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Cherubini JM, Cheng JL, Armstrong CM, Kamal MJ, Parise G, MacDonald MJ. Acute partial sleep restriction does not impact arterial function in young and healthy humans. Exp Physiol 2024; 109:1492-1504. [PMID: 38900696 DOI: 10.1113/ep091699] [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] [Received: 01/12/2024] [Accepted: 05/30/2024] [Indexed: 06/22/2024]
Abstract
Habitual short sleep durations are associated with several cardiovascular diseases. Experimental research generally supports these findings as metrics of arterial function are impaired after complete deprivation of sleep and after longer periods of partial sleep restriction. The acute influence of a single instance of partial sleep restriction (PSR), however, has not been defined. We evaluated arterial structure and function among 32 university-aged participants on two occasions: once after normal habitual sleep (NS), and again the morning after an acute partial sleep restriction (PSR) intervention involving only 3 h of sleep for a single night. Endothelial function was measured using ultrasonography at the brachial artery via flow-mediated dilatation (FMD), and a ramp peak oxygen uptake test was used to evaluate cardiorespiratory fitness. Blood samples were collected from a subset of participants to investigate the influence of circulatory factors on cellular mechanisms implicated in endothelial function. Sleep duration was lower after a night of PSR compared to NS (P < 0.001); however, there were no appreciable differences in any haemodynamic outcome between conditions. FMD was not different between NS and PSR (NS: 6.5 ± 2.9%; PSR: 6.3 ± 2.9%; P = 0.668), and cardiorespiratory fitness did not moderate the haemodynamic response to PSR (all P > 0.05). Ex vivo cell culture results aligned with in vivo data, showing that acute PSR does not alter intracellular processes involved in endothelial function. No differences in arterial structure or function were observed between NS and acute PSR in healthy and young participants, and cardiorespiratory fitness does not modulate the arterial response to acute sleep restriction.
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Affiliation(s)
- Joshua M Cherubini
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Jem L Cheng
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Calvin M Armstrong
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Michael J Kamal
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Gianni Parise
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
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Kwon Y, Gami AS, Javaheri S, Pressman GS, Scammell TE, Surkin LA, Zee PC. Cardiovascular Risks in People With Narcolepsy: Expert Panel Consensus Recommendations. J Am Heart Assoc 2024; 13:e035168. [PMID: 39119988 DOI: 10.1161/jaha.124.035168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 06/18/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Observational and retrospective studies suggest that people with narcolepsy may have an increased prevalence of cardiovascular and cardiometabolic comorbidities and may be at greater risk for future cardiovascular events. An expert consensus panel was formed to establish agreement on the risk of hypertension and cardiovascular/cardiometabolic disease in people with narcolepsy and to develop strategies to mitigate these risks. METHODS AND RESULTS Experts in sleep medicine and cardiology were selected to participate in the panel. After reviewing the relevant literature, the experts identified key elements, drafted recommendation statements, and developed discussion points to provide supporting evidence for the recommendations. The draft and final recommendations were rated on a scale from 0 (not at all agree) to 4 (very much agree). All experts had an agreement rating of 4.0 for all 14 revised recommendation statements for patients with narcolepsy. These statements comprised 3 themes: (1) recognize the risk of hypertension and cardiovascular/cardiometabolic disease, (2) reduce the risk of hypertension and cardiovascular/cardiometabolic disease, and (3) reduce sodium intake to lower the risk of hypertension and cardiovascular disease. CONCLUSIONS These consensus recommendations are intended to increase awareness of potential cardiovascular/cardiometabolic risks in patients with narcolepsy for all clinicians. Early monitoring for, and prevention of, cardiovascular risks in this population are of great importance, especially as narcolepsy usually develops in adolescents and young adults, who will be exposed to adverse effects of the disease for decades. Prospective systematic studies are needed to determine association and causation of narcolepsy with cardiovascular/cardiometabolic disorders.
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Affiliation(s)
| | | | | | - Gregg S Pressman
- Cardiovascular Diseases Fellowship Training Program Jefferson Einstein Hospital Philadelphia PA
| | | | - Lee A Surkin
- Empire Sleep Medicine and VirtuOx, Inc. New York NY
| | - Phyllis C Zee
- Center for Circadian and Sleep Medicine Northwestern University Chicago IL
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3
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Thorpy MJ, Siegel JM, Dauvilliers Y. REM sleep in narcolepsy. Sleep Med Rev 2024; 77:101976. [PMID: 39186901 DOI: 10.1016/j.smrv.2024.101976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 06/28/2024] [Accepted: 07/09/2024] [Indexed: 08/28/2024]
Abstract
Narcolepsy is mainly associated with excessive daytime sleepiness, but the characteristic feature is abnormal rapid eye movement (REM) sleep phenomena. REM sleep disturbances can manifest as cataplexy (in narcolepsy type 1), sleep paralysis, sleep-related hallucinations, REM sleep behavior disorder, abnormal dreams, polysomnographic evidence of REM sleep disruption with sleep-onset REM periods, and fragmented REM sleep. Characterization of REM sleep and related symptoms facilitates the differentiation of narcolepsy from other central hypersomnolence disorders and aids in distinguishing between narcolepsy types 1 and 2. A circuit comprising regions within the brainstem, forebrain, and hypothalamus is involved in generating and regulating REM sleep, which is influenced by changes in monoamines, acetylcholine, and neuropeptides. REM sleep is associated with brainstem functions, including autonomic control, and REM sleep disturbances may be associated with increased cardiovascular risk. Medications used to treat narcolepsy (and REM-related symptoms of narcolepsy) include stimulants/wake-promoting agents, pitolisant, oxybates, and antidepressants; hypocretin agonists are a potential new class of therapeutics. The role of REM sleep disturbances in narcolepsy remains an area of active research in pathophysiology, symptom management, and treatment. This review summarizes the current understanding of the role of REM sleep and its dysfunction in narcolepsy.
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Affiliation(s)
| | - Jerome M Siegel
- Department of Psychiatry and Brain Research Institute, University of California, Los Angeles, CA, USA; Department of Veterans Affairs, Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Yves Dauvilliers
- Sleep and Wake Disorders Centre, Department of Neurology, Gui de Chauliac Hospital, University Montpellier, INSERM INM, France
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Bigalke JA, Greenlund IM, Bigalke JR, Carter JR. Actigraphy-based sleep and muscle sympathetic nerve activity in humans. Am J Physiol Regul Integr Comp Physiol 2024; 327:R145-R151. [PMID: 38842513 DOI: 10.1152/ajpregu.00113.2024] [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] [Received: 04/26/2024] [Revised: 05/30/2024] [Accepted: 06/03/2024] [Indexed: 06/07/2024]
Abstract
Short and insufficient sleep are prevalent and associated with cardiovascular disease, with the sympathetic nervous system as a suspected mediator. The purpose of the present study was to investigate the association between objective, actigraphy-based total sleep time (TST), sleep efficiency (SE), and cardiovascular and sympathetic regulation in healthy adults. We hypothesized that short TST and low SE would be associated with elevated resting blood pressure, heart rate (HR), and muscle sympathetic nerve activity (MSNA). Participants included 94 individuals [46 males, 48 females, age: 30 ± 15 yr, body mass index (BMI): 26 ± 4 kg/m2]. All participants underwent at least 7 days of at-home, wristwatch actigraphy monitoring (avg: 10 ± 3 days). Seated blood pressures were assessed using brachial blood pressure measurements, followed by a 10-minute supine autonomic testing session consisting of continuous HR (electrocardiogram), beat-by-beat blood pressure (finger plethysmograph), and MSNA (microneurography) monitoring. Partial correlations were used to determine the relationship between sleep and cardiovascular parameters while accounting for the influence of age, sex, and BMI. TST was not associated with MAP (R = -0.105, P = 0.321), HR (R = 0.093, P = 0.383), or MSNA burst frequency (BF; R = -0.168, P = 0.112) and burst incidence (BI; R = -0.162, P = 0.124). Similarly, SE was not associated with MAP (R = -0.088, P = 0.408), HR (R = -0.118, P = 0.263), MSNA BF (R = 0.038, P = 0.723), or MSNA BI (R = 0.079, P = 0.459). In contrast to recent preliminary findings, our results do not support a significant association between actigraphy-based sleep duration or efficiency and measures of resting blood pressure, heart rate, and MSNA.NEW & NOTEWORTHY The present study investigated the independent association between actigraphy-based sleep duration, efficiency, and measures of blood pressure, heart rate, and muscle sympathetic nerve activity (MSNA) in adult males and females. Contrary to our hypothesis, the findings do not support an independent association between habitual sleep and cardiovascular or sympathetic neural activity. However, these findings do not preclude a potential association between these parameters in populations with sleep disorders and/or cardiovascular disease.
