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Mizuno S, Shimane T, Inoura S, Matsumoto T. Psychosocial characteristics of the general population who habitually use hypnotics: Results from a national survey on drug use among the Japanese. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2024; 3:e208. [PMID: 38988881 PMCID: PMC11233408 DOI: 10.1002/pcn5.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/10/2024] [Accepted: 05/11/2024] [Indexed: 07/12/2024]
Abstract
Aim The aim of this study was to examine the characteristics of habitual hypnotic users in Japan. Methods This nationwide, cross-sectional survey used self-administered questionnaires. Data were collected from four national surveys conducted every 2 years between 2015 and 2021. The participants were Japanese individuals who had taken prescription hypnotics in the past year or had never taken them. We divided 13,396 participants into three groups to compare the social background and status of taking medication and controlled drugs, drinking, and smoking among the three groups: people who use hypnotics habitually daily (habitual hypnotic users [HUs]), people who use them only occasionally (occasional hypnotic users [OUs]), and people who do not use them (hypnotic non-users [NUs]). We compared the perception of using hypnotics between the HU and OU groups. Results HUs were more likely to be older, unemployed, and to habitually use anxiolytics and analgesics than NUs. The main reasons for taking anxiolytics in HUs were alleviating insomnia and reducing anxiety, whereas the main reason for taking analgesics was improving joint pain. Additionally, the HU group had a higher proportion of habitual smokers than the OU group. There was no difference in drinking status or taking of controlled drugs among the three groups. HUs were more likely to use hypnotics and to have concerns about their side-effects than OUs. Conclusion HUs were more likely to be unemployed, habitually use anxiolytics and analgesics, smoke heavily, and take hypnotic drugs with concerns regarding side-effects. These results may help encourage the appropriate use of hypnotics.
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Affiliation(s)
- Satomi Mizuno
- Department of Drug Dependence ResearchNational Institute of Mental HealthKodairaJapan
- Department of Forensic Medicine, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Takuya Shimane
- Department of Drug Dependence ResearchNational Institute of Mental HealthKodairaJapan
| | - Satoshi Inoura
- Department of Drug Dependence ResearchNational Institute of Mental HealthKodairaJapan
| | - Toshihiko Matsumoto
- Department of Drug Dependence ResearchNational Institute of Mental HealthKodairaJapan
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Palamar JJ, Fitzgerald ND, Goldberger BA, Cottler LB. Monitoring illicit pentobarbital availability in the United States: A National Drug Early Warning System briefing. Drug Alcohol Depend 2024; 263:112402. [PMID: 39173219 DOI: 10.1016/j.drugalcdep.2024.112402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 07/31/2024] [Accepted: 08/01/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Pentobarbital is a Schedule II/III short-acting barbiturate with limited medical use in humans. Veterinary professionals use pentobarbital to euthanize dogs, cats, and other companion animals. Pentobarbital is also utilized in capital punishment and small amounts are illegally shipped or diverted to assist in suicides. However, five kilograms of pentobarbital smuggled in from Mexico was recently seized by an organized crime drug enforcement task force (along with fentanyl, heroin, and cocaine), which may suggest a shift in illicit supply. We investigated potential indicators of illicit pentobarbital use or availability in the US to help determine whether this drug is becoming an emerging public health concern. METHODS The National Drug Early Warning System requested information on pentobarbital from its sentinel surveillance sites and collaborators and conducted a search of current literature. RESULTS In early 2024, multiple batches of counterfeit pills (e.g., pressed as "M30s" to represent oxycodone) confiscated near the Southwest border tested positive for pentobarbital plus combinations of fentanyl, fentanyl analogs, and xylazine. Other indicators suggest pentobarbital is being smuggled in powder form and possibly sold as another drug such as heroin. One national drug analysis program detected pentobarbital in 217 drug submissions from 2020 to 2023, and there were at least 12 fatal exposures linked to use from 2020 to 2022. CONCLUSION Continued monitoring of illicit use and availability is needed as pentobarbital may continue to appear on the illicit market. Unknown exposure can occur if the drug is mixed into counterfeit pills or sold in powder form represented to be another drug.
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Affiliation(s)
- Joseph J Palamar
- NYU Grossman School of Medicine, Department of Population Health, New York, NY, USA.
| | - Nicole D Fitzgerald
- Columbia University Mailman School of Public Health, Department of Epidemiology, New York, NY, USA
| | - Bruce A Goldberger
- University of Florida College of Medicine, Department of Pathology, Immunology and Laboratory Medicine, Gainesville, FL, USA
| | - Linda B Cottler
- University of Florida, College of Public Health and Health Professions, College of Medicine Department of Epidemiology, USA
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Yeom JW, Cho CH. Herbal and Natural Supplements for Improving Sleep: A Literature Review. Psychiatry Investig 2024; 21:810-821. [PMID: 39086164 PMCID: PMC11321869 DOI: 10.30773/pi.2024.0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 05/30/2024] [Indexed: 08/02/2024] Open
Abstract
OBJECTIVE Herbal and natural supplements have gained popularity as alternative treatments to insomnia and sleep disorders due to their perceived safety and potential effectiveness. This literature review summarizes the current evidence on the efficacy, safety, and mechanisms of action of commonly used supplements for sleep, including valerian, hops, kava, German chamomile, cherry, tryptophan, theanine, melatonin, magnesium, and zinc. METHODS We conducted literature review of clinical research on herbal and supplements for sleep reported to date. We summarized key findings and reviewed outcomes related to clinical efficacy and side effects. RESULTS Findings suggest that certain supplements, particularly valerian, hops, and melatonin, could be effective in improving sleep quality and reducing insomnia symptoms through modulation of neurotransmitter systems and regulation of sleep-wake cycles. However, the strength of the evidence varies with unestablished optimal dosages, formulations, and treatment durations. Although generally considered safe, these supplements are not without risks, such as rare but serious adverse effects associated with kava and potential interactions with prescription medications. The quality and purity of supplements also vary widely due to a lack of strict regulations. CONCLUSION Healthcare providers should remain informed about the latest research and work closely with patients to develop personalized treatment plans. Herbal and natural supplements may offer promising alternatives or adjunct treatments for insomnia and sleep disorders, but their use should be guided by the best available evidence and individual patient requirements. Larger, well-designed clinical trials are needed to establish the efficacy and safety of these supplements for clinical decision-making.
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Affiliation(s)
- Ji Won Yeom
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Chul-Hyun Cho
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
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Lanza G, Mogavero MP, Salemi M, Ferri R. The Triad of Sleep, Immunity, and Cancer: A Mediating Perspective. Cells 2024; 13:1246. [PMID: 39120277 PMCID: PMC11311741 DOI: 10.3390/cells13151246] [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: 06/22/2024] [Revised: 07/18/2024] [Accepted: 07/23/2024] [Indexed: 08/10/2024] Open
Abstract
The triadic interplay between sleep, immunity, and cancer represents a growing area of biomedical research with significant clinical implications. This review synthesizes the current knowledge on how sleep influences immune function, the immune system's role in cancer dynamics, and the direct connections between sleep patterns and cancer risk. After a comprehensive overview of the interrelationships among these three domains, the mechanisms of sleep in immune function are described, detailing how sleep regulates the immune system, the effects of sleep duration and quality on immune responses, and the underlying molecular and cellular mechanisms. Also, the complex relationship between immunity and cancer is explored, highlighting the immune system's role in cancer prevention and progression, immune surveillance, tumor microenvironment, and the implications of immunodeficiency and immune modulation on cancer risk. The direct connections between sleep and cancer are then described, presenting epidemiological evidence linking sleep patterns to cancer risk, biological mechanisms that influence cancer development, and the role of sleep disorders in cancer prognosis. The mediating role of sleep between immunity and cancer is highlighted, proposing hypothesized pathways, summarizing evidence from experimental and clinical studies, and evaluating the impact of sleep interventions on immune function and cancer outcomes. This review concludes by discussing the clinical implications and future directions, emphasizing the potential for sleep-based interventions in cancer prevention and treatment, the integration of sleep management in oncology and immunotherapy, and outlining a future research agenda. This agenda includes understanding the mechanisms of the sleep-immunity-cancer interplay, conducting epidemiological studies on sleep and cancer risk, assessing the impact of sleep management in cancer treatment protocols, exploring sleep and tumor microenvironment interactions, and considering policy and public health implications. Through a detailed examination of these interconnected pathways, this review underscores the critical importance of sleep in modulating immune function and cancer outcomes, advocating for interdisciplinary research and clinical strategies to harness this knowledge for improved health outcomes.
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Affiliation(s)
- Giuseppe Lanza
- Oasi Research Institute—IRCCS, 94018 Troina, Italy; (G.L.); (M.S.)
- Department of Surgery and Medical–Surgical Specialties, University of Catania, 95100 Catania, Italy
| | - Maria P. Mogavero
- Vita-Salute San Raffaele University, 20132 Milan, Italy;
- Division of Neuroscience, Sleep Disorders Center, San Raffaele Scientific Institute, 20127 Milan, Italy
| | - Michele Salemi
- Oasi Research Institute—IRCCS, 94018 Troina, Italy; (G.L.); (M.S.)
| | - Raffaele Ferri
- Oasi Research Institute—IRCCS, 94018 Troina, Italy; (G.L.); (M.S.)
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Mekkawy KL, Rodriguez HC, Gosthe RG, Corces A, Roche MW. Immediate Postoperative Zolpidem Use Increases Risk of Falls and Implant Complication Rates Following Total Hip Arthroplasty: A Retrospective Case-Control Analysis. J Arthroplasty 2024; 39:169-173.e1. [PMID: 37562745 DOI: 10.1016/j.arth.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/31/2023] [Accepted: 08/03/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Zolpidem is the most widely used hypnotic in the United States and has known side effects. However, the morbidity of zolpidem use following total hip arthroplasty (THA) is not well-defined. Thus, the aim of this study was to assess the effects that zolpidem use has on medical and implant complications, falls, lengths of stay, and medical utilizations following THA. METHODS A retrospective query of a nationwide insurance claims database was conducted from 2010 to 2020. All cases of THA and hypnotic use were identified using procedural and national drug codes. Patients who were prescribed zolpidem within 90 days of surgery were matched to hypnotic naive patients 1:5 based on demographic and comorbidity profiles. The 90-day medical complications, falls, fragility fractures, costs, and readmission rates, as well as 2-year implant complications were compared between cohorts. A total of 50,328 zolpidem patients were matched to 251,286 hypnotic naive patients. RESULTS The zolpidem group had significantly higher rates of medical complications, falls, and fragility fractures when compared to the hypnotic-naive group. The zolpidem group had significantly higher rates of dislocation, mechanical loosening, and periprosthetic fracture. Likewise, healthcare utilization was significantly greater in the zolpidem group. CONCLUSION Zolpidem use following THA is associated with significant risk of medical and implant complications, as well as fall risks, increased costs, lengths of stay, and readmissions. The findings of this study may affect discussions between orthopaedic surgeons and their patients on the benefits of sleep quality in their recovery versus the incurred risks of zolpidem use. LEVEL OF EVIDENCE III, retrospective case-control study.
