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Antila H, Lilius TO, Palada V, Lohela T, Bell RF, Porkka-Heiskanen T, Kalso E. Effects of commonly used analgesics on sleep architecture-A topical review. Pain 2024:00006396-990000000-00539. [PMID: 38442410 DOI: 10.1097/j.pain.0000000000003201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 01/15/2024] [Indexed: 03/07/2024]
Affiliation(s)
- Hanna Antila
- Neuroscience Center, Helsinki Institute of Life Science, University of Helsinki, Finland
- SleepWell Research Program Unit, Faculty of Medicine, University of Helsinki, Finland
- Individualized Drug Therapy Research Program Unit, Faculty of Medicine, University of Helsinki, Finland
| | - Tuomas O Lilius
- Individualized Drug Therapy Research Program Unit, Faculty of Medicine, University of Helsinki, Finland
- Department of Pharmacology, Faculty of Medicine, University of Helsinki, Finland
- Department of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Finland
| | - Vinko Palada
- SleepWell Research Program Unit, Faculty of Medicine, University of Helsinki, Finland
- Department of Physiology, Faculty of Medicine, University of Helsinki, Finland
| | - Terhi Lohela
- Individualized Drug Therapy Research Program Unit, Faculty of Medicine, University of Helsinki, Finland
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and University of Helsinki, Finland
| | - Rae F Bell
- Regional Centre of Excellence in Palliative Care, Haukeland University Hospital, Bergen, Norway
| | | | - Eija Kalso
- SleepWell Research Program Unit, Faculty of Medicine, University of Helsinki, Finland
- Department of Pharmacology, Faculty of Medicine, University of Helsinki, Finland
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and University of Helsinki, Finland
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2
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Johnson CE, Duncan MJ, Murphy MP. Sex and Sleep Disruption as Contributing Factors in Alzheimer's Disease. J Alzheimers Dis 2024; 97:31-74. [PMID: 38007653 PMCID: PMC10842753 DOI: 10.3233/jad-230527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Abstract
Alzheimer's disease (AD) affects more women than men, with women throughout the menopausal transition potentially being the most under researched and at-risk group. Sleep disruptions, which are an established risk factor for AD, increase in prevalence with normal aging and are exacerbated in women during menopause. Sex differences showing more disrupted sleep patterns and increased AD pathology in women and female animal models have been established in literature, with much emphasis placed on loss of circulating gonadal hormones with age. Interestingly, increases in gonadotropins such as follicle stimulating hormone are emerging to be a major contributor to AD pathogenesis and may also play a role in sleep disruption, perhaps in combination with other lesser studied hormones. Several sleep influencing regions of the brain appear to be affected early in AD progression and some may exhibit sexual dimorphisms that may contribute to increased sleep disruptions in women with age. Additionally, some of the most common sleep disorders, as well as multiple health conditions that impair sleep quality, are more prevalent and more severe in women. These conditions are often comorbid with AD and have bi-directional relationships that contribute synergistically to cognitive decline and neuropathology. The association during aging of increased sleep disruption and sleep disorders, dramatic hormonal changes during and after menopause, and increased AD pathology may be interacting and contributing factors that lead to the increased number of women living with AD.
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Affiliation(s)
- Carrie E. Johnson
- University of Kentucky, College of Medicine, Department of Molecular and Cellular Biochemistry, Lexington, KY, USA
| | - Marilyn J. Duncan
- University of Kentucky, College of Medicine, Department of Neuroscience, Lexington, KY, USA
| | - M. Paul Murphy
- University of Kentucky, College of Medicine, Department of Molecular and Cellular Biochemistry, Lexington, KY, USA
- University of Kentucky, Sanders-Brown Center on Aging, Lexington, KY, USA
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3
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Vidafar P, Spitschan M. Light on Shedding: A Review of Sex and Menstrual Cycle Differences in the Physiological Effects of Light in Humans. J Biol Rhythms 2023; 38:15-33. [PMID: 36367137 PMCID: PMC9902977 DOI: 10.1177/07487304221126785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The human circadian system responds to light as low as 30 photopic lux. Furthermore, recent evidence shows that there are huge individual differences in light sensitivity, which may help to explain why some people are more susceptible to sleep and circadian disruption than others. The biological mechanisms underlying the differences in light sensitivity remain largely unknown. A key variable of interest in understanding these individual differences in light sensitivity is biological sex. It is possible that in humans, males and females differ in their sensitivity to light, but the evidence is inconclusive. This is in part due to the historic exclusion of women in biomedical research. Hormonal fluctuations across the menstrual cycle in women has often been cited as a confound by researchers. Attitudes, however, are changing with funding and publication agencies advocating for more inclusive research frameworks and mandating that women and minorities participate in scientific research studies. In this article, we distill the existing knowledge regarding the relationship between light and the menstrual cycle. There is some evidence of a relationship between light and the menstrual cycle, but the nature of this relationship seems dependent on the timing of the light source (sunlight, moonlight, and electric light at night). Light sensitivity may be influenced by biological sex and menstrual phase but there might not be any effect at all. To better understand the relationship between light, the circadian system, and the menstrual cycle, future research needs to be designed thoughtfully, conducted rigorously, and reported transparently.
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Affiliation(s)
- Parisa Vidafar
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
- Translational Sensory and Circadian Neuroscience, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Manuel Spitschan
- Translational Sensory and Circadian Neuroscience, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
- TUM Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
- TUM Institute for Advanced Study, Technical University of Munich, Garching, Germany
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4
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Rzechorzek NM, Thrippleton MJ, Chappell FM, Mair G, Ercole A, Cabeleira M, Rhodes J, Marshall I, O'Neill JS. A daily temperature rhythm in the human brain predicts survival after brain injury. Brain 2022; 145:2031-2048. [PMID: 35691613 PMCID: PMC9336587 DOI: 10.1093/brain/awab466] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 11/03/2021] [Accepted: 11/20/2021] [Indexed: 02/06/2023] Open
Abstract
Patients undergo interventions to achieve a 'normal' brain temperature; a parameter that remains undefined for humans. The profound sensitivity of neuronal function to temperature implies the brain should be isothermal, but observations from patients and non-human primates suggest significant spatiotemporal variation. We aimed to determine the clinical relevance of brain temperature in patients by establishing how much it varies in healthy adults. We retrospectively screened data for all patients recruited to the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) High Resolution Intensive Care Unit Sub-Study. Only patients with direct brain temperature measurements and without targeted temperature management were included. To interpret patient analyses, we prospectively recruited 40 healthy adults (20 males, 20 females, 20-40 years) for brain thermometry using magnetic resonance spectroscopy. Participants were scanned in the morning, afternoon, and late evening of a single day. In patients (n = 114), brain temperature ranged from 32.6 to 42.3°C and mean brain temperature (38.5 ± 0.8°C) exceeded body temperature (37.5 ± 0.5°C, P < 0.0001). Of 100 patients eligible for brain temperature rhythm analysis, 25 displayed a daily rhythm, and the brain temperature range decreased in older patients (P = 0.018). In healthy participants, brain temperature ranged from 36.1 to 40.9°C; mean brain temperature (38.5 ± 0.4°C) exceeded oral temperature (36.0 ± 0.5°C) and was 0.36°C higher in luteal females relative to follicular females and males (P = 0.0006 and P < 0.0001, respectively). Temperature increased with age, most notably in deep brain regions (0.6°C over 20 years, P = 0.0002), and varied spatially by 2.41 ± 0.46°C with highest temperatures in the thalamus. Brain temperature varied by time of day, especially in deep regions (0.86°C, P = 0.0001), and was lowest at night. From the healthy data we built HEATWAVE-a 4D map of human brain temperature. Testing the clinical relevance of HEATWAVE in patients, we found that lack of a daily brain temperature rhythm increased the odds of death in intensive care 21-fold (P = 0.016), whilst absolute temperature maxima or minima did not predict outcome. A warmer mean brain temperature was associated with survival (P = 0.035), however, and ageing by 10 years increased the odds of death 11-fold (P = 0.0002). Human brain temperature is higher and varies more than previously assumed-by age, sex, menstrual cycle, brain region, and time of day. This has major implications for temperature monitoring and management, with daily brain temperature rhythmicity emerging as one of the strongest single predictors of survival after brain injury. We conclude that daily rhythmic brain temperature variation-not absolute brain temperature-is one way in which human brain physiology may be distinguished from pathophysiology.