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Affiliation(s)
- Jeremy A Bigalke
- Robbins College of Health and Human Sciences, Baylor University, Waco, Texas, United States
- Department of Psychology, Montana State University, Bozeman, Montana, United States
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, Michigan, United States
| | - Ian M Greenlund
- Department of Psychology, Montana State University, Bozeman, Montana, United States
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, Michigan, United States
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Jennifer R Bigalke
- Robbins College of Health and Human Sciences, Baylor University, Waco, Texas, United States
| | - Jason R Carter
- Robbins College of Health and Human Sciences, Baylor University, Waco, Texas, United States
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, Michigan, United States
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D'agata MN, Hoopes EK, Keiser T, Patterson F, Szymanski KM, Matias AA, Brewer BC, Witman MA. Device-estimated sleep metrics do not mediate the relation between race and blood pressure dipping in young black and white women. J Clin Hypertens (Greenwich) 2024; 26:850-860. [PMID: 38923277 PMCID: PMC11232447 DOI: 10.1111/jch.14856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/01/2024] [Accepted: 05/17/2024] [Indexed: 06/28/2024]
Abstract
Short, disturbed, and irregular sleep may contribute to blunted nocturnal blood pressure (BP) dipping, a predictor of cardiovascular disease. Black women (BLW) demonstrate less BP dipping and poorer sleep health than White women (WHW). However, it remains unclear whether device-estimated sleep health metrics mediate the relation between race and BP dipping in young women. We hypothesized that the relation between race and BP dipping would be partly mediated by sleep health metrics of sleep duration, sleep efficiency, and sleep regularity. Participants (20 BLW, 17 WHW) were 18-29 years old, normotensive, nonobese, and without evidence of sleep disorders. Systolic and diastolic BP dipping were derived from 24-h ambulatory BP monitoring. Habitual sleep duration and sleep efficiency were estimated via 14 days of wrist actigraphy. Sleep duration regularity was calculated as the standard deviation (SD) of nightly sleep duration (SDSD). Sleep timing regularity metrics were calculated as the SD of sleep onset and sleep midpoint (SMSD). Mediation analysis tested the mediating effect of each sleep metric on the relation between race and BP dipping. BLW experienced less systolic (P = .02) and diastolic (P = .01) BP dipping. Sleep duration (P = .14) was not different between groups. BLW had lower sleep efficiency (P < .01) and higher SDSD (P = .02), sleep onset SD (P < .01) and SMSD (P = .01). No sleep metrics mediated the relation between race and BP dipping (all indirect effects P > .38). In conclusion, mediation pathways of sleep health metrics do not explain racial differences in nocturnal BP dipping between young BLW and WHW.
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Affiliation(s)
- Michele N. D'agata
- Department of Kinesiology and Applied PhysiologyCollege of Health SciencesUniversity of DelawareNewarkDelawareUSA
| | - Elissa K. Hoopes
- Department of Health Behavior and Nutrition SciencesCollege of Health SciencesUniversity of DelawareNewarkDelawareUSA
| | - Thomas Keiser
- Department of Health Behavior and Nutrition SciencesCollege of Health SciencesUniversity of DelawareNewarkDelawareUSA
| | - Freda Patterson
- Department of Health Behavior and Nutrition SciencesCollege of Health SciencesUniversity of DelawareNewarkDelawareUSA
| | - Krista M. Szymanski
- Department of Kinesiology and Applied PhysiologyCollege of Health SciencesUniversity of DelawareNewarkDelawareUSA
| | - Alexs A. Matias
- Department of Kinesiology and Applied PhysiologyCollege of Health SciencesUniversity of DelawareNewarkDelawareUSA
| | - Benjamin C. Brewer
- Department of EpidemiologyCollege of Health SciencesUniversity of DelawareNewarkDelawareUSA
| | - Melissa A. Witman
- Department of Kinesiology and Applied PhysiologyCollege of Health SciencesUniversity of DelawareNewarkDelawareUSA
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Jaspan VN, Greenberg GS, Parihar S, Park CM, Somers VK, Shapiro MD, Lavie CJ, Virani SS, Slipczuk L. The Role of Sleep in Cardiovascular Disease. Curr Atheroscler Rep 2024; 26:249-262. [PMID: 38795275 PMCID: PMC11192677 DOI: 10.1007/s11883-024-01207-5] [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] [Accepted: 05/01/2024] [Indexed: 05/27/2024]
Abstract
PURPOSE OF REVIEW Sleep is an important component of cardiovascular (CV) health. This review summarizes the complex relationship between sleep and CV disease (CVD). Additionally, we describe the data supporting the treatment of sleep disturbances in preventing and treating CVD. RECENT FINDINGS Recent guidelines recommend screening for obstructive sleep apnea in patients with atrial fibrillation. New data continues to demonstrate the importance of sleep quality and duration for CV health. There is a complex bidirectional relationship between sleep health and CVD. Sleep disturbances have systemic effects that contribute to the development of CVD, including hypertension, coronary artery disease, heart failure, and arrhythmias. Additionally, CVD contributes to the development of sleep disturbances. However, more data are needed to support the role of screening for and treatment of sleep disorders for the prevention of CVD.
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Affiliation(s)
- Vita N Jaspan
- Division of Cardiology, Montefiore Health System/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Garred S Greenberg
- Division of Cardiology, Montefiore Health System/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Siddhant Parihar
- Division of Cardiology, Montefiore Health System/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Christine M Park
- Division of Cardiology, Montefiore Health System/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Virend K Somers
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Michael D Shapiro
- Center for Preventive Cardiology, Section On Cardiovascular Medicine, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | - Carl J Lavie
- Ochsner Clinical School, John Ochsner Heart and Vascular Institute, The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Salim S Virani
- Office of the Vice Provost (Research), The Aga Khan University, Karachi, Pakistan
- Division of Cardiology, The Texas Heart Institute/Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA
| | - Leandro Slipczuk
- Division of Cardiology, Montefiore Health System/Albert Einstein College of Medicine, Bronx, NY, USA.
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7
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Knowles OE, Soria M, Saner NJ, Trewin AJ, Alexander SE, Roberts SSH, Hiam D, Garnham AP, Drinkwater EJ, Aisbett B, Lamon S. The interactive effect of sustained sleep restriction and resistance exercise on skeletal muscle transcriptomics in young females. Physiol Genomics 2024; 56:506-518. [PMID: 38766755 DOI: 10.1152/physiolgenomics.00010.2024] [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: 01/30/2024] [Revised: 05/03/2024] [Accepted: 05/09/2024] [Indexed: 05/22/2024] Open
Abstract
Both sleep loss and exercise regulate gene expression in skeletal muscle, yet little is known about how the interaction of these stressors affects the transcriptome. The aim of this study was to investigate the effect of nine nights of sleep restriction (SR), with repeated resistance exercise (REx) sessions, on the skeletal muscle transcriptome of young, trained females. Ten healthy females aged 18-35 yr old undertook a randomized cross-over study of nine nights of SR (5 h time in bed) and normal sleep (NS; ≥7 h time in bed) with a minimum 6-wk washout. Participants completed four REx sessions per condition (days 3, 5, 7, and 9). Muscle biopsies were collected both pre- and post-REx on days 3 and 9. Gene and protein expression were assessed by RNA sequencing and Western blot, respectively. Three or nine nights of SR had no effect on the muscle transcriptome independently of exercise. However, close to 3,000 transcripts were differentially regulated (false discovery rate < 0.05) 48 h after the completion of three resistance exercise sessions in both NS and SR conditions. Only 39% of downregulated genes and 18% of upregulated genes were common between both conditions, indicating a moderating effect of SR on the response to exercise. SR and REx interacted to alter the enrichment of skeletal muscle transcriptomic pathways in young, resistance-trained females. Performing exercise when sleep restricted may not provide the same adaptive response for individuals as if they were fully rested.NEW & NOTEWORTHY This study investigated the effect of nine nights of sleep restriction, with repeated resistance exercise sessions, on the skeletal muscle transcriptome of young, trained females. Sleep restriction and resistance exercise interacted to alter the enrichment of skeletal muscle transcriptomic pathways in young, resistance-trained females. Performing exercise when sleep restricted may not provide the same adaptive response for individuals as if they were fully rested.
