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Cornelius T, Edmondson D, Abdalla M, Scott A, Sedano BF, Hiti D, Sullivan AM, Schwartz JE, Kronish IM, Shechter A. Prospective Bidirectional Relationship Between Sleep Duration and Posttraumatic Stress Disorder Symptoms After Suspected Acute Coronary Syndrome. Psychosom Med 2024; 86:283-288. [PMID: 38724037 PMCID: PMC11090408 DOI: 10.1097/psy.0000000000001279] [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] [Indexed: 05/15/2024]
Abstract
OBJECTIVE Sleep disturbance is a "hallmark" symptom of posttraumatic stress disorder (PTSD). Poor sleep (including short sleep) after combat-related trauma can also predict subsequent PTSD. Less is known about the association between sleep duration and PTSD symptoms when PTSD is induced by acute coronary syndrome (ACS). We examined the bidirectional relationship between sleep duration and PTSD symptoms over the year after hospital evaluation for ACS. METHODS Participants were enrolled in this observational study after emergency department evaluation for ACS. Sleep duration ("During the past month, how many hours of actual sleep did you get at night?") and cardiac event or hospitalization-induced PTSD symptoms (PTSD Checklist) were assessed at 1, 6, and 12 months after hospital discharge. Cross-lagged path analysis was used to model the effects of sleep duration and PTSD symptoms on each other. Covariates included age, sex, race/ethnicity, cardiac severity, baseline depression symptoms, and early acute stress disorder symptoms. RESULTS The sample included 1145 participants; 16% screened positive for probable PTSD (PTSD Checklist score ≥33). Mean sleep duration across time points was 6.1 hours. Higher PTSD symptoms predicted shorter sleep duration at the next time point (i.e., 1-6 and 6-12 months; B = -0.14 hours/10-point difference, SE = 0.03, p < .001). Shorter sleep duration was associated with higher PTSD symptoms at the next time point (B = -0.25 points/hour, SE = 0.12, p = .04). CONCLUSIONS Short sleep duration and PTSD symptoms are mutually reinforcing across the first year after ACS evaluation. Findings suggest that sleep, PTSD symptoms, and their relationship should be considered in the post-ACS period.
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Affiliation(s)
- Talea Cornelius
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Marwah Abdalla
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Allie Scott
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Brandon Fernandez Sedano
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - David Hiti
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Alexandra M. Sullivan
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Joseph E. Schwartz
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook, NY
| | - Ian M. Kronish
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Ari Shechter
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY
- Center of Excellence for Sleep & Circadian Research, Columbia University Irving Medical Center, New York, NY
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Wang Y, Buayiximu K, Zhu T, Yan R, Zhu Z, Ni J, Du R, Zhu J, Wang X, Ding F, Yan X, Qu X, Li P, Zhang R, Xu Z, Quan W. Day-night pattern of acute ST-segment elevation myocardial infarction onset in patients with obstructive sleep apnea. J Clin Sleep Med 2024; 20:765-775. [PMID: 38174863 PMCID: PMC11063706 DOI: 10.5664/jcsm.10990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 01/05/2024]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is associated with acute nocturnal hemodynamic and neurohormonal abnormalities that may increase the risk of coronary events, especially during the nighttime. This study sought to investigate the day-night pattern of acute ST-segment elevation myocardial infarction (STEMI) onset in patients with OSA and its impact on cardiovascular adverse events. METHODS We prospectively enrolled 397 patients with STEMI, for which the time of onset of chest pain was clearly identified. All participants were categorized into non-OSA (n = 280) and OSA (n = 117) groups. The association between STEMI onset time and major adverse cardiovascular and cerebrovascular events was estimated by Cox proportional hazards regression. RESULTS STEMI onset occurred from midnight to 5:59 am in 33% of patients with OSA, as compared with 15% in non-OSA patients (P < .01). For individuals with OSA, the relative risk of STEMI from midnight to 5:59 am was 2.717 [95% confidence interval (CI) 1.616 - 4.568] compared with non-OSA patients. After a median of 2.89 ± 0.78 years follow-up, symptom onset time was found to be significantly associated with risk of major adverse cardiovascular and cerebrovascular events in patients with OSA, while there was no significant association observed in non-OSA patients. Compared with STEMI presenting during noon to 5:59 pm, the hazard ratios for major adverse cardiovascular and cerebrovascular events in patients with OSA were 4.683 (95% CI 2.024 - 21.409, P = .027) for midnight to 5:59 am and 6.964 (95% CI 1.379 - 35.169, P = .019) for 6 pm to midnight, whereas the hazard ratios for non-OSA patients were 1.053 (95% CI 0.394 - 2.813, P = .917) for midnight to 5:59 am and 0.745 (95% CI 0.278 - 1.995, P = .558) for 6 pm to midnight. CONCLUSIONS Patients with OSA exhibited a peak incidence of STEMI between midnight and 5:59 am, which showed an independent association with cardiovascular adverse events. CITATION Wang Y, Buayiximu K, Zhu T, et al. Day-night pattern of acute ST-segment elevation myocardial infarction onset in patients with obstructive sleep apnea. J Clin Sleep Med. 2024;20(5):765-775.
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Affiliation(s)
- Yueying Wang
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Keremu Buayiximu
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tianqi Zhu
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Renyu Yan
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhengbin Zhu
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jingwei Ni
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Run Du
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinzhou Zhu
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoqun Wang
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fenghua Ding
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoxiang Yan
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuezheng Qu
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ping Li
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruiyan Zhang
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhihong Xu
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiwei Quan
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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d’Ettorre G, Piscitelli P, Pellicani V, Tornese R, Ceccarelli G, d’Ettorre G, La Torre G. Occupational Risk for Coronary Artery Disease in Shift Workers - A Systematic Review. LA MEDICINA DEL LAVORO 2024; 115:e2024015. [PMID: 38686577 PMCID: PMC11181222 DOI: 10.23749/mdl.v115i2.15532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/08/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Coronary artery disease (CAD) prevention in shift workers (SWs) poses a significant challenge worldwide, as CAD remains a major cause of mortality and disability. In the past, SWs were found at higher risk of CAD than non-s SWs. Nevertheless, the pathogenic mechanism between shift work and CAD to date is unclear. This systematic review aims to enhance understanding of the risk of CAD occurrence in SWs. METHODS A systematic literature review was conducted from January 2013 to December 2023. MEDLINE/Pubmed databases were used initially, and additional relevant studies were searched from references. Shift work was defined as any schedule outside traditional shifts, including the night shift. RESULTS Fifteen pertinent papers were categorized into risk assessment or risk management. Findings demonstrated an increased risk of CAD among SWs compared to non-SWs, with an increased CAD risk observed for both shift work and night shift work. DISCUSSION Duration-response associations indicate that greater shift exposure is linked to higher CAD risk. SWs incur an increased risk of CAD through the atherosclerotic process. As shift work duration increases as the risk of atherosclerosis is higher, workers demonstrate a higher prevalence and severity of coronary artery plaques. CONCLUSIONS The evidence-based results underscore the increased risk of CAD in SWs and are sufficient for proposing guidelines aimed at reducing the risk of CAD in SWs and at managing people with CAD in return to work characterized by disrupted circadian rhythms.
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Affiliation(s)
- Gabriele d’Ettorre
- Department of Occupational Medicine, Local Health Authority, Lecce, Italy
| | - Prisco Piscitelli
- Department of Experimental Medicine, University of Salento, Lecce, Italy
- Vito Fazzi Hospital. Local Health Autority, Lecce, Italy
| | | | | | - Giancarlo Ceccarelli
- Azienda Ospedaliero-Universitaria Policlinico Umberto I, Rome, Italy
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, Rome, Italy
| | - Gabriella d’Ettorre
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, Rome, Italy
| | - Giuseppe La Torre
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, Rome, Italy
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Yang J, Wang K, Wang W, Niu J, Liu X, Shen H, Sun Y, Ge H, Han H. The Effect of Sleep Quality on Coronary Lesion Severity and Prognosis in the Young Acute Coronary Syndrome Population. J Cardiovasc Dev Dis 2024; 11:68. [PMID: 38392281 PMCID: PMC10889764 DOI: 10.3390/jcdd11020068] [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: 01/15/2024] [Revised: 02/06/2024] [Accepted: 02/17/2024] [Indexed: 02/24/2024] Open
Abstract
This study aimed to explore the effect of long-term (≥1 year) sleep quality on coronary lesion complexity and cardiovascular prognosis in young acute coronary syndrome (ACS) patients. We consecutively recruited young patients aged from 18 to 44 years old with first-episode ACS and significant epicardial stenosis on coronary angiography from January 2016 to January 2017. Coronary lesion complexity was evaluated based on SYNTAX scores. Long-term sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) (PSQI ≤ 5 and PSQI > 5 groups). The primary endpoints were major adverse cardiovascular events (MACEs). A total of 466 young ACS patients (93.13% male; median age, 41 years) were included. Poor sleepers (PSQI > 5) had higher SYNTAX scores. After adjusting for confounders, PSQI scores (continuous variables, OR: 1.264; 95%CI: 1.166-1.371; p < 0.001) and PSQI grade (binary variable, OR: 3.864; 95%CI: 2.313-6.394; p = 0.001) were significantly associated with an increased risk of complex coronary lesions. During a median follow-up of 74 months, long-term poor sleep quality (PSQI > 5) was significantly associated with an increased risk of MACEs (HR: 4.266; 95%CI: 2.274-8.001; p < 0.001). Long-term poor sleep quality was a risk factor for complex coronary lesions and has adverse effects on cardiovascular prognosis in the young ACS population.