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Affiliation(s)
- Kevin L Mekkawy
- Holy Cross Orthopedic Research Institute, Holy Cross Health, Fort Lauderdale, Florida; Hospital for Special Surgery, West Palm Beach, Florida; Department of Surgery, South Shore Universtiy Hospital, Bay Shore, New York
| | - Hugo C Rodriguez
- Hospital for Special Surgery, West Palm Beach, Florida; Larkin Community Hospital, Department of Orthopaedic Surgery, South Miami, Florida
| | - Raul G Gosthe
- Holy Cross Orthopedic Research Institute, Holy Cross Health, Fort Lauderdale, Florida
| | - Arturo Corces
- Larkin Community Hospital, Department of Orthopaedic Surgery, South Miami, Florida
| | - Martin W Roche
- Holy Cross Orthopedic Research Institute, Holy Cross Health, Fort Lauderdale, Florida; Hospital for Special Surgery, West Palm Beach, Florida
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Cheng JY, Lorch D, Lowe AD, Uchimura N, Hall N, Shah D, Moline M. A randomized, double-blind, placebo-controlled, crossover study of respiratory safety of lemborexant in moderate to severe obstructive sleep apnea. J Clin Sleep Med 2024; 20:57-65. [PMID: 37677076 PMCID: PMC10758559 DOI: 10.5664/jcsm.10788] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/25/2023] [Accepted: 09/01/2023] [Indexed: 09/09/2023]
Abstract
STUDY OBJECTIVES To evaluate the respiratory safety of lemborexant among adults and older adults with moderate to severe obstructive sleep apnea (OSA). METHODS E2006-A001-113 (Study 113; NCT04647383) was a double-blind, two-period crossover, placebo-controlled study in adults (ages ≥ 45 to ≤ 90 years, n = 33) with moderate (apnea-hypopnea index [AHI] score ≥ 15 to < 30 events/h, n = 13) or severe (AHI ≥ 30 events/h, n = 20) OSA. Participants were randomized to lemborexant 10 mg (LEM10) or placebo (PBO) for two treatment periods of 8 nights with a ≥ 14-day washout period. AHI and peripheral oxygen saturation were evaluated after treatment on Day 1 (after a single dose) and Day 8 (after multiple doses). RESULTS No significant differences in AHI were observed after single and multiple doses of LEM10 compared with PBO in participants with moderate to severe OSA (least-squares mean: single-dose LEM10, 41.7; PBO, 44.8; multiple-dose LEM10, 44.9; PBO, 45.7). In addition, there were no significant differences between treatments in peripheral oxygen saturation (least-squares mean: single-dose LEM10, 93.0; PBO, 93.1; multiple-dose LEM10, 93.1; PBO, 93.4). Further, there were no significant differences between treatments in percentage of total sleep time with peripheral oxygen saturation < 90%, < 85%, or < 80%. No significant differences were observed between treatments when AHI and peripheral oxygen saturation outcomes were analyzed by OSA severity. Altogether, 6/33 (18.2%) participants receiving LEM10, vs 3/33 (9.1%) PBO, reported treatment-emergent adverse events, mostly mild in severity. CONCLUSIONS LEM10 demonstrated respiratory safety and was well tolerated with single-dose and multiple-dose administration in participants with moderate to severe OSA. This suggests that LEM may be a treatment option for patients with OSA and comorbid insomnia. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: A Study to Evaluate the Respiratory Safety of Lemborexant in Adult and Elderly Participants With Moderate to Severe Obstructive Sleep Apnea and in Adult and Elderly Participants With Moderate to Severe Chronic Obstructive Pulmonary Disease; URL: https://clinicaltrials.gov/ct2/show/NCT04647383; Identifier: NCT04647383. CITATION Cheng JY, Lorch D, Lowe AD, et al. A randomized, double-blind, placebo-controlled, crossover study of respiratory safety of lemborexant in moderate to severe obstructive sleep apnea. J Clin Sleep Med. 2024;20(1):57-65.
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Affiliation(s)
| | | | - Alan D. Lowe
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Naohisa Uchimura
- Department of Neuropsychiatry, Kurume University School of Medicine, Fukuoka, Japan
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El-Solh AA, Lawson Y, Wilding GE. The risk of major adverse cardiovascular events associated with the use of hypnotics in patients with insomnia. Sleep Health 2023; 9:717-725. [PMID: 37393143 DOI: 10.1016/j.sleh.2023.05.006] [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: 03/08/2023] [Revised: 04/19/2023] [Accepted: 05/05/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVES To examine whether hypnotic use in patients with insomnia reduces major adverse cardiovascular events, including all-cause mortality and nonfatal major adverse cardiovascular events. METHODS Using the Veterans Affairs Corporate Data Warehouse, we conducted a retrospective cohort study of 16,064 patients who were newly diagnosed with insomnia between January 1, 2010, and December 31, 2019. A pair of 3912 hypnotic users and nonusers were selected based on a 1:1 propensity score methodology. The primary outcome was extended major adverse cardiovascular events, a composite of the first occurrence of all-cause mortality or nonfatal major adverse cardiovascular events. RESULTS During the median follow-up of 4.8 years, a total of 2791 composite events occurred, including 2033 deaths and 762 nonfatal major adverse cardiovascular events. Although the incidence rates of major adverse cardiovascular events were comparable between hypnotic users and nonusers in the propensity-matched cohort, users of benzodiazepines and Z-drugs had a higher risk of all-cause mortality (hazard ratio 1.47 [95% CI, 1.17-1.88] and 1.20 [95% CI, 1.03-1.39], respectively), while serotonin antagonist and reuptake inhibitors users had a survival advantage (hazard ratio 0.79 [95% CI, 0.69-0.91]) compared with nonusers. There were no differences in the risk of nonfatal major adverse cardiovascular events between all classes of hypnotics. Male patients and those aged 60 years or younger who were using benzodiazepines or Z-drugs experienced higher major adverse cardiovascular events than their counterparts. CONCLUSIONS In patients with newly diagnosed insomnia, treatment with hypnotics resulted in higher extended major adverse cardiovascular events but not nonfatal major adverse cardiovascular events with benzodiazepine and Z-drug users compared with nonusers. The use of serotonin antagonist and reuptake inhibitors agents had a protective effect against major adverse cardiovascular events warranting further investigation.
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Affiliation(s)
- Ali A El-Solh
- The Veterans Affairs Western New York Healthcare System, Western New York Respiratory Research Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Buffalo, NY, USA; Department of Medicine, Jacobs School of Medicine and Biomedical Sciences and School of Public Health and Health Professions, Buffalo, NY, USA; Department of Epidemiology and Environmental Health, Jacobs School of Medicine and Biomedical Sciences and School of Public Health and Health Professions, Buffalo, NY, USA.
| | - Yolanda Lawson
- The Veterans Affairs Western New York Healthcare System, Western New York Respiratory Research Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Buffalo, NY, USA.
| | - Gregory E Wilding
- Department of Biostatistics; Jacobs School of Medicine and Biomedical Sciences and School of Public Health and Health Professions, Buffalo, CY, USA.
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Hedna K, Waern M. Use of Psychoactive Medications and Risk of Suicide in Late Life (75+): A Total Population Study. Drugs Real World Outcomes 2023; 10:491-498. [PMID: 37421593 PMCID: PMC10491562 DOI: 10.1007/s40801-023-00380-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 07/10/2023] Open
Abstract
BACKGROUND Psychoactive medications play an important role for the mental health and risk of suicidal behaviour in the oldest segment of the population (75+). A better understanding of psychoactive medication use is advocated to prevent suicide in this age group. PURPOSE We investigated the risk of suicide associated with the use of psychoactive medications in the total population aged ≥ 75 years, with and without exposure to antidepressants. METHOD A national population-based register study, including all Swedish residents aged ≥ 75 years between 2006 and 2014 (N = 1,413,806). A nested case-control design was used to investigate psychoactive medications associated with suicide among users and non-users of antidepressants. Risk estimates were calculated in adjusted conditional logistic regression models for the entire cohort and by gender. RESULTS Suicide occurred in 1305 persons (907 men and 398 women). Among them, 555 (42.5%) were on an antidepressant at the time of suicide. Adjusted incidence rate ratio (aIRR) for suicide was increased in those who were on hypnotics in the total cohort (aIRR 2.05, 95% confidence interval 1.74 to 2.41), in both users and non-users of antidepressants and for both genders. Elevated suicide risk was observed in those who concomitantly used anxiolytics with antidepressants (1.51, 1.25 to 1.83). Decreased risk of suicide was observed among those who were on anti-dementia drugs, in the total cohort (0.33, 0.21 to 0.52) and in both users and non-users of antidepressants. Use of antipsychotics and mood stabilisers showed no effect on suicide risk. CONCLUSION Use of hypnotics and concomitant use of anxiolytics with antidepressants was associated with increased risk of late-life suicide. Our findings suggest the need for careful evaluation of the benefit-risk balance of psychoactive medications as well as their availability as a possible suicide means. Future research should consider the indication of use of the psychoactive medications and the severity of psychiatric and medical illnesses of the patients.
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Affiliation(s)
- Khedidja Hedna
- AgeCap Center, Department of Psychiatry and Neurochemistry, Gothenburg University, 41345, Gothenburg, Sweden.
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Statistikkonsulterna Västra AB, Gothenburg, Sweden.
| | - Margda Waern
- AgeCap Center, Department of Psychiatry and Neurochemistry, Gothenburg University, 41345, Gothenburg, Sweden
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Psychosis Clinic, Gothenburg, Sweden
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Schiel JE, Tamm S, Holub F, Petri R, Dashti HS, Domschke K, Feige B, Goodman MO, Jones SE, Lane JM, Ratti PL, Ray DW, Redline S, Riemann D, Rutter MK, Saxena R, Sexton CE, Tahmasian M, Wang H, Weedon MN, Weihs A, Kyle SD, Spiegelhalder K. Associations between sleep health and grey matter volume in the UK Biobank cohort ( n = 33 356). Brain Commun 2023; 5:fcad200. [PMID: 37492488 PMCID: PMC10365832 DOI: 10.1093/braincomms/fcad200] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 06/11/2023] [Accepted: 07/11/2023] [Indexed: 07/27/2023] Open
Abstract
As suggested by previous research, sleep health is assumed to be a key determinant of future morbidity and mortality. In line with this, recent studies have found that poor sleep is associated with impaired cognitive function. However, to date, little is known about brain structural abnormalities underlying this association. Although recent findings link sleep health deficits to specific alterations in grey matter volume, evidence remains inconsistent and reliant on small sample sizes. Addressing this problem, the current preregistered study investigated associations between sleep health and grey matter volume (139 imaging-derived phenotypes) in the UK Biobank cohort (33 356 participants). Drawing on a large sample size and consistent data acquisition, sleep duration, insomnia symptoms, daytime sleepiness, chronotype, sleep medication and sleep apnoea were examined. Our main analyses revealed that long sleep duration was systematically associated with larger grey matter volume of basal ganglia substructures. Insomnia symptoms, sleep medication and sleep apnoea were not associated with any of the 139 imaging-derived phenotypes. Short sleep duration, daytime sleepiness as well as late and early chronotype were associated with solitary imaging-derived phenotypes (no recognizable pattern, small effect sizes). To our knowledge, this is the largest study to test associations between sleep health and grey matter volume. Clinical implications of the association between long sleep duration and larger grey matter volume of basal ganglia are discussed. Insomnia symptoms as operationalized in the UK Biobank do not translate into grey matter volume findings.
