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Meidan R, Elalouf O, Tauman R, Furer V, Polachek A, Wollman J, Eviatar T, Zisapel M, Levartovsky D, Seyman E, Elkayam O, Paran D. Systemic Lupus Erythematous and Obstructive Sleep Apnea: A Possible Association. Life (Basel) 2023; 13:life13030697. [PMID: 36983852 PMCID: PMC10053665 DOI: 10.3390/life13030697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/27/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
Marked fatigue is common in patients with systemic lupus erythematosus (SLE). This study aimed to assess the association of sleep disorders, including obstructive sleep apnea (OSA), with SLE. Forty-two consecutive patients with SLE and 20 healthy controls were recruited and underwent a one-night ambulatory sleep examination. They completed questionnaires, including the Pittsburgh Sleep Quality Index (PSQI) and Functional Assessment of Chronic Illness Therapy (FACIT). SLE disease activity and damage were assessed by the SLE Disease Activity Index 2000 (SLEDAI-2K) and the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index (SDI). A significantly increased apnea/hypopnea index was noted in the SLE group compared to healthy controls (p = 0.004). SLE patients had higher rates of moderate-to-severe OSA (p = 0.04), PSQI (p = 0.001), and FACIT scores (p = 0.0008). Multivariate analysis revealed that the SDI was associated with OSA (p = 0.03). There was a positive association between SLEDAI-2K and moderate-to-severe OSA (p = 0.03). Patients with SLE had an increased prevalence of OSA and poorer quality of sleep compared to healthy controls. Our findings suggest that active disease and accumulated damage may be associated with OSA. These findings highlight the importance of identifying the presence of OSA in patients with SLE.
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Affiliation(s)
- Roni Meidan
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Correspondence:
| | - Ofir Elalouf
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Riva Tauman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Sleep Medicine Center, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Victoria Furer
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Ari Polachek
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Jonathan Wollman
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Tali Eviatar
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Michael Zisapel
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - David Levartovsky
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Estelle Seyman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Ori Elkayam
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Daphna Paran
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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The Relationship between the Plasma Concentration of Electrolytes and Intensity of Sleep Bruxism and Blood Pressure Variability among Sleep Bruxers. Biomedicines 2022; 10:biomedicines10112804. [PMID: 36359324 PMCID: PMC9687451 DOI: 10.3390/biomedicines10112804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/28/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
Plasma sodium plays a major role in regulating blood pressure (BP). An augmented variability of BP is considered a risk factor for the development of arterial hypertension, which is prevalent among patients with suspected sleep bruxism (SB). The aims of this study were to assess the plasma concentration of electrolytes and their effect on the intensity of SB and BP variability among sleep bruxers. A total of 51 patients were enrolled in this prospective, observational study. A single full-night polysomnographic examination was conducted in the Wroclaw Medical University Sleep Laboratory, Poland, and based on the guidelines of the American Academy of Sleep Medicine, the results were analyzed. The monitoring of ambulatory BP was performed the next day, and the plasma levels of sodium, potassium, magnesium, and calcium were measured. The mean age of the studied group was 33.9 ± 11.2 years, and the mean bruxism episode index (BEI) was 4.94 ± 3.53. The study revealed statistically significant differences in the plasma concentrations of sodium in the SB group. A decreased sodium concentration was observed in the group of mild bruxers (2 ≤ BEI < 4) (139.7 ± 1.4 vs. 142.8 ± 3.2, p = 0.002) and severe bruxers (BEI ≥ 4) (140.5 ± 2.0 vs. 142.8 ± 3.2, p = 0.016) compared to nonbruxers (BEI < 2). A statistically significant positive linear correlation was found between plasma sodium concentration and daytime systolic BP variability (r = 0.32, p < 0.05) as well as between plasma sodium concentration and nighttime diastolic BP variability (r = 0.31, p < 0.05). The preliminary results suggest the probable relationship between the lower plasma concentration of sodium and increased intensity of SB and BP variability among suspected sleep bruxers.
