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McNeil J, Clark KG, Adams WM, Pickett S, Propper CB, McCoy TP, Edwards KE, Exford TJ, Hemphill MA, Wideman L. Sleep, Health Outcomes and Body Weight (SHOW) study: a measurement burst design study on sleep and risk factors for obesity in black emerging adults in North Carolina, USA. BMJ Open 2024; 14:e087950. [PMID: 38977366 PMCID: PMC11256040 DOI: 10.1136/bmjopen-2024-087950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 06/24/2024] [Indexed: 07/10/2024] Open
Abstract
INTRODUCTION Black emerging adults (18-28 years) have the highest risk of short sleep duration and obesity. This increased risk may be partly explained by greater stress levels, which may result from race-related stress (racial discrimination and heightened race-related vigilance) or living in more disadvantaged home and neighbourhood environments. Insufficient sleep may also impact obesity risk via several weight-related mechanisms including energy balance, appetite and food reward, cortisol profiles and hydration status. This paper describes the rationale, design and methods for the Sleep, Health Outcomes and Body Weight (SHOW) study. This study aims to prospectively assess the effects of sleep, race-related stress and home/neighbourhood environments on weight-related mechanisms and obesity markers (body weight, waist circumference and fat mass) in 150 black emerging adults. METHODS AND ANALYSIS The SHOW study follows a measurement burst design that includes 3, 7-day data collection bursts (baseline, 6-month and 12-month follow-ups). Sleep is measured with three methods: sleep diary, actigraphy and polysomnography. Energy balance over 7 days is based on resting and postprandial energy expenditure measured via indirect calorimetry, physical activity via accelerometry and self-reported and ad libitum energy intake methods. Self-reported methods and blood biomarkers assess fasting and postprandial appetite profiles and a behavioural-choice task measures food reward. Cortisol awakening response and diurnal cortisol profiles over 3 days are assessed via saliva samples and chronic cortisol exposure via a hair sample. Hydration markers are assessed with 24-hour urine collection over 3 days and fasting blood biomarkers. Race-related stress is self-reported over 7 days. Home and neighbourhood environments (via the Windshield Survey) is observer assessed. ETHICS AND DISSEMINATION Ethics approval was granted by the University of North Carolina at Greensboro's Institutional Review Board. Study findings will be disseminated through peer-reviewed publications, presentations at scientific meetings and reports, briefs/infographics for lay and community audiences.
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Affiliation(s)
- Jessica McNeil
- Department of Kinesiology, The University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Krista G Clark
- Department of Kinesiology, The University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - William M Adams
- Department of Kinesiology, The University of North Carolina at Greensboro, Greensboro, North Carolina, USA
- Department of Sports Medicine, United States Olympic & Paralympic Committee, Colorado Springs, Colorado, USA
| | - Stephanie Pickett
- School of Nursing, The University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Cathi B Propper
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Thomas P McCoy
- School of Nursing, The University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Kathleen E Edwards
- Department of Educational Leadership and Cultural Foundations, The University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - T J Exford
- Dayton Veterans Affairs Medical Center, Dayton, Ohio, USA
| | - Michael A Hemphill
- Department of Kinesiology, The University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Laurie Wideman
- Department of Kinesiology, The University of North Carolina at Greensboro, Greensboro, North Carolina, USA
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Korkalainen H, Kainulainen S, Islind AS, Óskarsdóttir M, Strassberger C, Nikkonen S, Töyräs J, Kulkas A, Grote L, Hedner J, Sund R, Hrubos-Strom H, Saavedra JM, Ólafsdóttir KA, Ágústsson JS, Terrill PI, McNicholas WT, Arnardóttir ES, Leppänen T. Review and perspective on sleep-disordered breathing research and translation to clinics. Sleep Med Rev 2024; 73:101874. [PMID: 38091850 DOI: 10.1016/j.smrv.2023.101874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 09/18/2023] [Accepted: 11/09/2023] [Indexed: 01/23/2024]
Abstract
Sleep-disordered breathing, ranging from habitual snoring to severe obstructive sleep apnea, is a prevalent public health issue. Despite rising interest in sleep and awareness of sleep disorders, sleep research and diagnostic practices still rely on outdated metrics and laborious methods reducing the diagnostic capacity and preventing timely diagnosis and treatment. Consequently, a significant portion of individuals affected by sleep-disordered breathing remain undiagnosed or are misdiagnosed. Taking advantage of state-of-the-art scientific, technological, and computational advances could be an effective way to optimize the diagnostic and treatment pathways. We discuss state-of-the-art multidisciplinary research, review the shortcomings in the current practices of SDB diagnosis and management in adult populations, and provide possible future directions. We critically review the opportunities for modern data analysis methods and machine learning to combine multimodal information, provide a perspective on the pitfalls of big data analysis, and discuss approaches for developing analysis strategies that overcome current limitations. We argue that large-scale and multidisciplinary collaborative efforts based on clinical, scientific, and technical knowledge and rigorous clinical validation and implementation of the outcomes in practice are needed to move the research of sleep-disordered breathing forward, thus increasing the quality of diagnostics and treatment.