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Affiliation(s)
- Julian E Schiel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center—University of Freiburg, Hauptstraße 5, 79104 Freiburg, Germany
| | - Sandra Tamm
- Department of Clinical Neuroscience, Karolinska Institutet, Retzius väg 8, 17165 Stockholm, Sweden
- Department of Psychiatry, University of Oxford, Warneford Lane, OX3 7JX Oxford, UK
| | - Florian Holub
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center—University of Freiburg, Hauptstraße 5, 79104 Freiburg, Germany
| | - Roxana Petri
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center—University of Freiburg, Hauptstraße 5, 79104 Freiburg, Germany
| | - Hassan S Dashti
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Main St. 415, Cambridge, MA 02142, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Cambridge St. 185, Boston, MA 02114, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School,Fruit St. 55, Boston, MA 02114, USA
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center—University of Freiburg, Hauptstraße 5, 79104 Freiburg, Germany
| | - Bernd Feige
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center—University of Freiburg, Hauptstraße 5, 79104 Freiburg, Germany
| | - Matthew O Goodman
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Francis St. 75, Boston, MA 02115, USA
| | - Samuel E Jones
- Institute for Molecular Medicine (FIMM), University of Helsinki, Tukholmankatu 8, 00290 Helsinki, Finland
| | - Jacqueline M Lane
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Main St. 415, Cambridge, MA 02142, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Cambridge St. 185, Boston, MA 02114, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School,Fruit St. 55, Boston, MA 02114, USA
| | - Pietro-Luca Ratti
- Neurocenter of Southern Switzerland, Regional Hospital of Lugano, Viale Officina 3, 6500 Bellinzona, Switzerland
| | - David W Ray
- Division of Endocrinology, Diabetes & Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Grafton St. 46, M13 9NT Manchester, UK
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Francis St. 75, Boston, MA 02115, USA
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center—University of Freiburg, Hauptstraße 5, 79104 Freiburg, Germany
| | - Martin K Rutter
- Faculty of Biology, Medicine and Health, Centre for Biological Timing, University of Manchester, Grafton St. 46, M13 9NT Manchester, UK
- Diabetes, Endocrinology and Metabolism Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Grafton St. 46, M13 9NT Manchester, UK
| | - Richa Saxena
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Main St. 415, Cambridge, MA 02142, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Cambridge St. 185, Boston, MA 02114, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School,Fruit St. 55, Boston, MA 02114, USA
| | - Claire E Sexton
- Department of Psychiatry, University of Oxford, Warneford Lane, OX3 7JX Oxford, UK
- Department of Neurology, Global Brain Health Institute, Memory and Aging Center, University of California, Nelson Rising Lane 675, San Francisco, CA 94158, USA
| | - Masoud Tahmasian
- Institute of Neuroscience and Medicine, Brain and Behavior (INM-7), Research Center Jülich, Wilhelm-Johnen-Straße 14.6y, 52428 Jülich, Germany
- Medical Faculty, Institute for Systems Neuroscience, Heinrich-Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Heming Wang
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Main St. 415, Cambridge, MA 02142, USA
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Francis St. 75, Boston, MA 02115, USA
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Euclid Ave. 10900, Cleveland, OH 44106-7288, USA
| | - Michael N Weedon
- Genetics of Complex Traits, University of Exeter Medical School, Royal Devon & Exeter Hospital, Barrack Road, EX2 5DW Exeter, UK
| | - Antoine Weihs
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Ellernholzstraße 1-2, 17475 Greifswald, Germany
| | - Simon D Kyle
- Nuffield Department of Clinical Neurosciences, Sleep and Circadian Neuroscience Institute (SCNi), University of Oxford, South Parks Road, OX1 3QU Oxford, UK
| | - Kai Spiegelhalder
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center—University of Freiburg, Hauptstraße 5, 79104 Freiburg, Germany
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Sun Y, Tsai MK, Wen CP. Association of sleep duration and sleeping pill use with mortality and life expectancy: A cohort study of 484,916 adults. Sleep Health 2023; 9:354-362. [PMID: 37045661 DOI: 10.1016/j.sleh.2023.01.017] [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: 05/28/2022] [Revised: 01/15/2023] [Accepted: 01/31/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVES To compare mortality risk and life expectancy among individuals with different sleep durations and sleeping pill use. METHODS A cohort of 484,916 community-dwelling adults in Taiwan was recruited into a health screening program from 1994 to 2011. Subjects were categorized by daily sleep duration into 4 groups: extremely short (<4 hours), short (4-6 hours), medium (6-8 hours), and long (>8 hours). Cox proportional hazards models were used to investigate the associations of mortality risk with sleep duration and sleeping pill use. Models were adjusted for sociodemographic characteristics, lifestyle, and comorbidities. Life expectancy tables were calculated among sleeping pill users and nonusers with different sleep durations. RESULTS With 6- 8 hours of daily sleep, sleeping pill nonusers had the lowest mortality risk. Sleeping pill users, even with this optimal amount of sleep, had a 55% (p < .001, 95% CI, 1.38-1.73) higher mortality risk than nonusers. The life expectancy of 30-year-old male sleeping pill users with extremely short or long sleep durations was 12-13 years shorter than sleeping pill nonusers who had 6-8 hours of sleep. On average, life expectancy in individuals using sleeping pills (vs. nonusers) was shorter by 5.3 (95% CI, 4.10-6.32) years in men and 5.7 (95% CI, 5.28-7.98) years in women. CONCLUSIONS This study suggests that the use of sleeping pills is associated with an increased risk of mortality and shortened life expectancy, especially in extreme sleepers. Regular users should be aware of potential harms from sleeping pills.
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Affiliation(s)
- Yu Sun
- Department of Neurology, En Chu Kong Hospital, New Taipei City, Taiwan; Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Min-Kuang Tsai
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Chi-Pang Wen
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan; China Medical University, Taichung, Taiwan.
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11
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Mun JG, Wang D, Doerflein Fulk DL, Fakhary M, Gualco SJ, Grant RW, Mitmesser SH. A Randomized, Double-Blind, Crossover Study to Investigate the Pharmacokinetics of Extended-Release Melatonin Compared to Immediate-Release Melatonin in Healthy Adults. J Diet Suppl 2023; 21:182-194. [PMID: 37150895 DOI: 10.1080/19390211.2023.2206475] [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] [Indexed: 05/09/2023]
Abstract
Exogenous melatonin can be helpful for treatment of some sleep disorders. However, immediate-release formulations are rapidly absorbed and cleared from the body making it difficult to provide coverage for an entire sleep period. Extended-release melatonin formulations can better mimic the naturally occurring melatonin profile and increase efficacy, but few studies have reported on their pharmacokinetics. To assess the pharmacokinetics of extended-release melatonin, we conducted a randomized, double-blind, crossover study of extended-release melatonin (4 mg) compared to immediate-release melatonin (4 mg) in 18 healthy adults, ages 18-65 years. Participants received immediate-release or extended-release melatonin in clinic after an 8 h fast, and blood samples were taken over a 10-h period. After a 7-day washout period, the same procedures were repeated with the melatonin form not previously received. Extended-release melatonin had a longer time to peak concentration (1.56 vs 0.6 h) and elimination half-life (1.63 vs 0.95 h) compared with immediate-release melatonin. Maximum concentration was lower for extended-release melatonin compared with immediate-release melatonin (7581 pg/mL vs 13120 pg/mL). Extended-release melatonin raised melatonin levels in as little as 15 min and sustained elevated melatonin levels (>300 pg/mL) for 6 h before falling below 50 pg/mL by 9 h. No clinically relevant adverse events were observed, and safety parameters remained within normal ranges for both formulations. The pharmacokinetic profile of this extended-release melatonin formulation suggests that it could be used for future efficacy studies of melatonin and sleep outcomes. This trial is registered at ClinicalTrials.gov, NCT04067791.
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Affiliation(s)
| | - Dan Wang
- Pharmavite, LLC, Los Angeles, CA, USA
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12
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Hardman JR, Rees CS, Bonnar D, Ree MJ. Group cognitive behavioural therapy for insomnia: impact on psychiatric symptoms and insomnia severity in a psychiatric outpatient setting. CLIN PSYCHOL-UK 2023. [DOI: 10.1080/13284207.2022.2155034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Affiliation(s)
| | - Clare S. Rees
- School of Psychology, Curtin University, Perth, Australia
| | - Daniel Bonnar
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia
| | - Melissa J. Ree
- School of Psychological Science, University of Western Australia, The Marian Centre, Perth, Australia
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13
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Sleep quality traits correlate with inflammatory markers in the breast tissue of women. Cytokine 2022; 160:156028. [PMID: 36099755 DOI: 10.1016/j.cyto.2022.156028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 08/23/2022] [Accepted: 08/30/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Several mechanisms have been posited to play a role in the sleep and breast cancer association, including alterations in immune function, but evidence remains inconclusive. A closer look at how sleep quality traits affect the breast microenvironment may provide clues for molecular mechanisms underlying the link between sleep and breast cancer. We examined the association between sleep quality traits (sleep duration, sleep aids, and insomnia) and tissue-based protein levels and gene expression of several inflammatory markers associated with breast cancer. METHODS Breast tissues (normal n = 165 and adipose n = 74) were surgically obtained from women diagnosed with breast cancer. Protein levels by immunohistochemistry were determined using the quickscore method for 11 inflammatory markers in the normal epithelial breast tissue (interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor-alpha (TNF-α), C-reactive protein (CRP), cyclooxygenase-2 (COX-2), leptin, serum amyloid A1 (SAA1), lactoferrin, transforming growth factor-beta (TGF-β), and signal transducer and activator of transcription 3 markers (STAT3). Relative quantification of 4 genes (COX-2, IL-6, TNF-α and LEP) in the adipose breast tissue was carried out using qPCR. Patient characteristics and sleep traits (average sleep duration per night, taking sleeping aids in the past year, and the average number of insomnia episodes per month) were determined by telephone interview. Associations were tested using Spearman's rank correlation (rs) coefficients adjusted (ars) for age at surgery, menopausal status and PCR batch when applicable. Sleep duration categories (<7, 7-9, >9 h) and root- or log-transformed biomarker levels were examined with adjusted linear mixed models. RESULTS TGF-β and CRP levels in normal epithelial breast tissue were positively correlated with sleep aids (ars = 0.28, p = 0.013), and insomnia (ars = 0.23, p = 0.044) in postmenopausal women, respectively. IL-6 in the adipose breast tissue was inversely correlated with sleep aids (ars = -0.26, p = 0.029) in all women. None of the sleep traits significantly correlated with inflammatory markers in premenopausal women. Several markers tended to correlate at 0.05 ≥ p ≤ 0.10. Adjusted mean levels of inflammatory markers were significantly different across sleep duration categories (<7, 7-9, >9 h). Higher mean levels of IL-6, CRP, IL-10, and IL-6 and COX-2 expression were noted in the breast tissues of women sleeping < 7, and particularly, >9 h per night (p < 0.05). CONCLUSION Our findings indicate that sleep duration, sleep aids, and insomnia may differently affect women's breast tissues depending on menopausal status. From a public health perspective, these results warrant further validation in larger studies. Since sleep is a modifiable factor, it may be an interesting approach for breast cancer prevention.