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Affiliation(s)
- Jiaxin Yang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China
| | - Kexin Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Wenjie Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Jialong Niu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Xiaoli Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Hua Shen
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Yan Sun
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Hailong Ge
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
- Department of Cardiology, Beijing Geriatric Hospital, Beijing 100095, China
| | - Hongya Han
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
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Li Y, Peng X, Wang X, Lin R, Liu X, Meng F, Liu X, Li L, Bai R, Wen S, Ruan Y, Tang R, Liu N. Association of shift work and dietary inflammatory potential with all-cause death among us hypertensive population: national health and nutrition examination study, 2005-2010. BMC Public Health 2023; 23:1094. [PMID: 37280597 DOI: 10.1186/s12889-023-15740-6] [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: 10/21/2022] [Accepted: 04/23/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND & AIMS The individual effect of working schedule on survival in the hypertensive population has not been adequately studied. Shiftworkers are also prone to unhealthy lifestyles like pro-inflammatory diet. Therefore, we assessed the effect of shift work and its joint association with dietary inflammatory potential on mortality risk among the large US nationally representative sample of adult hypertensive population. METHODS Data were from a nationally representative prospective cohort among US hypertensive population (n = 3680; weighted population, 54,192,988). The participants were linked to the 2019 public-access linked mortality archives. The working schedule were self-reported using the Occupation Questionnaire Section. Dietary inflammatory index (DII) scores were equally calculated using the 24-hour dietary recall (24 h) interviews. Multivariable Cox proportional hazards regression models were used to estimate hazard ratio and 95% confidence intervals (95%CI) for survival of hypertension individuals by work schedule and dietary inflammatory potential. The joint effect of work schedule and dietary inflammatory potential was then examined. RESULTS Among the 3680 hypertension individuals (39.89% female [n = 1479] and 71.42% white [n = 1707]; weighted mean [SE] age, 47.35 [0.32] years), 592 individuals reported shift work status. 474 (10.76%) reported shift work status with pro-inflammatory dietary pattern (DII scores > 0). 118 (3.06%) reported shift work status with anti-inflammatory dietary pattern (DII scores < 0). 646 (19.64%) reported a non-shift working schedule with anti-inflammatory dietary pattern, while 2442 (66.54%) reported non-shift working schedule with pro-inflammatory dietary pattern. After a median follow-up of 11.67 years (140 months), 317 deaths (cardiovascular diseases (CVD), 65; cancer, 104) were registered. Cox regression analysis showed that shift work was associated with higher risk of all-cause mortality (hazard ratio [HR], 1.48; 95% CI, 1.07-2.06) compared with non-shift workers. In the joint analysis, shift work status combined with pro-inflammatory dietary pattern was associated with the highest all-cause mortality risk. Moreover, adopting the anti-inflammatory diet significantly attenuates the deleterious effect of shift work on mortality risk. CONCLUSIONS In this large representative sample of adults with hypertension in the U.S., the combination of shift work status with pro-inflammatory dietary pattern was highly prevalent and was associated with the highest risks of death from all causes.
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Affiliation(s)
- Yukun Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100012, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, 100012, China
| | - Xiaodong Peng
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100012, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, 100012, China
| | - Xuesi Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100012, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, 100012, China
| | - Rong Lin
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100012, China
- North China Medical & Health Group XingTai Genernal Hospital, Xingtai, 054000, China
| | - Xinmeng Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100012, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, 100012, China
| | - Fanchao Meng
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100012, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, 100012, China
| | - Xiaoying Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100012, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, 100012, China
| | - Linling Li
- Department of Cardiology, Bejing Chuiyangliu Hospital, Beijing, 100012, China
| | - Rong Bai
- Banner University Medical Center Phoenix, College of Medicine University of Arizona Phoenix, Arizona, 85123, USA
| | - Songnan Wen
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100012, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, 100012, China
| | - Yanfei Ruan
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100012, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, 100012, China
| | - Ribo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100012, China.
- National Clinical Research Center for Cardiovascular Diseases, Beijing, 100012, China.
| | - Nian Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100012, China.
- National Clinical Research Center for Cardiovascular Diseases, Beijing, 100012, China.
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Wong R, Crane A, Sheth J, Mayrovitz HN. Shift Work as a Cardiovascular Disease Risk Factor: A Narrative Review. Cureus 2023; 15:e41186. [PMID: 37525789 PMCID: PMC10387224 DOI: 10.7759/cureus.41186] [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: 06/13/2023] [Accepted: 06/30/2023] [Indexed: 08/02/2023] Open
Abstract
Shift work has emerged as a significant health concern in recent years, and research has revealed a link to circadian rhythm dysregulation and atherosclerosis, both of which can increase the risk of cardiovascular disease (CVD). Currently, there is a lack of updated reviews regarding the impact of shiftwork on CVD. Thus, the present narrative review aims to provide a comprehensive summary of the latest research on the relationship between shift work and CVD, identify potential gaps in the current knowledge, and highlight areas for future research. Database searches for peer-reviewed articles published between January 2013 to January 2023 on shift work associated CVD revealed many studies that found shift work is linked with increased prevalence of carotid artery plaque, increased arterial stiffness, and carotid artery intima-media thickness (IMT) all suggestive of a progression of atherosclerosis attributable to shift work. Hypertension, diabetes, and a sedentary lifestyle are known risks for CVD, and the results of the present study suggest that shift work should be added to that list. The elevation of inflammatory markers and DNA damage in shift workers may be linked to their increased progression of atherosclerosis and the positive association of shift work with coronary artery disease. There are minimal studies on mitigating approaches for shift work-related CVD, such as diet modification or exercise, emphasizing the need for further directed research in this area.
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Affiliation(s)
- Ryan Wong
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
| | - Alex Crane
- Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Jay Sheth
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
| | - Harvey N Mayrovitz
- Medical Education, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Davie, USA
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Tong J, Yu Q, Li Y, Du J, Qiu J. Obstructive sleep apnea and cardiovascular events in acute coronary syndrome: a meta-analysis. Coron Artery Dis 2023; 34:177-184. [PMID: 36762648 DOI: 10.1097/mca.0000000000001207] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) in patients with the acute coronary syndrome (ACS) were at high risk for cardiovascular events, but the results are currently inconclusive. We aimed to conduct a systematic review to determine the incidence of cardiovascular events among ACS patients with OSA by a meta-analysis of observational studies. METHODS PubMed, Embase, and Cochrane Library were searched for studies related to the association between OSA and the risk of cardiovascular events in patients with ACS. Risk of bias in observational studies was assessed according to the Risk Of Bias In the Non-randomized Studies-Of Interventions tool.We performed a meta-analysis using a random-effects model to calculate estimates of pooled hazard ratios (HR) with 95% confidence intervals (CI), and heterogeneity was assessed using the statistics. RESULTS A total of 12 studies evaluating ACS patients with OSA were included in the meta-analysis. OSA was related to the increased risk of MACE (HR = 2.2; 95% CI, 1.274-3.805, I2 = 76.1%). The effect of OSA on MACCE (HR = 1.921; 95% CI, 1.45-2.546; I2 = 19.1%) and readmission for unstable angina (HR = 3.137, 95% CI, 1.06-9.283; I2 = 52.4%) were statistically significant in the pooled analysis. All of the outcomes in the included studies had a serious risk of bias and the Grading of Recommendation, Assessment, Development, and Evaluation evidence level of all the evaluation results were very low. CONCLUSIONS OSA was associated with a significant increase in the risk of cardiovascular events for patients with ACS. Additional randomized controlled trial studies are required to confirm the results and to prove the treatment of OSA can change the prognosis.
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Affiliation(s)
- Jiangtao Tong
- Department of Cardiovascular Medicine, Foresea Life Insurance Guangzhou General Hospital, Guangzhou, China
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Xia Y, Chen A, Lu D, Jin J, Yin M, Wang Y, Zhang Y, Lu Y, Ma J, Deng L, Zhang P, Li S, Yang H, Li C, Lu H, Chen Z, Qian J, Ge J. Lipidome, central carbon metabolites, and sleep rhythm in coronary heart disease with nontraditional risks: An exploratory pilot study. Heliyon 2023; 9:e14827. [PMID: 37025865 PMCID: PMC10070923 DOI: 10.1016/j.heliyon.2023.e14827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 03/01/2023] [Accepted: 03/17/2023] [Indexed: 03/28/2023] Open
Abstract
Aims Altered lipid, energy metabolism and sleep disorders had been linked with coronary heart disease (CHD), however, the metabolic signatures and sleep rhythm in non-obstructive coronary atherosclerosis-CHD remain unclear. This pilot study aims to investigate the lipidome and central carbon metabolites profiles and associated sleep characteristics among CHD patients without traditional risk factors. Methods From January to July 2021, 15 CHD patients and 15 healthy controls were randomly selected from the cardiology unit of Zhongshan Hospital, Shanghai. A total of 464 lipids and 45 central carbon metabolites (CCM) were quantified in blood plasma. Metabolic signatures were selected through orthogonal projections to latent structures discriminant analysis (OPLS-DA) and principal component analysis (PCA) was conducted to link the profiles of identified metabolites with CHD risk, sleep patterns, cardiometabolic traits and cardiac electrophysiologic parameters. Results Using OPLS-DA, we identified 40 metabolites (variable influence on projection >1) that were altered in CHD patients, with 38 lipids, including 25 triacylglycerols (TAGs), 8 diacylglycerols (DAGs), being elevated and two CCM metabolites (i.e., succinic acid and glycolic acid) being reduced. Using PCA, four principal components (PCs) were identified and associated with increased risk of CHD. Specifically, one standard unit increasement in the PC that was characterized by high levels of DAG (18:1) and low succinic acid and the PC that was characterized by high levels of two sphingomyelins [SM (26:0) and SM (24:0)] was associated with 21% [odds ratio (OR) = 1.21, 95% CI: 1.02,1.43] and 14% (OR = 1.14,1.02,1.29) increased risk of CHD, respectively. Further regression analyses confirmed that the identified metabolites and the four PCs were positively associated with TG and ALT. Interestingly, glycolic acid was negatively associated with sleep quality and PSQI. Participants with night sleep mode tended to have a high level of the identified lipids, especially FFA (20:4). Conclusion In the present pilot study, our findings provide clues on alterations of lipid and energy metabolism in CHD patients without traditional risk factors, with multiple triacylglycerols and diacylglycerols metabolites seemingly elevated and certain nonlipids metabolites (e.g., succinic acid and glycolic acid) decreased in cases. Considering the limit sample size, further studies are warranted to confirm our results.
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Mentzelou M, Papadopoulou SK, Papandreou D, Spanoudaki M, Dakanalis A, Vasios GK, Voulgaridou G, Pavlidou E, Mantzorou M, Giaginis C. Evaluating the Relationship between Circadian Rhythms and Sleep, Metabolic and Cardiovascular Disorders: Current Clinical Evidence in Human Studies. Metabolites 2023; 13:370. [PMID: 36984810 PMCID: PMC10057970 DOI: 10.3390/metabo13030370] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/26/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
Circadian rhythms are generated by the circadian clock, a self-sustained internal timing system that exhibits 24-h rhythms in the body. Many metabolic, cellular, behavioral and physiological processes are regulated by the circadian clock in coordination with environmental cues. The present study is a comprehensive review of the currently existing evidence concerning the relationship between circadian rhythms and sleep, metabolic, and cardiovascular disorders. We thoroughly searched the online databases PubMed, Scopus, and Web of Science to find the existing clinical studies from the last twenty-three years (2000-2023). Circadian misalignment was found to be associated with an increase in the risk of metabolic disorders, cardiovascular diseases, and obesity, as well as inadequate sleep quality. In this review article, all the included studies had a strength protocol design and all of them were conducted on humans. However, the most common limitations of them were the small sample size and the short time of the intervention. In conclusion, managing the factors that disrupt the optimal function of central and peripheral clocks can help to reduce the risk of metabolic and cardiovascular diseases, improving also sleep quality. Future studies should further explore the underlying mechanisms of the interconnections between circadian clocks and sleep, metabolic, and cardiovascular disorders. This may provide new opportunities for advance chronotherapy approach.