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Affiliation(s)
- Olivia E Knowles
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Megan Soria
- School of Life and Environmental Sciences, Deakin University, Geelong, Victoria, Australia
| | - Nicholas J Saner
- Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia
| | - Adam J Trewin
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Sarah E Alexander
- Cardiometabolic Health and Exercise Physiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Spencer S H Roberts
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Danielle Hiam
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Andrew P Garnham
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Eric J Drinkwater
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Brad Aisbett
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Séverine Lamon
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
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Wright ID, Jensen CD, Duraccio KM. Predictors of adherence to a brief sleep extension protocol in emerging adults. J Pediatr Psychol 2024; 49:442-447. [PMID: 38578604 DOI: 10.1093/jpepsy/jsae025] [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: 07/14/2023] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 04/06/2024] Open
Abstract
OBJECTIVES This study examined how mental health symptoms (i.e., depression, anxiety, stress) and baseline sleep characteristics (i.e., sleep quality and levels of daytime sleepiness) predicted adherence to and initial success of a brief sleep extension research protocol in emerging adults. METHODS 184 emerging adults (ages 18-25; M = 20.96, SD = 2.04) were asked to extend their nightly sleep opportunity to 8 hr for 1 week and to anchor bedtime and waketime. Sleep outcomes (adherence and initial protocol success) were tracked using actigraphy. Baseline sleep quality, daytime sleepiness, depression, anxiety, and stress were assessed using self-report questionnaires. RESULTS Poorer baseline sleep quality predicted better adherence to the protocol (p = .002). Other baseline sleep characteristics and mental health were not predictive of adherence (ps>.50). Lower levels of baseline daytime sleepiness approached significance in predicting greater initial protocol success following the protocol (p = .05). Baseline sleep quality and mental health did not predict initial protocol success (ps > 0.34). CONCLUSIONS Mental health symptoms did not significantly predict adherence to or the success of a sleep extension protocol. Surprisingly, individuals with poor baseline sleep quality were more likely to adhere to the extension protocol, perhaps suggesting heightened motivation for change or increased risk for sleep problems. This research provides valuable insight into factors that predict adherence to sleep extension protocols in emerging adults.
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Affiliation(s)
- Isabella D Wright
- Department of Psychology, Brigham Young University, Provo, UT, United States
| | - Chad D Jensen
- Department of Psychology, Brigham Young University, Provo, UT, United States
| | - Kara M Duraccio
- Department of Psychology, Brigham Young University, Provo, UT, United States
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Pala B, Pennazzi L, Nardoianni G, Fogacci F, Cicero AFG, Di Renzo L, Barbato E, Tocci G. Gut Microbiota Dysbiosis and Sleep Disorders: Culprit in Cardiovascular Diseases. J Clin Med 2024; 13:3254. [PMID: 38892965 PMCID: PMC11173264 DOI: 10.3390/jcm13113254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 05/25/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Over the past decade, the gut microbiome (GM) has progressively demonstrated to have a central role in human metabolism, immunity, and cardiometabolic risk. Likewise, sleep disorders showed an impact on individual health and cardiometabolic risk. Recent studies seem to suggest multi-directional relations among GM, diet, sleep, and cardiometabolic risk, though specific interactions are not fully elucidated. We conducted a systematic review to synthesize the currently available evidence on the potential interactions between sleep and GM and their possible implications on cardiometabolic risk. Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for reporting systematic reviews and meta-analyses, including articles from January 2016 until November 2022. Narrative syntheses were employed to describe the results. Results: A total of 8 studies were selected according to these criteria. Our findings indicated that the sleep disorder and/or the acute circadian rhythm disturbance caused by sleep-wake shifts affected the human GM, mainly throughout microbial functionality. Conclusions: Sleep disorders should be viewed as cardiovascular risk factors and targeted for preventive intervention. More research and well-designed studies are needed to completely assess the role of sleep deprivation in the multi-directional relationship between GM and cardiometabolic risk.
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Affiliation(s)
- Barbara Pala
- Division of Cardiology, Department of Clinical and Molecular Medicine, University of Rome Sapienza, Sant’Andrea Hospital, 00189 Rome, Italy (G.N.); (E.B.)
| | - Laura Pennazzi
- Department of Obstetric Sciences, Faculty of Medicine and Surgery, Catholic University Sacro Cuore, 00168 Rome, Italy
| | - Giulia Nardoianni
- Division of Cardiology, Department of Clinical and Molecular Medicine, University of Rome Sapienza, Sant’Andrea Hospital, 00189 Rome, Italy (G.N.); (E.B.)
| | - Federica Fogacci
- Hypertension and Cardiovascular Risk Research Group, Medical and Surgical Sciences Department, University of Bologna, Sant’Orsola-Malpighi Hospital, 4013 Bologna, Italy (A.F.G.C.)
| | - Arrigo F. G. Cicero
- Hypertension and Cardiovascular Risk Research Group, Medical and Surgical Sciences Department, University of Bologna, Sant’Orsola-Malpighi Hospital, 4013 Bologna, Italy (A.F.G.C.)
- Cardiovascular Medicine Unit, IRCCS AOUBO, 40138 Bologna, Italy
| | - Laura Di Renzo
- Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy;
- School of Specialization in Food Science, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Emanuele Barbato
- Division of Cardiology, Department of Clinical and Molecular Medicine, University of Rome Sapienza, Sant’Andrea Hospital, 00189 Rome, Italy (G.N.); (E.B.)
| | - Giuliano Tocci
- Division of Cardiology, Department of Clinical and Molecular Medicine, University of Rome Sapienza, Sant’Andrea Hospital, 00189 Rome, Italy (G.N.); (E.B.)
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Najafabadi MM, Angoorani H, Charest J, Samuels CH, Bagherzadeh K, Nazari A, Mazaherinezhad A. The validity and reliability of the Persian version of the Athlete Sleep Screening Questionnaire. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2024; 29:1. [PMID: 38524740 PMCID: PMC10956700 DOI: 10.4103/jrms.jrms_246_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/20/2023] [Accepted: 09/26/2023] [Indexed: 03/26/2024]
Abstract
Background Sleep as a biological phenomenon is effective in the performance and recovery of athletes. Questionnaires can be used as a cost-effective initial assessment tool for sleep. The Athlete Sleep Screening Questionnaire (ASSQ) demonstrated a clinically valid instrument for screening relevant sleep issues in athletic populations. Due to the lack of validated tools for adequate screening for sleep difficulties in the Iranian athlete population, the present study was conducted to evaluate the validity and reliability of the Persian version of the ASSQ. Materials and Methods The translation process was performed using instructions by Beaton et al. Content validity was assessed by a panel of experts. Exploratory and confirmatory factor analysis was performed for two 5-item sleep difficulty scores (SDS) and a 4-item chronotype score. Internal consistency based on Cronbach's alpha and McDonald's omega and stability reliability were used to evaluate reliability. Results The ASSQ achieved conceptual and semantic equivalence with the original scale. The item-level content validity index (I-CVI) of each item ranged from 0.87 to 1, and the averaging scale-level CVI/average was 0.95. In factor analysis, one factor for SDS and one factor for chronotype score were identified and confirmed. The internal consistency of the SDS scale (α =0.77, Ω =0.83) and chronotype (α =0.74, Ω =0.77) was acceptable. Stability reliability was confirmed for SDS scale (intra-class correlation [ICC] =0.87) and for chronotype (ICC = 0.83). Conclusion Persian ASSQ has acceptable psychometric measurement properties as a screening tool to assess sleep in Iranian athletes.