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Woo JMP, Parks CG, Jacobsen S, Costenbader KH, Bernatsky S. The role of environmental exposures and gene-environment interactions in the etiology of systemic lupus erythematous. J Intern Med 2022; 291:755-778. [PMID: 35143075 DOI: 10.1111/joim.13448] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Systemic lupus erythematosus (SLE) is a complex, chronic autoimmune disease, whose etiology includes both genetic and environmental factors. Individual genetic risk factors likely only account for about one-third of observed heritability among individuals with a family history of SLE. A large portion of the remaining risk may be attributable to environmental exposures and gene-environment interactions. This review focuses on SLE risk associated with environmental factors, ranging from chemical and physical environmental exposures to lifestyle behaviors, with the weight of evidence supporting positive associations between SLE and occupational exposure to crystalline silica, current smoking, and exogenous estrogens (e.g., oral contraceptives and postmenopausal hormones). Other risk factors may include lifestyle behaviors (e.g., dietary intake and sleep) and other exposures (e.g., ultraviolet [UV] radiation, air pollution, solvents, pesticides, vaccines and medications, and infections). Alcohol use may be associated with decreased SLE risk. We also describe the more limited body of knowledge on gene-environment interactions and SLE risk, including IL-10, ESR1, IL-33, ITGAM, and NAT2 and observed interactions with smoking, UV exposure, and alcohol. Understanding genetic and environmental risk factors for SLE, and how they may interact, can help to elucidate SLE pathogenesis and its clinical heterogeneity. Ultimately, this knowledge may facilitate the development of preventive interventions that address modifiable risk factors in susceptible individuals and vulnerable populations.
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Affiliation(s)
- Jennifer M P Woo
- Epidemiology Branch, National Institutes of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
| | - Christine G Parks
- Epidemiology Branch, National Institutes of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
| | - Søren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Karen H Costenbader
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sasha Bernatsky
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
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The Association of Sleep Quality and Vitamin D Levels in Hemodialysis Patients. BIOMED RESEARCH INTERNATIONAL 2021; 2021:4612091. [PMID: 34604382 PMCID: PMC8481063 DOI: 10.1155/2021/4612091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/16/2021] [Accepted: 09/04/2021] [Indexed: 12/16/2022]
Abstract
Background To date, hemodialysis (HD) is the most common therapy for chronic kidney disease (CKD) patients. However, it causes different complications such as sleep disorders. Sleep regulation is connected to vitamin D; hence, its deficiency might influence the quality and duration of sleep. This study is aimed at evaluating the correlation of sleep quality and vitamin D levels in 80 HD patients. Methods This cross-sectional study was performed on 80 hemodialysis patients admitted to 29 Bahman hospitals in Tabriz, Iran. Before beginning of dialysis, serum 25 (OH) D levels were assessed among patients and the sleep patterns and sleep quality of patients were accurately calculated by the Pittsburgh sleep quality index (PSQI) standard questionnaire. Results Our results showed that 22 HD patients (27.5%) had severe sleep disorders. In addition, it was found that serum levels of vitamin D had significant correlation with sleep quality (r = −0.341, p = 0.002) in general, even after adjusting confounding factors such as calcium (Ca), phosphate (P), and parathyroid hormone (PTH) level. In poor sleepers (PSQI ≤ 5), a negative correlation was observed between the levels of vitamin D and PSQI score (r = −0.397, p = 0.004). PSQI scores in the normal range of PTH (r = −0.377, p = 0.006) and in >600 pg/ml of PTH (r = −0.675, p = 0.011) had a correlation with vitamin D levels. The level of vitamin D was the single independent predictor of sleep efficiency (β coefficient = −0.386, p = 0.001). Conclusion The present project reported that the positive effect of vitamin D is associated with sleep disorder in HD patients. In future studies, normal levels of Ca and P should be considered along with normal vitamin D levels among the included patients.
