Peripheral circadian misalignment: contributor to systemic insulin resistance and potential intervention to improve bariatric surgical outcomes

Patients With Chronic Foot and Ankle Conditions Experience Significant Improvements in Sleep Quality Following Surgical Intervention

BACKGROUND

Poor sleep quality is associated with metabolic dysregulation and impaired healing. The purpose of the current study was to quantify the prevalence of poor sleep in patients with atraumatic foot and ankle (F&A) conditions and determine whether surgical treatment is associated with sleep quality improvement.

METHODS

Patients scheduled for surgical management of atraumatic F&A conditions were enrolled by 4 fellowship-trained orthopaedic F&A surgeons between May 2018 and April 2019. Patients completed the Pittsburgh Sleep Quality Index (PSQI) pre- and postoperatively. The PSQI ranges from 0 to 21, with a score ≥5 indicative of poor sleep quality. Patients also reported their perception of how their current F&A pain influenced their sleep quality on a scale of 0 to 10, where 0 indicated no influence and 10 indicated a strong influence (pain perception score [PPS]). Patients with known sleep disorders, acute surgical trauma, and infection were excluded.

RESULTS

A total of 115 patients were enrolled. The mean preoperative PSQI and PPS were 8.1 ± 3.6 (range, 2-19) and 3.1 ± 2.7 (range, 0-10), respectively. Overall, 86.1% of patients had poor sleep quality (PSQI score ≥5). Similarly, 64.3% of patients had a PPS ≥1, indicating the belief that F&A pain contributed to sleep disturbance. A minimum of 6 months of follow-up was collected for 72 (62.6%) patients. On average, these 72 patients experienced significant improvements in sleep quality (mean PSQI decreased from 7.8 ± 3.2 to 5.4 ± 3.1, P < .001). Of these patients, 59.7% continued to experience poor sleep quality (PSQI ≥5), and 55.6% perceived that F&A pain contributed to sleep disturbance (PPS ≥1).

CONCLUSION

In this series, 86.1% of patients presenting for management of atraumatic F&A conditions had poor sleep quality at the time of their initial visit, with 64.3% perceiving their F&A conditions to influence their sleep quality. Improvements in sleep quality were observed at 6 months postoperatively, though over half of patients continued to experience poor sleep quality. The location of pathology and procedure performed was not associated with sleep quality.

LEVELS OF EVIDENCE

Level IV: Prospective case series.

A comprehensive study on the relieving effect of Lilium brownii on the intestinal flora and metabolic disorder in p-chlorphenylalanine induced insomnia rats

CONTEXT

The bulb of Lilium brownii F. E. Brown (Liliaceae) (LB) is a common Chinese medicine to relieve insomnia.

OBJECTIVE

To investigate the molecular mechanism of LB relieving insomnia.

MATERIALS AND METHODS

Insomnia model was induced by intraperitoneally injection p-chlorophenylalanine (PCPA) in Wistar rats. Rats were divided into three groups: Control, PCPA (400 mg/kg, i.p. 2 days), LB (598.64 mg/kg, oral 7 days). The levels of 5-hydroxytryptamine (5-HT), norepinephrine (NE), melatonin (MT), and the expression of GABA_A, 5-HT1A and MT receptors, as well as pathological changes in hypothalamus, were evaluated. 16S rDNA sequencing and UPLC-MS/MS were used to reveal the change of the intestinal flora and metabolic profile.

RESULTS

The adverse changes in the abundance and diversity of intestinal flora and faecal metabolic phenotype altered by PCPA in rats were reversed after LB treatment, accompanied by the up-regulated levels of 5-HT as 8.14 ng/mL, MT as 16.16 pg/mL, 5-HT1A R and GABA_A R, down-regulated level of NE as 0.47 ng/mL, and the improvement of pathological phenomena of cells in the hypothalamus. And the arachidonic acid metabolism and tryptophan metabolism pathway most significantly altered by PCPA were markedly regulated by LB. Besides, it was also found that LB reduced the levels of kynurenic acid related to psychiatric disorders and trimethylamine-N-oxide associated with cardiovascular disease.

CONCLUSION

The mechanism of LB relieving insomnia involves regulating flora and metabolites to resemble the control group. As a medicinal and edible herb, LB could be considered for development as a health-care food to relieve increasing insomniacs in the future.