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Affiliation(s)
| | - Michael J Thrippleton
- Edinburgh Imaging (Royal Infirmary of Edinburgh) Facility, Edinburgh EH16 4SA, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Francesca M Chappell
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Grant Mair
- Edinburgh Imaging (Royal Infirmary of Edinburgh) Facility, Edinburgh EH16 4SA, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Ari Ercole
- Division of Anaesthesia, University of Cambridge, Box 93 Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Manuel Cabeleira
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Box 167, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | | | - Jonathan Rhodes
- Department of Anaesthesia, Critical Care and Pain Medicine, NHS Lothian, Room No. S8208 (2nd Floor), Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - Ian Marshall
- Edinburgh Imaging (Royal Infirmary of Edinburgh) Facility, Edinburgh EH16 4SA, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - John S O'Neill
- MRC Laboratory of Molecular Biology, Cambridge CB2 0QH, UK
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5
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Modelling Female Physiology from Head to Toe: Impact of Sex Hormones, Menstrual Cycle, and Pregnancy. J Theor Biol 2022; 540:111074. [DOI: 10.1016/j.jtbi.2022.111074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 12/14/2022]
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6
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Bloukh S, Wazaify M, Matheson C. Paracetamol: unconventional uses of a well-known drug. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2021; 29:527-540. [PMID: 34455434 DOI: 10.1093/ijpp/riab058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 08/04/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To describe and map what is known about unconventional uses of paracetamol through a scoping review of published literature by adopting adopted a PRISMA systematic approach methodology. KEY FINDINGS Four themes for unconventional uses of paracetamol emerged: (a) use of paracetamol in sleep (a-1) positive effect of paracetamol on sleep (n = 9) or (a-2) neutral or negative effect of paracetamol on sleep (n = 9); (b) use of paracetamol in sport (n = 13); (c) mixing paracetamol with drinks, waterpipe and illicit drugs (n = 5); and (d) miscellaneous uses (n = 4). Forty records were reviewed and charted. Available literature supports concern around the potential of harmful or non-medical use of paracetamol, especially among patients with a history of substance use, parents of young children or athletes. SUMMARY Paracetamol (acetaminophen) is one of the most popular and widely used drugs for the treatment of pain and fever. It is considered remarkably safe if used within instructions. However, there is growing evidence that paracetamol, is sometimes used outside approved indications or abused (i.e. used for non-medical reasons). This review highlights the need for enhanced pharmacovigilance and surveillance of non-medical paracetamol use and raising general public awareness of its potential dangers especially in higher than recommended doses.
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Affiliation(s)
- Sarah Bloukh
- School of Pharmacy, The University of Jordan (UJ), Amman, Jordan
| | - Mayyada Wazaify
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan (UJ), Amman, Jordan
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7
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Dib R, Gervais NJ, Mongrain V. A review of the current state of knowledge on sex differences in sleep and circadian phenotypes in rodents. Neurobiol Sleep Circadian Rhythms 2021; 11:100068. [PMID: 34195482 PMCID: PMC8240025 DOI: 10.1016/j.nbscr.2021.100068] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/25/2021] [Accepted: 06/08/2021] [Indexed: 12/27/2022] Open
Abstract
Sleep is a vital part of our lives as it is required to maintain health and optimal cognition. In humans, sex differences are relatively well-established for many sleep phenotypes. However, precise differences in sleep phenotypes between male and female rodents are less documented. The main goal of this article is to review sex differences in sleep architecture and electroencephalographic (EEG) activity during wakefulness and sleep in rodents. The effects of acute sleep deprivation on sleep duration and EEG activity in male and female rodents will also be covered, in addition to sex differences in specific circadian phenotypes. When possible, the contribution of the female estrous cycle to the observed differences between males and females will be described. In general, male rodents spend more time in non-rapid eye movement sleep (NREMS) in comparison to females, while other differences between sexes in sleep phenotypes are species- and estrous cycle phase-dependent. Altogether, the review illustrates the need for a sex-based perspective in basic sleep and circadian research, including the consideration of sex chromosomes and gonadal hormones in sleep and circadian phenotypes. In rodents, males spend less time awake, and more time in NREMS than females. The recovery from sleep deprivation is also dependent on biological sex. Gonadal hormones modulate sleep and circadian phenotypes in rodents. A more systematic comparison of sex in basic sleep/circadian research is needed.