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Sahebari M, Ravanshad S, Ravanshad Y, Rezaeitalab F, Bayegi HRP, Asadpour H, Javadinia SA, Rezaieyazdi Z. A Survey on Sleep Disorders and Related Hormones in Patients with Newly Diagnosed Systemic Lupus Erythematosus. Mediterr J Rheumatol 2021; 32:148-157. [PMID: 34447911 PMCID: PMC8369266 DOI: 10.31138/mjr.32.2.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/12/2021] [Indexed: 11/04/2022] Open
Abstract
Background and Objectives Systemic lupus erythematosus (SLE) is reportedly associated with sleep disorders. Thus, the present study aimed to investigate sleep disorders in newly diagnosed SLE patients. Materials and Methods This study was conducted on patients with newly diagnosed SLE (ie, case group) and a control group. The case and control groups were matched in terms of gender, age, socioeconomic status, and educational level. Venous blood samples were obtained from the participants to measure prolactin and melatonin levels. Furthermore, they were subjected to polysomnography. The data were analysed by SPSS (version 16) at a significance level of 0.05. Results A total of 28 women were enrolled in this study (ie, 14 individuals in each group). The frequencies of sleep disorder in the case and control groups were obtained as 64.3% and 50%, respectively (P=0.4). These two groups had the mean sleep onset times of 10.76±10.64 and 8.67±7.12 min (P=0.5) and the respiratory disturbance indices of 9.20±10.23 and 8.44±9.27, respectively (P=0.8). The frequency of sleep apnoea was obtained at 50% for both case and control groups (P=1). There was no significant difference between these groups in terms of the mean serum prolactin and melatonin levels (P=0.3 and P=0.2, respectively). Serum melatonin level showed a direct correlation with sleep latency to N1 (i.e., the first part of non-rapid eye movement in sleep) and spontaneous arousal index in the case group (P=0.02, r=0.602 and P=0.04, r=0.544, respectively). Conclusion According to the findings, there was no significant difference in the frequency of sleep disorders between the healthy subjects and patients at the onset of lupus. Additionally, melatonin and prolactin levels showed no significant difference between the groups. Our results are inconsistent with previous studies, due to the difference in disease duration probably. It seems that the chronicity and complications of the disease, as well as the adoption of glucocorticoid therapy for the chronic disease affect sleep quality in SLE patients more than disease duration.
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Affiliation(s)
- Maryam Sahebari
- Rheumatic Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sahar Ravanshad
- Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Yalda Ravanshad
- Education Development Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Community Medicine, Mashhad Branch, Islamic Azad University, Mashhad, Iran
| | - Fariborz Rezaeitalab
- Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Houshang Rafat Panah Bayegi
- Immunology Research Center, Division of Inflammatory Disease, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hadi Asadpour
- Sleep Clinic of Ebn-e-Sina Hospital, Psychiatry and Behavioral Sciences Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Alireza Javadinia
- Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Rezaieyazdi
- Rheumatic Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Alkhatatbeh MJ, Hmoud ZL, Abdul-Razzak KK, Alem EM. Self-reported sleep bruxism is associated with vitamin D deficiency and low dietary calcium intake: a case-control study. BMC Oral Health 2021; 21:21. [PMID: 33413308 PMCID: PMC7792220 DOI: 10.1186/s12903-020-01349-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 11/17/2020] [Indexed: 12/26/2022] Open
Abstract
Background Sleep bruxism may result in deleterious effects including loss of tooth enamel,
fracture of teeth or restorations, teeth hypersensitivity or pain, and headache. The aim was to study the link between sleep bruxism, low serum vitamin D, low consumption of dietary calcium, psychological symptoms, and frequent headache. Methods This case-controlled study included 50 individuals with sleep bruxism and 50 age and gender matched controls. 25-hydroxyvitamin D was measured in serum. Hospital Anxiety and Depression Scale was used to measure anxiety and depression. Data about dietary calcium and frequent headache were self-reported. Results Participants with sleep bruxism had lower 25-hydroxyvitamin D and higher scores of anxiety and depression compared to controls (p < 0.05). Vitamin D deficiency, abnormal scores of anxiety and depression, low calcium consumption (< 323 mg/day), and frequent headache were reported in higher % of individuals with sleep bruxism compared to controls (p < 0.05). Binary logistic regression showed that sleep bruxism was significantly associated with vitamin D deficiency (OR = 6.66, p = 0.02), low consumption of dietary calcium (OR = 5.94, p = 0.01), and frequent headache (OR = 9.24, p < 0.001). Multiple linear regression showed that anxiety was significantly associated with decreased 25-hydroxyvitamin D (p = 0.03), increased scores of depression (p < 0.001) and female sex (p = 0.01). Binary logistic regression also showed that frequent headache was significantly associated with sleep bruxism (OR = 5.51, p < 0.01). Conclusions Sleep bruxism was associated with vitamin D deficiency and low consumption of calcium and was also associated with increased scores of anxiety and depression. Further investigations should be performed to check if vitamin D and calcium supplementation could relieve sleep bruxism.