Intestinal Microbiota and Sleep Inversion

Various human lifestyle and environmental factors are known to influence sleep. The number of adults and children suffering from chronic sleep disorders has grown over the past decade. Lack of sleep and impaired circadian rhythms have been proven to be associated with adverse metabolic health effects. Often, such disorders are associated with gastrointestinal tract diseases, and accompanied by dysbiosis. Significant number of studies have been conducted on animal models in recent years. They have shown the correlation between the gut microbiota and brain functions. According to these results scientists have clearly demonstrated the role of gut microbiota in regulating brain function, sleep, and behavior. The number of studies with volunteers is currently limited. The bacteria forming gut microbiota have significant impact on human health by synthesizing and secreting biologically active substances such as vitamins, essential amino acids, lipids, and others. Moreover, they have an indirect effect by modulating metabolic processes and the immune system. Changes in gut microbiota diversity occur due to the lack of sleep and shifting circadian rhythms, and it can lead to changes in the structure and function of microorganisms living in the gut. This can lead to changes in the composition and number of metabolites synthesized by these microorganisms (such as short-chain fatty acids and secondary bile acids) which contributes to the development of chronic inflammation, increased body weight and endocrine changes. This article provides the literature review on issues of interaction between gut microbiota and processes occurring during sleep.

Improvements in Sleep Quality Are Maintained at a Minimum of 2 Years Following Hip Arthroscopy for Femoroacetabular Impingement Syndrome

PURPOSE

To present the results of a mid-term follow-up study on sleep quality at a minimum of 2 years after hip arthroscopy for femoroacetabular impingement syndrome.

METHODS

Original inclusion criteria were consecutive patients undergoing primary hip arthroscopy for cam/pincer correction between March 1, 2017, and July 1, 2017, who did not respond to nonoperative management, whereas exclusion criteria were revision arthroscopy, gluteus medius repair, contralateral procedure during the follow-up period, and known sleep disorders. Patients who had followed up at 6 months were contacted at a minimum of 2 years following their surgery. In total, 37 of 55 (67.3%) were available for follow-up. New Pittsburgh Sleep Quality Index (PSQI) scores were obtained and compared with previously reported scores at preoperative and 6-month time points. The PSQI ranges from 0 to 21, with a score of ≥5 indicating poor sleep quality. Point biserial correlations and χ² tests of associations were used to investigate associations between demographics, preoperative patient-reported outcome measures, and the incidence of poor sleep quality at 2 years postoperatively.

RESULTS

Preoperatively, 94.5% of patients (52/55) had a PSQI of ≥5 with a mean PSQI score of 9.8 ± 4.2. Statistically significant improvements were observed at both 6 (PSQI: 2.2 ± 0.2, P < .001) and 24 months (PSQI: 4.3 ± 3.9) postoperatively compared to baseline (P < .001, both). The mean PSQIs at 2 years and 6 months postoperatively were not statistically different (P = .06). A total of 21.7% (10/46) of patients continued to experience poor sleep quality at 6 months postoperatively, whereas a total of 29.7% (11/37) did so at 2 years postoperatively (P = .36). No preoperative factors were associated with poor sleep quality (P > .05 all).

CONCLUSIONS

The early improvements in sleep quality observed 6 months postoperatively from an original small cohort were maintained at a mean 2.8-year follow-up in those who responded. However, approximately 30% of hip arthroscopy patients still experience poor sleep quality.

LEVEL OF EVIDENCE

IV, therapeutic case series.