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Affiliation(s)
- Rama Dib
- Department of Neuroscience, Université de Montréal, Montréal, QC, Canada.,Center for Advanced Research in Sleep Medicine, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal (CIUSSS-NIM), Montréal, QC, Canada
| | - Nicole J Gervais
- Rotman Research Institute - Baycrest Centre, North York, ON, Canada
| | - Valérie Mongrain
- Department of Neuroscience, Université de Montréal, Montréal, QC, Canada.,Center for Advanced Research in Sleep Medicine, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal (CIUSSS-NIM), Montréal, QC, Canada
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8
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Ayoub SS. Paracetamol (acetaminophen): A familiar drug with an unexplained mechanism of action. Temperature (Austin) 2021; 8:351-371. [PMID: 34901318 PMCID: PMC8654482 DOI: 10.1080/23328940.2021.1886392] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 02/02/2023] Open
Abstract
Paracetamol (acetaminophen) is undoubtedly one of the most widely used drugs worldwide. As an over-the-counter medication, paracetamol is the standard and first-line treatment for fever and acute pain and is believed to remain so for many years to come. Despite being in clinical use for over a century, the precise mechanism of action of this familiar drug remains a mystery. The oldest and most prevailing theory on the mechanism of analgesic and antipyretic actions of paracetamol relates to the inhibition of CNS cyclooxygenase (COX) enzyme activities, with conflicting views on the COX isoenzyme/variant targeted by paracetamol and on the nature of the molecular interactions with these enzymes. Paracetamol has been proposed to selectively inhibit COX-2 by working as a reducing agent, despite the fact that in vitro screens demonstrate low potency on the inhibition of COX-1 and COX-2. In vivo data from COX-1 transgenic mice suggest that paracetamol works through inhibition of a COX-1 variant enzyme to mediate its analgesic and particularly thermoregulatory actions (antipyresis and hypothermia). A separate line of research provides evidence on potentiation of the descending inhibitory serotonergic pathway to mediate the analgesic action of paracetamol, but with no evidence of binding to serotonergic molecules. AM404 as a metabolite for paracetamol has been proposed to activate the endocannabinoid and the transient receptor potential vanilloid-1 (TRPV1) systems. The current review gives an update and in some cases challenges the different theories on the pharmacology of paracetamol and raises questions on some of the inadequately explored actions of paracetamol. List of Abbreviations: AM404, N-(4-hydroxyphenyl)-arachidonamide; CB1R, Cannabinoid receptor-1; Cmax, Maximum concentration; CNS, Central nervous system; COX, Cyclooxygenase; CSF, Cerebrospinal fluid; ED50, 50% of maximal effective dose; FAAH, Fatty acid amidohydrolase; IC50, 50% of the maximal inhibitor concentration; LPS, Lipopolysaccharide; NSAIDs, Non-steroidal anti-inflammatory drugs; PGE2, Prostaglandin E2; TRPV1, Transient receptor potential vanilloid-1.
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Affiliation(s)
- Samir S Ayoub
- School of Health, Sport and Bioscience, Medicines Research Group, University of East London, London, UK
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9
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Dorsey A, de Lecea L, Jennings KJ. Neurobiological and Hormonal Mechanisms Regulating Women's Sleep. Front Neurosci 2021; 14:625397. [PMID: 33519372 PMCID: PMC7840832 DOI: 10.3389/fnins.2020.625397] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/22/2020] [Indexed: 01/22/2023] Open
Abstract
Sleep is crucial for optimal well-being, and sex differences in sleep quality have significant implications for women's health. We review the current literature on sex differences in sleep, such as differences in objective and subjective sleep measures and their relationship with aging. We then discuss the convincing evidence for the role of ovarian hormones in regulating female sleep, and survey how these hormones act on a multitude of brain regions and neurochemicals to impact sleep. Lastly, we identify several important areas in need of future research to narrow the knowledge gap and improve the health of women and other understudied populations.
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Affiliation(s)
| | | | - Kimberly J. Jennings
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA, United States
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10
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Zhang S, Osumi H, Uchizawa A, Hamada H, Park I, Suzuki Y, Tanaka Y, Ishihara A, Yajima K, Seol J, Satoh M, Omi N, Tokuyama K. Changes in sleeping energy metabolism and thermoregulation during menstrual cycle. Physiol Rep 2021; 8:e14353. [PMID: 31981319 PMCID: PMC6981303 DOI: 10.14814/phy2.14353] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/26/2019] [Accepted: 12/26/2019] [Indexed: 11/24/2022] Open
Abstract
Women with ovulatory menstrual cycles show an increase in body temperature in the luteal phase, compared with follicular phase, particularly during the night. Several, albeit not all, studies reported higher energy expenditure in the luteal phase compared with follicular phase. Q10 of biological reactions lies between 2.0 and 3.0, predicting a 7‐12% increase in energy expenditure when body temperature rises by 1°C. In this study, temperature dependence of energy expenditure was assessed by comparing changes in sleeping energy expenditure and thermoregulation with menstrual cycle in 9 young females. Energy expenditure was measured using a metabolic chamber, in which sleep was recorded polysomnographically, and core body temperature and skin temperature were continuously monitored. Distal‐to‐proximal skin temperature gradient was assessed as an index of heat dissipation. In the luteal phase, a significant increase in average core body temperature (+0.27°C) and energy expenditure (+6.9%) were observed. Heat dissipation was suppressed during the first 2 hr of sleep in the luteal phase, compared with follicular phase. Rise in basal body temperature in the luteal phase was accompanied by increased energy expenditure and suppressed heat dissipation. The 6.9% increase in metabolic rate would require a Q10 of 12.4 to be attributable solely to temperature (+0.27°C), suggesting that energy expenditure in the luteal phase is enhanced through the mechanism, dependent and independent of luteal‐phase rise in body temperature presumably reflects other effects of the sex hormones.
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Affiliation(s)
- Simeng Zhang
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan
| | - Haruka Osumi
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
| | - Akiko Uchizawa
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
| | - Haruka Hamada
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
| | - Insung Park
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan
| | - Yoko Suzuki
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan
| | - Yoshiaki Tanaka
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
| | - Asuka Ishihara
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan
| | - Katsuhiko Yajima
- Department of Pharmaceutical Sciences, Faculty of Pharmacy and Pharmaceutical Sciences, Josai University, Sakado, Japan
| | - Jaehoon Seol
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
| | - Makoto Satoh
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan
| | - Naomi Omi
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
| | - Kumpei Tokuyama
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan
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11
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Brown AMC, Gervais NJ. Role of Ovarian Hormones in the Modulation of Sleep in Females Across the Adult Lifespan. Endocrinology 2020; 161:5879359. [PMID: 32735650 PMCID: PMC7450669 DOI: 10.1210/endocr/bqaa128] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 07/22/2020] [Indexed: 12/13/2022]
Abstract
Ovarian hormones, including 17β-estradiol, are implicated in numerous physiological processes, including sleep. Beginning at puberty, girls report more sleep complaints than boys, which is maintained throughout the reproductive life stage. Sleep problems are exacerbated during the menopausal transition, evidenced by greater risk for sleep disorders. There is emerging evidence that menopause-associated hormone loss contributes to this elevated risk, but age is also an important factor. The extent to which menopause-associated sleep disturbance persists into postmenopause above and beyond the effects of age remains unknown. Untreated sleep disturbances have important implications for cognitive health, as they are emerging as risk factors for dementia. Given that sleep loss impairs memory, an important knowledge gap concerns the role played by menopause-associated hormone loss in exacerbating sleep disturbance and, ultimately, cognitive function in aging women. In this review, we take a translational approach to illustrate the contribution of ovarian hormones in maintaining the sleep-wake cycle in younger and middle-aged females, with evidence implicating 17β-estradiol in supporting the memory-promoting effects of sleep. Sleep physiology is briefly reviewed before turning to behavioral and neural evidence from young females linking 17β-estradiol to sleep-wake cycle maintenance. Implications of menopause-associated 17β-estradiol loss is also reviewed before discussing how ovarian hormones may support the memory-promoting effects of sleep, and why menopause may exacerbate pathological aging via effects on sleep. While still in its infancy, this research area offers a new sex-based perspective on aging research, with a focus on a modifiable risk factor for pathological aging.
