physical activity, while in parallel it has some other good health
indicators such as: low age-standardized mortality for both genders,
nutrition in terms of energy and fruit consumption, smoking and alcohol,
obesity and overweight prevalence. The aim of this study was to characterize
health and chronic diseases, lifestyles and quality of life in subjects with
short and long sleep duration. Methods A population-based cross-sectional evaluation of the third wave of follow-up
of the EpiDoC Cohort was carried between 2015-2016. A sample of 5,436 adults
≥18 years, representative of the national population, self-reported
their daily total sleep time. Associations between short sleep duration (SSD
≤5h), long sleep duration (LSD≥9h) and independent variables
were determined. Results The prevalence for SSD was high (20.7%) and the LSD (5.9%) was low. Being
older, with lower education, retired and unemployed were associated to SSD
and LSD (p<0.01). Being obese was associated to SSD as
well as hypertension, gastrointestinal disease and hypercholesterolemia
(p<0.01). SSD and LSD, were associated with diabetes
(p<0.01 and p=0.03) and depression
(p<0.01 and p=0.02) respectively.
Cardiovascular disease (p<0.01) was associated to LSD.
Multimorbidity (p<0.01) was associated to SSD. Worse
quality of life and bad physical function were associated to SSD and LSD, as
well as being hospitalized in the previous 12 months
(p<0.01). Conclusions Socio-demographic, physical activity and chronic diseases were associated to
reduction and extension of sleep duration. There was no association between
rheumatic diseases and cancer with sleep duration, as found in other
studies. This study emphasizes the burden of self-reported SSD for Portugal,
its consequences to health and the need to increase sleep awareness
campaigns enhancing the importance of sleep in health. Furthermore, it
emphasizes that chronic diseases risks are dependent on multiple parameters
which varying in different countries or regions, imply the need of regional
studies and interventions.
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Affiliation(s)
- Cátia Reis
- Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal, Instituto de Saúde Ambiental (ISAMB) - Lisboa - Lisboa - Portugal.,CENC - Sleep Medicine Center, Sleep and circadian rhythms - Lisboa - Lisboa - Portugal
| | - Sara Dias
- EpiDoC Unit, NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), Centro de Estudos de Doenças Crónicas (CEDOC) - Lisboa - Lisboa - Portugal.,EpiSaúde, Associação Científica - Évora - Évora - Portugal.,Escola Superior de Saúde do Instituto Politécnico de Leiria, CiTechCare, Center for innovative care and health technology - Leiria - Leiria - Portugal
| | - Ana Maria Rodrigues
- EpiDoC Unit, NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), Centro de Estudos de Doenças Crónicas (CEDOC) - Lisboa - Lisboa - Portugal.,Sociedade Portuguesa de Reumatologia, Sociedade Portuguesa de Reumatologia - Lisboa - Lisboa - Portugal.,Instituto de Medicina Molecular, Rheumatology Research Unit - Lisboa - Lisboa - Portugal.,EpiSaúde, Associação Científica - Évora - Évora - Portugal
| | - Rute Dinis Sousa
- EpiDoC Unit, NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), Centro de Estudos de Doenças Crónicas (CEDOC) - Lisboa - Lisboa - Portugal.,EpiSaúde, Associação Científica - Évora - Évora - Portugal
| | - Maria João Gregório
- EpiDoC Unit, NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), Centro de Estudos de Doenças Crónicas (CEDOC) - Lisboa - Lisboa - Portugal.,Direção-Geral da Saúde, Programa Nacional para a Promoção da Alimentação Saudável - Lisboa - Lisboa - Portugal.,Universidade do Porto, Faculdade de Ciências da Nutrição e Alimentação - Porto - Porto - Portugal
| | - Jaime Branco
- EpiDoC Unit, NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), Centro de Estudos de Doenças Crónicas (CEDOC) - Lisboa - Lisboa - Portugal.,Sociedade Portuguesa de Reumatologia, Sociedade Portuguesa de Reumatologia - Lisboa - Lisboa - Portugal.,Centro Hospitalar Lisboa Ocidental (CHLO- E.P.E.), Serviço de Reumatologia do Hospital Egas Moniz - Lisboa - Lisboa - Portugal