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Affiliation(s)
- Mohammad Mandegar Najafabadi
- Department of Sports and Exercise Medicine, School of Medicine, Hazrat-e Rasool General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Hooman Angoorani
- Department of Sports and Exercise Medicine, School of Medicine, Hazrat-e Rasool General Hospital, Iran University of Medical Sciences, Tehran, Iran
- Iran Football Medical Assessment and Rehabilitation Center (IFMARC), FIFA Medical Centre of Excellence, Tehran, Iran
| | - Jonathan Charest
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Centre for Sleep & Human Performance, Calgary, Alberta, Canada
| | | | - Kiana Bagherzadeh
- Department of Motor Behavior and Sports Psychology, University of Tehran, Tehran, Iran
| | - Ahmad Nazari
- Department of Sports and Exercise Medicine, School of Medicine, Hazrat-e Rasool General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Mazaherinezhad
- Department of Sports and Exercise Medicine, School of Medicine, Hazrat-e Rasool General Hospital, Iran University of Medical Sciences, Tehran, Iran
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
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11
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Duraccio KM, Kamhout S, Baron KG, Reutrakul S, Depner CM. Sleep extension and cardiometabolic health: what it is, possible mechanisms and real-world applications. J Physiol 2024:10.1113/JP284911. [PMID: 38268197 PMCID: PMC11266528 DOI: 10.1113/jp284911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/08/2024] [Indexed: 01/26/2024] Open
Abstract
Short sleep duration is associated with heightened cardiometabolic disease risk and has reached epidemic proportions among children, adolescents and adults. Potential mechanisms underlying this association are complex and multifaceted, including disturbances in circadian timing, food intake and appetitive hormones, brain regions linked to control of hedonic eating, physical activity, an altered microbiome and impaired insulin sensitivity. Sleep extension, or increasing total sleep duration, is an emerging and ecologically relevant intervention with significant potential to advance our understanding of the mechanisms underlying the association between short sleep duration and the risk of cardiometabolic disease. If effective, sleep extension interventions have potential to improve cardiometabolic health across the lifespan. Existing data show that sleep extension is feasible and might have potential cardiometabolic health benefits, although there are limitations that the field must overcome. Notably, most existing studies are short term (2-8 weeks), use different sleep extension strategies, analyse a wide array of cardiometabolic health outcomes in different populations and, frequently, lack adequate statistical power, thus limiting robust scientific conclusions. Overcoming these limitations will require fully powered, randomized studies conducted in people with habitual short sleep duration and existing cardiometabolic risk factors. Additionally, randomized controlled trials comparing different sleep extension strategies are essential to determine the most effective interventions. Ongoing and future research should focus on elucidating the potential cardiometabolic health benefits of sleep extension. Such studies have high potential to generate crucial knowledge with potential to improve health and quality of life for those struggling with short sleep duration.
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Affiliation(s)
- Kara M. Duraccio
- Department of Psychology, Brigham Young University, Provo, Utah, USA
| | - Sarah Kamhout
- Department of Psychology, Brigham Young University, Provo, Utah, USA
| | - Kelly G. Baron
- Division of Public Health, Department of Family and Preventative Medicine, University of Utah, Salt Lake City, 84112, USA
| | - Sirimon Reutrakul
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine; and Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
| | - Christopher M. Depner
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, 84112, USA
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12
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Zhang J, Chen L, Zhang S, Cai M, Zou H, Vaughn MG, Tabet M, Qian Z(M, Lin H. Associations of Sleep Patterns With Dynamic Trajectory of Cardiovascular Multimorbidity and Mortality: A Multistate Analysis of a Large Cohort. J Am Heart Assoc 2023; 12:e029463. [PMID: 37776189 PMCID: PMC10727256 DOI: 10.1161/jaha.123.029463] [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: 01/10/2023] [Accepted: 07/11/2023] [Indexed: 10/02/2023]
Abstract
Background The purpose of this study was to explore the association of sleep patterns with the development of first cardiovascular diseases (FCVD), progression to cardiovascular multimorbidity (CVM), and subsequently to mortality. Methods and Results This prospective study included 381 179 participants without coronary heart disease, stroke, atrial fibrillation, or heart failure at baseline, and they were followed up until March 31, 2021. We generated sleep patterns by summing the scores for 5 sleep behaviors, whereby <7 or >8 hours/d of sleep, evening chronotype, frequent insomnia, snoring, and daytime dozing were defined as high-risk groups. We used a multistate model to estimate the impacts of sleep patterns on the dynamic progression of cardiovascular diseases. Over a median follow-up of 12.1 years, 41 910 participants developed FCVD, 7302 further developed CVM, and 20 707 died. We found that adverse sleep patterns were significantly associated with the transition from health to FCVD, from FCVD to CVM, and from health to death, with hazard ratio associated with 1-factor increase in sleep scores being 1.08 (95% CI, 1.07-1.09), 1.04 (95% CI, 1.02-1.06), and 1.04 (95% CI, 1.02-1.05), respectively. When further dividing FCVD into coronary heart disease, stroke, atrial fibrillation, and heart failure, adverse sleep patterns showed a significant and persistent effect on the transition from health to each cardiovascular disease, and from heart failure or atrial fibrillation to CVM. Conclusions Our study provides evidence that adverse sleep patterns might increase the risk for the progression from health to cardiovascular diseases and further to CVM. Our findings suggest that improving sleep behaviors might be helpful for the primary and secondary prevention of cardiovascular diseases.
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Affiliation(s)
- Jingyi Zhang
- Department of Epidemiology, School of Public HealthSun Yat‐sen UniversityGuangzhouChina
| | - Lan Chen
- Department of Epidemiology, School of Public HealthSun Yat‐sen UniversityGuangzhouChina
| | - Shiyu Zhang
- Department of Epidemiology, School of Public HealthSun Yat‐sen UniversityGuangzhouChina
| | - Miao Cai
- Department of Epidemiology, School of Public HealthSun Yat‐sen UniversityGuangzhouChina
| | - Hongtao Zou
- Department of Epidemiology, School of Public HealthSun Yat‐sen UniversityGuangzhouChina
| | - Michael G. Vaughn
- School of Social WorkCollege for Public Health & Social Justice, Saint Louis UniversitySaint LouisMO
| | - Maya Tabet
- College of Global Population Health, University of Health Sciences and Pharmacy in St. LouisSaint LouisMO
| | - Zhengmin (Min) Qian
- Department of Epidemiology and BiostatisticsCollege for Public Health & Social Justice, Saint Louis UniversitySaint LouisMO
| | - Hualiang Lin
- Department of Epidemiology, School of Public HealthSun Yat‐sen UniversityGuangzhouChina
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13
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Reichenberger DA, Ness KM, Strayer SM, Mathew GM, Schade MM, Buxton OM, Chang AM. Recovery Sleep After Sleep Restriction Is Insufficient to Return Elevated Daytime Heart Rate and Systolic Blood Pressure to Baseline Levels. Psychosom Med 2023; 85:744-751. [PMID: 37363991 PMCID: PMC10543608 DOI: 10.1097/psy.0000000000001229] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
OBJECTIVE Sleep restriction alters daytime cardiac activity, including elevating heart rate (HR) and blood pressure (BP). There is minimal research on the cumulative effects of sleep loss and the response after subsequent recovery sleep on HR and BP. This study examined patterns of HR and BP across baseline, sleep restriction, and recovery conditions using multiple daytime cardiac measurements. METHODS Participants (15 healthy men, mean [standard deviation] = 22.3 [2.8] years) completed an 11-day inpatient protocol with three nights of 10 hours/night baseline sleep opportunity, five sleep restriction nights (5-hour/night sleep opportunity), and two recovery nights (10-hour/night sleep opportunity). Resting HR and BP were measured every 2 hours during wake. Multilevel models with random effects for individuals examined daytime HR and BP across study conditions and days into the study. RESULTS Mean daytime HR was 1.2 (0.5) beats/min lower during sleep restriction compared with baseline ( p < .001). During recovery, HR was 5.5 (1.0) beats/min higher ( p < .001), and systolic BP (SBP) was 2.9 (1.1) mm Hg higher ( p = .009). When accounting for days into the study (irrespective of condition) and measurement timing across the day, HR increased by 7.6 beats/min and SBP increased by 3.4 mm Hg across the study period ( p < .001). CONCLUSIONS Our findings suggest that daytime HR and SBP increase after successive nights of sleep restriction, even after accounting for measurement time of day. HR and SBP did not recover to baseline levels after two recovery nights of sleep, suggesting that longer recovery sleep may be necessary to recover from multiple, consecutive nights of moderate sleep restriction.