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Affiliation(s)
- Alana M C Brown
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Nicole J Gervais
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
- Correspondence: Nicole J. Gervais, University of Toronto, Department of Psychology, 100 St. George Street, Toronto, ON, Canada M5S 3G3. E-mail:
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12
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Baker FC, Siboza F, Fuller A. Temperature regulation in women: Effects of the menstrual cycle. Temperature (Austin) 2020; 7:226-262. [PMID: 33123618 PMCID: PMC7575238 DOI: 10.1080/23328940.2020.1735927] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 02/17/2020] [Accepted: 02/24/2020] [Indexed: 02/08/2023] Open
Abstract
Core body temperature changes across the ovulatory menstrual cycle, such that it is 0.3°C to 0.7°C higher in the post-ovulatory luteal phase when progesterone is high compared with the pre-ovulatory follicular phase. This temperature difference, which is most evident during sleep or immediately upon waking before any activity, is used by women as a retrospective indicator of an ovulatory cycle. Here, we review both historical and current literature aimed at characterizing changes in core body temperature across the menstrual cycle, considering the assessment of the circadian rhythm of core body temperature and thermoregulatory responses to challenges, including heat and cold exposure, exercise, and fever. We discuss potential mechanisms for the thermogenic effect of progesterone and the temperature-lowering effect of estrogen, and discuss effects on body temperature of exogenous formulations of these hormones as contained in oral contraceptives. We review new wearable temperature sensors aimed at tracking daily temperature changes of women across multiple menstrual cycles and highlight the need for future research on the validity and reliability of these devices. Despite the change in core body temperature across the menstrual cycle being so well identified, there remain gaps in our current understanding, particularly about the underlying mechanisms and microcircuitry involved in the temperature changes.
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Affiliation(s)
- Fiona C. Baker
- Center for Health Sciences, SRI International, Menlo Park, USA
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Felicia Siboza
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrea Fuller
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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13
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Molina E, Sanabria D, Jung TP, Correa Á. Electroencephalographic and peripheral temperature dynamics during a prolonged psychomotor vigilance task. ACCIDENT; ANALYSIS AND PREVENTION 2019; 126:198-208. [PMID: 29061281 DOI: 10.1016/j.aap.2017.10.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 09/26/2017] [Accepted: 10/16/2017] [Indexed: 06/07/2023]
Abstract
Attention lapses and fatigue are a main source of impaired performance that can lead to accidents. This study analyzed electroencephalographic (EEG) dynamics and body skin temperature as markers of attentional fluctuations in non-sleep deprived subjects during a 45min Psychomotor Vigilance Task (PVT). Independent Component Analysis and time-frequency analysis were used to evaluate the EEG data. Results showed a positive association between distal and distal-to-proximal gradient (DPG) temperatures and reaction time (RT); increments in EEG power in alpha-, theta- and beta-band frequencies in parieto-occipital, central-medial and frontal components, were associated with poor performance (slower RT) in the task. This generalized power increment fits with an increased activity in the default mode network, associated with attention lapses. This study highlights the potential use of the PVT as a tool to obtain individual physiological indices of vigilance and fatigue that could be applied to other vigilance tasks typically performed in occupational settings.
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Affiliation(s)
- Enrique Molina
- Centro de Investigación Mente, Cerebro y Comportamiento, University of Granada, Campus de Cartuja, s/n, 18071, Granada, Spain.
| | - Daniel Sanabria
- Centro de Investigación Mente, Cerebro y Comportamiento, University of Granada, Campus de Cartuja, s/n, 18071, Granada, Spain.
| | - Tzyy-Ping Jung
- Swartz Center for Computational Neuroscience, Institute for Neural Computation, University of California, San Diego, CA, USA.
| | - Ángel Correa
- Centro de Investigación Mente, Cerebro y Comportamiento, University of Granada, Campus de Cartuja, s/n, 18071, Granada, Spain.
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14
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Mong JA, Cusmano DM. Sex differences in sleep: impact of biological sex and sex steroids. Philos Trans R Soc Lond B Biol Sci 2016; 371:20150110. [PMID: 26833831 DOI: 10.1098/rstb.2015.0110] [Citation(s) in RCA: 280] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2015] [Indexed: 12/19/2022] Open
Abstract
Men and women sleep differently. While much is known about the mechanisms that drive sleep, the reason for these sex differences in sleep behaviour is unknown and understudied. Historically, women and female animals are underrepresented in studies of sleep and its disorders. Nevertheless, there is a growing recognition of sex disparities in sleep and rhythm disorders. Women typically report poorer quality and more disrupted sleep across various stages of life. Findings from clinical and basic research studies strongly implicate a role for sex steroids in sleep modulation. Understanding how neuroendocrine mediators and sex differences influence sleep is central to advancing our understanding of sleep-related disorders. The investigation into sex differences and sex steroid modulation of sleep is in its infancy. Identifying the mechanisms underlying sex and gender differences in sleep will provide valuable insights leading to tailored therapeutics that benefit each sex. The goal of this review is to discuss our current understanding of how biological sex and sex steroids influence sleep behaviour from both the clinical and pre-clinical perspective.
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Affiliation(s)
- Jessica A Mong
- Program in Neuroscience, University of Maryland, School of Medicine, Baltimore, MD 21201, USA Department of Pharmacology, University of Maryland, School of Medicine, Baltimore, MD 21201, USA
| | - Danielle M Cusmano
- Program in Neuroscience, University of Maryland, School of Medicine, Baltimore, MD 21201, USA
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15
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Abstract
Cortical electroencephalographic activity arises from corticothalamocortical interactions, modulated by wake-promoting monoaminergic and cholinergic input. These wake-promoting systems are regulated by hypothalamic hypocretin/orexins, while GABAergic sleep-promoting nuclei are found in the preoptic area, brainstem and lateral hypothalamus. Although pontine acetylcholine is critical for REM sleep, hypothalamic melanin-concentrating hormone/GABAergic cells may "gate" REM sleep. Daily sleep-wake rhythms arise from interactions between a hypothalamic circadian pacemaker and a sleep homeostat whose anatomical locus has yet to be conclusively defined. Control of sleep and wakefulness involves multiple systems, each of which presents vulnerability to sleep/wake dysfunction that may predispose to physical and/or neuropsychiatric disorders.
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Affiliation(s)
- Michael D Schwartz
- Biosciences Division, Center for Neuroscience, SRI International, 333 Ravenswood Avenue, Menlo Park, CA 94025, USA
| | - Thomas S Kilduff
- Biosciences Division, Center for Neuroscience, SRI International, 333 Ravenswood Avenue, Menlo Park, CA 94025, USA.