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Affiliation(s)
- Mohammad J Alkhatatbeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan.
| | - Zainab L Hmoud
- Department of Nutrition and Food Technology, Faculty of Agriculture, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Khalid K Abdul-Razzak
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Esam M Alem
- Department of Prosthodontics, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, 22110, Jordan
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Mak A. The Impact of Vitamin D on the Immunopathophysiology, Disease Activity, and Extra-Musculoskeletal Manifestations of Systemic Lupus Erythematosus. Int J Mol Sci 2018; 19:ijms19082355. [PMID: 30103428 PMCID: PMC6121378 DOI: 10.3390/ijms19082355] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/01/2018] [Accepted: 08/08/2018] [Indexed: 12/11/2022] Open
Abstract
Over the past two decades it has been increasingly recognized that vitamin D, aside from its crucial involvement in calcium and phosphate homeostasis and the dynamics of the musculoskeletal system, exerts its influential impact on the immune system. The mechanistic roles that vitamin D plays regarding immune activation for combating infection, as well as pathologically and mediating autoimmune conditions, have been progressively unraveled. In vitro and in vivo models have demonstrated that the action of vitamin D on various immunocytes is not unidirectional. Rather, how vitamin D affects immunocyte functions depends on the context of the immune response, in the way that its suppressive or stimulatory action offers physiologically appropriate and immunologically advantageous outcomes. In this review, the relationship between various aspects of vitamin D, starting from its adequacy in circulation to its immunological functions, as well as its autoimmune conditions, in particular systemic lupus erythematosus (SLE), a prototype autoimmune condition characterized by immune-complex mediated inflammation, will be discussed. Concurring with other groups of investigators, our group found that vitamin D deficiency is highly prevalent in patients with SLE. Furthermore, the circulating vitamin D levels appear to be correlated with a higher disease activity of SLE as well as extra-musculoskeletal complications of SLE such as fatigue, cardiovascular risk, and cognitive impairment.
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Affiliation(s)
- Anselm Mak
- Department of Medicine, National University of Singapore, Singapore 119228, Singapore.
- Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore 119228, Singapore.
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Young KA, Munroe ME, Harley JB, Guthridge JM, Kamen DL, Gilkensen GS, Weisman MH, Karp DR, Wallace DJ, James JA, Norris JM. Less than 7 hours of sleep per night is associated with transitioning to systemic lupus erythematosus. Lupus 2018; 27:1524-1531. [PMID: 29804502 DOI: 10.1177/0961203318778368] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background The role of sleep in the etiology of systemic lupus erythematosus (SLE) has not been well studied. We examined whether sleep duration was associated with subsequent transitioning to SLE in individuals at risk for SLE. Methods Four hundred and thirty-six relatives of SLE patients who did not have SLE themselves at baseline were evaluated again an average of 6.3 (± 3.9) years later. Fifty-six individuals transitioned to SLE (≥ 4 cumulative American College of Rheumatology (ACR) criteria). Sleep duration, medication use and medical history were assessed by questionnaire; ACR criteria were confirmed by medical record review. Vitamin D was measured by ELISA. Generalized estimating equations, accounting for correlation within families, assessed associations between baseline sleep and the outcome of transitioning to SLE. Results Reporting sleeping less than 7 hours per night at baseline was more common in those who subsequently transitioned than those who did not transition to SLE (55% versus 32%, p = 0.0005; OR: 2.8, 95% CI 1.6-4.9). Those who transitioned to SLE were more likely to sleep less than 7 hours per night than those who did not transition to SLE adjusting for age, sex and race (OR: 2.8, 95% CI 1.6-5.1). This association remained after individual adjustment for conditions and early symptoms that could affect sleep, including prednisone use, vitamin D deficiency and number of ACR criteria (OR: 2.0, 95% CI 1.1-4.2). Conclusion Lack of sleep may be associated with transitioning to SLE, independent of early clinical manifestations of SLE that may influence sleep duration. Further evaluation of sleeping patterns and biomarkers in at-risk individuals is warranted.