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Affiliation(s)
- Maria Mentzelou
- Department of Food Science and Nutrition, School of Environment, University of Aegean, 81400 Myrina, Lemnos, Greece
| | - Sousana K. Papadopoulou
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece
| | - Dimitrios Papandreou
- Department of Health Sciences, College of Natural and Health Sciences, Zayed University, Abu Dhabi P.O. Box 144534, United Arab Emirates
| | - Maria Spanoudaki
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece
- Clinical Dietetics & Nutrition Department of 424 General Military Hospital, New Efkarpia Ring Road, 56429 Thessaloniki, Greece
| | - Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 38, 20900 Monza, Italy
| | - Georgios K. Vasios
- Department of Food Science and Nutrition, School of Environment, University of Aegean, 81400 Myrina, Lemnos, Greece
| | - Gavriela Voulgaridou
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece
| | - Eleni Pavlidou
- Department of Food Science and Nutrition, School of Environment, University of Aegean, 81400 Myrina, Lemnos, Greece
| | - Maria Mantzorou
- Department of Food Science and Nutrition, School of Environment, University of Aegean, 81400 Myrina, Lemnos, Greece
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, School of Environment, University of Aegean, 81400 Myrina, Lemnos, Greece
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10
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Zhu C, Lu Y, Cheng M, Zhou Z, Zhang Y, Lei X, Wang X, Hou Y, Lu M. Sleep profile and the risk of cardiovascular events in patients undergoing percutaneous coronary intervention. PSYCHOL HEALTH MED 2023; 28:799-811. [PMID: 34565236 DOI: 10.1080/13548506.2021.1985148] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A significant proportion of patients with coronary artery disease (CAD) who undergo percutaneous coronary intervention (PCI) suffer from physical and mental disorders which lead to the decline of sleep profile. Sleep disorders are highly prevalent in these patients. But the effect of sleep on the outcomes of post-PCI patients remains unclear. We aim to examine the individual and joint effects of sleep quality and sleep duration on the risk of adverse cardiovascular events in post-PCI patients. We included 314 participants who were diagnosed with a first CAD and underwent PCI with drug-eluting stents and followed up for a mean duration of 341 days to assess major adverse cardiovascular events (MACEs). Sleep quality, based on the Pittsburgh Sleep Quality Index, was categorized as good (a score of ≤7) or poor (>7). Sleep duration was categorized into three classes: ≤ 5, 6-8 (reference group) and ≥ 9 hours per day. The log-rank test and the Cox regression model were used for data analysis. MACEs occurred in 26 (8.3%) patients. Subjects whose sleep duration was ≤ 5 hours per day had a shorter time to MACEs than those whose sleep duration was 6-8 hours (p = 0.036). A significantly increased risk for MACEs was observed for participants with a ≤ 5 hours sleep duration (HR = 2.18, 95% CI = 1.02-4.64) after adjustment for demographic and clinical confounders. Associations between long sleep duration (≥ 9 hours), sleep quality, or their joint effect and MACEs were not found. This suggests the importance of considering sleep loss when developing strategies to improve health outcomes of PCI patients. And further researches are needed to examine the effects of different aspects of sleep quality on the prognosis of PCI patients and explore the reasons that lead to the decline of sleep profile.
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Affiliation(s)
- Chenya Zhu
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China.,School of Nursing, Soochow University Medical College, Suzhou, China
| | - Yang Lu
- School of Nursing, Soochow University Medical College, Suzhou, China
| | - Ming Cheng
- School of Nursing, Soochow University Medical College, Suzhou, China
| | - Zichun Zhou
- School of Nursing, Soochow University Medical College, Suzhou, China
| | - Yuxian Zhang
- School of Nursing, Soochow University Medical College, Suzhou, China
| | - Xiaoqing Lei
- School of Nursing, Soochow University Medical College, Suzhou, China
| | - Xiaohua Wang
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China.,School of Nursing, Soochow University Medical College, Suzhou, China
| | - Yunying Hou
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China.,School of Nursing, Soochow University Medical College, Suzhou, China
| | - Minxia Lu
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
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11
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Justin Paul G, Sankaran S, Saminathan K, Iliyas M, Sethupathy S, Saravanan S, Prabhu SS, Kurian S, Srinivas S, Anurag P, Srinivasan K, Manimegalai E, Nagarajan S, Ramesh R, Nageswaran PM, Sangareddi V, Govindarajulu R. Outcomes of ST Segment Elevation Myocardial Infarction without Standard Modifiable Cardiovascular Risk Factors - Newer Insights from a Prospective Registry in India. Glob Heart 2023; 18:13. [PMID: 36936250 PMCID: PMC10022543 DOI: 10.5334/gh.1189] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/02/2023] [Indexed: 03/18/2023] Open
Abstract
Objectives Patients with ST elevation myocardial infarction (STEMI) without standard modifiable cardiovascular risk factors (SMuRFs; dyslipidaemia, hypertension, diabetes mellitus and smoking) are reported to have a worse clinical outcome compared to those with SMuRFs. However, robust prospective data and low-and middle-income country perspective are lacking. We aimed to study the patients with first STEMI and assess the influence of SMuRFs on clinical outcomes by comparing the patients with and without SMuRFs. Methods We included all consecutive STEMI patients without prior coronary artery disease enrolled in the Madras Medical College STEMI Registry from September 2018 to October 2019. We collected baseline clinical characteristics, revascularisation strategies and clinical outcome. We analysed suboptimal self-reported sleep duration as a 5th extended SMuRF (eSMuRF). Primary outcome was in-hospital mortality. Secondary outcomes included in-hospital complications and one-year all-cause mortality. Results Among 2,379 patients, 605 patients (25.4%) were SMuRF-less. More women were SMuRF-less than men (27.1% vs 22.1%; P = 0.012). SMuRF-less patients were older (57.44 ± 13.95 vs 55.68 ± 11.74; P < 0.001), more often former tobacco users (10.4% vs 5.0%; P < 0.001), with more anterior wall MI (62.6% vs 52.1%; P = 0.032). The primary outcome [in-hospital mortality (10.7% vs 11.3%; P = 0.72)] and secondary outcomes [in-hospital complications (29.1% vs 31.7%; P = 0.23) and one-year all-cause mortality (22.3% vs 22.7%; P = 0.85)] were similar in both groups. Addition of suboptimal self-reported sleep duration as a 5th eSMuRF yielded similar results. Conclusions 25% of first STEMI patients were SMuRF-less. Clinical outcomes of patients without SMuRFs were similar to those with SMuRFs. Suboptimal sleep duration did not account for the risk associated with the SMuRF-less status.
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Affiliation(s)
- Gnanaraj Justin Paul
- Institute of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India
- Rajiv Gandhi Government General Hospital, Park Town, Chennai, India
- The Tamil Nadu Dr MGR Medical University, Guindy, Chennai, India
| | - Sabarish Sankaran
- Institute of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India
- Rajiv Gandhi Government General Hospital, Park Town, Chennai, India
- The Tamil Nadu Dr MGR Medical University, Guindy, Chennai, India
| | - Karthikaa Saminathan
- Institute of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India
- Rajiv Gandhi Government General Hospital, Park Town, Chennai, India
- The Tamil Nadu Dr MGR Medical University, Guindy, Chennai, India
| | - Mohamed Iliyas
- Institute of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India
- Rajiv Gandhi Government General Hospital, Park Town, Chennai, India
- The Tamil Nadu Dr MGR Medical University, Guindy, Chennai, India
| | - Suryakanth Sethupathy
- Institute of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India
- Rajiv Gandhi Government General Hospital, Park Town, Chennai, India
- The Tamil Nadu Dr MGR Medical University, Guindy, Chennai, India
| | - Sivasubramaniam Saravanan
- Institute of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India
- Rajiv Gandhi Government General Hospital, Park Town, Chennai, India
- The Tamil Nadu Dr MGR Medical University, Guindy, Chennai, India
| | - Salai Sudhan Prabhu
- Institute of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India
- Rajiv Gandhi Government General Hospital, Park Town, Chennai, India
- The Tamil Nadu Dr MGR Medical University, Guindy, Chennai, India
| | - Sijoy Kurian
- Institute of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India
- Rajiv Gandhi Government General Hospital, Park Town, Chennai, India
- The Tamil Nadu Dr MGR Medical University, Guindy, Chennai, India
| | - Sandeep Srinivas
- Institute of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India
- Rajiv Gandhi Government General Hospital, Park Town, Chennai, India
- The Tamil Nadu Dr MGR Medical University, Guindy, Chennai, India
| | - Polavarappu Anurag
- Institute of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India
- Rajiv Gandhi Government General Hospital, Park Town, Chennai, India
- The Tamil Nadu Dr MGR Medical University, Guindy, Chennai, India
| | - Kumaran Srinivasan
- Institute of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India
- Rajiv Gandhi Government General Hospital, Park Town, Chennai, India
- The Tamil Nadu Dr MGR Medical University, Guindy, Chennai, India
| | - Elavarasi Manimegalai
- Institute of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India
- Rajiv Gandhi Government General Hospital, Park Town, Chennai, India
- The Tamil Nadu Dr MGR Medical University, Guindy, Chennai, India
| | - Swaminathan Nagarajan
- Institute of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India
- Rajiv Gandhi Government General Hospital, Park Town, Chennai, India
- The Tamil Nadu Dr MGR Medical University, Guindy, Chennai, India
| | - Rajasekar Ramesh
- Institute of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India
- Rajiv Gandhi Government General Hospital, Park Town, Chennai, India
- The Tamil Nadu Dr MGR Medical University, Guindy, Chennai, India
| | - P. M. Nageswaran
- Institute of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India
- Rajiv Gandhi Government General Hospital, Park Town, Chennai, India
- The Tamil Nadu Dr MGR Medical University, Guindy, Chennai, India
| | - Venkatesan Sangareddi
- Institute of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India
- Rajiv Gandhi Government General Hospital, Park Town, Chennai, India
- The Tamil Nadu Dr MGR Medical University, Guindy, Chennai, India
| | - Ravishankar Govindarajulu
- Institute of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India
- Rajiv Gandhi Government General Hospital, Park Town, Chennai, India
- The Tamil Nadu Dr MGR Medical University, Guindy, Chennai, India
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12
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Jiao L, Wang Y, Zhang S, Wang Y, Liu Z, Liu Z, Zhou Y, Zhou H, Xu X, Li Z, Liu Z, Yu Z, Nie L, Zhou L, Jiang H. Melatonin improves cardiac remodeling and brain-heart sympathetic hyperactivation aggravated by light disruption after myocardial infarction. J Pineal Res 2022; 73:e12829. [PMID: 36031757 DOI: 10.1111/jpi.12829] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 08/11/2022] [Accepted: 08/24/2022] [Indexed: 11/27/2022]
Abstract
Light in the external environment might affect cardiovascular function. The light disruption seems to be related to changes in cardiovascular physiological functions, and disturbing light may be a risk factor for cardiovascular diseases. Prior studies have found that light disruption after myocardial infarction (MI) exacerbates cardiac remodeling, and the brain-heart sympathetic nervous system may be one of the key mechanisms. However, how to improve light-disrupted cardiac remodeling remains unclear. Melatonin is an indoleamine secreted by the pineal gland and controlled by endogenous circadian oscillators within the suprachiasmatic nucleus, which is closely associated with light/dark cycle. This study aimed to explore whether melatonin could improve light-disrupted cardiac remodeling and modulate the brain-heart sympathetic nervous system. Our study revealed that light disruption reduced serum melatonin levels, aggravated cardiac sympathetic remodeling, caused overactivation of the brain-heart sympathetic nervous system, exacerbated cardiac dysfunction, and increased cardiac fibrosis after MI, while melatonin treatment improved light disruption-exacerbated cardiac remodeling and brain-heart sympathetic hyperactivation after MI. Furthermore, RNA-Seq results revealed the significant changes at the cardiac transcription level. In conclusion, melatonin may be a potential therapy for light-disrupted cardiac remodeling.