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Lord C, Sekerovic Z, Carrier J. Sleep regulation and sex hormones exposure in men and women across adulthood. ACTA ACUST UNITED AC 2014; 62:302-10. [PMID: 25218407 DOI: 10.1016/j.patbio.2014.07.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 07/11/2014] [Indexed: 02/02/2023]
Abstract
This review aims to discuss how endogenous and exogenous testosterone exposures in men and estrogens/progesterone exposures in women interact with sleep regulation. In young men, testosterone secretion peaks during sleep and is linked to sleep architecture. Animal and human studies support the notion that sleep loss suppresses testosterone secretion. Testosterone levels decline slowly throughout the aging process, but relatively few studies investigate its impact on age-related sleep modifications. Results suggest that poorer sleep quality is associated with lower testosterone concentrations and that sleep loss may have a more prominent effect on testosterone levels in older individuals. In women, sex steroid levels are characterized by a marked monthly cycle and reproductive milestones such as pregnancy and menopause. Animal models indicate that estrogens and progesterone influence sleep. Most studies do not show any clear effects of the menstrual cycle on sleep, but sample sizes are too low, and research designs often inhibit definitive conclusions. The effects of hormonal contraceptives on sleep are currently unknown. Pregnancy and the postpartum period are associated with increased sleep disturbances, but their relation to the hormonal milieu still needs to be determined. Finally, studies suggest that menopausal transition and the hormonal changes associated with it are linked to lower subjective sleep quality, but results concerning objective sleep measures are less conclusive. More research is necessary to unravel the effects of vasomotor symptoms on sleep. Hormone therapy seems to induce positive effects on sleep, but key concerns are still unresolved, including the long-term effects and efficacy of different hormonal regimens.
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Affiliation(s)
- C Lord
- Département de psychologie, université de Montréal, Pavillon Marie-Victorin, 90, avenue Vincent-d'Indy, H2V 2S9 Montréal, Québec, Canada
| | - Z Sekerovic
- Département de psychologie, université de Montréal, Pavillon Marie-Victorin, 90, avenue Vincent-d'Indy, H2V 2S9 Montréal, Québec, Canada
| | - J Carrier
- Département de psychologie, université de Montréal, Pavillon Marie-Victorin, 90, avenue Vincent-d'Indy, H2V 2S9 Montréal, Québec, Canada; Center for advanced research in sleep medicine, hôpital du Sacré-Cœur de Montréal, 5400, boulevard Gouin-Ouest, H4J 1C5 Montréal, Québec, Canada; Institut universitaire de gériatrie de Montréal, université de Montréal, Pavillon Côte des neiges, 4565, chemin Queen-Mary, H3W1W5 Montréal, Québec, Canada.
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Cusmano DM, Hadjimarkou MM, Mong JA. Gonadal steroid modulation of sleep and wakefulness in male and female rats is sexually differentiated and neonatally organized by steroid exposure. Endocrinology 2014; 155:204-14. [PMID: 24189140 PMCID: PMC3868804 DOI: 10.1210/en.2013-1624] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The paucity of clinical and preclinical studies investigating sex differences in sleep has resulted in mixed findings as to the exact nature of these differences. Although gonadal steroids are known to modulate sleep in females, less is known about males. Moreover, little evidence exists concerning the origin of these sex differences in sleep behavior. Thus, the goal of this study was to directly compare the sensitivity of sleep behavior in male and female Sprague Dawley rats to changes in the gonadal steroid milieu and to test whether the sex differences in sleep are the result of brain sexual differentiation or differences in circulating gonadal steroids. Here we report the magnitude of change in sleep behavior induced by either estradiol (E2) or testosterone (T) was greater in females compared with males, suggesting that sleep behavior in females is more sensitive to the suppressive effects of gonadal steroids. Furthermore, we demonstrated that the organizational effects of early gonadal steroid exposure result in male-like responsivity to gonadal steroids and directly alter the activity of the ventrolateral preoptic area (VLPO), an established sleep-promoting nucleus, in adult masculinized females. Moreover, the nonaromatizable androgen dihydrotestosterone did not suppress sleep in either males or females, suggesting that the T-mediated effect in females was due to the aromatization of T into E2. Together our data suggest that, like sex behavior, sex differences in sleep follow the classical organizational/activational effects of gonadal steroids.
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Affiliation(s)
- Danielle M Cusmano
- Program in Neuroscience (D.M.C., J.A.M.) and Department of Pharmacology (D.M.C., M.M.H., J.A.M.), University of Maryland School of Medicine, Baltimore, Maryland 21201; and Department of Psychology (M.M.H.), University of Nicosia, 1700 Nicosia, Cyprus
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18
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de Zambotti M, Nicholas CL, Colrain IM, Trinder JA, Baker FC. Autonomic regulation across phases of the menstrual cycle and sleep stages in women with premenstrual syndrome and healthy controls. Psychoneuroendocrinology 2013; 38:2618-27. [PMID: 23850226 PMCID: PMC3812396 DOI: 10.1016/j.psyneuen.2013.06.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 06/07/2013] [Accepted: 06/08/2013] [Indexed: 11/24/2022]
Abstract
To investigate the influence of menstrual cycle phase and the presence of severe premenstrual symptoms on cardiac autonomic control during sleep, we performed heart rate variability (HRV) analysis during stable non-rapid eye movement (NREM) and REM sleep in 12 women with severe premenstrual syndrome and 14 controls in the mid-follicular, mid-luteal, and late-luteal phases of the menstrual cycle. Heart rate was higher, along with lower high frequency (HF) power, reflecting reduced vagal activity, and a higher ratio of low frequency (LF) to high frequency power, reflecting a shift to sympathetic dominance, in REM sleep compared with NREM sleep in both groups of women. Both groups of women had higher heart rate during NREM and REM sleep in the luteal phase recordings compared with the mid-follicular phase. HF power in REM sleep was lowest in the mid-luteal phase, when progesterone was highest, in both groups of women. The mid-luteal phase reduction in HF power was also evident in NREM sleep in control women but not in women with PMS, suggesting some impact of premenstrual syndrome on autonomic responses to the hormone environment of the mid-luteal phase. In addition, mid-luteal phase progesterone levels correlated positively with HF power and negatively with LF/HF ratio in control women in NREM sleep and with the LF/HF ratio during REM sleep in both groups of women. Our findings suggest the involvement of female reproductive steroids in cardiac autonomic control during sleep in women with and without premenstrual syndrome.