Sleep and Microbiome in Psychiatric Diseases

Objectives: Disturbances in the gut–brain barrier play an essential role in the development of mental disorders. There is considerable evidence showing that the gut microbiome not only affects digestive, metabolic and immune functions of the host but also regulates host sleep and mental states through the microbiota–gut–brain axis. The present review summarizes the role of the gut microbiome in the context of circadian rhythms, nutrition and sleep in psychiatric disorders. Methods: A PubMed search (studies published between April 2015–April 2020) was conducted with the keywords: “sleep, microbiome and psychiatry”; “sleep, microbiome and depression”; “sleep, microbiome and bipolar disorder”, “sleep, microbiome and schizophrenia”, “sleep, microbiome and anorexia nervosa”, “sleep, microbiome and substance use disorder”, “sleep, microbiome and anxiety”; “clock gene expression and microbiome”, “clock gene expression and nutrition”. Only studies investigating the relationship between sleep and microbiome in psychiatric patients were included in the review. Results: Search results yielded two cross-sectional studies analyzing sleep and gut microbiome in 154 individuals with bipolar disorder and one interventional study analyzing the effect of fecal microbiota transplantation in 17 individuals with irritable bowel syndrome on sleep. In patients with bipolar disorder, Faecalibacterium was significantly associated with improved sleep quality scores and a significant correlation between Lactobacillus counts and sleep. Conclusion: Translational research on this important field is limited and further investigation of the bidirectional pathways on sleep and the gut microbiome in mood disorders is warranted.

Role of the microbiota in circadian rhythms of the host

Life for meta-organisms is based on a strong relationship between gut bacteria and body cells. This review summarizes to what extent the microbiota can influence host circadian rhythms via a literature review on the topic. The results show that microbiota can influence the host's circadian gene expression through direct interactions via immunoreceptors and microbiota-derived metabolites, especially in peripheral tissues. Noteworthy metabolites that are only attributable to the microbiota are short-chain fatty acids and unconjugated bile acids. The microbiota also serves as a mediator for the interplay between the host's diet and circadian rhythmicity. This work furthermore displays that the microbiota is subject to diurnal variations in terms of structure and function and that the host and the host's diet influence these fluctuations. As most of these results originate in mouse models, we hope this work stimulates further research in human derived tissue to verify these conclusions.

The Role of Microbiome in Insomnia, Circadian Disturbance and Depression

Good sleep and mood are important for health and for keeping active. Numerous studies have suggested that the incidence of insomnia and depressive disorder are linked to biological rhythms, immune function, and nutrient metabolism, but the exact mechanism is not yet clear. There is considerable evidence showing that the gut microbiome not only affects the digestive, metabolic, and immune functions of the host but also regulates host sleep and mental states through the microbiome-gut-brain axis. Preliminary evidence indicates that microorganisms and circadian genes can interact with each other. The characteristics of the gastrointestinal microbiome and metabolism are related to the host's sleep and circadian rhythm. Moreover, emotion and physiological stress can also affect the composition of the gut microorganisms. The gut microbiome and inflammation may be linked to sleep loss, circadian misalignment, affective disorders, and metabolic disease. In this review article, we discuss various functions of the gut microbiome and how its activities interact with the circadian rhythms and emotions of the host. Exploring the effects of the gut microbiome on insomnia and depression will help further our understanding of the pathogenesis of mental disorders. It is therefore important to regulate and maintain a normal gastrointestinal micro-ecological environment in patients when treating mental disorders.

Circadian rhythmicity: A functional connection between differentiated embryonic chondrocyte-1 (DEC1) and small heterodimer partner (SHP)

Circadian rhythm misalignment has been increasingly recognized to pose health risk for a wide range of diseases, particularly metabolic disorders. The liver maintains metabolic homeostasis and expresses many circadian genes, such as differentiated embryo chondrocyte-1 (DEC1) and small heterodimer partner (SHP). DEC1 is established to repress transcription through E-box elements, and SHP belongs to the superfamily of nuclear receptors and has multiple E-box elements in its promoter. Importantly, DEC1 and SHP are inversely oscillated. This study was performed to test the hypothesis that the SHP gene is a target gene of DEC1. Cotransfection demonstrated that DEC1 repressed the SHP promoter and attenuated the transactivation of the classic circadian activator complex of Clock/Bmal1. Site-directed mutagenesis, electrophoretic mobility shift assay and chromatin immunoprecipitation established that the repression was achieved through the E-box in the proximal promoter. Transfection of DEC1 suppressed the expression of SHP. In circadian-inducing cells, the epileptic agent valproate inversely altered the expression of DEC1 and SHP. Both DEC1 and SHP are involved in energy balance and valproate is known to induce hepatic steatosis. Our findings collectively establish that DEC1 participates in the negative loop of SHP oscillating expression with potential implications in metabolic homeostasis.