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14
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Kommentar zu „Schlafstörungen: Welche Intervention wirkt am besten?“. Dtsch Med Wochenschr 2022. [DOI: 10.1055/a-1916-6180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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15
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Hedna K, Fastbom J, Jonson M, Wilhelmson K, Waern M. Psychoactive medication use and risk of suicide in long-term care facility residents. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5684. [PMID: 35142388 PMCID: PMC9306521 DOI: 10.1002/gps.5684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/26/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To investigate psychoactive medication use and risk of suicide in long-term care facility (LTCF) residents aged 75 and above. A second aim was to investigate the role of psychiatric and medical conditions in the occurrence of suicide in LTCF residents. METHODS A Swedish national register-based cohort study of LTFC residents aged ≥75 years between 1 January 2008 and 31 December 2015, and followed until 31 December 2016 (N = 288,305). Fine and Gray regression models were used to analyse associations with suicide. RESULTS The study identified 110 suicides (15.8 per 100,000 person-years). Half of these occurred during the first year of residence. Overall, 54% of those who died by suicide were on hypnotics and 45% were on antidepressants. Adjusted sub-hazard ratio (aSHR) for suicide was decreased in those who were on antidepressants (aSHR 0.64, 95% confidence interval 0.42-0.97), even after the exclusion of residents who had healthcare contacts for dementia or were on anti-dementia drugs. The aSHR for suicide was more than two-fold higher in those who were on hypnotics (2.20, 1.46-3.31). Suicide risk was particularly elevated in those with an episode of self-harm prior to LTCF admittance (15.78, 10.01-24.87). Specialized care for depression was associated with increased risk, while medical morbidity was not. CONCLUSIONS A lower risk of suicide in LTCF residents was found in users of antidepressants, while elevated risk was observed in those on hypnotics. Our findings suggest that more can be done to prevent suicide in this setting.
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Affiliation(s)
- Khedidja Hedna
- AgeCap Center, Department of Psychiatry and NeurochemistryGothenburg UniversityGothenburgSweden,Statistikkonsulterna ABGothenburgSweden
| | - Johan Fastbom
- Aging Research CenterKarolinska Institute and Stockholm UniversityStockholmSweden
| | - Mattias Jonson
- AgeCap Center, Department of Psychiatry and NeurochemistryGothenburg UniversityGothenburgSweden,Neuropsychiatric Epidemiology Unit, Department of Psychiatry and NeurochemistrySahlgrenska Academy, University of GothenburgGothenburgSweden,Affective ClinicRegion Västra Götaland, Sahlgrenska University HospitalGothenburgSweden
| | - Katarina Wilhelmson
- AgeCap Center, Department of Psychiatry and NeurochemistryGothenburg UniversityGothenburgSweden,Department of Health and RehabilitationInstitute of Neuroscience and Physiology, Sahlgrenska Academy, University of GothenburgGothenburgSweden,Department of Acute Medicine and GeriatricsRegion Västra Götaland, Sahlgrenska University HospitalGothenburgSweden
| | - Margda Waern
- AgeCap Center, Department of Psychiatry and NeurochemistryGothenburg UniversityGothenburgSweden,Psychosis ClinicRegion Västra Götaland, Sahlgrenska University HospitalGothenburgSweden
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16
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Sotelo MI, Tyan J, Markunas C, Sulaman BA, Horwitz L, Lee H, Morrow JG, Rothschild G, Duan B, Eban-Rothschild A. Lateral hypothalamic neuronal ensembles regulate pre-sleep nest-building behavior. Curr Biol 2022; 32:806-822.e7. [PMID: 35051354 PMCID: PMC10455050 DOI: 10.1016/j.cub.2021.12.053] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 11/17/2021] [Accepted: 12/21/2021] [Indexed: 01/08/2023]
Abstract
The transition from wakefulness to sleep requires striking alterations in brain activity, physiology, and behavior, yet the precise neuronal circuit elements facilitating this transition remain unclear. Prior to sleep onset, many animal species display characteristic behaviors, including finding a safe location, performing hygiene-related behaviors, and preparing a space for sleep. It has been proposed that the pre-sleep period is a transitional phase in which engaging in a specific behavioral repertoire de-arouses the brain and facilitates the wake-to-sleep transition, yet both causal evidence for this premise and an understanding of the neuronal circuit elements involved are lacking. Here, we combine detailed behavioral observations, EEG-EMG recordings, selective targeting, and activity modulation of pre-sleep-active neurons to reveal the behaviors preceding sleep initiation and their underlying neurobiological mechanisms. We show that mice engage in temporally structured behaviors with stereotypic EEG signatures prior to sleep and that nest-building and grooming become significantly more prevalent with sleep proximity. We next demonstrate that the ability to build a nest promotes the initiation and consolidation of sleep and that the lack of nesting material chronically fragments sleep. Lastly, we identify broadly projecting and predominantly glutamatergic neuronal ensembles in the lateral hypothalamus that regulate the motivation to engage in pre-sleep nest-building behavior and gate sleep initiation and intensity. Our study provides causal evidence for the facilitatory role of pre-sleep behaviors in sleep initiation and consolidation and a functional characterization of the neuronal underpinnings regulating a sleep-related and goal-directed complex behavior.
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Affiliation(s)
- Maria I Sotelo
- Department of Psychology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Jean Tyan
- Department of Psychology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Chelsea Markunas
- Department of Psychology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Bibi A Sulaman
- Department of Psychology, University of Michigan, Ann Arbor, MI 48109, USA; Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI 48109, USA
| | - Lorraine Horwitz
- Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI 48109, USA; Department of Molecular, Cellular and Developmental Biology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Hankyu Lee
- Department of Molecular, Cellular and Developmental Biology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Joshua G Morrow
- Department of Psychology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Gideon Rothschild
- Department of Psychology, University of Michigan, Ann Arbor, MI 48109, USA; Kresge Hearing Research Institute and Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Bo Duan
- Department of Molecular, Cellular and Developmental Biology, University of Michigan, Ann Arbor, MI 48109, USA
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17
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18
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Hwang S, Son H, Kim M, Lee SK, Jung KY. Association of Zolpidem With Increased Mortality in Patients With Brain Cancer: A Retrospective Cohort Study Based on the National Health Insurance Service Database. J Clin Neurol 2022; 18:65-70. [PMID: 35021278 PMCID: PMC8762495 DOI: 10.3988/jcn.2022.18.1.65] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/07/2021] [Accepted: 08/09/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose Zolpidem is one of the most common hypnotics prescribed to treat insomnia worldwide. However, there are numerous reports of a positive association between zolpidem and mortality, including an association with increased cancer-specific mortality found in a Taiwanese cohort study. This study aimed to determine the association between zolpidem use and brain-cancer-specific mortality in patients with brain cancer. Methods This population-based, retrospective cohort study analyzed data in the National Health Insurance Service database. All incident cases of brain cancer at an age of ≥18 years at the time of brain cancer diagnosis over a 15-year period (2003–2017) were included. A multivariate Cox regression analysis after adjustment for covariables was performed to evaluate the associations of zolpidem exposure with brain-cancer-specific and all-cause mortality. Results This study identified 38,037 incident cases of brain cancer, among whom 11,823 (31.1%) patients were exposed to zolpidem. In the multivariate Cox regression model, the brain-cancer-specific mortality rate was significantly higher in patients who were prescribed zolpidem than in those with no zolpidem prescription (adjusted hazard ratio [HR]=1.14, 95% confidence interval [CI]=1.08–1.21, p<0.001). Zolpidem exposure was significantly associated with increased brain-cancer-specific mortality after adjustment in younger adults (age 18–64 years; adjusted HR=1.37, 95% CI=1.27–1.49) but not in older adults (age ≥65 years; adjusted HR=0.94, 95% CI=0.86–1.02). Conclusions Zolpidem exposure was significantly associated with increased brain-cancer-specific mortality in patients with brain cancer aged 18–64 years. Further prospective studies are warranted to understand the mechanism underlying the effect of zolpidem on mortality in patients with brain cancer.
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Affiliation(s)
- Sungeun Hwang
- Department of Neurology, Seoul National University Hospital, Seoul, Korea.,Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Neurology, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Hyoshin Son
- Department of Neurology, Seoul National University Hospital, Seoul, Korea.,Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Manho Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Korea.,Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Korea.,Neuroscience and Protein Metabolism Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Kun Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Korea.,Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ki-Young Jung
- Department of Neurology, Seoul National University Hospital, Seoul, Korea.,Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Korea.,Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Sensory Organ Research Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea.
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19
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Association Between Benzodiazepine and Opioid Prescription and Mortality Among Patients in a Large Healthcare System. J Addict Med 2022; 16:65-71. [PMID: 35120065 PMCID: PMC8817063 DOI: 10.1097/adm.0000000000000828] [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] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Coprescription of opioids and benzodiazepines (BDZ) is associated with adverse outcomes, including greater healthcare utilization and overdose risk. This study aims to examine opioid and BDZ coprescription, dosing, and mortality among patients with and without opioid use disorder (OUD) in a large healthcare system. METHODS Using data from the California state Prescription Drug Monitoring Program during 2010 to 2014 linked with a large healthcare system electronic health record database and mortality records from the Centers for Disease Control National Death Index, this study examined 5202 patients (1978 with OUD, 3224 controls). Multiple logistic regression analyses were conducted to examine relationships between most recent BDZ and opioid prescription, and their interaction with respect to mortality. RESULTS About 10.5% of the sample died on or before December 31, 2014. About 17.7% were prescribed BDZ during the final month of observation. Individuals with OUD were prescribed higher average BDZ and opioid doses than those without OUD. After adjusting for covariates, increased prescribed doses of BDZ (odds ratio [OR]=1.34, 95%CI: 1.15-1.55 per 10 mg/d increment) and opioids (OR = 1.04, 95%CI: 1.02-1.05 per 10 mg/d increment) were positively associated with mortality. Non-OUD patients who received both BDZ and opioid prescriptions had a higher mortality than those who received only BDZ or opioids (The ratio of odds ratio (ROR) = 3.83, 95%CI: 1.78-8.21). CONCLUSIONS Study findings highlight significant mortality associated with the coprescription of opioids and BDZ in a general healthcare setting. Further research is needed to elucidate factors associated with mortality among non-OUD patients who are co-prescribed opioids and BDZ.
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20
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Lei H, Wang W, Cao Y, Ma Y, Xue X. Efficacy and safety evaluation of bright light therapy in patients with post-stroke insomnia: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e27937. [PMID: 34918641 PMCID: PMC8677890 DOI: 10.1097/md.0000000000027937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Post-stroke insomnia (PSI) is a common and severe illness among the complications of stroke. Although there are plenty of drugs currently used for PSI treatment, they generate several side effects and other problems. Bright light therapy (BLT) is thought to be relatively safe and effective in treating PSI patients. Despite this, there is still a lack of systematic review on BLT in the treatment of PSI. Allowing for this, the aim of this study is to assess the efficacy and safety of BLT for PSI. METHODS The meta-analysis and systematic review will perform a comprehensive electronic search for items fulfilling the required criteria in Web of Science, Google Scholar, Wan Fang database, MEDLINE, Baidu Scholar, PubMed, SinoMed, Embase, Chinese Biomedical Literature Database (CBM), China national knowledge infrastructure database (CNKI), Cochrane Library Central Register of Controlled Trials (CENTRAL), and Wei Pu database from establishment to January 1, 2022. We will select articles, collect data, and assess the methodology quality. And we will set the primary outcome and secondary outcomes in this research. RevMan 5.3 software will be used to analyze the data for this investigation. RESULTS The work of this research will be published in peer-reviewed scientific journals. CONCLUSION The aim of this study is to assess the efficacy and safety of BLT for PSI and present robust scientific evidence concerning BLT for PSI. REGISTRATION INPLASY2021100065.