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Affiliation(s)
- Liying Jiao
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, 430060, China
| | - Yuhong Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, 430060, China
| | - Song Zhang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, 430060, China
| | - Yueyi Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, 430060, China
| | - Zhihao Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, 430060, China
| | - Zihan Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, 430060, China
| | - Yuyang Zhou
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, 430060, China
| | - Huixin Zhou
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, 430060, China
| | - Xiao Xu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, 430060, China
| | - Zeyan Li
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, 430060, China
| | - Zhihao Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, 430060, China
| | - Zhongyang Yu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, 430060, China
| | - Liqing Nie
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, 430060, China
| | - Liping Zhou
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, 430060, China
| | - Hong Jiang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiac Autonomic Nervous System Research Center of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, 430060, China
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13
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Zhao Y, Lu X, Wan F, Gao L, Lin N, He J, Wei L, Dong J, Qin Z, Zhong F, Qiao Z, Wang W, Ge H, Ding S, Yang Y, Xiu J, Shan P, Yan F, Zhao S, Ji Y, Pu J. Disruption of Circadian Rhythms by Shift Work Exacerbates Reperfusion Injury in Myocardial Infarction. J Am Coll Cardiol 2022; 79:2097-2115. [PMID: 35618347 DOI: 10.1016/j.jacc.2022.03.370] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/08/2022] [Accepted: 03/21/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Shift work is associated with increased risk of acute myocardial infarction (AMI) and worsened prognosis. However, the mechanisms linking shift work and worsened prognosis in AMI remain unclear. OBJECTIVES This study sought to investigate the impact of shift work on reperfusion injury, a major determinant of clinical outcomes in AMI. METHODS Study patient data were obtained from the database of the EARLY-MYO-CMR (Early Assessment of Myocardial Tissue Characteristics by CMR in STEMI) registry, which was a prospective, multicenter registry of patients with ST-segment elevation myocardial infarction (STEMI) undergoing cardiac magnetic resonance (CMR) imaging after reperfusion therapy. The primary endpoint was CMR-defined post-reperfusion infarct size. A secondary clinical endpoint was the composite of major adverse cardiac events (MACE) during follow-up. Potential mechanisms were explored with the use of preclinical animal AMI models. RESULTS Of 706 patients enrolled in the EARLY-MYO-CMR registry, 412 patients with STEMI were ultimately included. Shift work was associated with increased CMR-defined infarct size (β = 5.94%; 95% CI: 2.94-8.94; P < 0.0001). During a median follow-up of 5.0 years, shift work was associated with increased risks of MACE (adjusted HR: 1.92; 95% CI: 1.12-3.29; P = 0.017). Consistent with clinical findings, shift work simulation in mice and sheep significantly augmented reperfusion injury in AMI. Mechanism studies identified a novel nuclear receptor subfamily 1 group D member 1/cardiotrophin-like cytokine factor 1 axis in the heart that played a crucial role in mediating the detrimental effects of shift work on myocardial injury. CONCLUSIONS The current study provided novel findings that shift work increases myocardial infarction reperfusion injury. It identified a novel nuclear receptor subfamily 1 group D member 1/cardiotrophin-like cytokine factor 1 axis in the heart that might play a crucial role in mediating this process. (Early Assessment of Myocardial Tissue Characteristics by CMR in STEMI [EARLY-MYO-CMR] registry; NCT03768453).
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Affiliation(s)
- Yichao Zhao
- State Key Laboratory for Oncogenes and Related Genes, Division of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai, China
| | - Xiyuan Lu
- State Key Laboratory for Oncogenes and Related Genes, Division of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai, China
| | - Fang Wan
- State Key Laboratory for Oncogenes and Related Genes, Division of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai, China
| | - Lingchen Gao
- State Key Laboratory for Oncogenes and Related Genes, Division of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai, China
| | - Nan Lin
- State Key Laboratory for Oncogenes and Related Genes, Division of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai, China
| | - Jie He
- State Key Laboratory for Oncogenes and Related Genes, Division of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai, China
| | - Lai Wei
- State Key Laboratory for Oncogenes and Related Genes, Division of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai, China
| | - Jianxun Dong
- State Key Laboratory for Oncogenes and Related Genes, Division of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai, China
| | - Zihan Qin
- State Key Laboratory for Oncogenes and Related Genes, Division of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai, China
| | - Fangyuan Zhong
- State Key Laboratory for Oncogenes and Related Genes, Division of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai, China
| | - Zhiqin Qiao
- State Key Laboratory for Oncogenes and Related Genes, Division of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai, China
| | - Wei Wang
- State Key Laboratory for Oncogenes and Related Genes, Division of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai, China
| | - Heng Ge
- State Key Laboratory for Oncogenes and Related Genes, Division of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai, China
| | - Song Ding
- State Key Laboratory for Oncogenes and Related Genes, Division of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai, China
| | - Yining Yang
- The First Affiliated Hospital, Xinjiang Medical University, Wulumuqi, China
| | - Jiancheng Xiu
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Peiren Shan
- The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shihua Zhao
- Department of Cardiovascular Magnetic Resonance, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yong Ji
- Key Laboratory of Cardiovascular and Cerebrovascular Medicine, Key Laboratory of Targeted Intervention of Cardiovascular Disease, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing Medical University, Nanjing, China
| | - Jun Pu
- State Key Laboratory for Oncogenes and Related Genes, Division of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai, China.
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14
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Zhu CY, Hu HL, Tang GM, Sun JC, Zheng HX, Zhai CL, He CJ. Sleep Quality, Sleep Duration, and the Risk of Adverse Clinical Outcomes in Patients With Myocardial Infarction With Non-obstructive Coronary Arteries. Front Cardiovasc Med 2022; 9:834169. [PMID: 35295257 PMCID: PMC8918559 DOI: 10.3389/fcvm.2022.834169] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/24/2022] [Indexed: 12/25/2022] Open
Abstract
BackgroundMyocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous entity with varying underlying etiologies and occurs in ~5–10% of patients with acute myocardial infarction. Sleep disorders and short sleep duration are common phenomena experienced by patients with coronary heart disease and are associated with poor clinical outcomes. However, the association between sleep quality, sleep duration, and the MINOCA prognosis is less clear.MethodsWe performed a prospective observational study of 607 patients with MINOCA between February 2016 and June 2018. The mean follow-up period was 3.9 years. Sleep quality and sleep duration were measured by the Chinese version of the Pittsburgh Sleep Quality Index. The primary endpoint was all-cause mortality, and the secondary endpoint was major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, non-fatal myocardial infarction, stroke and heart failure hospitalization.ResultsDuring the follow-up period, all-cause death occurred in 69 participants and 105 participants developed MACE. The Kaplan–Meier survival analysis demonstrated a significant association between poor sleep quality and all-cause mortality (log-rank P = 0.005) and MACE (log-rank P = 0.004). Multivariable Cox regression model indicated that poor sleep quality was an independent predictor of all-cause mortality as well as MACE [adjusted hazard ratio (HR) = 1.649; 95% confidence interval (CI), 1.124–2.790; P < 0.001; and adjusted HR = 1.432; 95% CI, 1.043–2.004; P = 0.003, respectively]. For sleep duration, short sleep duration (<6 h/d) was significantly associated with an increased risk of all-cause mortality and MACE (adjusted HR = 1.326; 95% CI, 1.103–1.812; P = 0.004; and adjusted HR = 1.443; 95% CI, 1.145–1.877; P < 0.001, respectively), whereas long sleep duration was not (>8 h/d). A poorer sleep profile (including poor sleep quality and short sleep duration) was associated with a 149.4% increased risk of death (HR = 2.494; 95% CI, 1.754–4.562; P < 0.001) and a 96.7% increased risk of MACE (HR = 1.967; 95% CI, 1.442–3.639; P < 0.001) than those with neither.ConclusionSleep disorders were common among Chinese patients with MINOCA. Poor sleep quality and short sleep duration were independently associated with an increased risk of all-cause mortality and MACE in the MINOCA population. Meanwhile, a poor sleep profile has an additive effect with regard to cardiovascular risks; in these populations, efforts should be made to improve both sleep quality and sleep duration for secondary cardiovascular prevention.Clinical Trial Registrationhttp://www.chictr.org.cn, identifier: ChiCTR2000040701.