| | - Helena Canhão
- EpiDoC Unit, NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), Centro de Estudos de Doenças Crónicas (CEDOC) - Lisboa - Lisboa - Portugal.,Sociedade Portuguesa de Reumatologia, Sociedade Portuguesa de Reumatologia - Lisboa - Lisboa - Portugal.,EpiSaúde, Associação Científica - Évora - Évora - Portugal
| | - Teresa Paiva
- CENC - Sleep Medicine Center, Sleep and circadian rhythms - Lisboa - Lisboa - Portugal
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Sevilla Berrios RA, Gay PC. Advances and New Approaches to Managing Sleep-Disordered Breathing Related to Chronic Pulmonary Disease. Sleep Med Clin 2016; 11:257-64. [PMID: 27236061 DOI: 10.1016/j.jsmc.2016.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a common disease affecting about 20 million US adults. Sleep-disordered breathing (SDB) problems are frequent and poorly characterized for patients with COPD. Both the well-known success of noninvasive ventilation (NIV) in the acute COPD exacerbation in the hospital setting and that NIV is the cornerstone of chronic therapy for SDBs have urged the attention of the medical community to determine the impact of NIV on chronic COPD management with and without coexisting SDBs. Early observational studies showed decreased long-term survival rates on patients with COPD with concomitant chronic hypercapnia when compared with normocapnic patients.
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Affiliation(s)
| | - Peter C Gay
- Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
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8
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Effects of suvorexant, an orexin receptor antagonist, on breathing during sleep in patients with chronic obstructive pulmonary disease. Respir Med 2015; 109:416-26. [PMID: 25661282 DOI: 10.1016/j.rmed.2014.12.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 12/16/2014] [Accepted: 12/25/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVES There is a general concern that hypnotic medications in patients with respiratory disorders have the potential to decrease respiratory effort and blunt the arousal response to hypoxemia which may lead to sleep breathing disorders. We investigated whether suvorexant, an orexin receptor antagonist approved for treatment of insomnia at a maximum daily dose of 20 mg in the US, causes sleep breathing disorders in patients with chronic obstructive pulmonary disease (COPD). DESIGN This was a randomized, double-blind, placebo-controlled, 2-period, cross-over, study performed in 9 sleep laboratories/clinical research units in the United States. The participants were 25 COPD patients aged 39-72 y with mild-to-moderate airflow limitation based on GOLD spirometry criteria. In each period, patients received suvorexant (40 mg in <65 y-olds; 30 mg in ≥65 y-olds) or placebo for four consecutive nights. Respiratory function during sleep was measured by oxygen saturation using pulse oximetry (SpO2, primary endpoint) and Apnea Hypopnea Index (AHI, secondary endpoint). The study was powered to rule out a difference between treatments of -2 percentage points in SpO2 on Day 4. RESULTS There was no treatment effect following single and multiple doses of suvorexant on mean SpO2 during total sleep time (Day 1: suvorexant = 93.14%, placebo = 93.24%, difference = -0.10 [90% CI: -0.50, 0.31]; Day 4: suvorexant = 93.38%, placebo = 92.99%, difference = 0.39 [90% CI: -0.12, 0.91]). There was no clinically meaningful increase in mean AHI by suvorexant compared with placebo on Day 1 (difference = 0.72 [90% CI: -0.60, 2.04]) or Day 4 (difference = 2.05 [90% CI: 0.33, 3.77]). CONCLUSIONS These data do not suggest an overt respiratory depressant effect with 30-40 mg daily doses of suvorexant, up to twice the maximum recommended dose for treating insomnia in the US, in patients with mild-to-moderate COPD. Trial registration Clinicaltrials.gov identifier: NCT01293006.