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21
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Ree MJ, Richardson C. Insomnia disorder update: the benefits of screening and treatment for this common presentation. Intern Med J 2021; 51:1798-1805. [PMID: 34796636 DOI: 10.1111/imj.15567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 05/02/2021] [Accepted: 06/19/2021] [Indexed: 11/28/2022]
Abstract
Insomnia is a chronic condition and major healthcare problem for Australians across the lifespan. Insomnia's high prevalence and disease burden render it an important target for treatment. Further, and importantly, there exist established bidirectional links between insomnia and a range of health conditions, with insomnia both contributing to risk, maintenance and relapse of comorbid conditions. Recent clinical research demonstrates that treating insomnia in its own right is important for resolution of insomnia and for optimising treatment outcomes for comorbid presenting problems. Due to its effectiveness and favourable side-effect profile, Cognitive Behaviour Therapy-Insomnia (CBT-I) is the recommended first-line treatment even when comorbid conditions are present. CBT-I is a brief treatment often delivered in four to eight consultations. Individual, group and online CBT-I have each demonstrated effectiveness. Outcomes for online CBT-I are often stronger when individualised clinician support is provided. Specifically assessing for and treating insomnia in clinical practice may provide an opportunity to optimise treatment outcome in many patients.
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Affiliation(s)
- Melissa J Ree
- School of Psychological Science, The University of Western Australia, Perth, Western Australia, Australia
| | - Cele Richardson
- School of Psychological Science, The University of Western Australia, Perth, Western Australia, Australia
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22
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Genovese TJ, Gehrman P, Yang M, Li Y, Garland SN, Orlow I, Mao JJ. Genetic Predictors of Response to Acupuncture or Cognitive Behavioral Therapy for Insomnia in Cancer Survivors: An Exploratory Analysis. J Pain Symptom Manage 2021; 62:e192-e199. [PMID: 33716034 PMCID: PMC9297333 DOI: 10.1016/j.jpainsymman.2021.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 02/24/2021] [Accepted: 03/04/2021] [Indexed: 11/30/2022]
Abstract
CONTEXT Insomnia is a common problem affecting cancer survivors. While effective nonpharmacological treatments are available, it is unknown whether individual genetic characteristics influence treatment response. OBJECTIVES We conducted an exploratory analysis of genetic associations with insomnia treatment response in a randomized trial of cognitive behavioral therapy for insomnia (CBT-I) vs. acupuncture in a heterogeneous group of cancer survivors. METHODS We successfully genotyped 136 participants for 11 genetic variants. Successful treatment response was defined as a reduction in Insomnia Severity Index score of at least eight points from baseline to week 8. We used Fisher exact tests to evaluate associations between genotype and treatment success for each treatment arm, for an alpha level of 0.05 with unadjusted and Holm-Bonferroni-adjusted P-values. RESULTS We found that more carriers of COMT rs4680-A alleles responded to acupuncture compared to the GG carriers (63.6% vs. 27.8%, P = 0.013). More carriers of the NFKB2 rs1056890 CC genotype also responded to acupuncture compared to TT or CT carriers (72.2% vs. 38.9%, P = 0.009). There were no significant differences found between any of the tested gene variants and CBT-I response. None of the results remained statistically significant after adjustment for multiple testing. CONCLUSION In cancer survivors, specific variants in the COMT and NFKB2 genes are potentially associated with response to acupuncture but not to CBT-I. Confirming these preliminary results will help inform precision insomnia management for cancer survivors.
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Affiliation(s)
- Timothy J Genovese
- Harvard T.H. Chan School of Public Health, Boston, MA, USA; The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Philip Gehrman
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - MingXiao Yang
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sheila N Garland
- Departments of Psychology and Oncology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Irene Orlow
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jun J Mao
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Kyriazis M, Mikellides G, Pantelidakis H, Polycarpou M, Panayiotou B. COVID-19 Isolation and Risk of Death in Cyprus Elderly People. Front Med (Lausanne) 2021; 8:717692. [PMID: 34409055 PMCID: PMC8365165 DOI: 10.3389/fmed.2021.717692] [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: 05/31/2021] [Accepted: 07/12/2021] [Indexed: 11/25/2022] Open
Abstract
Social isolation is associated with a higher risk of morbidity and death in older people. The quarantine and social distancing measures due to Covid-19 imposed in most countries and particularly in Cyprus, aim to isolate individuals from direct contact with others. This has resulted in vulnerable older people being isolated at their places of residence for several months, while the recommendations for continuing lockdowns do not appear to be ending. The risk of death from causes other than those related to Covid-19 increases in such individuals and it is due to the effects of social isolation. We estimate that in the next years, there will be a significant increase in the death numbers of such older people in Cyprus. The health authorities must develop a program of support for these older individuals to include medical, social, physical, and psychological elements. Examples of such support are given here.
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Affiliation(s)
| | | | | | | | - Barnabas Panayiotou
- Postgraduate School of Medicine, Keele University, Stoke-on-Trent, Staffordshire, United Kingdom
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24
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Jorge-Samitier P, Fernández-Rodrigo MT, Juárez-Vela R, Antón-Solanas I, Gea-Caballero V. Management of Hypnotics in Patients with Insomnia and Heart Failure during Hospitalization: A Systematic Review. NURSING REPORTS 2021; 11:373-381. [PMID: 34968214 PMCID: PMC8608124 DOI: 10.3390/nursrep11020036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/26/2021] [Accepted: 05/12/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Heart failure is a chronic, progressive syndrome of signs and symptoms, which has been associated to a range of comorbidities including insomnia. Acute decompensation of heart failure frequently leads to hospital admission. During hospital admission, long-term pharmacological treatments such as hypnotics can be modified or stopped. AIM To synthesize the scientific evidence available about the effect of withdrawing hypnotic drugs during hospital admission in patients with decompensated heart failure and insomnia. METHOD A systematic review of the literature following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines was carried out in the following scientific databases: PubMed, Scopus, Dialnet and Cochrane. INCLUSION CRITERIA studies including a population of adults with heart failure and sleep disorders in treatment with hypnotics and admitted to hospital, studies written in English or Spanish and published until June 2020. EXCLUSION CRITERIA studies involving children, patients admitted to intensive care and patients diagnosed with sleep apnea. RESULTS We identified a total of 265 documents; only nine papers met the selection criteria. The most frequently used drugs for the treatment of insomnia in patients with heart failure were benzodiazepines and benzodiazepine agonists; their secondary effects can alter perceived quality of life and increase the risk of adverse effects. Withdrawal of these drugs during hospital admission could increase the risk of delirium. Future research in this area should evaluate the management of hypnotics during hospital admission in patients with decompensated heart failure. In addition, safe and efficient non-pharmacological alternatives for the treatment of insomnia in this population should be tested and implemented.
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Affiliation(s)
- Pablo Jorge-Samitier
- Hospital Clínico Lozano Blesa, Avenida San Juan Bosco, 15, 50009 Zaragoza, Spain;
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, C/Domingo Miral s/n, 50009 Zaragoza, Spain
| | - María Teresa Fernández-Rodrigo
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, C/Domingo Miral s/n, 50009 Zaragoza, Spain
| | - Raúl Juárez-Vela
- Faculty of Medicine, University of Salamanca, Avenida Alfonso X El Sabio SN, 37008 Salamanca, Spain;
| | - Isabel Antón-Solanas
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, C/Domingo Miral s/n, 50009 Zaragoza, Spain
- Research Group GENIAPA (GIIS094), Institute of Research of Aragon, Avenida San Juan Bosco, 13, 50009 Zaragoza, Spain
| | - Vicente Gea-Caballero
- Nursing School La Fe, Adscript Center of the University of Valencia, Research Group GREIACC, Health Research Institute La Fe, 46026 Valencia, Spain;
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Sun J, McPhillips MV, Chen KC, Zang Y, Li J, Oehlke J, Brewster GS, Gooneratne NS. Primary care provider evaluation and management of insomnia. J Clin Sleep Med 2021; 17:1083-1091. [PMID: 33576737 DOI: 10.5664/jcsm.9154] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To evaluate the type and extent of information collected from patients with insomnia during their first office encounter for insomnia and the prescribing therapies of primary care providers during this initial encounter. METHODS This study was a retrospective chart review of randomly selected patients who had a primary care provider office visit at any clinic affiliated with a university medical system between March 1, 2013, and March 1, 2016. Demographic and clinical information was abstracted for analysis. RESULTS Our sample (n = 200) was primarily female (63.5%), White (69%), middle-aged (ages 44.6 ± 15.1 years) adults. Most (68.5%) encounter notes did not have significant information related to insomnia risk factors and symptoms (< 50% of the notes). When examining comorbidities, we found that younger patients (<45 years old) were more likely to have anxiety linked to insomnia (P = .025), whereas older patients (≥45) were less likely to have any identified comorbidities associated with insomnia (P = .009). Only 5.0% of patients with insomnia were referred for cognitive-behavioral therapy for insomnia, whereas 51.5% of patients were prescribed sleep medications. The younger cohort was statistically more likely to receive sleep hygiene or cognitive-behavioral therapy for insomnia as a treatment option in comparison to the older cohort (P = .01 and P = .04, respectively). CONCLUSIONS Progress notes from primary care providers tend to have a paucity of information on insomnia symptoms and related comorbidities. Medications are often prescribed as the first-line treatment for insomnia. Cognitive-behavioral therapy for insomnia remains underutilized despite robust evidence suggesting that cognitive-behavioral therapy for insomnia is a safe and effective treatment for insomnia.
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Affiliation(s)
- Joy Sun
- Division of Geriatric Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Miranda V McPhillips
- Center for Sleep and Respiratory Neurobiology and Division of Sleep Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ker-Cheng Chen
- Division of Geriatric Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yinyin Zang
- Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Junxin Li
- School of Nursing, John Hopkins University, Baltimore, Maryland
| | - Jessica Oehlke
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Glenna S Brewster
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Nalaka S Gooneratne
- Division of Geriatric Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Center for Sleep and Respiratory Neurobiology and Division of Sleep Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Ardeljan AD, Polisetty TS, Palmer JR, Toma JJ, Vakharia RM, Roche MW. Impact of Postoperative Zolpidem Use on Primary Total Knee Arthroplasty: A Retrospective Matched-Controlled Analysis of a Private Insurance Database. J Arthroplasty 2021; 36:1322-1329. [PMID: 33250327 DOI: 10.1016/j.arth.2020.10.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/23/2020] [Accepted: 10/28/2020] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Zolpidem has gained popularity as a pharmaceutical therapy for insomnia, being the most prescribed hypnotic in the United States today. However, it is associated with increased mortality and morbidity. Literature regarding zolpidem use in the total knee arthroplasty (TKA) population is limited. The aim of the study was to analyze postoperative zolpidem use in the TKA population regarding medical and implant complications, falls, and readmission. METHODS The study group was queried according to zolpidem use. Controls consisted of patients who underwent primary TKA without a history of hypnotic drug use. Study group patients were matched to controls in a 1:5 ratio by demographics and comorbidities. Results yielded 99,178 study participants and 495,795 controls. Primary endpoints included 90-day medical and implant complications, fall risk, and readmission. Chi-squared test was used to compare categorical variables. Multivariate logistic regression was used to calculate odds (OR) for complications, fall risk, and readmission. A P value less than 0.05 was considered statistically significant. RESULTS Study group patients had increased odds of medical complications (OR: 1.76, 95% CI: 1.71-1.82, P < .0001) and implant complications (OR: 1.35, 95% CI: 1.23-1.47, P < .0001) compared to controls. Furthermore, patients in the study group were found to have an increased risk of 90- day falls (OR: 1.16, 95% CI: 1.11-1.21, P < .0001). Readmission was similar to controls (5.10% vs 4.84%, P = .12). CONCLUSION Zolpidem use following primary TKA is associated with the risk of morbidity and falls. The findings are consistent with the literature regarding zolpidem. These findings may affect discussion between orthopedic surgeons and patients in the decision-making process prior to undergoing TKA.