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Affiliation(s)
- Massimiliano de Zambotti
- Human Sleep Research Program, SRI International, 333 Ravenswood Avenue, Menlo Park, CA 94025, USA
| | - Christian L. Nicholas
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Ian M. Colrain
- Human Sleep Research Program, SRI International, 333 Ravenswood Avenue, Menlo Park, CA 94025, USA
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - John A. Trinder
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Fiona C. Baker
- Human Sleep Research Program, SRI International, 333 Ravenswood Avenue, Menlo Park, CA 94025, USA
- Brain Function Research Group, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
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Kräuchi K, Konieczka K, Roescheisen-Weich C, Gompper B, Hauenstein D, Schoetzau A, Fraenkl S, Flammer J. Diurnal and menstrual cycles in body temperature are regulated differently: a 28-day ambulatory study in healthy women with thermal discomfort of cold extremities and controls. Chronobiol Int 2013; 31:102-13. [PMID: 24131147 DOI: 10.3109/07420528.2013.829482] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Diurnal cycle variations in body-heat loss and heat production, and their resulting core body temperature (CBT), are relatively well investigated; however, little is known about their variations across the menstrual cycle under ambulatory conditions. The main purpose of this study was to determine whether menstrual cycle variations in distal and proximal skin temperatures exhibit similar patterns to those of diurnal variations, with lower internal heat conductance when CBT is high, i.e. during the luteal phase. Furthermore, we tested these relationships in two groups of women, with and without thermal discomfort of cold extremities (TDCE). In total, 19 healthy eumenorrheic women with regular menstrual cycles (28-32 days), 9 with habitual TDCE (ages 29 ± 1.5 year; BMI 20.1 ± 0.4) and 10 controls without these symptoms (CON: aged 27 ± 0.8 year; BMI 22.7 ± 0.6; p < 0.004 different to TDCE) took part in the study. Twenty-eight days continuous ambulatory skin temperature measurements of distal (mean of hands and feet) and proximal (mean of sternum and infraclavicular regions) skin regions, thighs, and calves were carried out under real-life, ambulatory conditions (i-Buttons® skin probes, sampling rate: 2.5 min). The distal minus proximal skin temperature gradient (DPG) provided a valuable measure for heat redistribution from the core to the shell, and, hence, for internal heat conduction. Additionally, basal body temperature was measured sublingually directly after waking up in bed. Mean diurnal amplitudes in skin temperatures increased from proximal to distal skin regions and the 24-h mean values were inversely related. TDCE compared to CON showed significantly lower hand skin temperatures and DPG during daytime. However, menstrual cycle phase did not modify these diurnal patterns, indicating that menstrual and diurnal cycle variations in skin temperatures reveal additive effects. Most striking was the finding that all measured skin temperatures, together with basal body temperature, revealed a similar menstrual cycle variation (independent of BMI), with highest and lowest values during the luteal and follicular phases, respectively. These findings lead to the conclusion that in contrast to diurnal cycle, variations in CBT variation across the menstrual cycle cannot be explained by changes in internal heat conduction under ambulatory conditions. Although no measurements of metabolic heat production were carried out increased metabolic heat generation during the luteal phase seems to be the most plausible explanation for similar body temperature increases.
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Affiliation(s)
- Kurt Kräuchi
- Thermophysiological Chronobiology, Centre for Chronobiology, Psychiatric Hospital of the University of Basel , Basel , Switzerland and
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20
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Shechter A, Lespérance P, Ng Ying Kin NMK, Boivin DB. Nocturnal polysomnographic sleep across the menstrual cycle in premenstrual dysphoric disorder. Sleep Med 2012; 13:1071-8. [PMID: 22749440 DOI: 10.1016/j.sleep.2012.05.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 05/14/2012] [Accepted: 05/15/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Women with premenstrual dysphoric disorder (PMDD) experience disturbed mood, altered melatonin circadian rhythms, and frequent reports of insomnia during the luteal phase (LP) of their menstrual cycle. In this study we aimed to investigate nocturnal polysomnographic (PSG) sleep across the menstrual cycle in PMDD women and controls. METHODS Seven PMDD women who indicated insomnia during LP, and five controls, spent every third night throughout a complete menstrual cycle sleeping in the laboratory. RESULTS In PMDD and controls progesterone and core body temperature (BT(core)) were elevated during LP compared to the follicular phase (FP). Stage 2 sleep showed a significant main effect of menstrual phase and was significantly increased during mid-LP compared to early-FP in both groups. Rapid eye movement (REM) sleep for both groups was decreased during early-LP compared to early-FP. Slow wave sleep (SWS) was significantly increased, and melatonin significantly decreased, in PMDD women compared to controls. CONCLUSIONS PMDD women who experience insomnia during LP had decreased melatonin secretion and increased SWS compared to controls. The sleep and melatonin findings in PMDD women may be functionally linked. Results also suggest an altered homeostatic regulation of the sleep-wake cycle in PMDD, perhaps implicating melatonin in the homeostatic process of sleep-wake regulation.
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Affiliation(s)
- Ari Shechter
- Centre for Study and Treatment of Circadian Rhythms, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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21
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Shechter A, Boudreau P, Varin F, Boivin DB. Predominance of distal skin temperature changes at sleep onset across menstrual and circadian phases. J Biol Rhythms 2011; 26:260-70. [PMID: 21628553 DOI: 10.1177/0748730411404677] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Menstrual cycle-associated changes in reproductive hormones affect body temperature in women. We aimed to characterize the interaction between the menstrual, circadian, and scheduled sleep-wake cycles on body temperature regulation. Eight females entered the laboratory during the midfollicular (MF) and midluteal (ML) phases of their menstrual cycle for an ultradian sleep-wake cycle procedure, consisting of 36 cycles of 60-minute wake episodes alternating with 60-minute nap opportunities, in constant bed-rest conditions. Core body temperature (CBT) and distal skin temperature (DT) were recorded and used to calculate a distal-core gradient (DCG). Melatonin, sleep, and subjective sleepiness were also recorded. The circadian variation of DT and DCG was not affected by menstrual phase. DT and DCG showed rapid, large nap episode-dependent increases, whereas CBT showed slower, smaller nap episode-dependent decreases. DCG values were significantly reduced for most of the wake episode in an overall 60-minute wake/60-minute nap cycle during ML compared to MF, but these differences were eliminated at the wake-to-nap lights-out transition. Nap episode-dependent decreases in CBT were further modulated as a function of both circadian and menstrual factors, with nap episode-dependent deceases occurring more prominently during the late afternoon/evening in ML, whereas nap episode-dependent DT and DCG increases were not significantly affected by menstrual phase but only circadian phase. Circadian rhythms of melatonin secretion, DT, and DCG were significantly phase-advanced relative to CBT and sleep propensity rhythms. This study explored how the thermoregulatory system is influenced by an interaction between circadian phase and vigilance state and how this is further modulated by the menstrual cycle. Current results agree with the thermophysiological cascade model of sleep and indicate that despite increased CBT during ML, heat loss mechanisms are maintained at a similar level during nap episodes, which may allow for comparable circadian sleep propensity rhythms between menstrual phases.