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9
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Examination of pulse oximetry tracings to detect obstructive sleep apnea in patients with advanced chronic obstructive pulmonary disease. Can Respir J 2014; 21:171-5. [PMID: 24524112 DOI: 10.1155/2014/948717] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Nocturnal hypoxemia and obstructive sleep apnea (OSA) are common comorbidities in patients with chronic obstructive pulmonary disease (COPD). The authors sought to develop a strategy to interpret nocturnal pulse oximetry and assess its capacity for detection of OSA in patients with stage 3 to stage 4 COPD. A review of consecutive patients with COPD who were clinically prescribed oximetry and polysomnography was conducted. OSA was diagnosed if the polysomnographic apnea-hypopnea index was >15 events⁄h. Comprehensive criteria were developed for interpretation of pulse oximetry tracings through iterative validation and interscorer concordance of ≥80%. Criteria consisted of visually identified desaturation 'events' (sustained desaturation ≥4%, 1 h time scale), 'patterns' (≥3 similar desaturation⁄saturation cycles, 15 min time scale) and the automated oxygen desaturation index. The area under the curve (AUC), sensitivity, specificity and accuracy were calculated. Of 59 patients (27 male), 31 had OSA (53%). The mean forced expiratory volume in 1 s was 46% of predicted (range 21% to 74% of predicted) and 52% of patients were on long-term oxygen therapy. Among 59 patients, 35 were correctly identified as having OSA or not having OSA, corresponding to an accuracy of 59%, with a sensitivity and specificity of 59% and 60%, respectively. The AUC was 0.57 (95% CI 0.55 to 0.59). Using software-computed desaturation events (hypoxemia ≥4% for ≥10 s) indexed at ≥15 events⁄h of sleep as diagnostic criteria, sensitivity was 60%, specificity was 63% and the AUC was 0.64 (95%CI 0.62 to 0.66). No single criterion demonstrated important diagnostic utility. Pulse oximetry tracing interpretation had a modest diagnostic value in identifying OSA in patients with moderate to severe COPD.
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10
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Young IH, Bye PTP. Gas exchange in disease: asthma, chronic obstructive pulmonary disease, cystic fibrosis, and interstitial lung disease. Compr Physiol 2013; 1:663-97. [PMID: 23737199 DOI: 10.1002/cphy.c090012] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Ventilation-perfusion (VA/Q) inequality is the underlying abnormality determining hypoxemia and hypercapnia in lung diseases. Hypoxemia in asthma is characterized by the presence of low VA/Q units, which persist despite improvement in airway function after an attack. This hypoxemia is generally attenuated by compensatory redistribution of blood flow mediated by hypoxic vasoconstriction and changes in cardiac output, however, mediator release and bronchodilator therapy may cause deterioration. Patients with chronic obstructive pulmonary disease have more complex patterns of VA/Q inequality, which appear more fixed, and changes in blood flow and ventilation have less benefit in improving gas exchange efficiency. The inability of ventilation to match increasing cardiac output limits exercise capacity as the disease progresses. Deteriorating hypoxemia during exacerbations reflects the falling mixed venous oxygen tension from increased respiratory muscle activity, which is not compensated by any redistribution of VA/Q ratios. Shunt is not a feature of any of these diseases. Patients with cystic fibrosis (CF) have no substantial shunt when managed according to modern treatment regimens. Interstitial lung diseases demonstrate impaired oxygen diffusion across the alveolar-capillary barrier, particularly during exercise, although VA/Q inequality still accounts for most of the gas exchange abnormality. Hypoxemia may limit exercise capacity in these diseases and in CF. Persistent hypercapnic respiratory failure is a feature of advancing chronic obstructive pulmonary disease and CF, closely associated with sleep disordered breathing, which is not a prominent feature of the other diseases. Better understanding of the mechanisms of hypercapnic respiratory failure, and of the detailed mechanisms controlling the distribution of ventilation and blood flow in the lung, are high priorities for future research.