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Affiliation(s)
- Andrew D Ardeljan
- Nova Southeastern College of Osteopathic Medicine, Ft. Lauderdale, FL; Holy Cross Hospital, Orthopaedic Research Institute, Ft. Lauderdale, FL
| | - Teja S Polisetty
- Holy Cross Hospital, Orthopaedic Research Institute, Ft. Lauderdale, FL; Harvard Medical School, Harvard University, Boston, MA
| | - Joseph R Palmer
- Department of Orthopaedic Surgery, Broward Health Medical Center, Ft. Lauderdale, FL
| | - Justin J Toma
- Holy Cross Hospital, Orthopaedic Research Institute, Ft. Lauderdale, FL
| | - Rushabh M Vakharia
- Holy Cross Hospital, Orthopaedic Research Institute, Ft. Lauderdale, FL; Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, NY
| | - Martin W Roche
- Holy Cross Hospital, Orthopaedic Research Institute, Ft. Lauderdale, FL
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Liou YF, Li SF, Ho CC, Lee MW. Risk of insomnia and hypnotics use among emergency physicians. INDUSTRIAL HEALTH 2021; 59:99-106. [PMID: 33298645 PMCID: PMC8010163 DOI: 10.2486/indhealth.2020-0217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/30/2020] [Indexed: 06/12/2023]
Abstract
This study investigated the risk of insomnia and hypnotics use among emergency physicians. This cross-sectional study recruited physicians working in Taiwanese hospitals in 2015 and the general population as the participants. Data from 1,097 emergency physicians obtained from the National Health Insurance Research Database were grouped into the case group, whereas 14,112 nonemergency physicians and 4,388 people from the general population were categorized into the control groups. This study used logistic regression and conditional logistic regression to compare the risks of insomnia between emergency and nonemergency physicians and between emergency physicians and the general population, respectively. The prevalence of insomnia among emergency physicians, nonemergency physicians and general population was 5.56%, 4.08%, and 1.73%, respectively. Compared with nonemergency physicians and the general population, emergency physicians had a significantly higher risk of insomnia. The proportions of emergency physicians, nonemergency physicians, and general population using hypnotics were 19.96%, 18.24%, and 13.26%, respectively. Among emergency physicians who used hypnotics, 49.77%, 25.57%, and 24.66% used only benzodiazepines, only nonbenzodiazepines, and both benzodiazepines and nonbenzodiazepines, respectively. Nonpharmacological interventions to improve insomnia and reminder of safe use of hypnotics to emergency physicians can serve as references for hospitals in developing health-promoting activities.
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Affiliation(s)
- Yih-Farng Liou
- Department of Internal Medicine, Feng Yuan Hospital, Ministry of Health and Welfare, Taiwan (R.O.C.)
- Institute of Medicine, Chung Shan Medical University, Taiwan (R.O.C.)
| | - Shu-Fen Li
- Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taiwan (R.O.C.)
| | - Chin-Chih Ho
- Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taiwan (R.O.C.)
| | - Mei-Wen Lee
- Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taiwan (R.O.C.)
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Efficacy of simplified-cognitive behavioral therapy for insomnia(S-CBTI) among female COVID-19 patients with insomnia symptom in Wuhan mobile cabin hospital. Sleep Breath 2021; 25:2213-2219. [PMID: 33754249 PMCID: PMC7985232 DOI: 10.1007/s11325-021-02350-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/04/2021] [Accepted: 03/13/2021] [Indexed: 11/23/2022]
Abstract
Background The outbreak of Coronavirus Disease-2019 (COVID-19) caused great psychological distress often with comorbid insomnia. Insomnia is common in patients with COVID-19 admitted to mobile cabin hospitals. Insomnia may lead to immune dysfunction, a condition not conducive to recovery from COVID-19. The use of sedative-hypnotic drugs is limited by their inhibitory effect on the respiratory system. A paucity of research is available regarding psychotherapy interventions to improve insomnia symptoms among patients with COVID-19. In the general population, sleep problems are more common in women than in men; insomnia in women patients requires special attention. The aim of this study was to develop simplified-cognitive behavioral therapy for insomnia (S-CBTI) for patients with COVID-19 and comorbid insomnia symptoms and to verify its effectiveness through a self-control trial. A second aim was to compare the effectiveness of S-CBTI between acute and chronic insomnia among women with COVID-19 and comorbid insomnia symptoms in Wuhan Jianghan Cabin Hospital. Methods S-CBTI consisted of education on COVID-19 and sleep hygiene, stimulus control, sleep restriction, and self-suggestion relaxation training over a period of two consecutive weeks. Of 67 women, 66 completed psychological intervention and baseline and post-intervention assessments. There were 31 women with acute insomnia and 35 with chronic insomnia. The Insomnia Severity Index (ISI) score and self-compiled sleep data were assessed at baseline and post-intervention, and subjective sleep evaluations were assessed at days 4, 7, 12, and 14. Results The ISI score, sleep latency, night sleep time, and sleep efficiency were statistically significantlly improved from baseline to post-intervention by paired T-test. After the intervention, the mean ISI score of the acute insomnia group was lower than that of the chronic insomnia group. The reduction of the ISI score and the improvement of sleep time from baseline to post-intervention in the acute insomnia group were greater than those in the chronic insomnia group. Utilization of sedative-hypnotic drugs in the acute insomnia group was less than that in the chronic insomnia group, and the difference was statistically significant. Conclusions S-CBTI can improve the insomnia symptoms of women with COVID-19 in mobile cabin hospitals, especially for stress-related acute insomnia.
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Bruni O, Ferini-Strambi L, Giacomoni E, Pellegrino P. Herbal Remedies and Their Possible Effect on the GABAergic System and Sleep. Nutrients 2021; 13:530. [PMID: 33561990 PMCID: PMC7914492 DOI: 10.3390/nu13020530] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 01/29/2021] [Accepted: 02/02/2021] [Indexed: 01/22/2023] Open
Abstract
Sleep is an essential component of physical and emotional well-being, and lack, or disruption, of sleep due to insomnia is a highly prevalent problem. The interest in complementary and alternative medicines for treating or preventing insomnia has increased recently. Centuries-old herbal treatments, popular for their safety and effectiveness, include valerian, passionflower, lemon balm, lavender, and Californian poppy. These herbal medicines have been shown to reduce sleep latency and increase subjective and objective measures of sleep quality. Research into their molecular components revealed that their sedative and sleep-promoting properties rely on interactions with various neurotransmitter systems in the brain. Gamma-aminobutyric acid (GABA) is an inhibitory neurotransmitter that plays a major role in controlling different vigilance states. GABA receptors are the targets of many pharmacological treatments for insomnia, such as benzodiazepines. Here, we perform a systematic analysis of studies assessing the mechanisms of action of various herbal medicines on different subtypes of GABA receptors in the context of sleep control. Currently available evidence suggests that herbal extracts may exert some of their hypnotic and anxiolytic activity through interacting with GABA receptors and modulating GABAergic signaling in the brain, but their mechanism of action in the treatment of insomnia is not completely understood.
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Affiliation(s)
- Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University, 00185 Rome, Italy
| | - Luigi Ferini-Strambi
- Department of Neurology, Ospedale San Raffaele Turro, 20127 Milan, Italy;
- Sleep Disorders Center, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Elena Giacomoni
- Department of Medical Affairs, Sanofi Consumer HealthCare, 20158 Milan, Italy; (E.G.); (P.P.)
| | - Paolo Pellegrino
- Department of Medical Affairs, Sanofi Consumer HealthCare, 20158 Milan, Italy; (E.G.); (P.P.)
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Sun J, Zuo Z, Song R, Bao X, Zhu M. Acupuncture combined with moxibustion for insomnia after stroke: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2021; 100:e24112. [PMID: 33546019 PMCID: PMC7837922 DOI: 10.1097/md.0000000000024112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Stroke is the main cause of death and disability in the world and insomnia is a common complication of stroke patients. Insomnia will not only seriously affect the prognosis and quality of life of patients with stroke, but even cause the recurrence of stroke. Many studies have proved that acupuncture and moxibustion can effectively improve insomnia symptoms. This study will systematically evaluate the effectiveness and safety of acupuncture combined with moxibustion in treating insomnia after stroke. METHODS The following 8 databases will be searched from the inception to October 31, 2020, including China National Knowledge Infrastructure Database (CNKI), Chinese Scientific Journal Database (VIP database), China Biomedical Literature Database (CBM), Wanfang Data Chinese Database, PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), Allied and Alternative Medicine Database (AMED), Excerpt Medica Database (Embase). We will also search for ongoing trials from the World Health Organization International Clinical Trial Registration Platform search portal, Chinese Clinical Trial Register, Clinical trials.gov. In addition, the reference lists of studies meeting the inclusion criteria will also be searched for achieving the comprehensive retrieval to the maximum. All randomized controlled trials of acupuncture and moxibustion in treating insomnia after stroke will be included. Two reviewers will conduct literature screening, data extraction, and quality evaluation respectively. The main outcome is the Pittsburgh sleep quality index (PSQI), and the secondary outcomes include clinical efficacy, quality of life, and safety. RevMan V.5.4.1 will be used for meta-analysis. We will express the results as risk ratio (RR) with 95% confidence intervals (CIs) for dichotomous data and mean difference (MD) or standard mean difference (SMD) 95% CIs for continuous data. RESULTS This study will provide a comprehensive review of the available evidence of acupuncture combined with moxibustion in treating insomnia after stroke. CONCLUSION The conclusion of our study will provide the updated evidence to judge the effectiveness and safety of acupuncture combined with moxibustion for the treatment of insomnia after stroke. TRIAL REGISTRATION NUMBER PROSPERO CRD42020216720.