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Affiliation(s)
- Chun-Yan Zhu
- Department of Anesthesiology, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Hui-Lin Hu
- Department of Cardiology, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Guan-Min Tang
- Department of Cardiology, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Jing-Chao Sun
- Department of Cardiology, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Hui-Xiu Zheng
- Department of Cardiology, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Chang-Lin Zhai
- Department of Cardiology, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Chao-Jie He
- Department of Cardiology, The Affiliated Hospital of Jiaxing University, Jiaxing, China
- *Correspondence: Chao-Jie He
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15
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Koritala BSC, Conroy Z, Smith DF. Circadian Biology in Obstructive Sleep Apnea. Diagnostics (Basel) 2021; 11:1082. [PMID: 34199193 PMCID: PMC8231795 DOI: 10.3390/diagnostics11061082] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 11/16/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a complex process that can lead to the dysregulation of the molecular clock, as well as 24 h rhythms of sleep and wake, blood pressure, and other associated biological processes. Previous work has demonstrated crosstalk between the circadian clock and hypoxia-responsive pathways. However, even in the absence of OSA, disrupted clocks can exacerbate OSA-associated outcomes (e.g., cardiovascular or cognitive outcomes). As we expand our understanding of circadian biology in the setting of OSA, this information could play a significant role in the diagnosis and treatment of OSA. Here, we summarize the pre-existing knowledge of circadian biology in patients with OSA and examine the utility of circadian biomarkers as alternative clinical tools.
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Affiliation(s)
- Bala S. C. Koritala
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA;
| | - Zachary Conroy
- College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA;
| | - David F. Smith
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA;
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- The Sleep Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- The Center for Circadian Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
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16
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Abstract
Adequate sleep is an important component of cardiovascular health. Due to circadian misalignment and irregular shifts, inadequate sleep is common in shift workers. Adverse consequences include daytime sleepiness, decreased cognitive performance, increased sympathetic tone, inflammation, impaired glucose tolerance, and altered leptin and ghrelin levels. When circadian adjustment has not occurred, daytime sleepers often experience decreased sleep duration and increased wakefulness during displaced sleep; additionally, skipping sleep is common in shift workers, further contributing to sleep deprivation. Habitual decreased sleep duration and physiological changes contribute to obesity, diabetes, hypertension, and increased cardiovascular disease risk in shift workers. Shift workers with obstructive sleep apnea (OSA), the most common sleep-related breathing disorder, can experience more frequent sleep disruptions than non-shift workers with OSA. Furthermore, shift work-induced circadian misalignment may potentiate cardiometabolic risk in OSA patients through autonomic nervous system dysfunction and other mechanisms.
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Affiliation(s)
- Amir Gohari
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Darrin Wiebe
- Department of Medicine, University of British Columbia, Vancouver, Canada.,Leon Judah Blackmore Centre for Sleep Disorders, University of British Columbia Hospital, Vancouver, Canada
| | - Najib Ayas
- Department of Medicine, University of British Columbia, Vancouver, Canada.,Leon Judah Blackmore Centre for Sleep Disorders, University of British Columbia Hospital, Vancouver, Canada
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17
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Fitzpatrick J, Kerns ES, Kim ED, Sozio SM, Jaar BG, Estrella MM, Tereshchenko LG, Monroy-Trujillo JM, Parekh RS, Bourjeily G. Functional outcomes of sleep predict cardiovascular intermediary outcomes and all-cause mortality in incident hemodialysis patients. J Clin Sleep Med 2021; 17:1707-1715. [PMID: 33779539 DOI: 10.5664/jcsm.9304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Patients with end-stage kidney disease (ESKD) commonly experience sleep disturbances. Sleep disturbance has been inconsistently associated with mortality risk in hemodialysis patients, but the burden of symptoms from sleep disturbances has emerged as a marker that may shed light on these discrepancies and guide treatment decisions. This study examines whether functional outcomes of sleep are associated with increased risk of intermediary CV outcomes or mortality among adults initiating hemodialysis. METHODS In 228 participants enrolled in the Predictors of Arrhythmic and Cardiovascular risk in ESRD (PACE) study, the Functional Outcomes of Sleep Questionnaire-10 (FOSQ-10), which assesses functional outcomes of daytime sleepiness, was administered within 6 months of enrollment. Intermediary CV outcomes included QTc [ms], heart rate variance [ms²], left ventricular mass index [g/m², LVMI], and left ventricular hypertrophy [LVH]. The association of FOSQ-10 score with all-cause mortality was examined using proportional hazards regression. Results: Mean age was 55 years, median BMI was 28 kg/m² (IQR 24,33), with 70% African Americans. Median FOSQ-10 score was 19.7 (IQR: 17.1,20.0). A 10% lower FOSQ-10 score was associated with increased mortality risk (HR 1.09, 95%CI 1.01-1.18). Lower FOSQ-10 scores were associated with longer QTc duration and lower heart rate variance, but not LVMI or LVH. CONCLUSIONS In adults initiating dialysis, sleep-related functional impairment is common and is associated with intermediary cardiovascular disease measures and increased mortality risk. Future studies should assess the impact of screening for sleep disturbances in ESKD patients to identify individuals at increased risk for cardiovascular complications and death.
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Affiliation(s)
- Jessica Fitzpatrick
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eric S Kerns
- Lahey Hospital and Medical Center, Burlington, MA
| | - Esther D Kim
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.,Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD
| | - Stephen M Sozio
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Bernard G Jaar
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.,Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.,Nephrology Center of Maryland, Baltimore, MD
| | - Michelle M Estrella
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco and Department of Medicine, San Francisco VA Health Care System, San Francisco, CA
| | - Larisa G Tereshchenko
- Knight Cardiovascular Institute, Department of Medicine, Oregon Health and Science University, Portland, OR
| | | | - Rulan S Parekh
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.,Division of Nephrology, Department of Pediatrics and Medicine, The Hospital for Sick Children, University Health Network and University of Toronto, Ontario, Canada
| | - Ghada Bourjeily
- Department of Medicine, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI
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18
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Huang W, Liu Y, Wang X, Li X, Liu Y, Zou J, Xu H, Zhu H, Yi H, Guan J, Yin S. Effect of Interaction Between Slow Wave Sleep and Obstructive Sleep Apnea on Insulin Resistance: A Large-Scale Study. Nat Sci Sleep 2021; 13:739-749. [PMID: 34113201 PMCID: PMC8187030 DOI: 10.2147/nss.s311130] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/20/2021] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Slow-wave sleep (SWS) and obstructive sleep apnea (OSA) have attracted recent research attention. However, their joint effects on insulin resistance (IR) remain unclear. This study explored whether SWS influences the relationship between OSA and IR. METHODS We enrolled potential participants in our sleep center from 2007 to 2019. We collected demographic and clinical characteristics and determined IR status. SWS was derived from polysomnography data. Logistic regression analysis was used to reveal the associations between SWS and IR. RESULTS In all, 6966 participants (5709 OSA and 1257 primary snoring [PS] subjects) were enrolled. Less SWS increased the risk of IR in OSA patients but not in PS patients. OSA patients with SWS <6.5% were more likely to have IR than were those with SWS >21.3%. OSA was an independent risk factor for IR after adjusting for potential confounding factors. In stratified analyses according to the percentage of SWS, OSA patients with SWS <6.5% had an odds ratio for IR of 2.461 (95% CI, 2.018-3.002) compared to the PS group after adjusting for potential confounders. CONCLUSION Less SWS is associated with higher odds for IR in OSA patients but not in PS patients. OSA is independently associated with IR. In addition, OSA combined with an extreme lack of SWS has a more harmful effect on the status of IR than OSA itself.
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Affiliation(s)
- Weijun Huang
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, People's Republic of China
| | - Yuenan Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, People's Republic of China
| | - Xiaoting Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, People's Republic of China
| | - Xinyi Li
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, People's Republic of China
| | - Yupu Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, People's Republic of China
| | - Jianyin Zou
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, People's Republic of China
| | - Huajun Xu
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, People's Republic of China
| | - Huaming Zhu
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, People's Republic of China
| | - Hongliang Yi
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, People's Republic of China
| | - Jian Guan
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, People's Republic of China
| | - Shankai Yin
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, People's Republic of China
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19
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Luo M, Song B, Zhu J. Electroacupuncture: A New Approach for Improved Postoperative Sleep Quality After General Anesthesia. Nat Sci Sleep 2020; 12:583-592. [PMID: 32922103 PMCID: PMC7457783 DOI: 10.2147/nss.s261043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 08/04/2020] [Indexed: 11/23/2022] Open
Abstract
General anesthesia produces a state of drug-induced unconsciousness that is controlled by the extent and duration of administered agents. Whether inhalation or intravenous in formulation, such agents may interfere with normal sleep-wake cycles, impairing postoperative sleep quality and creating complications. Electroacupuncture is a new approach widely applied in clinical practice during recent years. This particular technology helps regulate neurotransmitter concentrations in the brain, lowering norepinephrine and dopamine levels to improve sleep quality. It also alleviates surgical pain that degrades postoperative sleep quality after general anesthesia by downregulating immune activity (SP, NK-1, and COX-1) and upregulating serotonin receptor (5-HT1AR, 5-HT2AR) and endocannabinoid expression levels. However, large-scale, multicenter studies are still needed to determine the optimal duration, frequency, and timing of electroacupuncture for such use.
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Affiliation(s)
- Man Luo
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Bijia Song
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
- Department of Anesthesiology, Friendship Hospital of Capital Medical University, Beijing, People’s Republic of China
| | - Junchao Zhu
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
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20
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Abstract
In this highly digitalized era, sleep disorders are becoming more common and are associated with an increased burden of chronic disease. Shift workers are at an increased risk for both sleep disorders and metabolic syndrome. In this article, the authors outline the connection between circadian discordance, hormonal imbalance, and the development of metabolic syndrome in shift workers. Based on a literature review of animal model studies, observational studies, and clinical trials conducted between August and October of 2018, the authors offer several clinical interventions, including work schedules, light therapy, medications, and dietary habits to improve the circadian synchronicity of shift workers and reduce their risk of morbidity and mortality. It is important for physicians to be familiar with the consequences of shift work and ways to mitigate the risks for this patient population.
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21
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Ryan S, Cummins EP, Farre R, Gileles-Hillel A, Jun JC, Oster H, Pepin JL, Ray DW, Reutrakul S, Sanchez-de-la-Torre M, Tamisier R, Almendros I. Understanding the pathophysiological mechanisms of cardiometabolic complications in obstructive sleep apnoea: towards personalised treatment approaches. Eur Respir J 2020; 56:13993003.02295-2019. [PMID: 32265303 DOI: 10.1183/13993003.02295-2019] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/15/2020] [Indexed: 12/19/2022]
Abstract
In January 2019, a European Respiratory Society research seminar entitled "Targeting the detrimental effects of sleep disturbances and disorders" was held in Dublin, Ireland. It provided the opportunity to critically review the current evidence of pathophysiological responses of sleep disturbances, such as sleep deprivation, sleep fragmentation or circadian misalignment and of abnormalities in physiological gases such as oxygen and carbon dioxide, which occur frequently in respiratory conditions during sleep. A specific emphasis of the seminar was placed on the evaluation of the current state of knowledge of the pathophysiology of cardiovascular and metabolic diseases in obstructive sleep apnoea (OSA). Identification of the detailed mechanisms of these processes is of major importance to the field and this seminar offered an ideal platform to exchange knowledge, and to discuss pitfalls of current models and the design of future collaborative studies. In addition, we debated the limitations of current treatment strategies for cardiometabolic complications in OSA and discussed potentially valuable alternative approaches.