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Affiliation(s)
- Ari Shechter
- Centre for Study and Treatment of Circadian Rhythms, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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22
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Toussaint K, Yang XC, Zielinski MA, Reigle KL, Sacavage SD, Nagar S, Raffa RB. What do we (not) know about how paracetamol (acetaminophen) works? J Clin Pharm Ther 2011; 35:617-38. [PMID: 21054454 DOI: 10.1111/j.1365-2710.2009.01143.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
WHAT IS KNOWN AND BACKGROUND Although paracetamol (acetaminophen), N-(4-Hydroxyphenyl)acetamide, is one of the world's most widely used analgesics, the mechanism by which it produces its analgesic effect is largely unknown. This lack is relevant because: (i) optimal pain treatment matches the analgesic mechanism to the (patho)physiology of the pain and (ii) modern drug discovery relies on an appropriate screening assay. OBJECTIVE To review the clinical profile and preclinical studies of paracetamol as means of gaining insight into its mechanism of analgesic action. METHODS A literature search was conducted of clinical and preclinical literature and the information obtained was organized and reviewed from the perspective of its contribution to an understanding of the mechanism of analgesic action of paracetamol. RESULTS Paracetamol's broad spectrum of analgesic and other pharmacological actions is presented, along with its multiple postulated mechanism(s) of action. No one mechanism has been definitively shown to account for its analgesic activity. WHAT IS NEW AND CONCLUSION Further research is needed to uncover the mechanism of analgesic action of paracetamol. The lack of this knowledge affects optimal clinical use and impedes drug discovery efforts.
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Affiliation(s)
- K Toussaint
- Temple University School of Pharmacy, Philadelphia, PA 19140, USA
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23
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Shechter A, Varin F, Boivin DB. Circadian variation of sleep during the follicular and luteal phases of the menstrual cycle. Sleep 2010; 33:647-56. [PMID: 20469807 PMCID: PMC2864880 DOI: 10.1093/sleep/33.5.647] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES Women experience insomnia more frequently than men. Menstrual cycle changes in reproductive hormones and circadian rhythms may contribute to sleep disruptions. Our aim, therefore, was to clarify the interaction between menstrual and circadian processes as it affects sleep. DESIGN Participants entered the laboratory during the mid-follicular (MF) and mid-luteal (ML) phases of their menstrual cycle for an ultra-rapid sleep-wake cycle (URSW) procedure, consisting of 36 cycles of 60-min wake episodes alternating with 60-min nap opportunities. This procedure concluded with an ad libitum nap episode. SETTING Time-isolation suite. PARTICIPANTS Eight unmedicated, physically and mentally healthy females with regular ovulatory menstrual cycles. INTERVENTIONS N/A. MEASUREMENTS Polysomnographic sleep from nocturnal sleep episodes and 60-min naps; subjective alertness; core body temperature (CBT); salivary melatonin; urinary estradiol; and urinary progesterone. RESULTS Increased CBT values at night and decreased CBT amplitude were observed during ML compared to MF. Circadian phase of CBT and the circadian melatonin profile were unaffected by menstrual phase. All analyzed sleep parameters showed a circadian variation throughout the URSW procedure, with no menstrual phase differences observed for most, including slow wave sleep (SWS). The circadian variation of REM sleep duration, however, was sensitive to menstrual phase, with reduced REM sleep during ML at circadian phase 0 degrees and 30 degrees. CONCLUSIONS Moderate but significant changes in REM sleep across the menstrual and circadian cycles were observed. These results support an interaction between circadian and menstrual processes in the regulation of REM sleep.
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Affiliation(s)
- Ari Shechter
- Centre for Study and Treatment of Circadian Rhythms, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada
| | - France Varin
- Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada
| | - Diane B. Boivin
- Centre for Study and Treatment of Circadian Rhythms, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada
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Shechter A, Boivin DB. Sleep, Hormones, and Circadian Rhythms throughout the Menstrual Cycle in Healthy Women and Women with Premenstrual Dysphoric Disorder. Int J Endocrinol 2010; 2010:259345. [PMID: 20145718 PMCID: PMC2817387 DOI: 10.1155/2010/259345] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 10/16/2009] [Indexed: 11/17/2022] Open
Abstract
A relationship exists between the sleep-wake cycle and hormone secretion, which, in women, is further modulated by the menstrual cycle. This interaction can influence sleep across the menstrual cycle in healthy women and in women with premenstrual dysphoric disorder (PMDD), who experience specific alterations of circadian rhythms during their symptomatic luteal phase along with sleep disturbances during this time. This review will address the variation of sleep at different menstrual phases in healthy and PMDD women, as well as changes in circadian rhythms, with an emphasis on their relationship with female sex hormones. It will conclude with a brief discussion on nonpharmacological treatments of PMDD which use chronotherapeutic methods to realign circadian rhythms as a means of improving sleep and mood in these women.
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Affiliation(s)
- Ari Shechter
- Centre for Study and Treatment of Circadian Rhythms, Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada H4H 1R3
- Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada H3A 2B4
| | - Diane B. Boivin
- Centre for Study and Treatment of Circadian Rhythms, Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada H4H 1R3
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25
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Abstract
Eicosanoids are a large group of oxygenated fatty acids [viz., omega-3 (n-3) and omega-6 (n-6) C(20) polyunsaturated fatty acids], the most important source being the omega-6 cell membrane-derived arachidonic acid (AA). Eicosanoids are produced by many different cell types; through their ligation and activation of specific membrane-bound and intracellular receptors, they regulate myriad physiological and pathological functions, including body temperature (T(b)). However, the thermoregulatory role of eicosanoids has mainly been associated with fever, i.e., with T(b) changes induced during illness; their importance in maintaining T(b) during health remains unclear. In this review, we address the question of whether AA-derived mediators (viz., prostaglandins, leukotrienes and other lipoxygenase metabolites, and the endocannabinoids/endovanilloids) are involved in normal (non-febrile) thermoregulation. We conclude that although prostaglandin E(2) is a principal mediator of fever, it is unlikely to be involved in the maintenance of normal T(b). Other eicosanoids reviewed also seem to have no major role in non-febrile thermoregulation. Newly discovered signaling pathways for eicosanoids, such as the endovanilloid system, may participate in thermoregulation, but further studies are required before definitive conclusions can be made.
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Affiliation(s)
- David M Aronoff
- Division of Infectious Diseases, Department of Internal Medicine, The University of Michigan Health Systems, Ann Arbor, MI 48109-0642, USA.