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Affiliation(s)
- Junjun Sun
- Beijing University of Chinese Medicine, Beijing
| | - Zheng Zuo
- Yunnan University of Chinese Medicine
| | - Ran Song
- Kunming St. John's Rehabilitation Hospital
| | - Xiongying Bao
- Second Affiliated Hospital of Yunnan University of Chinese Medicine, Kunming, China
| | - Miansheng Zhu
- Institute of Time-Acupoints-Space Acupuncture, Paris, France
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Patki M, Palekar S, Nukala PK, Vartak R, Patel K. Overdose and Alcohol Sensitive Immediate Release System (OASIS) for Deterring Accidental Overdose or Abuse of Drugs. AAPS PharmSciTech 2020; 22:9. [PMID: 33241538 DOI: 10.1208/s12249-020-01879-7] [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] [Received: 08/11/2020] [Accepted: 11/12/2020] [Indexed: 12/17/2022] Open
Abstract
Death from an accidental or intentional overdose of sleeping tablets has increased exponentially in the USA. Furthermore, the simultaneous consumption of sleeping tablets with alcoholic beverages not only intensifies the effect of sleeping tablets but also leads to blackouts, sleepwalking, and death in many cases. In this article, we proposed a unique and innovative technology to prevent multi-tablet and alcohol-associated abuse of sleeping tablet. Agonist- and antagonist-loaded polymeric filaments of appropriate Eudragit® polymers were prepared using hot melt extrusion. Metoprolol tartrate and hydrochlorothiazide were used as model drugs in place of zolpidem tartrate (agonist-BCS class I) and flumazenil (antagonist-BCS class IV), respectively. Crushed filaments were converted into a tablet with a novel rapidly soluble co-processed alkalizing agent. Dissolution studies of single tablet and multiple tablets (5) in fasted state simulated gastric fluid (FaSSGF) confirmed that the release of the agonist was significantly (p < 0.0001) reduced in multi-tablet dissolution. Furthermore, the release of antagonist was significantly higher when tablet was exposed to FaSSGF+20% ethanol and various alcoholic beverages. Thus, appropriate use of Eudragit® polymer's chemistry could help design a tablet to prevent the release of agonist in case of overdose and simultaneous release of antagonist when consumed with alcohol.
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Garland SN, Xie SX, DuHamel K, Bao T, Li Q, Barg FK, Song S, Kantoff P, Gehrman P, Mao JJ. Acupuncture Versus Cognitive Behavioral Therapy for Insomnia in Cancer Survivors: A Randomized Clinical Trial. J Natl Cancer Inst 2020; 111:1323-1331. [PMID: 31081899 DOI: 10.1093/jnci/djz050] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/21/2019] [Accepted: 03/29/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Insomnia is a common and debilitating disorder experienced by cancer survivors. Although cancer survivors express a preference for using nonpharmacological treatment to manage insomnia, the comparative effectiveness between acupuncture and Cognitive Behavioral Therapy for Insomnia (CBT-I) for this disorder is unknown. METHODS This randomized trial compared 8 weeks of acupuncture (n = 80) and CBT-I (n = 80) in cancer survivors. Acupuncture involved stimulating specific points on the body with needles. CBT-I included sleep restriction, stimulus control, cognitive restructuring, relaxation training, and education. We measured insomnia severity (primary outcome), pain, fatigue, mood, and quality of life posttreatment (8 weeks) with follow-up until 20 weeks. We used linear mixed-effects models for analyses. All statistical tests were two-sided. RESULTS The mean age was 61.5 years and 56.9% were women. CBT-I was more effective than acupuncture posttreatment (P < .001); however, both acupuncture and CBT-I produced clinically meaningful reductions in insomnia severity (acupuncture: -8.31 points, 95% confidence interval = -9.36 to -7.26; CBT-I: -10.91 points, 95% confidence interval = -11.97 to -9.85) and maintained improvements up to 20 weeks. Acupuncture was more effective for pain at the end of treatment; both groups had similar improvements in fatigue, mood, and quality of life and reduced prescription hypnotic medication use. CBT-I was more effective for those who were male (P < .001), white (P = .003), highly educated (P < .001), and had no pain at baseline (P < .001). CONCLUSIONS Although both treatments produced meaningful and durable improvements, CBT-I was more effective and should be the first line of therapy. The relative differences in the comparative effectiveness between the two interventions for specific groups should be confirmed in future adequately powered trials to guide more tailored interventions for insomnia.
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Yeh MH, Wu HC, Lin NW, Hsieh JJ, Yeh JW, Chiu HP, Wu MC, Tsai TY, Yeh CC, Li TM. Long-term use of combined conventional medicine and Chinese herbal medicine decreases the mortality risk of patients with lung cancer. Complement Ther Med 2020; 52:102427. [PMID: 32951705 DOI: 10.1016/j.ctim.2020.102427] [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] [Received: 09/26/2019] [Revised: 03/21/2020] [Accepted: 05/04/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND We explored the effect of Chinese herbal medicine (CHM) on the long-term survival of lung cancer patients and hazard ratio (HR) and to analyse CHM herbs and formulas for lung cancer treatment. METHODS We conducted a retrospective cohort study on diagnosed lung cancer patients in 2003-2016 from Taipei and Dalin Tzu Chi General Hospital Cancer Registry Database and from outpatient database from Chinese Medicine and Conventional Medicine Department. We categorised the patients into CHM user and CHM nonuser groups according to the CHM consumption time. After passing the proportional hazard assumption, we used the Cox PH model to calculate the groups' survival hazard ratio (HR) and examine the statistical difference and effect of CHM on lung cancer survival. RESULTS We classified 2557 lung cancer patients into 1643 CHM nonusers and 228 CHM users. The CHM users had lower mortality than the CHM nonusers. With the multivariable Cox model, we observed that the CHM use was associated with 35% lower risk of mortality (adjusted HR: 0.65; 95% confidence interval: 0.51-0.76). Continuous CHM use of >180 days may further lessen the mortality risk by 64%. Finally, eight herbs and two formulas could significantly lower the mortality. After pairing the eight herbs for analysis, seven combinations could reduce the mortality better than only using one herb. CONCLUSION CHM users had significantly lower mortality than CHM nonusers. The longer the CHM use, the more the mortality HR declined. Glehnia littoralisF. Schmidt ex Miq., Polyporus umbellatus(Pers.) Fries and Trichosanthes kirilowii Maxim. possess a highly substantial anticancer activity compared with other herbs.
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Affiliation(s)
- Ming-Hsien Yeh
- Graduate Institute of Chinese Medicine, China Medical University, Taichung City, 40402, Taiwan; Department of Chinese Medicine, Dalin Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi, 62247, Taiwan; School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien City, Hualien, 97004, Taiwan
| | - Hsien-Chang Wu
- Department of Chinese Medicine, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, 23142, Taiwan; School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien City, Hualien, 97004, Taiwan
| | - Nai-Wei Lin
- Department of Computer Science and Information Engineering, National Chung Cheng University, Minxiong, Chiayi, 621, Taiwan
| | - Jin-Jian Hsieh
- Department of Mathematics, National Chung Cheng University, Minxiong, Chiayi, 621, Taiwan
| | - Jin-Wen Yeh
- Department of Computer Science and Information Engineering, National Chung Cheng University, Minxiong, Chiayi, 621, Taiwan
| | - Hung-Pin Chiu
- Department of Information Management, Nanhua University, Dalin, Chiayi, 62249, Taiwan
| | - Mei-Chun Wu
- Department of Information Management, Nanhua University, Dalin, Chiayi, 62249, Taiwan
| | - Tzung-Yi Tsai
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70428, Taiwan; Department of Medical Research, Dalin Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, 2 Minsheng Road, Dalin Township, Chiayi, 62247, Taiwan; Department of Nursing, Tzu Chi University of Science and Technology, 880 Chien-Kuo Road Section 2, Hualien, 62247, Taiwan.
| | - Chia-Chou Yeh
- Department of Chinese Medicine, Dalin Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi, 62247, Taiwan; Department of Medical Research, Dalin Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, 2 Minsheng Road, Dalin Township, Chiayi, 62247, Taiwan; School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien City, Hualien, 97004, Taiwan.
| | - Te-Mao Li
- Graduate Institute of Chinese Medicine, China Medical University, Taichung City, 40402, Taiwan.
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Cho CH, Jee HJ, Nam YJ, An H, Kim L, Lee HJ. Temporal association between zolpidem medication and the risk of suicide: A 12-year population-based, retrospective cohort study. Sci Rep 2020; 10:4875. [PMID: 32184423 PMCID: PMC7078307 DOI: 10.1038/s41598-020-61694-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 03/02/2020] [Indexed: 01/25/2023] Open
Abstract
There have been concerns about abuse and unnecessary chronic administration of zolpidem, and zolpidem's relation to suicide risk. To investigate the temporal association of zolpidem with the risk of suicide, we conducted a 12-year, population-based, retrospective cohort study on the National Health Insurance Service-National Sample Cohort (NHIS-NSC), South Korea. Data were collected from 2002 to 2013 from the NHIS-NSC, and data cleaning was performed for 1,125,691 subjects. Cox proportional hazards regression analysis was used to investigate the correlation over time between zolpidem medication and suicide. Over intervals commencing after 80 months of observation, the adjusted hazard ratio of suicides associated with the use of the zolpidem was 2.01 (95% CI: 1.58-2.56; p < 0.001). The mean cumulative number of days of zolpidem prescription was significantly longer in the suicide group than in the non-suicide group after log-transformation (p = 0.005). Cases of chronic use of zolpidem (over six months or one year) were significantly more common in the suicide group compared to the non-suicide group (p = 0.002 and 0.005, respectively). Subjects who received zolpidem medication had a significantly higher risk of suicide after at least 80 months of observation, suggesting a long-term increased suicide risk associated with insomnia exposed to zolpidem medication.
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Affiliation(s)
- Chul-Hyun Cho
- Department of Psychiatry, School of Medicine, Chungnam National University, Daejeon, South Korea
- Department of Psychiatry, Sejong Chungnam National University Hospital, Sejong, South Korea
- Korea University Chronobiology Institute, Seoul, South Korea
| | - Hee-Jung Jee
- Department of Biostatistics, Korea University College of Medicine, Seoul, South Korea
| | - Yoon-Ju Nam
- Department of Psychiatry, Korea University College of Medicine, Seoul, South Korea
| | - Hyonggin An
- Department of Biostatistics, Korea University College of Medicine, Seoul, South Korea
| | - Leen Kim
- Korea University Chronobiology Institute, Seoul, South Korea
- Department of Psychiatry, Korea University College of Medicine, Seoul, South Korea
| | - Heon-Jeong Lee
- Korea University Chronobiology Institute, Seoul, South Korea.
- Department of Psychiatry, Korea University College of Medicine, Seoul, South Korea.
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Nguyen K, Watanabe J. Association Between Sleep Medications and Falls and Fall-related Worries in Community-Dwelling Older Adults in the United States. JOURNAL OF CONTEMPORARY PHARMACY PRACTICE 2019. [DOI: 10.37901/jcphp18-00022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background
Falls are the leading cause of unintentional fatal and nonfatal injuries in seniors. Sleep medications are associated with adverse events risk in older adults. The objective of this study is to quantify the relationship between different levels of sleep medication use with falls and fall-related worries in United States adults aged 65 years and older using a nationally representative sample.
Methods
Using the 2011 National Health and Aging Trends Study, survey-weighted multiple logistic regression was used to determine the association between participants who reported sleep medication use and the outcomes: falls in the last month, falls in the last year, multiple falls in the last year, fall-related worries, and limitation of activities due to fall-related worries.