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Affiliation(s)
| | - Kelly M. Ness
- Department of Medicine, Division of Metabolism, Endocrinology, and Nutrition, University of Washington
| | | | - Gina Marie Mathew
- Program in Public Health; Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, United States
| | | | - Orfeu M. Buxton
- Department of Biobehavioral Health, Pennsylvania State University
| | - Anne-Marie Chang
- Department of Biobehavioral Health, Pennsylvania State University
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14
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Maloney A, Mengesteab S, Kallas N, Bennett M, Kanaley JA. Sleep restriction by sleep timing late night or early wake: The impact on physical activity and dietary intake in adults. Appetite 2023; 189:106996. [PMID: 37544330 DOI: 10.1016/j.appet.2023.106996] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 08/08/2023]
Abstract
PURPOSE To date, few studies have assessed whether the timing of sleep restriction impacts physical activity and energy intake patterns. Thus, we aimed to quantify physical activity and energy intake during an early wake (EW) and late sleep (LS) period. METHODS Fourteen participants who met the inclusion criteria (sleep 7-9 h/night and a BMI of <40 kg/m2) participated in 3 crossover free-living conditions: normal sleep (NS, 7-9 h), EW (2-h early wake-time), and LS (2-h late to sleep) for 4 nights. Sleep duration (via Actiwatch), energy intake (via food diaries), and physical activity (via hip accelerometry) were recorded for 4 days/4 nights throughout each condition. RESULTS Sleep duration was reduced in both sleep restriction conditions compared to NS (p < 0.001) with no difference between sleep restriction conditions. Daily energy intake tended to increase in the LS condition (p = 0.056) but was unchanged during EW (p = 0.56). Fat (p = 0.031) and sodium (p = 0.039) intake were increased in the LS condition only compared to NS. During the EW condition, fat (p = 0.24) and sodium (p = 0.18) intake were not altered. No changes in carbohydrate or protein intake occurred between conditions. Daily steps tended to increase in the EW condition compared to NS (p = 0.058), while steps during the LS condition were unchanged (p = 0.28), with no differences between sleep restriction conditions. CONCLUSION The timing of sleep curtailment differentially influences physical activity and EI the following day, such that EW results in increased physical activity, while LS leads to poorer dietary choices.
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Affiliation(s)
- Alan Maloney
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO, USA
| | - Senay Mengesteab
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO, USA
| | - Nadine Kallas
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO, USA
| | - Maura Bennett
- Department of Exercise Science, Northern Kentucky University, USA
| | - Jill A Kanaley
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO, USA.
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15
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Shah R, Shah VK, Emin M, Gao S, Sampogna RV, Aggarwal B, Chang A, St-Onge MP, Malik V, Wang J, Wei Y, Jelic S. Mild sleep restriction increases endothelial oxidative stress in female persons. Sci Rep 2023; 13:15360. [PMID: 37717072 PMCID: PMC10505226 DOI: 10.1038/s41598-023-42758-y] [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] [Received: 02/13/2023] [Accepted: 09/14/2023] [Indexed: 09/18/2023] Open
Abstract
Sleep restriction is associated with increased cardiovascular risk, which is more pronounced in female than male persons. We reported recently first causal evidence that mild, prolonged sleep restriction mimicking "real-life" conditions impairs endothelial function, a key step in the development and progression of cardiovascular disease, in healthy female persons. However, the underlying mechanisms are unclear. In model organisms, sleep restriction increases oxidative stress and upregulates antioxidant response via induction of the antioxidant regulator nuclear factor (erythroid-derived 2)-like 2 (Nrf2). Here, we assessed directly endothelial cell oxidative stress and antioxidant responses in healthy female persons (n = 35) after 6 weeks of mild sleep restriction (1.5 h less than habitual sleep) using randomized crossover design. Sleep restriction markedly increased endothelial oxidative stress without upregulating antioxidant response. Using RNA-seq and a predicted protein-protein interaction database, we identified reduced expression of endothelial Defective in Cullin Neddylation-1 Domain Containing 3 (DCUN1D3), a protein that licenses Nrf2 antioxidant responses, as a mediator of impaired endothelial antioxidant response in sleep restriction. Thus, sleep restriction impairs clearance of endothelial oxidative stress that over time increases cardiovascular risk.Trial Registration: NCT02835261 .
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Affiliation(s)
- Riddhi Shah
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Vikash Kumar Shah
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Memet Emin
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Su Gao
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Rosemary V Sampogna
- Division of Nephrology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Brooke Aggarwal
- Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Audrey Chang
- NewYork-Presbyterian Morgan Stanley Children's Hospital, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Marie-Pierre St-Onge
- Division of General Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Vikas Malik
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Columbia Center for Human Development and Columbia Stem Cell Initiative, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Jianlong Wang
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Columbia Center for Human Development and Columbia Stem Cell Initiative, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Ying Wei
- Division of Biostatistics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Sanja Jelic
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
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16
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Bock JM, Greenlund IM, Somers VK, Baker SE. Sex Differences in Neurovascular Control: Implications for Obstructive Sleep Apnea. Int J Mol Sci 2023; 24:13094. [PMID: 37685900 PMCID: PMC10487948 DOI: 10.3390/ijms241713094] [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] [Received: 07/11/2023] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 09/10/2023] Open
Abstract
Patients with obstructive sleep apnea (OSA) have a heightened risk of developing cardiovascular diseases, namely hypertension. While seminal evidence indicates a causal role for sympathetic nerve activity in the hypertensive phenotype commonly observed in patients with OSA, no studies have investigated potential sex differences in the sympathetic regulation of blood pressure in this population. Supporting this exploration are large-scale observational data, as well as controlled interventional studies in healthy adults, indicating that sleep disruption increases blood pressure to a greater extent in females relative to males. Furthermore, females with severe OSA demonstrate a more pronounced hypoxic burden (i.e., disease severity) during rapid eye movement sleep when sympathetic nerve activity is greatest. These findings would suggest that females are at greater risk for the hemodynamic consequences of OSA and related sleep disruption. Accordingly, the purpose of this review is three-fold: (1) to review the literature linking sympathetic nerve activity to hypertension in OSA, (2) to highlight recent experimental data supporting the hypothesis of sex differences in the regulation of sympathetic nerve activity in OSA, and (3) to discuss the potential sex differences in peripheral adrenergic signaling that may contribute to, or offset, cardiovascular risk in patients with OSA.
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Affiliation(s)
- Joshua M. Bock
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55901, USA; (J.M.B.)
| | - Ian M. Greenlund
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55901, USA; (J.M.B.)
| | - Virend K. Somers
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55901, USA; (J.M.B.)
| | - Sarah E. Baker
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN 55901, USA
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17
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Greenlund IM, Covassin N, Somers VK. Hitting the Snooze Button on Chronic Kidney Disease. Am J Nephrol 2023; 54:245-248. [PMID: 37343535 DOI: 10.1159/000531625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/07/2023] [Indexed: 06/23/2023]
Affiliation(s)
- Ian M Greenlund
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Naima Covassin
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Virend K Somers
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA,
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18
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Barochiner J, Díaz RR, Martínez R. Prevalence and Characteristics of Isolated Nocturnal Hypertension and Masked Nocturnal Hypertension in a Tertiary Hospital in the City of Buenos Aires. Diagnostics (Basel) 2023; 13:1419. [PMID: 37189519 PMCID: PMC10138072 DOI: 10.3390/diagnostics13081419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/09/2023] [Accepted: 04/10/2023] [Indexed: 05/17/2023] Open
Abstract
Isolated nocturnal hypertension (INH) and masked nocturnal hypertension (MNH) increase cardiovascular risk. Their prevalence and characteristics are not clearly established and seem to differ among populations. We aimed to determine the prevalence and associated characteristics of INH and MNH in a tertiary hospital in the city of Buenos Aires. We included 958 hypertensive patients ≥ 18 years who underwent an ambulatory blood pressure monitoring (ABPM) between October and November 2022, as prescribed by their treating physician to diagnose or to assess hypertension control. INH was defined as nighttime BP ≥ 120 mmHg systolic or ≥70 diastolic in the presence of normal daytime BP (<135/85 mmHg regardless of office BP; MNH was defined as the presence of INH with office BP < 140/90 mmHg). Variables associated with INH and MNH were analyzed. The prevalences of INH and MNH were 15.7% (95% CI 13.5-18.2%) and 9.7 (95% CI 7.9-11.8%), respectively. Age, male sex, and ambulatory heart rate were positively associated with INH, whereas office BP, total cholesterol, and smoking habits showed a negative association. In turn, diabetes and nighttime heart rate were positively associated with MNH. In conclusion, INH and MNH are frequent entities, and determination of clinical characteristics such as those detected in this study is critical since this might contribute to a more appropriate use of resources.
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Affiliation(s)
- Jessica Barochiner
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199, Argentina; (R.R.D.); (R.M.)
- Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB), UE de Triple Dependencia CONICET-Instituto Universitario del Hospital Italiano (IUHI)-Hospital Italiano (HIBA), Buenos Aires C1199, Argentina
| | - Romina R. Díaz
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199, Argentina; (R.R.D.); (R.M.)
| | - Rocío Martínez
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199, Argentina; (R.R.D.); (R.M.)
- Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB), UE de Triple Dependencia CONICET-Instituto Universitario del Hospital Italiano (IUHI)-Hospital Italiano (HIBA), Buenos Aires C1199, Argentina
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19
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Cao Y, Li M, Gu L, Zhao X, Zhou A, Miao Y, Wu Y, Ke Z, Hu R, Wang Z, Wu X. Chinese traditional formula Kaixin San suppressed ferroptosis of hippocampal neurons and cardiomyocytes in mice with paradoxical sleep deprivation. JOURNAL OF ETHNOPHARMACOLOGY 2023; 304:116034. [PMID: 36529245 DOI: 10.1016/j.jep.2022.116034] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 12/01/2022] [Accepted: 12/04/2022] [Indexed: 06/17/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Kaixin San (KXS) is one of the most famous traditional Chinese formulas prescribed by Sun Simiao in 652 Christian era. It is composed of Panax ginseng C.A.Mey, Polygala tenuifolia, Poria cocos and Acorus calamus var. angustatus Besser. KXS is widely used for the treatment of emotion-thought disease, such as settling fright, quieting the spirit and nourishing the heart. However, whether KXS benefits hippocampal neurons and myocardial cells of mice impaired by paradoxical sleep deprivation (PSD) and its mechanism remains unclear. AIM OF THE STUDY This study was aimed to investigate the effect of KXS on hippocampal neuron and cardiac ferroptosis in rapid-eye-movement (REM) sleep deprived mice and clarify its potential mechanism. MATERIALS AND METHODS PSD was induced by a modified multi-platform method. Morris water maze (MWM) was used to detect the ability of learning and memory. Cardiac morphological changes were assessed by hematoxylin and eosin (HE) staining. Heart rate was detected by a PowerLab multichannel physiological recorder. Serum levels of atrial natriuretic peptide (ANP) and lactate dehydrogenase (LDH) were measured with biochemical kits. Transmission electron microscopy (TEM), immunofluorescent, and Western blotting analysis were used to observe the process and pathway of ferrotosis in hippocampus tissue and heart tissue of PSD mice. RESULTS KXS administration improved the impaired learning and memory of PSD mice. It prevented the damage of mitochondria in the hippocampus and heart of PSD mice. KXS also alleviated the myocardial injury, such as morphological damage, abnormal heart rate, serum ANP, and serum LDH induced by PSD. Further study disclosed that KXS reversed the expressions of proteins involved in ferroptosis such as TFRC, SLC7A11/xCT, GPX-4, ACSL4, and FTH1 in hippocampus and heart tissues. CONCLUSIONS KXS improved learning and memory of mice with REM sleep deprivation, which was closely associated with suppressed ferroptosis in hippocampal neurons and myocardiocytes.
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Affiliation(s)
- Yin Cao
- Key Laboratory of Xin'an Medicine, Ministry of Education, Anhui Province Key Laboratory of R&D of Chinese Medicine, Anhui University of Chinese Medicine, Hefei, 230038, China
| | - Mingrui Li
- Key Laboratory of Xin'an Medicine, Ministry of Education, Anhui Province Key Laboratory of R&D of Chinese Medicine, Anhui University of Chinese Medicine, Hefei, 230038, China
| | - Lihua Gu
- Shanghai Key Laboratory of Compound Chinese Medicines, The Ministry of Education (MOE) Key Laboratory for Standardization of Chinese Medicines, The Sate Administration of TCM (SATCM) Key Laboratory for New Resources and Quality Evaluation of Chinese Medicine, Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Xin Zhao
- Shanghai Key Laboratory of Compound Chinese Medicines, The Ministry of Education (MOE) Key Laboratory for Standardization of Chinese Medicines, The Sate Administration of TCM (SATCM) Key Laboratory for New Resources and Quality Evaluation of Chinese Medicine, Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - An Zhou
- Key Laboratory of Xin'an Medicine, Ministry of Education, Anhui Province Key Laboratory of R&D of Chinese Medicine, Anhui University of Chinese Medicine, Hefei, 230038, China
| | - Yuping Miao
- Key Laboratory of Xin'an Medicine, Ministry of Education, Anhui Province Key Laboratory of R&D of Chinese Medicine, Anhui University of Chinese Medicine, Hefei, 230038, China
| | - Yi Wu
- Key Laboratory of Xin'an Medicine, Ministry of Education, Anhui Province Key Laboratory of R&D of Chinese Medicine, Anhui University of Chinese Medicine, Hefei, 230038, China
| | - Zunji Ke
- Academy of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Rongfeng Hu
- Key Laboratory of Xin'an Medicine, Ministry of Education, Anhui Province Key Laboratory of R&D of Chinese Medicine, Anhui University of Chinese Medicine, Hefei, 230038, China.
| | - Zhengtao Wang
- Shanghai Key Laboratory of Compound Chinese Medicines, The Ministry of Education (MOE) Key Laboratory for Standardization of Chinese Medicines, The Sate Administration of TCM (SATCM) Key Laboratory for New Resources and Quality Evaluation of Chinese Medicine, Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
| | - Xiaojun Wu
- Shanghai Key Laboratory of Compound Chinese Medicines, The Ministry of Education (MOE) Key Laboratory for Standardization of Chinese Medicines, The Sate Administration of TCM (SATCM) Key Laboratory for New Resources and Quality Evaluation of Chinese Medicine, Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
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20
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Rozanski A, Sakul S, Narula J, Berman D. Assessment of lifestyle "vital signs" in healthcare settings. Prog Cardiovasc Dis 2023; 77:107-118. [PMID: 36848965 DOI: 10.1016/j.pcad.2023.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 02/20/2023] [Indexed: 02/27/2023]
Abstract
Unhealthy lifestyles, such as maintenance of poor diets and physical inactivity, are a powerful driver of disease-producing risk factors and chronic illnesses. This has led to an increasing call to assess adverse lifestyle factors in healthcare settings. This approach could be aided by designating health-related lifestyle factors as "vital signs" that can be recorded during patient visits. Just such an approach has been used for assessing patients' smoking habits since the 1990s. In this review, we assess the rationale for addressing six other health-related lifestyle factors, beyond smoking, in patient care settings: physical activity (PA), sedentary behavior (SB), participation in muscle strengthening exercises, mobility limitations, diet, and sleep quality. For each domain, we evaluate the evidence that supports currently proposed ultra-short screening tools. Our analysis indicates strong medical evidence to support the use of one to two-item screening questions for assessing patients' PA, SB, muscle strengthening activities, and presence of "pre-clinical" mobility limitations. We also present a theoretical basis for measuring patients' diet quality through use of an ultrashort dietary screen, based on evaluation of healthy food intake (fruits/vegetables) and unhealthy food intake (high consumption of highly processed meats and/or consumption of sugary foods and beverages) and a proposed evaluation of sleep quality using a single-item screener. The result is a 10-item lifestyle questionnaire that is based on patient self-report. As such, this questionnaire has the potential to be employed as a practical tool for assessing health behaviors in clinical care settings without impairing the normal workflow of healthcare providers.
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Affiliation(s)
- Alan Rozanski
- Division of Cardiology, Mount Sinai Morningside Hospital, Mount Sinai Heart, and the Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
| | - Sakul Sakul
- Division of Cardiology, Mount Sinai Morningside Hospital, Mount Sinai Heart, and the Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Jagat Narula
- Division of Cardiology, Mount Sinai Morningside Hospital, Mount Sinai Heart, and the Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Daniel Berman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
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21
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Bock JM, Siddharthan DVM, Somers VK. Exosomes, sleep apnea, and cardiovascular disease: Implications for pathogenesis and promises for prevention. Sleep Med Rev 2022; 66:101711. [PMID: 36410077 DOI: 10.1016/j.smrv.2022.101711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Joshua M Bock
- Department of Cardiovascular Medicine, Rochester, MN, United States
| | - Dhivya Vadhana Meenakshi Siddharthan
- Department of Cardiovascular Medicine, Rochester, MN, United States; Van Cleve Cardiac Regenerative Medicine Program, Mayo Clinic, Rochester, MN, United States
| | - Virend K Somers
- Department of Cardiovascular Medicine, Rochester, MN, United States.