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Affiliation(s)
- Silke Ryan
- Pulmonary and Sleep Disorders Unit, St Vincent's University Hospital, Dublin, Ireland .,School of Medicine, Conway Institute, University College Dublin, Dublin, Ireland
| | - Eoin P Cummins
- School of Medicine, Conway Institute, University College Dublin, Dublin, Ireland
| | - Ramon Farre
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona-IDIBAPS, and CIBER Enfermedades Respiratorias, Barcelona, Spain
| | - Alex Gileles-Hillel
- Pediatric Pulmonology and Sleep Unit, Dept of Pediatrics, and The Wohl Institute for Translational Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Jonathan C Jun
- Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Henrik Oster
- Institute of Neurobiology, University of Lübeck, Lübeck, Germany
| | | | - David W Ray
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK.,Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Sirimon Reutrakul
- Division of Endocrinology, Diabetes, and Metabolism, Dept of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Manuel Sanchez-de-la-Torre
- Group of Precision Medicine in Chronic Diseases, Hospital Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Renaud Tamisier
- HP2 INSERM U1042, Université Grenoble Alpes, Grenoble, France
| | - Isaac Almendros
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona-IDIBAPS, and CIBER Enfermedades Respiratorias, Barcelona, Spain
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22
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Xu H, Liang C, Zou J, Yi H, Guan J, Gu M, Feng Y, Yin S. Interaction between obstructive sleep apnea and short sleep duration on insulin resistance: a large-scale study : OSA, short sleep duration and insulin resistance. Respir Res 2020; 21:151. [PMID: 32546151 PMCID: PMC7298870 DOI: 10.1186/s12931-020-01416-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/08/2020] [Indexed: 12/16/2022] Open
Abstract
Objectives Both short sleep duration and obstructive sleep apnea (OSA) seem to be associated with insulin resistance. We aimed to explore whether short sleep duration modifies the relationship between OSA and insulin resistance. Methods Participants were consecutively enrolled from our sleep center during the period from 2007 to 2017. The index of homeostasis model assessment insulin resistance (HOMA-IR) was calculated from insulin and glucose. Sleep duration was determined by standard polysomnography. The associations between sleep duration and insulin resistance were estimated by logistic regression analyses. Results A total of 5447 participants (4507 OSA and 940 primary snorers) were included in the study. OSA was independently correlated with insulin resistance after adjusting for all potential confounders (OR, 1.319; 95% CI, 1.088–1.599), but not short sleep duration. In stratified analysis by sleep duration, compared with primary snorers, in the OSA group only extremely short sleep duration (< 5 h) was significantly associated with insulin resistance after adjusting for all covariates (OR, 2.229; 95% CI, 1.283–3.874). Rapid eye movement predominant OSA was significantly associated with insulin resistance (OR = 1.355, 95% CI: 1.019–1.802) after adjustment for confounding factors including age, sex and body mass index. Conclusions OSA, but not short sleep duration, was independently associated with insulin resistance. It is worth noting that OSA combined with extremely short sleep duration showed a greater detrimental effect than OSA itself with regard to insulin resistance.
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Affiliation(s)
- Huajun Xu
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, Shanghai, 200233, China.,Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Yishan Road 600, Shanghai, 200233, China
| | - Chen Liang
- Drug clinical trial institution, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, Shanghai, 200233, China
| | - Jianyin Zou
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, Shanghai, 200233, China.,Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Yishan Road 600, Shanghai, 200233, China
| | - Hongliang Yi
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, Shanghai, 200233, China.,Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Yishan Road 600, Shanghai, 200233, China
| | - Jian Guan
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, Shanghai, 200233, China. .,Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233, China. .,Shanghai Key Laboratory of Sleep Disordered Breathing, Yishan Road 600, Shanghai, 200233, China.
| | - Meizhen Gu
- Department of Otolaryngology-Head & Neck Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Huding Road 355, Shanghai, 200062, China.
| | - Yanhong Feng
- Department of Ultrasound, The First Affiliated Hospital of Jinzhou Medical University, No. 2, 5 Duan, Renmin Street, Guta District, Jinzhou, 121000, Liaoning Province, China.
| | - Shankai Yin
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, Shanghai, 200233, China.,Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Yishan Road 600, Shanghai, 200233, China
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23
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Hittle BM, Caruso CC, Jones HJ, Bhattacharya A, Lambert J, Gillespie GL. Nurse Health: The Influence of Chronotype and Shift Timing. West J Nurs Res 2020; 42:1031-1041. [PMID: 32419655 DOI: 10.1177/0193945920916802] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Extreme chronotype and circadian disrupting work hours may increase nurse disease risks. This national, cross-sectional study of nurses (N = 527) had three hypotheses. When chronotype and shift times are incongruent, nurses will experience increased likelihood of (1) obesity, (2) cardiovascular disease/risk factors, and (3) obesity or cardiovascular disease/risk factors when theoretically linked variables exist. Chronotype mismatched nurses' (n = 206) average sleep (6.1 hours, SD = 1.2) fell below 7-9 hours/24-hours sleep recommendations. Proportion of male nurses was significantly higher chronotype mismatched (12.3%) than matched (6.3%). Analyses found no direct relationship between chronotype match/mismatch with outcome variables. Exploratory interaction analysis demonstrated nurses with mismatched chronotype and above average sleep quality had an estimated 3.51 times the adjusted odds (95% CI 1.52,8.17; p = .003) of being obese. Although mechanism is unclear, this suggests sleep quality may be intricately associated with obesity. Further research is needed to inform nurses on health risks from disrupted sleep, chronotypes, and shift work.
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Affiliation(s)
| | - Claire C Caruso
- National Institute for Occupational Safety and Health, Division of Science Integration, Cincinnati, OH
| | - Holly J Jones
- College of Nursing, University of Cincinnati, Cincinnati, OH
| | | | - Joshua Lambert
- College of Nursing, University of Cincinnati, Cincinnati, OH
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24
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McCall CA, Turkheimer E, Tsang S, Avery A, Duncan GE, Watson NF. Sleep duration and post-traumatic stress disorder symptoms: a twin study. Sleep 2020; 42:5549607. [PMID: 31408518 DOI: 10.1093/sleep/zsz179] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 06/18/2019] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Long and short sleep duration are associated with greater risk of developing post-traumatic stress disorder (PTSD); however, it is unknown how genetic and environmental influences affect this relationship. Thus, we investigated the association between sleep duration and PTSD symptoms using twin models. METHODS Data were obtained from 1865 monozygotic and 758 dizygotic twin pairs enrolled in the community-based Washington State Twin Registry. PTSD symptoms were assessed using the Impact of Events Scale (IES). A classical twin model decomposed the variances of sleep duration and IES score into additive genetic, shared environmental, and unique environmental components. We used correlated factor models to examine the moderation of variance components of sleep duration and IES. RESULTS Shorter and longer sleep duration were associated with higher IES scores with a quadratic association (p < 0.001). The heritability of sleep duration was 36%, and IES 31%. Variance in sleep duration attributable to shared (b1C1 = 2.91, 95% CI = 1.40 to 4.43; p < 0.001) and unique (b1E1 = 0.18, 95% CI = 0.10 to 0.27; p < 0.001) environment was moderated by IES score. Similarly, but to a lesser extent, variance in IES attributable to additive genetics (b1A2 = -0.23, 95% CI = -0.45 to 0.00; p = 0.048) was moderated by sleep duration. CONCLUSIONS Greater PTSD symptom severity was associated with short and long sleep duration. Increasing PTSD symptoms increased variability in sleep duration primarily via shared environmental factors, whereas decreasing sleep duration increased variability in PTSD symptoms primarily via additive genetic factors. This suggests childhood experiences affect variability of sleep duration and genetic factors affect the variability of PTSD symptoms in trauma-exposed individuals.
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Affiliation(s)
- Catherine A McCall
- Department of Pulmonary, Critical Care, and Sleep Medicine, VA Puget Sound Health Care System, Seattle.,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine and University of Washington Sleep Medicine Center, Seattle
| | - Eric Turkheimer
- Department of Psychology, University of Virginia, Charlottesville
| | - Siny Tsang
- Washington State Twin Registry, Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Ally Avery
- Washington State Twin Registry, Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Glen E Duncan
- Washington State Twin Registry, Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Nathaniel F Watson
- Department of Neurology, University of Washington School of Medicine and University of Washington Sleep Medicine Center, Seattle
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25
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EDITORIAL COMMENT. Urology 2020; 138:58. [DOI: 10.1016/j.urology.2019.10.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 10/31/2019] [Indexed: 11/18/2022]
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26
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Yu Z, Yang J, Xiang D, Li G, Liu D, Zhang C. Circadian rhythms and bile acid homeostasis: a comprehensive review. Chronobiol Int 2020; 37:618-628. [PMID: 32126853 DOI: 10.1080/07420528.2020.1733590] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Zaoqin Yu
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinyu Yang
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dong Xiang
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guodong Li
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dong Liu
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chengliang Zhang
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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27
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Abstract
PURPOSE OF REVIEW Sleep is an essential component of human health, and suboptimal sleep duration has been associated with increased cardiovascular morbidity and mortality. This review summarizes physiological and pathological effects of sleep duration on the cardiovascular system. RECENT FINDINGS Both decreased and increased duration of sleep lead to increased cardiovascular mortality and has a U-shaped curve. Sleep apnea is an independent risk factor for atherosclerosis and hypertension, and its treatment with continuous positive airway pressure (CPAP) results in increased survival. Estimated sleep duration of 6-8 h is associated with decreased mortality and major cardiovascular events and should be addressed by clinicians during routine visits.
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28
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Tiuganji NM, Nehme P, Marqueze EC, Isherwood CM, Martins AJ, Vasconcelos S, Cipolla-Neto J, Lowden A, Skene DJ, Moreno CRC. Eating Behavior (Duration, Content, and Timing) Among Workers Living under Different Levels of Urbanization. Nutrients 2020; 12:E375. [PMID: 32023914 PMCID: PMC7071231 DOI: 10.3390/nu12020375] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/20/2020] [Accepted: 01/24/2020] [Indexed: 01/22/2023] Open
Abstract
Urbanization has contributed to extended wakefulness, which may in turn be associated with eating over a longer period. Here, we present a field study conducted in four groups with different work hours and places of living in order to investigate eating behavior (duration, content, and timing). Anthropometric measures were taken from the participants (rural (n = 22); town (n = 19); city-day workers (n = 11); city-night workers (n = 14)). In addition, a sociodemographic questionnaire was self-answered and 24-h food recalls were applied for three days. The 24-h food recalls revealed that fat intake varied according to the groups, with the highest consumption by the city-day workers. By contrast, city-day workers had the lowest intake of carbohydrate, whereas the rural group had the highest. In general, all groups had some degree of inadequacy in food consumption. Eating duration was negatively correlated with total energy intake, fat, and protein consumption in the rural and town groups. There was a positive correlation between body mass index and eating duration in both city groups. The rural group had the earliest start time of eating, and this was associated with a lower body mass index. This study suggested that food content and timing, as well as eating duration, differed according to place of living, which in turn may be linked to lifestyle.