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Affiliation(s)
- K A Young
- 1 Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - M E Munroe
- 2 Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, USA
| | - J B Harley
- 3 Center for Autoimmune Genomics and Etiology (CAGE), Cincinnati Children's Hospital Medical Center, Cincinnati, USA.,4 US Department of Veterans Affairs Medical Center, Cincinnati, USA
| | - J M Guthridge
- 2 Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, USA
| | - D L Kamen
- 5 Division of Rheumatology, Medical University of South Carolina, Charleston, USA
| | - G S Gilkensen
- 5 Division of Rheumatology, Medical University of South Carolina, Charleston, USA
| | - M H Weisman
- 6 Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, USA
| | - D R Karp
- 7 Division of Rheumatic Diseases, University of Texas Southwestern Dallas, USA
| | - D J Wallace
- 6 Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, USA
| | - J A James
- 2 Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, USA.,8 Departments of Medicine and Pathology, Oklahoma University Health Sciences Center, Oklahoma City, USA
| | - J M Norris
- 1 Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, USA
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Vitamin D and systemic lupus erythematosus - The hype and the hope. Autoimmun Rev 2017; 17:19-23. [PMID: 29108830 DOI: 10.1016/j.autrev.2017.11.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 09/07/2017] [Indexed: 02/07/2023]
Abstract
Over the past 20years, much has been written about the potential role of vitamin D in on adverse health outcomes. In recent years, evidence has accumulated regarding the effect of vitamin D on the immune system, and its different cells. Some studies have noted lower vitamin D concentrations in patients with SLE. These epidemiological data still not answer the question: is vitamin D deficiency the cause or the effect? To answer this, we will discuss the association between vitamin D deficiency and SLE and review the evidence from interventional studies.
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Salman-Monte TC, Torrente-Segarra V, Vega-Vidal AL, Corzo P, Castro-Dominguez F, Ojeda F, Carbonell-Abelló J. Bone mineral density and vitamin D status in systemic lupus erythematosus (SLE): A systematic review. Autoimmun Rev 2017; 16:1155-1159. [DOI: 10.1016/j.autrev.2017.09.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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11
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Han B, Zhu FX, Shi C, Wu HL, Gu XH. Association between Serum Vitamin D Levels and Sleep Disturbance in Hemodialysis Patients. Nutrients 2017; 9:nu9020139. [PMID: 28216568 PMCID: PMC5331570 DOI: 10.3390/nu9020139] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 01/17/2017] [Accepted: 02/07/2017] [Indexed: 01/25/2023] Open
Abstract
Sleep disturbance is a frequent and serious complication of hemodialysis (HD). Low serum vitamin D levels have been associated with sleep quality in non-HD subjects. Our aim was to examine the possible association between serum vitamin D levels and the presence of sleep disturbance in HD patients. We recruited 141 HD patients at the HD center of the First Affiliated Hospital of Jiaxing University during 2014–2015. Serum levels of 25-hydroxyvitamin D (25(OH)D) were determined by the competitive protein-binding assay. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). Demographic, clinical and laboratory data were recorded. Meanwhile, 117 healthy control subjects were also recruited and underwent measurement of 25(OH)D. Eighty-eight patients (62.4%) had sleep disturbance (PSQI scores ≥ 5). Patients with sleep disturbance showed lower levels of 25(OH)D as compared to those without sleep disturbance (85.6 ± 37.4 vs. 39.1 ± 29.1 nmol/L, p < 0.001). In multivariate analyses, serum levels of 25(OH)D (≤48.0 nmol/L) were independently associated with sleep disturbance in HD patients (OR 9.897, 95% CI 3.356–29.187, p < 0.001) after adjustment for possible variables. Our study demonstrates that low serum levels of vitamin D are independently associated with sleep disturbance in HD patients, but the finding needs to be confirmed in future experimental and clinical studies.