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22
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Bigalke JA, Shan Z, Carter JR. Orexin, Sleep, Sympathetic Neural Activity, and Cardiovascular Function. Hypertension 2022; 79:2643-2655. [PMID: 36148653 PMCID: PMC9649879 DOI: 10.1161/hypertensionaha.122.19796] [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: 11/04/2022]
Abstract
Inadequate sleep duration and quality are associated with reduced cardiovascular health and increased mortality. Experimental evidence points to the sympathetic nervous system as a key mediator in the observed relationship between poor sleep and cardiovascular dysfunction. However, brain mechanisms underpinning the impaired sympathetic function associated with poor sleep remain unclear. Recent evidence suggests the central orexin system, particularly orexins A and B and their receptors, have a key regulatory role for sleep in animal and human models. While orexin system activity has been observed to significantly impact sympathetic regulation in animals, the extension of these findings to humans has been difficult due to an inability to directly assess orexin system activity in humans. However, direct measures of sympathetic activity in populations with narcolepsy and chronic insomnia, 2 sleep disorders associated with deficient and excessive orexin neural activity, have allowed indirect assessment of the relationships between orexin, sleep, and sympathetic regulation. Further, the recent pharmaceutical development of dual orexin receptor antagonists for use in clinical insomnia populations offers an unprecedented opportunity to examine the mechanistic role of orexin in sleep and cardiovascular health in humans. The current review assesses the role of orexin in both sleep and sympathetic regulation from a translational perspective, spanning animal and human studies. The review concludes with future research directions necessary to fully elucidate the mechanistic role for orexin in sleep and sympathetic regulation in humans.
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Affiliation(s)
- Jeremy A. Bigalke
- Department of Health and Human Development, Montana State University, Bozeman, Montana
- Department of Psychology, Montana State University, Bozeman, Montana
| | - Zhiying Shan
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, Michigan
| | - Jason R. Carter
- Department of Health and Human Development, Montana State University, Bozeman, Montana
- Department of Psychology, Montana State University, Bozeman, Montana
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23
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Abstract
PURPOSE OF REVIEW We discuss the relationship between sleep and circadian factors with cardiovascular disease (CVD) risk, including physiologic, behavioral, and psychological mechanisms along this pathway. RECENT FINDINGS The relationship between short and long sleep duration, as well as insomnia, with CVD risk is well-established. Recent work has highlighted how other sleep factors, such as sleep regularity (i.e., consistency of sleep timing), multidimensional sleep health, and circadian factors like chronotype and social jetlag, relate to CVD risk. Sleep-focused interventions (e.g., cognitive behavioral therapy for insomnia and sleep extension) may be effective to reduce CVD risk and disease burden. Sleep is increasingly recognized as an integral component of cardiovascular health. This was underscored by the recent inclusion of sleep duration as a health behavior in the American Heart Association's Life's Essential 8 for defining optimal cardiovascular health.
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Affiliation(s)
- Joseph Belloir
- School of Nursing, Columbia University, New York, NY, USA
| | - Nour Makarem
- Department of Epidemiology, Mailman School of Public Health Columbia University Irving Medical Center, New York, NY, USA
| | - Ari Shechter
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, 622 West 168th Street, 9th Floor, New York, NY, 10032, USA.
- Center of Excellence for Sleep & Circadian Research, Columbia University Irving Medical Center, New York, NY, USA.
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24
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Zhao M, Chen T, Huang C, Zhong Q. Association between sleep duration and ideal cardiovascular health in Chinese adults: results from the China health and nutrition survey. Fam Pract 2022; 40:314-321. [PMID: 35994051 DOI: 10.1093/fampra/cmac095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Ideal cardiovascular health (CVH) is related to the future risk of cardiovascular disease. Sleep duration is an important factor influencing health outcomes. The association between sleep duration and CVH is unclear. OBJECTIVES We aimed to explore the associations between sleep duration and CVH among Chinese adults. METHODS This cross-sectional study was based on nationally representative samples from 2009 China Health and Nutrition Survey (CHNS). Sleep duration was categorized as ≤6, 7, 8, and ≥9 h. The CVH scores were evaluated. Generalized linear regressions and restricted cubic splines were used to determine the association between sleep duration and CVH. RESULTS A total of 8,103 Chinese adults with a mean age of 50.29 (14.97) years were included. The mean (SD) CVH score was 3.96 (1.43). Only 36.7% of the participants had ideal CVH. Sleep duration was positively associated with ideal CVH (P-trend < 0.05). When comparing the long sleep duration with the short sleep duration, short sleep duration significantly decreased the mean CVH score, β = -0.24 (95% CI: -0.36, -0.13) and increased the risk of nonideal CVH, OR = 1.38 (95% CI: 1.15, 1.67) by generalized linear regressions. The restricted cubic splines showed CVH did not have a significant nonlinear relationship with sleep duration. The P-value for nonlinear was 0.161. The association of sleep duration with CVH had no obvious threshold. CONCLUSION Short sleep duration was associated with decreased odds of ideal CVH and lower mean CVH score. Confirmation through longitudinal studies is needed.
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Affiliation(s)
- Min Zhao
- Department of Pharmacy, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Ting Chen
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Chenglong Huang
- Department of Pharmacy, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Qiuan Zhong
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
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25
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Huang JF, Zhang DY, Sheng CS, An DW, Li M, Cheng YB, Guo QH, Wang Y, Wang JG, Li Y. Isolated nocturnal hypertension in relation to host and environmental factors and clock genes. J Clin Hypertens (Greenwich) 2022; 24:1255-1262. [PMID: 35942908 PMCID: PMC9581097 DOI: 10.1111/jch.14532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/09/2022] [Accepted: 04/11/2022] [Indexed: 12/20/2022]
Abstract
Isolated nocturnal hypertension (INH) is a special type of out-of-office hypertension. Its determinants and pathophysiology remain unclear. In a nested case-control study, we intend to investigate the host, environmental, and genetic factors in relation to INH. Among 2030 outpatients screened from December 2008 till June 2015, 128 patients with INH were identified, and then 128 normotensives were matched according to sex and age. INH was an elevated nocturnal blood pressure (BP ≥120/70 mmHg) in the presence of a normal daytime BP (< 135/85 mmHg). Host factors included age, sex, body mass index, smoking and drinking, sleep time and duration, heart rate, serum lipids, and serum creatinine. Environmental cues encompassed season, ambient temperature, atmospheric pressure, humidity, and wind speed, and genetic cues 29 single-nucleotide polymorphisms (SNPs) in 12 clock genes. Daytime and nighttime BPs averaged 124.9/80.7 and 114.5/73.7 mmHg, respectively, in the INH patients and 121.0/76.5 and 101.8/63.3 mmHg in the normotensive controls. Stepwise logistic regression analyses revealed that INH was associated with nighttime heart rate (P = .0018), sleep duration (P = .0499), and relative humidity (P = .0747). The odds ratios (95% CI) for each 10 beats/min faster nighttime heart rate and 10% lower relative humidity were 1.82 (1.25-2.65) and 0.82 (0.67-1.00), respectively. Irrespective of the genetic models, no significant association was observed between INH and the SNPs (P ≥ .054). In conclusion, INH was associated with host and environmental factors rather than genetic markers.
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Affiliation(s)
- Jian-Feng Huang
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Dong-Yan Zhang
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chang-Sheng Sheng
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - De-Wei An
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Mingxuan Li
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yi-Bang Cheng
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qian-Hui Guo
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ying Wang
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ji-Guang Wang
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yan Li
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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26
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McCarter SJ, Hagen PT, St Louis EK, Rieck TM, Haider CR, Holmes DR, Morgenthaler TI. Physiological markers of sleep quality: A scoping review. Sleep Med Rev 2022; 64:101657. [PMID: 35753151 DOI: 10.1016/j.smrv.2022.101657] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 05/16/2022] [Accepted: 05/29/2022] [Indexed: 10/18/2022]
Abstract
Understanding the associations between adequate sleep, performance and health outcomes is vital, yet a major limitation in the design and interpretation of studies of sleep and performance is the variability of subjective and objective markers used to assess sleep quality. The aim of this scoping review is to investigate how various physiological signals recorded during sleep or wakefulness relate to objective measures of cognitive or physical performance and subjectively perceived sleep quality to inform conceptual understanding of the elusive, amorphous, and multi-dimensional construct of sleep quality. We also aimed to suggest priorities for future areas of research in sleep quality and performance. We searched six databases ultimately yielding 439 studies after duplicate removal. Sixty-five studies were selected for full review. In general, correlations between objectively measured sleep and objective performance or subjectively assessed sleep quality were weak to moderate. Slow wave sleep was moderately correlated with better performance on tasks of vigilance, motor speed, and executive function as well as better subjective sleep quality and feeling well-rested, suggesting that slow wave sleep may be important for sleep quality and optimal daytime performance. However, these findings were inconsistent across studies. Increased sleep fragmentation was associated with poorer subjective sleep quality in both polysomnographic and actigraphic studies. Studies which simultaneously assessed physiologic sleep measures, performance measures and subjective sleep perception were few, limiting the ability to evaluate correlations between subjective and objective outcomes concurrently in the same individuals. Factors influencing the relationship between sleep quality and performance include circadian variability, sleep inertia, and mismatch between sleep stages studied and outcome measures of choice. Ultimately, the determination of "quality sleep" remains largely subjective and inconsistently quantifiable by current measures. Methods evaluating sleep as a continuous measure rather than traditional sleep stages may provide an intriguing approach to future studies of sleep and performance. Future well-designed studies using novel measures of sleep or multimodal ambulatory wearables assessing the three domains of sleep and performance (objective sleep physiology, objective performance, and subjective sleep quality) are needed to better define quality sleep.