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Affiliation(s)
- Natalia M. Tiuganji
- School of Public Health, University of São Paulo, 715 Av. Dr. Arnaldo, São Paulo SP 01246-904, Brazil; (N.M.T.); (P.N.); (E.C.M.); (A.J.M.)
| | - Patricia Nehme
- School of Public Health, University of São Paulo, 715 Av. Dr. Arnaldo, São Paulo SP 01246-904, Brazil; (N.M.T.); (P.N.); (E.C.M.); (A.J.M.)
| | - Elaine C. Marqueze
- School of Public Health, University of São Paulo, 715 Av. Dr. Arnaldo, São Paulo SP 01246-904, Brazil; (N.M.T.); (P.N.); (E.C.M.); (A.J.M.)
- Epidemiology, Public Health Graduate Program, Catholic University of Santos, 300 Av. Conselheiro Nébias, Santos SP 11045-003, Brazil
| | - Cheryl M. Isherwood
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey GU2 7XH, UK (D.J.S.)
| | - Andressa J. Martins
- School of Public Health, University of São Paulo, 715 Av. Dr. Arnaldo, São Paulo SP 01246-904, Brazil; (N.M.T.); (P.N.); (E.C.M.); (A.J.M.)
| | - Suleima Vasconcelos
- Department of Health Science and Sports Center, Federal University of Acre, Rodovia BR 364, Km 04–Rio Branco–AC 69920-900, Brazil;
| | - José Cipolla-Neto
- Institute of Biomedical Sciences, University of São Paulo, 1524 Av. Prof. Lineu Prestes, São Paulo SP 05508-000, Brazil;
| | - Arne Lowden
- Stress Research Institute, Department of Psychology, University of Stockholm, SE-106 91 Stockholm, Sweden;
| | - Debra J. Skene
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey GU2 7XH, UK (D.J.S.)
| | - Claudia R. C. Moreno
- School of Public Health, University of São Paulo, 715 Av. Dr. Arnaldo, São Paulo SP 01246-904, Brazil; (N.M.T.); (P.N.); (E.C.M.); (A.J.M.)
- Stress Research Institute, Department of Psychology, University of Stockholm, SE-106 91 Stockholm, Sweden;
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Khan S, Malik BH, Gupta D, Rutkofsky I. The Role of Circadian Misalignment due to Insomnia, Lack of Sleep, and Shift Work in Increasing the Risk of Cardiac Diseases: A Systematic Review. Cureus 2020; 12:e6616. [PMID: 32064196 PMCID: PMC7008727 DOI: 10.7759/cureus.6616] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Around 121.5 million people suffer from cardiovascular diseases globally. The risk of cardiovascular diseases increases with advancing age in both genders. Circadian rhythm is responsible for a streamlined functioning of various body functions. Certain functions and hormones have their peak levels according to the biological day or night of circadian rhythm. Shift work and sleep disorders like obstructive sleep apnea can cause circadian misalignment that affects different metabolic, immunological, and cardiovascular functions, which ultimately increases the risk of cardiovascular diseases. We systematically searched the online database PubMed to find papers on randomized controlled trials (RCTs) from the past five years, evaluating the role of shift work and different sleep disorders in causing circadian misalignment and its effect on the risk of cardiovascular diseases. Fifty papers were shortlisted, and after the application of various inclusion and exclusion criteria, 18 papers were chosen; and then after a thorough analysis of the text, eight papers were selected for the review. All papers were evaluated for quality. Two papers focused on the effect of shift work on cardiovascular diseases, whereas five papers evaluated the role of sleep disorders on circadian rhythm and the risk of cardiovascular diseases. Shift work and sleep-related disorders were found to cause circadian misalignment, and it was found to be associated with an increase in the risk of cardiovascular diseases. Managing these disorders can help reduce the risk of cardiovascular diseases.
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Affiliation(s)
- Safeera Khan
- Family Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Bilal Haider Malik
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Deepti Gupta
- Reproductive Medicine, Saint Mary's Hospital, Manchester, GBR
| | - Ian Rutkofsky
- Psychiatry, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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Spiesshoefer J, Linz D, Skobel E, Arzt M, Stadler S, Schoebel C, Fietze I, Penzel T, Sinha AM, Fox H, Oldenburg O. Sleep – the yet underappreciated player in cardiovascular diseases: A clinical review from the German Cardiac Society Working Group on Sleep Disordered Breathing. Eur J Prev Cardiol 2019; 28:189-200. [PMID: 33611525 DOI: 10.1177/2047487319879526] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 09/10/2019] [Indexed: 11/16/2022]
Abstract
Abstract
Patients with a wide variety of cardiovascular diseases, including arterial and pulmonary hypertension, arrhythmia, coronary artery disease and heart failure, are more likely to report impaired sleep with reduced sleep duration and quality, and also, sometimes, sleep interruptions because of paroxysmal nocturnal dyspnoea or arrhythmias. Overall, objective short sleep and bad sleep quality (non-restorative sleep) and subjective long sleep duration are clearly associated with major cardiovascular diseases and fatal cardiovascular outcomes. Sleep apnoea, either obstructive or central in origin, represents the most prevalent, but only one, of many sleep-related disorders in cardiovascular patients. However, observations suggest a bidirectional relationship between sleep and cardiovascular diseases that may go beyond what can be explained based on concomitant sleep-related disorders as confounding factors. This makes sleep itself a modifiable treatment target. Therefore, this article reviews the available literature on the association of sleep with cardiovascular diseases, and discusses potential pathophysiological mechanisms. In addition, important limitations of the current assessment, quantification and interpretation of sleep in patients with cardiovascular disease, along with a discussion of suitable study designs to address future research questions and clinical implications are highlighted. There are only a few randomised controlled interventional outcome trials in this field, and some of the largest studies have failed to demonstrate improved survival with treatment (with worse outcomes in some cases). In contrast, some recent pilot studies have shown a benefit of treatment in selected patients with underlying cardiovascular diseases.
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Affiliation(s)
- Jens Spiesshoefer
- Institute of Life Sciences, Scuola Superiore Sant Anna, Pisa, Italy
- Respiratory Physiology Laboratory, Department of Neurology with Institute for Translational Neurology, University of Muenster, Muenster, Germany
| | - Dominik Linz
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Erik Skobel
- Medical Care Unit Pneumology, Sleep Medicine, Allergology and Cardiology, Luisenhospital Aachen, Aachen, Germany
| | - Michael Arzt
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Stefan Stadler
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Christoph Schoebel
- Interdisciplinary Sleep Medicine Center, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Ingo Fietze
- Interdisciplinary Sleep Medicine Center, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Penzel
- Interdisciplinary Sleep Medicine Center, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | | | - Henrik Fox
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Olaf Oldenburg
- Ludgerus-Kliniken Münster, Clemenshospital, Department of Cardiology, Münster, Germany
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Randerath W, Bonsignore MR, Herkenrath S. Obstructive sleep apnoea in acute coronary syndrome. Eur Respir Rev 2019; 28:28/153/180114. [PMID: 31366458 PMCID: PMC9488646 DOI: 10.1183/16000617.0114-2018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 05/12/2019] [Indexed: 12/25/2022] Open
Abstract
Obstructive sleep apnoea (OSA) syndrome affects about 13% of the male and 7–9% of the female population. Hypoxia, oxidative stress and systemic inflammation link OSA and cardiovascular and metabolic consequences, including coronary artery disease. Current research has identified several clinical phenotypes, and the combination of breathing disturbances during sleep, systemic effects and end-organ damage might help to develop personalised therapeutic approaches. It is unclear whether OSA is a risk factor for acute coronary syndrome (ACS) and might affect its outcome. On the one hand, OSA in patients with ACS may worsen prognosis; on the other hand, OSA-related hypoxaemia could favour the development of coronary collaterals, thereby exerting a protective effect. It is unknown whether positive airway pressure treatment may influence adverse events and consequences of ACS. In non-sleepy patients with OSA and stable coronary artery disease, randomised controlled trials failed to show that continuous positive airway pressure (CPAP) treatment protected against cardiovascular events. Conversely, uncontrolled studies suggested positive effects of CPAP treatment in such patients. Fewer data are available in subjects with ACS and OSA, and results of randomised controlled studies on the effects of CPAP are expected shortly. Meanwhile, the search for reliable markers of risk continues. Recent studies suggest that daytime sleepiness may indicate a more severe OSA phenotype with regard to cardiovascular risk. Finally, some studies suggest sex-related differences. The picture is still incomplete, and the potential role of OSA in patients with ACS awaits confirmation, as well as clear definition of subgroups with different degrees of risk. Evidence suggests a high prevalence of OSA in ACS. While some studies suggest hypoxia may have a protective effect, the majority show increased adverse cardiac outcomes. Treatment effectiveness on ACS outcome crucially depends on patients' adherence.http://bit.ly/2Id97ec
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Huang F, Wang K, Shen J. Lipoprotein-associated phospholipase A2: The story continues. Med Res Rev 2019; 40:79-134. [PMID: 31140638 PMCID: PMC6973114 DOI: 10.1002/med.21597] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 04/20/2019] [Accepted: 04/30/2019] [Indexed: 12/15/2022]
Abstract
Inflammation is thought to play an important role in the pathogenesis of vascular diseases. Lipoprotein-associated phospholipase A2 (Lp-PLA2) mediates vascular inflammation through the regulation of lipid metabolism in blood, thus, it has been extensively investigated to identify its role in vascular inflammation-related diseases, mainly atherosclerosis. Although darapladib, the most advanced Lp-PLA2 inhibitor, failed to meet the primary endpoints of two large phase III trials in atherosclerosis patients cotreated with standard medical care, the research on Lp-PLA2 has not been terminated. Novel pathogenic, epidemiologic, genetic, and crystallographic studies regarding Lp-PLA2 have been reported recently, while novel inhibitors were identified through a fragment-based lead discovery strategy. More strikingly, recent clinical and preclinical studies revealed that Lp-PLA2 inhibition showed promising therapeutic effects in diabetic macular edema and Alzheimer's disease. In this review, we not only summarized the knowledge of Lp-PLA2 established in the past decades but also emphasized new findings in recent years. We hope this review could be valuable for helping researchers acquire a much deeper insight into the nature of Lp-PLA2, identify more potent and selective Lp-PLA2 inhibitors, and discover the potential indications of Lp-PLA2 inhibitors.