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Affiliation(s)
- Bin Han
- Department of nephrology, First Affiliated Hospital of Jiaxing University, Jiaxing 314000, China.
| | - Fu-Xiang Zhu
- Department of nephrology, First Affiliated Hospital of Jiaxing University, Jiaxing 314000, China.
| | - Chao Shi
- Department of nephrology, First Affiliated Hospital of Jiaxing University, Jiaxing 314000, China.
| | - Heng-Lan Wu
- Department of nephrology, First Affiliated Hospital of Jiaxing University, Jiaxing 314000, China.
| | - Xiao-Hong Gu
- Department of nephrology, First Affiliated Hospital of Jiaxing University, Jiaxing 314000, China.
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Inoue M, Shiozawa K, Yoshihara R, Yamane T, Shima Y, Hirano T, Makimoto K. Predictors of poor sleep quality in patients with systemic lupus erythematosus. Clin Rheumatol 2017; 36:1053-1062. [PMID: 28138857 DOI: 10.1007/s10067-017-3545-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/11/2017] [Accepted: 01/13/2017] [Indexed: 11/26/2022]
Abstract
Sleep problems are common in patients with systemic lupus erythematosus (SLE). This study aimed to examine the following: (1) predictors of sleep quality and (2) fluctuations in sleep quality in patients with SLE. Patients with SLE were recruited from three rheumatology centers in Japan. We collected demographic and clinical data and data on sleep quality as measured by the Pittsburgh Sleep Quality Index (PSQI), the Medical Outcome Study Short Form-12, and the Lupus Patient Reported Outcome Tool (LupusPRO). Fluctuations in sleep quality were examined by administering the PSQI a second time after a 2-week interval. We used multiple linear regression analysis to predict sleep quality. Of 205 patients who completed the survey, 62.9% showed poor sleep quality. The largest fluctuation in sleep quality was for "waking in the middle of the night or early morning." "LupusPRO pain/vitality" was a major predictor of poor sleep. The other significant predictors were mostly LupusPRO subscales and clinical variables and SF-12 subscales were mostly non-predictive. The majority of the participants had poor sleep quality. A lupus-specific QoL scale is important for understanding poor sleep quality in SLE patients. Symptom management appeared to play a key role in improving sleep quality.
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Affiliation(s)
- M Inoue
- Department of Nursing, Graduate School of Medicine, Osaka University, 1-7 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - K Shiozawa
- Rheumatology & Collagen Disease Center, Hyogo Prefectural Kakogawa Medical Center, 203 Kanno, Kanno-cho, Kakogawa, Hyogo, 675-0003, Japan
| | - R Yoshihara
- Rheumatology & Collagen Disease Center, Hyogo Prefectural Kakogawa Medical Center, 203 Kanno, Kanno-cho, Kakogawa, Hyogo, 675-0003, Japan
| | - T Yamane
- Rheumatology Center, Kakogawa City Hospital, 439 Honmachi, Kakogawa-cho, Kakogawa, Hyogo, 675-0037, Japan
| | - Y Shima
- Department of Allergy and Rheumatic Disease, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - T Hirano
- Department of Allergy and Rheumatic Disease, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - K Makimoto
- Department of Nursing, Graduate School of Medicine, Osaka University, 1-7 Yamadaoka, Suita, Osaka, 565-0871, Japan.
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Prevalence and predictors of vitamin D insufficiency in supplemented and non-supplemented women with systemic lupus erythematosus in the Mediterranean region. Rheumatol Int 2016; 36:975-85. [DOI: 10.1007/s00296-016-3497-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 05/12/2016] [Indexed: 11/25/2022]
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14
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Azrielant S, Shoenfeld Y. Eppur Si Muove: vitamin D is essential in preventing and modulating SLE. Lupus 2016; 25:563-572. [DOI: 10.1177/0961203316629001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Systemic lupus erythematosus (abbreviated SLE or lupus) is a systemic autoimmune disease, with genetic, immunologic, hormonal, and environmental factors. 1 One of the environmental factors that has been studied over the years is vitamin D, which is created in the human body in response to exposure to sunlight and ultraviolet (UV) radiation. This review aims at examining findings from recent years, specifically 2013–2014, regarding the relationship between vitamin D deficiency and SLE flares, severity, and clinical manifestation, as well as to examine the treatment options derived from this relationship.
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Affiliation(s)
- S Azrielant
- The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Y Shoenfeld
- The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Incumbent of the Laura Schwarz-Kip Chair for Research of Autoimmune Diseases, Tel-Aviv University, Israel
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