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Affiliation(s)
- Iven H Young
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, and The University of Sydney, Australia.
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11
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Hynninen MJ, Pallesen S, Hardie J, Eagan TML, Bjorvatn B, Bakke P, Nordhus IH. Insomnia symptoms, objectively measured sleep, and disease severity in chronic obstructive pulmonary disease outpatients. Sleep Med 2013; 14:1328-33. [PMID: 24238965 DOI: 10.1016/j.sleep.2013.08.785] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 08/02/2013] [Accepted: 08/09/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND Sleep disturbances are known to have a negative impact on a range of clinical outcomes in chronic obstructive pulmonary disease (COPD). We examined the associations of insomnia symptoms and objectively measured sleep parameters to a composite score for body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index (a multidimensional index of COPD severity), arterial blood gases, nocturnal respiratory disturbances, periodic limb movements (PLM), psychologic distress, pain, age, and sex. METHODS The sample comprised 73 COPD outpatients (mean age, 63.6years; standard deviation {SD}, 7.5; range 47-85years; 41.1% women). Insomnia symptoms were measured with the Bergen Insomnia Scale (BIS) and sleep efficiency (SE), slow-wave sleep (SWS), and total sleep time (TST) were assessed with clinical polysomnography (PSG). RESULTS BODE index was positively associated with composite BIS score (P=.040). Patients with more severe COPD presented more complaints of nonrestorative sleep compared to patients with less severe COPD (P=.010). In multivariate analysis, the composite BIS score was independently associated with PLM (P<.001), nocturnal respiratory disturbances (P=.001), pain (P=.031), and psychologic distress (P=.044) but not with the BODE index. Objectively measured sleep variables were not associated with any of the health-related variables. CONCLUSION Insomnia symptoms in COPD patients result from a wide range of health-related factors. More severe COPD may be associated with a subjective experience of nonrestorative sleep but not with objectively measured sleep variables.
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Affiliation(s)
- Minna J Hynninen
- Department of Clinical Psychology, University of Bergen, Christies Gate 12, 5015 Bergen, Norway; NKS Olaviken, Hospital for Old Age Psychiatry, Askvegen 150, 5306 Erdal, Norway.
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12
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Correlations of sleep disorders with severity of obstructive airway disease in mustard gas-injured patients. Sleep Breath 2011; 16:443-51. [DOI: 10.1007/s11325-011-0522-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 03/02/2011] [Accepted: 04/06/2011] [Indexed: 11/27/2022]
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Smolensky MH, Di Milia L, Ohayon MM, Philip P. Sleep disorders, medical conditions, and road accident risk. ACCIDENT; ANALYSIS AND PREVENTION 2011; 43:533-48. [PMID: 21130215 DOI: 10.1016/j.aap.2009.12.004] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Accepted: 12/07/2009] [Indexed: 05/08/2023]
Abstract
Sleep disorders and various common acute and chronic medical conditions directly or indirectly affect the quality and quantity of one's sleep or otherwise cause excessive daytime fatigue. This article reviews the potential contribution of several prevalent medical conditions - allergic rhinitis, asthma, chronic obstructive pulmonary disease, rheumatoid arthritis/osteoarthritis - and chronic fatigue syndrome and clinical sleep disorders - insomnia, obstructive sleep apnea, narcolepsy, periodic limb movement of sleep, and restless legs syndrome - to the risk for drowsy-driving road crashes. It also explores the literature on the cost-benefit of preventive interventions, using obstructive sleep apnea as an example. Although numerous investigations have addressed the impact of sleep and medical disorders on quality of life, few have specifically addressed their potential deleterious effect on driving performance and road incidents. Moreover, since past studies have focused on the survivors of driver crashes, they may be biased. Representative population-based prospective multidisciplinary studies are urgently required to clarify the role of the fatigue associated with common ailments and medications on traffic crash risk of both commercial and non-commercial drivers and to comprehensively assess the cost-effectiveness of intervention strategies.