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26
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28
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Baker FC, Driver HS. Circadian rhythms, sleep, and the menstrual cycle. Sleep Med 2007; 8:613-22. [PMID: 17383933 DOI: 10.1016/j.sleep.2006.09.011] [Citation(s) in RCA: 269] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2006] [Revised: 08/28/2006] [Accepted: 09/15/2006] [Indexed: 01/24/2023]
Abstract
Women with ovulatory menstrual cycles have a circadian rhythm superimposed on the menstrual-associated rhythm; in turn, menstrual events affect the circadian rhythm. In this paper, we review circadian rhythms in temperature, selected hormone profiles, and sleep-wake behavior in healthy women at different phases of the menstrual cycle. The effects on menstrual cycle rhythmicity of disrupted circadian rhythms, for example, with shiftwork and altered circadian rhythms in women with menstrual-related mood disturbances, are discussed. Compared to the follicular phase, in the post-ovulation luteal phase, body temperature is elevated, but the amplitude of the temperature rhythm is reduced. Evidence indicates that the amplitude of other rhythms, such as melatonin and cortisol, may also be blunted in the luteal phase. Subjective sleep quality is lowest around menses, but the timing and composition of sleep remains relatively stable across the menstrual cycle in healthy women, apart from an increase in spindle frequency activity and a minor decrease in rapid eye movement (REM) sleep during the luteal phase. Disruption of circadian rhythms is associated with disturbances in menstrual function. Female shiftworkers compared to non-shiftworkers are more likely to report menstrual irregularity and longer menstrual cycles. There also is accumulating evidence that circadian disruption increases the risk of breast cancer in women, possibly due to altered light exposure and reduced melatonin secretion. Further investigations into the biological consequences of circadian disruption in women will offer insight into some menstrual-associated disorders, including mood changes, as well as reproductive function and possible links with breast cancer.
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Affiliation(s)
- Fiona C Baker
- Human Sleep Research Program, SRI International, 333 Ravenswood Avenue, Menlo Park, CA 94025, USA.
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29
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Barger LK, Hoban-Higgins TM, Fuller CA. Assessment of circadian rhythms throughout the menstrual cycle of female rhesus monkeys. Am J Primatol 2007; 70:19-25. [PMID: 17523165 DOI: 10.1002/ajp.20451] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Reproductive cyclicity has a significant influence on the regulation of circadian rhythms in rodents. Studies have suggested that there are changes in body temperature rhythms between the follicular and luteal phases in human females. This study examined the effects of menstrual cyclicity on physiological and behavioral circadian rhythms in female rhesus monkeys (Macaca mulatta), an acknowledged biomedical model. Seven unrestrained subjects were implanted with a biotelemetry transmitter to measure body temperature and heart rate and an accelerometer was used to measure physical activity. Water was available ad libitum and drinking was measured via an electronic circuit attached to a water lixit. A video-based task system, the Psychomotor Test System, provided environmental enrichment and delivered a pelletized diet. Mean, phase, and amplitude of each rhythm were calculated. Estrogen and progesterone conjugates were assayed and quantified from daily urine samples to identify follicular and luteal phases of the menstrual cycle. Average circadian variables were then compared between these phases. Heart rate was significantly (P< or =0.05) delayed in the luteal phase. Albeit non-significant, analysis showed a trend toward decreased circadian amplitude of body temperature in the luteal phase.
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Affiliation(s)
- Laura K Barger
- Section of Neurobiology, Physiology and Behavior, University of California, Davis, California, USA
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30
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McEnany GW, Lee KA. Effects of light therapy on sleep, mood, and temperature in women with nonseasonal major depression. Issues Ment Health Nurs 2005; 26:781-94. [PMID: 16126652 DOI: 10.1080/01612840591008410] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Research has supported the applicability and efficacy of light therapy in the treatment of nonseasonal depression. The investigators examined the effects of light therapy on sleep, core temperature, depressed mood, and perception of fatigue and energy in a sample of pre-menopausal and post-menopausal women diagnosed with nonseasonal, nonbipolar depression. Women were randomly assigned to either light therapy (n = 16) or placebo (n = 13) for a 28-day period. Pre and post measures of sleep and core temperature were collected. In addition, measures of depressed mood, fatigue, and energy were collected throughout the study period. Significant changes in depression and energy were found in the treatment group, but not in the placebo group. There was a significant reduction in the temperature mesor and less wake time during the first third of the sleep period in the treatment group but not in the placebo group. Light therapy yielded significant improvement in depression when compared with placebo intervention and core temperature mesor returned to normal. There was no significant phase shift, perhaps due in part to the absence of any baseline circadian phase disturbances. Relationships between temperature, sleep, depressed mood, fatigue, and energy variables offer potential directions for future research and clinical intervention.
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Affiliation(s)
- Geoffry W McEnany
- Department of Nursing, School of Health and Environment, University of Massachusetts-Lowell, 2 Solomont Avenue, Lowell, MA 01854-5121, USA.
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Ayoub SS, Botting RM, Goorha S, Colville-Nash PR, Willoughby DA, Ballou LR. Acetaminophen-induced hypothermia in mice is mediated by a prostaglandin endoperoxide synthase 1 gene-derived protein. Proc Natl Acad Sci U S A 2004; 101:11165-9. [PMID: 15263079 PMCID: PMC503757 DOI: 10.1073/pnas.0404185101] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Acetaminophen is a widely used antipyretic analgesic, reducing fever caused by bacterial and viral infections and by clinical trauma such as cancer or stroke. In rare cases in humans, e.g., in febrile children or HIV or stroke patients, acetaminophen causes hypothermia while therapeutic blood levels of the drug are maintained. In C57/BL6 mice, acetaminophen caused hypothermia that was dose related and maximum (>2 degrees C below normal) with a dose of 300 mg/kg. The reduction and recovery of body temperature was paralleled by a fall of >90% and a subsequent rise of prostaglandin (PG)E(2) concentrations in the brain. In cyclooxygenase (COX)-2(-/-) mice, acetaminophen (300 mg/kg) produced hypothermia accompanied by a reduction in brain PGE(2) levels, whereas in COX-1(-/-) mice, the hypothermia to this dose of acetaminophen was attenuated. The brains of COX-1(-/-) mice had approximately 70% lower levels of PGE(2) than those of WT animals, and these levels were not reduced further by acetaminophen. The putative selective COX-3 inhibitors antipyrine and aminopyrine also reduced basal body temperature and brain PGE(2) levels in normal mice. We propose that acetaminophen is a selective inhibitor of a COX-1 variant and this enzyme is involved in the continual synthesis of PGE(2) that maintains a normal body temperature. Thus, acetaminophen reduces basal body temperature below normal in mice most likely by inhibiting COX-3.
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Affiliation(s)
- Samir S Ayoub
- Experimental Pathology Group, Queen Mary University of London, St. Bartholomew's and the London School of Medicine and Dentistry, Charterhouse Square, London EC1M 6BQ, United Kingdom
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Moline ML, Broch L, Zak R. Sleep in women across the life cycle from adulthood through menopause. Med Clin North Am 2004; 88:705-36, ix. [PMID: 15087212 DOI: 10.1016/j.mcna.2004.01.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Margaret L Moline
- Department of Psychiatry, Weill Medical College of Cornell University, New York, NY, USA.
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