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Affiliation(s)
- Henri Korkalainen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.
| | - Samu Kainulainen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Anna Sigridur Islind
- Department of Computer Science, Reykjavik University, Reykjavik, Iceland; Reykjavik University Sleep Institute, Reykjavik University, Reykjavik, Iceland
| | - María Óskarsdóttir
- Department of Computer Science, Reykjavik University, Reykjavik, Iceland
| | - Christian Strassberger
- Centre for Sleep and Wake Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Sami Nikkonen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Juha Töyräs
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, Australia; Science Service Center, Kuopio University Hospital, Kuopio, Finland
| | - Antti Kulkas
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Department of Clinical Neurophysiology, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Ludger Grote
- Centre for Sleep and Wake Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Sleep Disorders Centre, Pulmonary Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jan Hedner
- Centre for Sleep and Wake Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Sleep Disorders Centre, Pulmonary Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Reijo Sund
- School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Harald Hrubos-Strom
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Ear, Nose and Throat Surgery, Akershus University Hospital, Lørenskog, Norway
| | - Jose M Saavedra
- Reykjavik University Sleep Institute, Reykjavik University, Reykjavik, Iceland; Physical Activity, Physical Education, Sport and Health (PAPESH) Research Group, Department of Sports Science, Reykjavik University, Reykjavik, Iceland
| | | | | | - Philip I Terrill
- School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, Australia
| | - Walter T McNicholas
- School of Medicine, University College Dublin, and Department of Respiratory and Sleep Medicine, St Vincent's Hospital Group, Dublin Ireland
| | - Erna Sif Arnardóttir
- Reykjavik University Sleep Institute, Reykjavik University, Reykjavik, Iceland; Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Timo Leppänen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland; School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, Australia
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Borker PV, Macatangay BJ, Margolick JB, Punjabi NM, Rinaldo CR, Stosor V, Hyong-Jin Cho J, McKay H, Patel SR. Shorter total sleep time is associated with lower CD4+/CD8+ T cell ratios in virally suppressed men with HIV. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2024; 5:zpae001. [PMID: 38420256 PMCID: PMC10901437 DOI: 10.1093/sleepadvances/zpae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/06/2023] [Indexed: 03/02/2024]
Abstract
Study Objectives Although poor sleep quality is associated with lower CD4+ T cell counts among people living with HIV (PLWH), the association between objective sleep metrics and T lymphocyte subset counts is unknown. We evaluated the association between polysomnography (PSG) derived sleep metrics and T lymphocyte subpopulations in a cohort of men living with HIV. Methods Virally suppressed men living with HIV participating in the Multicenter AIDS Cohort Study underwent home overnight PSG. We assessed the association of PSG parameters with CD4+ and CD8+ T cell counts and the CD4+/CD8+ T cell ratio. Results Overall, 289 men with mean (±SD) age 55.3 ± 11.3 years and mean CD4+ T cell count 730 ± 308 cells/mm3 were evaluated. Total sleep time (TST) was significantly associated with CD8+ but not CD4+ T cell counts. After adjusting for age, race, depressive symptoms, antidepressant use, and non-nucleoside reverse transcriptase inhibitors use, every hour of shorter TST was associated with an additional 33 circulating CD8+ T cells/mm3 (p = 0.05) and a 5.6% (p = 0.0007) decline in CD4+/CD8+ T cell ratio. In adjusted models, every hour of shorter rapid eye movement (REM) sleep was associated with an additional 113 CD8+ T cells/mm3 (p = 0.02) and a 15.1% lower CD4+/CD8+ T cell ratio (p = 0.006). In contrast, measures of sleep efficiency and sleep-disordered breathing were not associated with differences in T lymphocyte subpopulations. Conclusions Our findings suggest that shorter TST and REM sleep durations are associated with differences in T lymphocyte subpopulations among men living with HIV. Addressing sleep may reflect a novel opportunity to improve immune function in PLWH.
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Affiliation(s)
- Priya V Borker
- Division of Pulmonary Allergy, Critical Care and Sleep Medicine, University of Pittsburgh, Pittsburgh, PAUSA
| | | | - Joseph B Margolick
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Naresh M Punjabi
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Charles R Rinaldo
- Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, PAUSA
| | - Valentina Stosor
- Divisions of Infectious Diseases and Organ Transplantation, Northwestern University, Chicago, IL, USA
| | - Joshua Hyong-Jin Cho
- Cousins Center for Psychoneuroimmunology, Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CAUSA
| | - Heather McKay
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sanjay R Patel
- Division of Pulmonary Allergy, Critical Care and Sleep Medicine, University of Pittsburgh, Pittsburgh, PAUSA
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