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De Carolis A, Giubilei F, Caselli G, Casolla B, Cavallari M, Vanacore N, Leonori R, Scrocchia I, Fersini A, Quercia A, Orzi F. Chronic obstructive pulmonary disease is associated with altered neuropsychological performance in young adults. Dement Geriatr Cogn Dis Extra 2011; 1:402-8. [PMID: 22187547 PMCID: PMC3243636 DOI: 10.1159/000333079] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Subjects with ischemic lesions have an increased risk of dementia. In addition, Alzheimer's disease (AD) and vascular cognitive impairment share many risk factors. These observations suggest that different diseases that cause altered blood perfusion of the brain or hypoxia promote AD neurodegeneration. In this case-control, cross-sectional study, we sought to test the hypothesis that hypoxia facilitates cognitive decline. METHODS We looked for altered neuropsychological performance in subjects with chronic obstructive pulmonary disease (COPD) without apparent cardio- or cerebrovascular diseases or risk factors for atherosclerosis. A selected, homogeneous group of workers from two ceramic factories in a small town of central Italy was enrolled in this study. RESULTS The COPD patients had a slightly, but significantly worse performance than controls in a number of neuropsychological tests. CONCLUSION The findings are consistent with the working hypothesis that chronic hypoxia facilitates cognitive decline.
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Affiliation(s)
- Antonella De Carolis
- Department of Neuroscience, Mental Health and Sensory Organs, University of Rome La Sapienza, Rome
| | - Franco Giubilei
- Department of Neuroscience, Mental Health and Sensory Organs, University of Rome La Sapienza, Rome
| | - Giulio Caselli
- Department of Neuroscience, Mental Health and Sensory Organs, University of Rome La Sapienza, Rome
| | - Barbara Casolla
- Department of Neuroscience, Mental Health and Sensory Organs, University of Rome La Sapienza, Rome
| | - Michele Cavallari
- Department of Neuroscience, Mental Health and Sensory Organs, University of Rome La Sapienza, Rome
| | - Nicola Vanacore
- National Center of Epidemiology, Surveillance and Health Promotion, National Institute of Health, Rome
| | - Rita Leonori
- PISLL, Azienda Unità Sanitaria Locale, Viterbo, Italy
| | | | - Anna Fersini
- PISLL, Azienda Unità Sanitaria Locale, Viterbo, Italy
| | | | - Francesco Orzi
- Department of Neuroscience, Mental Health and Sensory Organs, University of Rome La Sapienza, Rome
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Bossenbroek L, Gordijn M, Kosse N, van der Hoeven J, ten Hacken N, de Greef M. Validation of the Dynaport Minimod during Sleep: A Pilot Study. Percept Mot Skills 2010; 111:936-46. [DOI: 10.2466/03.15.pms.111.6.936-946] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To measure activity during sleep, polysomnography and actigraphy are often used. The DynaPort MiniMod measures movement intensity and body position day and night. The goal was to examine the validity of the DynaPort MiniMod in assessing physical activity and body posture during sleep. In Study A, 10 healthy participants slept with the DynaPort MiniMod and the Actiwatch for one night. In Study B, 8 participants suspected of having Obstructive Sleep Apnoea Syndrome slept for one night with the DynaPort MiniMod and underwent complete polysomnography as part of the typical care protocol. In Study A, there was a significant moderate correlation ( r = .70) between the movement scores of the Actiwatch and the DynaPort MiniMod. In Study B, a high intraclass correlation ( r = .84) between body posture scores of the DynaPort MiniMod and the polysomnography position sensor was observed. The DynaPort MiniMod is a valid measurement device for physical activity during sleep.