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Affiliation(s)
- Stuart J McCarter
- Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA; Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA.
| | - Philip T Hagen
- Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Erik K St Louis
- Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA; Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA; Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Thomas M Rieck
- Mayo Clinic Healthy Living Program, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Clifton R Haider
- Section of Biostatistics, Mayo Clinic and Foundation, Rochester, MN, USA
| | - David R Holmes
- Section of Biostatistics, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Timothy I Morgenthaler
- Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA; Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, MN, USA; Department of Pulmonology, Mayo Clinic and Foundation, Rochester, MN, USA
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27
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Greenlund IM, Carter JR. Sympathetic neural responses to sleep disorders and insufficiencies. Am J Physiol Heart Circ Physiol 2022; 322:H337-H349. [PMID: 34995163 PMCID: PMC8836729 DOI: 10.1152/ajpheart.00590.2021] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Short sleep duration and poor sleep quality are associated with cardiovascular risk, and sympathetic nervous system (SNS) dysfunction appears to be a key contributor. The present review will characterize sympathetic function across several sleep disorders and insufficiencies in humans, including sleep deprivation, insomnia, narcolepsy, and obstructive sleep apnea (OSA). We will focus on direct assessments of sympathetic activation, e.g., plasma norepinephrine and muscle sympathetic nerve activity, but include heart rate variability (HRV) when direct assessments are lacking. The review also highlights sex as a key biological variable. Experimental models of total sleep deprivation and sleep restriction are converging to support several epidemiological studies reporting an association between short sleep duration and hypertension, especially in women. A systemic increase of SNS activity via plasma norepinephrine is present with insomnia and has also been confirmed with direct, regionally specific evidence from microneurographic studies. Narcolepsy is characterized by autonomic dysfunction via both HRV and microneurographic studies but with opposing conclusions regarding SNS activation. Robust sympathoexcitation is well documented in OSA and is related to baroreflex and chemoreflex dysfunction. Treatment of OSA with continuous positive airway pressure results in sympathoinhibition. In summary, sleep disorders and insufficiencies are often characterized by sympathoexcitation and/or sympathetic/baroreflex dysfunction, with several studies suggesting women may be at heightened risk.
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Affiliation(s)
- Ian M. Greenlund
- 1Department of Health and Human Development, Montana State University, Bozeman, Montana,2Department of Psychology, Montana State University, Bozeman, Montana
| | - Jason R. Carter
- 1Department of Health and Human Development, Montana State University, Bozeman, Montana,2Department of Psychology, Montana State University, Bozeman, Montana
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28
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Bock JM, Vungarala S, Covassin N, Somers VK. Sleep Duration and Hypertension: Epidemiological Evidence and Underlying Mechanisms. Am J Hypertens 2022; 35:3-11. [PMID: 34536276 DOI: 10.1093/ajh/hpab146] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/04/2021] [Accepted: 09/16/2021] [Indexed: 12/22/2022] Open
Abstract
While the contribution of several physiological systems to arterial blood pressure regulation has been studied extensively, the role of normal and disrupted sleep as a modifiable determinant of blood pressure control, and in the pathophysiology of hypertension, has only recently emerged. Several sleep disorders, including sleep apnea and insomnia, are thought to contribute to the development of hypertension, although less attention is paid to the relationship between sleep duration and blood pressure independent of sleep disorders per se. Accordingly, this review focuses principally on the physiology of sleep and the consequences of abnormal sleep duration both experimentally and at the population level. Clinical implications for patients with insomnia who may or may not have abbreviated sleep duration are explored. As a corollary, we further review studies of the effects of sleep extension on blood pressure regulation. We also discuss epidemiological evidence suggesting that long sleep may also be associated with hypertension and describe the parabolic relationship between total sleep time and blood pressure. We conclude by highlighting gaps in the literature regarding the potential role of gut microbial health in the cross-communication of lifestyle patterns (exercise, diet, and sleep) with blood pressure regulation. Additionally, we discuss populations at increased risk of short sleep, and specifically the need to understand mechanisms and therapeutic opportunities in women, pregnancy, the elderly, and in African Americans.
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Affiliation(s)
- Joshua M Bock
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Soumya Vungarala
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Naima Covassin
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Virend K Somers
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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29
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Lin W, Saner NJ, Weng X, Caruana NJ, Botella J, Kuang J, Lee MJC, Jamnick NA, Pitchford NW, Garnham A, Bartlett JD, Chen H, Bishop DJ. The Effect of Sleep Restriction, With or Without Exercise, on Skeletal Muscle Transcriptomic Profiles in Healthy Young Males. Front Endocrinol (Lausanne) 2022; 13:863224. [PMID: 35937838 PMCID: PMC9355502 DOI: 10.3389/fendo.2022.863224] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Inadequate sleep is associated with many detrimental health effects, including increased risk of developing insulin resistance and type 2 diabetes. These effects have been associated with changes to the skeletal muscle transcriptome, although this has not been characterised in response to a period of sleep restriction. Exercise induces a beneficial transcriptional response within skeletal muscle that may counteract some of the negative effects associated with sleep restriction. We hypothesised that sleep restriction would down-regulate transcriptional pathways associated with glucose metabolism, but that performing exercise would mitigate these effects. METHODS 20 healthy young males were allocated to one of three experimental groups: a Normal Sleep (NS) group (8 h time in bed per night (TIB), for five nights (11 pm - 7 am)), a Sleep Restriction (SR) group (4 h TIB, for five nights (3 am - 7 am)), and a Sleep Restriction and Exercise group (SR+EX) (4 h TIB, for five nights (3 am - 7 am) and three high-intensity interval exercise (HIIE) sessions (performed at 10 am)). RNA sequencing was performed on muscle samples collected pre- and post-intervention. Our data was then compared to skeletal muscle transcriptomic data previously reported following sleep deprivation (24 h without sleep). RESULTS Gene set enrichment analysis (GSEA) indicated there was an increased enrichment of inflammatory and immune response related pathways in the SR group post-intervention. However, in the SR+EX group the direction of enrichment in these same pathways occurred in the opposite directions. Despite this, there were no significant changes at the individual gene level from pre- to post-intervention. A set of genes previously shown to be decreased with sleep deprivation was also decreased in the SR group, but increased in the SR+EX group. CONCLUSION The alterations to inflammatory and immune related pathways in skeletal muscle, following five nights of sleep restriction, provide insight regarding the transcriptional changes that underpin the detrimental effects associated with sleep loss. Performing three sessions of HIIE during sleep restriction attenuated some of these transcriptional changes. Overall, the transcriptional alterations observed with a moderate period of sleep restriction were less evident than previously reported changes following a period of sleep deprivation.
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Affiliation(s)
- Wentao Lin
- College of Exercise and Health, Guangzhou Sport University, Guangzhou, China
| | - Nicholas J. Saner
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
- Human Integrative Physiology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Xiquan Weng
- College of Exercise and Health, Guangzhou Sport University, Guangzhou, China
| | - Nikeisha J. Caruana
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
- Department of Biochemistry and Pharmacology and Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Parkville, VIC, Australia
| | - Javier Botella
- Department of Biochemistry and Pharmacology and Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Parkville, VIC, Australia
| | - Jujiao Kuang
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
| | - Matthew J-C. Lee
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
| | - Nicholas A. Jamnick
- Metabolic Research Unit, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Nathan W. Pitchford
- School of Health Sciences, University of Tasmania, Launceston, TAS, Australia
| | - Andrew Garnham
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
| | | | - Hao Chen
- College of Exercise and Health, Guangzhou Sport University, Guangzhou, China
- *Correspondence: Hao Chen, ; David J. Bishop,
| | - David J. Bishop
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
- *Correspondence: Hao Chen, ; David J. Bishop,
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30
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Sleep and Cardiovascular Disease. J Cardiovasc Nurs 2021; 37:3-4. [PMID: 34870945 DOI: 10.1097/jcn.0000000000000870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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