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Affiliation(s)
- Fubao Huang
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica (SIMM), Chinese Academy of Sciences, Shanghai, China.,School of Pharmacy, University of Chinese Academy of Sciences, Beijing, China
| | - Kai Wang
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica (SIMM), Chinese Academy of Sciences, Shanghai, China
| | - Jianhua Shen
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica (SIMM), Chinese Academy of Sciences, Shanghai, China
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Redeker NS, Caruso CC, Hashmi SD, Mullington JM, Grandner M, Morgenthaler TI. Workplace Interventions to Promote Sleep Health and an Alert, Healthy Workforce. J Clin Sleep Med 2019; 15:649-657. [PMID: 30952228 DOI: 10.5664/jcsm.7734] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 03/07/2019] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The purpose of this review is to synthesize the published literature that addresses employer-initiated interventions to improve the sleep of workers and in turn improve health, productivity, absenteeism, and other outcomes that have been associated with sleep disorders or sleep deficiency. METHODS We conducted a systematic search and a selective narrative review of publications in PubMed from 1966 to December 2017. We extracted study characteristics, including the workers' professions, workplace settings and shift work, and workplace interventions focused on worker sleep. Because of the high degree of heterogeneity in design and outcomes, we conducted a narrative review. RESULTS We identified 219 publications. After restriction to publications with studies of workplace interventions that evaluated the outcomes of sleep duration or quality, we focused on 47 articles. An additional 13 articles were accepted in the pearling process. Most studies employed non-randomized or controlled pretest and posttest designs and self-reported measures of sleep. The most common workplace interventions were educational programs stressing sleep hygiene or fatigue management. Other interventions included timed napping before or after work, urging increased daytime activity levels, modifying workplace environmental characteristics such as lighting, and screening, and referral for sleep disorders treatment. Overall, most reports indicated that employer efforts to encourage improved sleep hygiene and healthier habits result in improvements in sleep duration, sleep quality, and self-reported sleepiness complaints. CONCLUSIONS These studies suggest employer-sponsored efforts can improve sleep and sleep-related outcomes. The existing evidence, although weak, suggests efforts by employers to encourage better sleep habits and general fitness result in self-reported improvements in sleep-related outcomes, and may be associated with reduced absenteeism and better overall quality of life. Candidate workplace strategies to promote sleep health are provided.
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Affiliation(s)
| | - Claire C Caruso
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio
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Smith DF, Amin RS. OSA and Cardiovascular Risk in Pediatrics. Chest 2019; 156:402-413. [PMID: 30790552 DOI: 10.1016/j.chest.2019.02.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 01/21/2019] [Accepted: 02/08/2019] [Indexed: 02/07/2023] Open
Abstract
OSA occurs in approximately 1% to 5% of children in the United States. Long-term cardiovascular risks associated with OSA in the adult population are well documented. Although changes in BP regulation occur in children with OSA, the pathways leading to chronic cardiovascular risks of OSA in children are less clear. Risk factors associated with cardiovascular disease in adult populations could carry the same future risk for children. It is imperative to determine whether known mechanisms of cardiovascular diseases in adults are like those that lead to pediatric disease. Early pathophysiologic changes may lead to a lifetime burden of cardiovascular disease and early mortality. With this perspective in mind, our review discusses pathways leading to cardiovascular pathology in children with OSA and provides a comprehensive overview of recent research findings related to cardiovascular sequelae in the pediatric population.
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Affiliation(s)
- David F Smith
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Raouf S Amin
- Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
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Wang S, Gao H, Ru Z, Zou Y, Li Y, Cao W, Meng W, Li J, Yao Y, Zhang Y, Lang X, Zhang Y. Poor Sleep Quality Associated With High Risk Of Ventricular Tachycardia After Acute Myocardial Infarction. Nat Sci Sleep 2019; 11:281-289. [PMID: 31802960 PMCID: PMC6827508 DOI: 10.2147/nss.s222359] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 09/24/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Sleep disorders (SDs) are usually associated with an increase in frequency of ventricular tachycardia (VT). However, the relationship between SDs and the prevalence of VT within the first week of acute myocardial infarction (AMI) remains unclear. This study aimed to evaluate their associations and potential mechanisms. METHODS This structured questionnaire-based cross-sectional study enrolled 303 patients with AMI from a hospital in northern China. Pittsburgh Sleep Quality Index (PSQI) was used to determine sleep quality of subjects. Heart rate variability (HRV) of patients was investigated by ambulatory electrocardiography recorders. Enzyme-linked immunosorbent assay was used to measure the plasma levels of catecholamine in a subgroup including 80 patients with AMI. RESULTS After adjusting to basic cardiovascular characteristics, results of multivariate logistic regression demonstrated that the global PSQI score and its main components were positively associated with VT prevalence in inpatients with AMI. There were significantly different HRV parameters interpreted as autonomic nerve activity in two groups of AMI patients with different sleep quality. In addition, we found the influence of sleep quality on plasma concentrations of adrenaline and norepinephrine in AMI patients. CONCLUSION Sleep status was significantly associated with the initiation of VT within the first week of AMI, probably due to the effect of SDs on sympathetic nerve activity. Amelioration of sleep quality and sympathetic hyperactivity may be prospective strategy to curb arrhythmias after AMI.
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Affiliation(s)
- Shipeng Wang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, People's Republic of China.,Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin 150086, People's Republic of China
| | - Hui Gao
- Department of Cardiology, People' Hospital of Xinzheng, Xinzheng, Henan Province 451150, People's Republic of China
| | - Zewen Ru
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, People's Republic of China
| | - Yanan Zou
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, People's Republic of China
| | - Yilan Li
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, People's Republic of China
| | - Wei Cao
- Department of Cardiology, Heilongjiang Provincial Hospital Affiliated to Harbin Institute of Technology, Harbin 150036, People's Republic of China
| | - Wei Meng
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, People's Republic of China
| | - Jihe Li
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, People's Republic of China
| | - Yuan Yao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, People's Republic of China
| | - Yanxiu Zhang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, People's Republic of China
| | - Xueyan Lang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, People's Republic of China
| | - Yao Zhang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, People's Republic of China.,Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin 150086, People's Republic of China
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von Allmen DC, Francey LJ, Rogers GM, Ruben MD, Cohen AP, Wu G, Schmidt RE, Ishman SL, Amin RS, Hogenesch JB, Smith DF. Circadian Dysregulation: The Next Frontier in Obstructive Sleep Apnea Research. Otolaryngol Head Neck Surg 2018; 159:948-955. [PMID: 30200807 DOI: 10.1177/0194599818797311] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To review the effects of the circadian clock on homeostasis, the functional interaction between the circadian clock and hypoxia-inducible factors, and the role of circadian dysregulation in the progression of cardiopulmonary disease in obstructive sleep apnea (OSA). DATA SOURCES The MEDLINE database was accessed through PubMed. REVIEW METHODS A general review is presented on molecular pathways disrupted in OSA, circadian rhythms and the role of the circadian clock, hypoxia signaling, crosstalk between the circadian and hypoxia systems, the role of the circadian clock in cardiovascular disease, and implications for practice. Studies included in this State of the Art Review demonstrate the potential contribution of the circadian clock and hypoxia in animal models or human disease. CONCLUSIONS Molecular crosstalk between the circadian clock and hypoxia-inducible factors has not been evaluated in disease models of OSA. IMPLICATIONS FOR PRACTICE Pediatric OSA is highly prevalent and, if left untreated, may lead to cardiopulmonary sequelae. Changes in inflammatory markers that normally demonstrate circadian rhythmicity are also seen among patients with OSA. Hypoxia-inducible transcription factors interact with core circadian clock transcription factors; however, the interplay between these pathways has not been elucidated in the cardiopulmonary system. This gap in knowledge hinders our ability to identify potential biomarkers of OSA and develop alternative therapeutic strategies. A deeper understanding of the mechanisms by which OSA impinges on clock function and the impact of clock dysregulation on the cardiopulmonary system may lead to future advancements for the care of patients with OSA. The aim of this review is to shed light on this important clinical topic.
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Affiliation(s)
- Douglas C von Allmen
- 1 Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Lauren J Francey
- 2 Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Garrett M Rogers
- 3 College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Marc D Ruben
- 2 Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Aliza P Cohen
- 4 Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Gang Wu
- 2 Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Robert E Schmidt
- 2 Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Stacey L Ishman
- 1 Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
- 4 Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- 5 Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Raouf S Amin
- 5 Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- 6 Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - John B Hogenesch
- 2 Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- 6 Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - David F Smith
- 1 Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
- 4 Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- 5 Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Shiftwork-Mediated Disruptions of Circadian Rhythms and Sleep Homeostasis Cause Serious Health Problems. Int J Genomics 2018; 2018:8576890. [PMID: 29607311 PMCID: PMC5828540 DOI: 10.1155/2018/8576890] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 12/12/2017] [Indexed: 12/12/2022] Open
Abstract
Shiftwork became common during the last few decades with the growing demands of human life. Despite the social inactivity and irregularity in habits, working in continuous irregular shifts causes serious health issues including sleep disorders, psychiatric disorders, cancer, and metabolic disorders. These health problems arise due to the disruption in circadian clock system, which is associated with alterations in genetic expressions. Alteration in clock controlling genes further affects genes linked with disorders including major depression disorder, bipolar disorder, phase delay and phase advance sleep syndromes, breast cancer, and colon cancer. A diverse research work is needed focusing on broad spectrum changes caused by jet lag in brain and neuronal system. This review is an attempt to motivate the researchers to conduct advanced studies in this area to identify the risk factors and mechanisms. Its goal is extended to make the shift workers aware about the risks associated with shiftwork.
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Geyer C. In Search of a Good Night's Sleep: Hormones, Mind, Movement, and Breath. Am J Lifestyle Med 2017; 12:120-123. [PMID: 30283249 DOI: 10.1177/1559827617747222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Sleep disturbances are common in postmenopausal women and contribute to increased morbidity and mortality. Sleep apnea may be underdiagnosed in women, and other conditions such as insomnia and restless legs may coexist with sleep apnea. This case illustrates the complex interplay of anatomical, hormonal, metabolic and psychological factors that can interfere with restorative sleep, and the importance of both diagnostic testing and clinical history in identifying which combination of therapies will be most beneficial in improving sleep quality and quantity.
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