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Affiliation(s)
| | | | - Nienke Kosse
- Institute of Human Movement Sciences, University Medical Center Groningen, University of Groningen
| | | | | | - Mathieu de Greef
- Institute of Human Movement Sciences, University Medical Center Groningen, University of Groningen
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Sharafkhaneh A, Jayaraman G, Kaleekal T, Sharafkhaneh H, Hirshkowitz M. Sleep disorders and their management in patients with COPD. Ther Adv Respir Dis 2009; 3:309-18. [PMID: 19880428 DOI: 10.1177/1753465809352198] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a prevalent progressive condition that adversely affects quality of life and sleep. Patients with COPD suffer from variety of sleep disorders including insomnia, sleep disordered breathing and restless leg syndrome. The sleep disorders in COPD patients may stem from poor control of primary disease or due to side effects of pharmacotherapy. Thus, optimization of COPD therapy is the main step in treating insomnia in these patients. Further, pharmacotherapy of sleep disorders may result in respiratory depression and related complications. Therefore, clear understanding of respiratory physiology during transition from wakefulness to sleep and during various stages of sleep plays an important role in therapies that are recommended in patients with significant airway obstruction. In this publication, we review respiratory physiology as it relates to sleep and discuss sleep disorders and their management in patients with COPD.
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Affiliation(s)
- Amir Sharafkhaneh
- Baylor College of Medicine, Sleep Disorders and Research Center, Michael E. DeBakey VA Medical Center, Houston TX, USA.
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17
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Rama AN, Zachariah R, Kushida CA. Differentiating Nocturnal Movements: Leg Movements, Parasomnias, and Seizures. Sleep Med Clin 2009. [DOI: 10.1016/j.jsmc.2009.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Elevated economic burden in obstructive lung disease patients with concomitant sleep apnea syndrome. Sleep Breath 2009; 13:317-23. [PMID: 19484281 DOI: 10.1007/s11325-009-0266-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Revised: 02/23/2009] [Accepted: 03/23/2009] [Indexed: 12/11/2022]
Abstract
PURPOSE The purpose of this study is to examine the incremental economic burden of sleep apnea syndrome (SAS) among individuals with concomitant asthma, chronic obstructive pulmonary disease (COPD), or both (i.e., asthma/COPD). METHODS Maryland Medicaid claims data were used to identify beneficiaries with asthma (n = 3,072), COPD (n = 3,455), or both (n = 2,604). We compared patient's baseline characteristics by SAS and stratified the analyses by disease cohort to examine the effect of SAS on medical utilization and cost. RESULTS SAS was more prevalent among beneficiaries with asthma/COPD (6.72%) than beneficiaries with COPD alone (2.87%) or asthma alone (2.15%). Asthma/COPD and COPD beneficiaries with SAS had more medical service claims (p < 0.001) and higher medical cost than beneficiaries without SAS: $5,773 and $4,155 in excess costs among asthma/COPD (p = 0.037) and COPD patients (p = 0.035), respectively. Medical utilization and cost did not differ by SAS in asthma patients (p = 0.567). CONCLUSIONS SAS may add additional economic burden on beneficiaries who already have COPD or asthma/COPD.
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Increased frequency of restless legs syndrome in chronic obstructive pulmonary disease patients. Sleep Med 2008; 10:572-6. [PMID: 18996743 DOI: 10.1016/j.sleep.2008.04.014] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Revised: 04/22/2008] [Accepted: 04/25/2008] [Indexed: 11/20/2022]
Abstract
BACKGROUND Despite complaints of poor sleep being very common in people with chronic obstructive pulmonary disease (COPD), restless legs syndrome (RLS) symptoms have not been extensively investigated in these patients. OBJECTIVE To assess the prevalence and severity of RLS in patients with COPD and to investigate the factors potentially associated with RLS. METHODS A total of 87 patients with COPD and 110 controls, matched for age and sex, were evaluated regarding the presence and severity of RLS symptoms. A diagnosis of RLS was made according to the criteria of the International RLS Study Group (IRSLSSG), and severity was assessed by the IRLSSG severity scale. Excessive daytime somnolence was assessed using the Epworth sleepiness scale (ESS). RESULTS RLS was significantly more frequent in COPD patients than in controls (36.8% vs. 11%; p < 0.001). Compared to controls, COPD patients with RLS showed higher disease severity (mean IRLSSG severity scale score: 20.5 +/- 2.8 for COPD, and 18 +/- 3.5 for controls; p = 0.016) and more pronounced daytime somnolence (mean ESS score: 11.8 +/- 1.1 for COPD, and 8.6 +/- 3.6 for controls; p = 0.009). Moreover, compared to those without RLS, COPD patients with RLS showed increased daytime sleepiness (mean ESS score: 11.8 +/- 1.1 for COPD/RLS, and 7.3 +/- 4 for COPD/non-RLS; p < 0.001) and longer disease duration (11.9 +/- 7 years for COPD/RLS, and 8.7 +/- 6.9 years for COPD/non-RLS; p = 0.045). Multivariate analysis showed that ESS score was the only factor significantly associated with RLS in COPD patients. CONCLUSIONS RLS is a frequent cause of disabling sleep disturbance in patients with COPD and should be specifically investigated in these patients.
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Nunes D, Mota R, Machado M, Pereira E, de Bruin V, de Bruin P. Effect of melatonin administration on subjective sleep quality in chronic obstructive pulmonary disease. Braz J Med Biol Res 2008; 41:926-31. [DOI: 10.1590/s0100-879x2008001000016] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2008] [Accepted: 10/14/2008] [Indexed: 11/22/2022] Open
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Abstract
Chronic obstructive pulmonary disease (COPD) no longer is regarded simply as a disease of the lungs and airways. There is growing awareness of the multisystemic nature of this disease. Research has shown increased levels of systemic inflammation and cardiovascular, neurologic, psychiatric, and endocrine system dysfunction associated with COPD. Skeletal muscle dysfunction associated with COPD is discussed in the article by Schols in this issue of Clinics in Chest Medicine. In this article, other systemic manifestations of COPD are discussed. Although this field is expanding rapidly, this article focuses on recent advances and reviews.
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Affiliation(s)
- Andrew C Stone
- Brown University School of Medicine, Providence, RI, USA
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Kryger M, Wang-Weigand S, Zhang J, Roth T. Effect of Ramelteon, a selective MT1/MT2-receptor agonist, on respiration during sleep in mild to moderate COPD. Sleep Breath 2007; 12:243-50. [DOI: 10.1007/s11325-007-0156-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Zhang L, Samet J, Caffo B, Punjabi NM. Cigarette smoking and nocturnal sleep architecture. Am J Epidemiol 2006; 164:529-37. [PMID: 16829553 DOI: 10.1093/aje/kwj231] [Citation(s) in RCA: 232] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Cigarette smoking has been associated with a high prevalence of sleep-related complaints. However, its effects on sleep architecture have not been fully examined. The primary objective of this investigation was to assess the impact of cigarette smoking on sleep architecture. Polysomnography was used to characterize sleep architecture among 6,400 participants of the Sleep Heart Health Study (United States, 1994-1999). Sleep parameters included total sleep time, latency to sleep onset, sleep efficiency, and percentage of time in each sleep stage. The study sample consisted of 2,916 never smokers, 2,705 former smokers, and 779 current smokers. Compared with never smokers, current smokers had a longer initial sleep latency (5.4 minutes, 95% confidence interval (CI): 2.9, 7.9) and less total sleep time (14.0 minutes, 95% CI: 6.4, 21.7). Furthermore, relative to never smokers, current smokers also had more stage 1 sleep (relative proportion = 1.24, 95% CI: 1.14, 1.33) and less slow wave sleep (relative proportion = 0.86, 95% CI: 0.78, 0.95). Finally, no differences in sleep architecture were noted between former and never smokers. The results of this study show that cigarette smoking is independently associated with disturbances in sleep architecture, including a longer latency to sleep onset and a shift toward lighter stages of sleep. Nicotine in cigarette smoke and acute withdrawal from it may contribute to disturbances in sleep architecture.
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Affiliation(s)
- Lin Zhang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21224, USA.
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