Results
In adjusted analyses, older adults who used sleep medications every night compared to non-users of sleep medications were at increased odds of falls in the last year with an odds ratio (OR) of 1.51 (95% confidence limit [CL] 1.27, 1.78) and of multiple falls with an OR = 1.67 (95% CL 1.35, 2.06). For those who used sleep medications less than every night compared to non-users, there were no statistically significant increased odds of fall outcomes. Older adults who used sleep medication most nights (5–6 nights per week) and every night compared to non-users had increased odds of having fall-related worries with an OR = 1.61 (95% CL 1.06, 2.45) and an OR = 1.32 (95% CL 1.11, 1.58), respectively.
Conclusion
Older adults who use sleep medication every night are at greater odds of experiencing falls and having fall-related worries. Increased involvement by pharmacists in the community setting and pharmacist-led comprehensive medication reviews are efforts that may reduce sleep medication use and result in fewer falls in older adults.
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Staub C. Concept of diverse sleep treatments in physiotherapy. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2019. [DOI: 10.1080/21679169.2018.1505948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Cristina Staub
- Ausgeschlafen.ch: Physiotherapy and Sleep Consulting, Zürich, Switzerland
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Brupbacher G, Straus D, Porschke H, Zander-Schellenberg T, Gerber M, von Känel R, Schmidt-Trucksäss A. The acute effects of aerobic exercise on sleep in patients with depression: study protocol for a randomized controlled trial. Trials 2019; 20:352. [PMID: 31196147 PMCID: PMC6567535 DOI: 10.1186/s13063-019-3415-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 05/08/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Unipolar depression is one of the most important mental disorders. Insomnia is a symptom of cardinal importance in depression. It increases the risk to develop depression, negatively affects disease trajectory, is the most common symptom after remission, increases the risk of relapse, and is associated with higher suicide rates. Existing therapies for insomnia in depression have limitations. Further adjuvant therapies are therefore needed. Acute aerobic exercise has been shown to have beneficial effects on sleep in healthy individuals and patients with insomnia. We therefore hypothesize that a single session of aerobic exercise has a positive impact on sleep in patients with unipolar depression. This trial aims to investigate the effects of a single bout of aerobic exercise on the subsequent night's sleep in patients with depression. METHODS/DESIGN This is a two-arm parallel group, randomized, outcome assessor blinded, controlled, superiority trial. Patients between 18 and 65 years of age with a primary diagnosis of unipolar depression (without a psychotic episode) are included. Exclusion criteria are regular use of hypnotic agents, opioids, and certain beta-blockers, as well as the presence of factors precluding exercise, history of epilepsy, restless legs syndrome, moderate obstructive sleep apnea, and a BMI > 40. The intervention is a single bout of aerobic exercise, performed for 30 min on a bicycle ergometer at 80% individual anaerobic threshold. The control group sits and reads for 30 min. The primary outcome is sleep efficiency measured by polysomnography. Secondary outcomes include further polysomnographic variables, subjective pre-sleep arousal, nocturnal cardiovascular autonomic modulation, subjective sleep quality, daytime sleepiness, and adverse events. According to the sample size calculation, a total of 92 patients will be randomized using minimization. DISCUSSION This trial will add new information to the body of knowledge concerning the treatment of insomnia in patients with depression. Thereby, the results will inform decision makers on the utility of acute aerobic exercise. TRIAL REGISTRATION Clinicaltrials.gov, NCT03673397 . Protocol version 1 registered on 17 September 2018.
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Affiliation(s)
- Gavin Brupbacher
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052, Basel, Switzerland.
- OBERWAID AG, Rorschacher Strasse 311, 9016, St. Gallen, Switzerland.
| | - Doris Straus
- OBERWAID AG, Rorschacher Strasse 311, 9016, St. Gallen, Switzerland
| | | | - Thea Zander-Schellenberg
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
| | - Markus Gerber
- Division of Sport and Psychosocial Health, Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052, Basel, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Culmannstrasse 8, 8091, Zurich, Switzerland
| | - Arno Schmidt-Trucksäss
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, 4052, Basel, Switzerland
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Ku SC, Ho PS, Tseng YT, Yeh TC, Cheng SL, Liang CS. Benzodiazepine-Associated Carcinogenesis: Focus on Lorazepam-Associated Cancer Biomarker Changes in Overweight Individuals. Psychiatry Investig 2018; 15:900-906. [PMID: 30235918 PMCID: PMC6166024 DOI: 10.30773/pi.2018.05.02.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 05/02/2018] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE Cellular, animal, and human epidemiological studies suggested that benzodiazepines increase the risk of cancer and cancer mortality. Obesity is also clearly linked to carcinogenesis. However, no human studies have examined benzodiazepine-associated carcinogenesis as assessed by changes in cancer biomarkers. METHODS A total of 19 patients were recruited, and received a 6-week treatment of 0.5 mg lorazepam. The measured cancer biomarkers were angiopoietin-2 (ANG-2), soluble CD40 ligand, epidermal growth factor, endoglin, soluble Fas ligand (sFASL), heparin-binding EGF-like growth factor (HB-EGF), insulin-like growth factor binding protein, interleukin (IL)-6, IL-8, IL-18, plasminogen activator inhibitor (PLGF), placental growth factor, transforming growth factor (TGF)-α, tumor necrosis factor (TNF)-α, urokinase-type plasminogen (uPA), vascular endothelial growth factor (VEGF)-A, VEGF-C, and VEGF-D. RESULTS Six cancer biomarkers were significantly increased in all patients as a whole. The subgroup analysis revealed a distinct pattern of change. Overweight patients showed a significant increase in 11 cancer biomarkers, including ANG-2, sFASL, HB-EGF, IL-8, PLGF, TGF-α, TNF-α, uPA, VEGF-A, VEGF-C, and VEGF-D. However, normal-weight patients did not show any changes in cancer biomarkers. CONCLUSION Adiposity may have primed the carcinogenic potential, leading to lorazepam-associated carcinogenesis in overweight patients. Epidemiological studies addressing this issue should consider the potential modulator contributing to benzodiazepine-associated carcinogenesis.
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Affiliation(s)
- Shih-Chieh Ku
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Pei-Shen Ho
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Yu-Ting Tseng
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Ta-Chuan Yeh
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Shu-Li Cheng
- Department of Nursing, Mackay Medical College, Taipei, Taiwan, ROC
| | - Chih-Sung Liang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC.,Graduate Institute of Medical Sciences, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
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Schonmann Y, Goren O, Bareket R, Comaneshter D, Cohen AD, Vinker S. Chronic hypnotic use at 10 years—does the brand matter? Eur J Clin Pharmacol 2018; 74:1623-1631. [PMID: 30090968 DOI: 10.1007/s00228-018-2531-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 07/31/2018] [Indexed: 10/28/2022]
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41
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Bianchi MT. Sleep devices: wearables and nearables, informational and interventional, consumer and clinical. Metabolism 2018; 84:99-108. [PMID: 29080814 DOI: 10.1016/j.metabol.2017.10.008] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/16/2017] [Accepted: 10/20/2017] [Indexed: 12/16/2022]
Abstract
The field of sleep is in many ways ideally positioned to take full advantage of advancements in technology and analytics that is fueling the mobile health movement. Combining hardware and software advances with increasingly available big datasets that contain scored data obtained under gold standard sleep laboratory conditions completes the trifecta of this perfect storm. This review highlights recent developments in consumer and clinical devices for sleep, emphasizing the need for validation at multiple levels, with the ultimate goal of using personalized data and advanced algorithms to provide actionable information that will improve sleep health.
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Affiliation(s)
- Matt T Bianchi
- Neurology Department, Massachusetts General Hospital, Wang 720, Boston, MA 02114, United States; Division of Sleep Medicine, Harvard Medical School, Boston, MA, 02115, United States.
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Yayeh T, Leem YH, Kim KM, Jung JC, Schwarz J, Oh KW, Oh S. Administration of Alpha s1-Casein Hydrolysate Increases Sleep and Modulates GABA A Receptor Subunit Expression. Biomol Ther (Seoul) 2018; 26:268-273. [PMID: 29316237 PMCID: PMC5933893 DOI: 10.4062/biomolther.2017.083] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 08/29/2017] [Accepted: 09/19/2017] [Indexed: 12/28/2022] Open
Abstract
Sleep is the most basic and essential physiological requirement for mental health, and sleep disorders pose potential risks of metabolic and neurodegenerative diseases. Tryptic hydrolysate of αS1-casein (αS1-CH) has been shown to possess stress relieving and sleep promoting effects. However, the differential effects of αS1-CH on electroencephalographic wave patterns and its effects on the protein levels of γ-aminobutyric acid A (GABAA) receptor subtypes in hypothalamic neurons are not well understood. We found αS1-CH (120, 240 mg/kg) increased sleep duration in mice and reduced sleep-wake cycle numbers in rats. While αS1-CH (300 mg/kg) increased total sleeping time in rats, it significantly decreased wakefulness. In addition, electroencephalographic theta (θ) power densities were increased whereas alpha (α) power densities were decreased by αS1-CH (300 mg/kg) during sleep-wake cycles. Furthermore, protein expressions of GABAA receptor β1 subtypes were elevated in rat hypothalamus by αS1-CH. These results suggest αS1-CH, through GABAA receptor modulation, might be useful for treating sleep disorders.
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Affiliation(s)
- Taddesse Yayeh
- Department of Molecular Medicine and TIDRC, School of Medicine, Ewha Womans University, Seoul 07985, Republic of Korea
| | - Yea-Hyun Leem
- Department of Molecular Medicine and TIDRC, School of Medicine, Ewha Womans University, Seoul 07985, Republic of Korea
| | - Kyung-Mi Kim
- Life Science Research Institute, Novarex Co., Ltd, Ochang, Cheongwon 28126, Republic of Korea
| | - Jae-Chul Jung
- Life Science Research Institute, Novarex Co., Ltd, Ochang, Cheongwon 28126, Republic of Korea
| | | | - Ki-Wan Oh
- Department of Pharmacy, College of Pharmacy, Chungbuk National University, Cheongju 28160, Republic of Korea
| | - Seikwan Oh
- Department of Molecular Medicine and TIDRC, School of Medicine, Ewha Womans University, Seoul 07985, Republic of Korea
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Markwald RR, Iftikhar I, Youngstedt SD. Behavioral Strategies, Including Exercise, for Addressing Insomnia. ACSM'S HEALTH & FITNESS JOURNAL 2018; 22:23-29. [PMID: 31467475 PMCID: PMC6715137 DOI: 10.1249/fit.0000000000000375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
UNLABELLED Cognitive-behavioral therapy for insomnia is superior to sleeping pills for treating insomnia, and its accessibility is rapidly improving. Exercise can also promote sleep in insomnia. A list of recommendations on good sleep practices can be applied prior to consulting with a clinician and can often resolve insomnia symptoms. SUMMARY STATEMENT Insomnia is associated with negative psychological and physiological health outcomes. Established behavioral strategies for addressing insomnia such as adoption of good sleep habits and engagement in Cognitive Behavioral Therapy for Insomnia have documented efficacy. Exercise is also efficacious with unique health benefits.
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Affiliation(s)
| | | | - Shawn D Youngstedt
- College of Health Solutions, Arizona State University
- College of Nursing and Health Innovation, Arizona State University
- Phoenix VA Health Care System
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44
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Yu X, Franks NP, Wisden W. Sleep and Sedative States Induced by Targeting the Histamine and Noradrenergic Systems. Front Neural Circuits 2018; 12:4. [PMID: 29434539 PMCID: PMC5790777 DOI: 10.3389/fncir.2018.00004] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 01/11/2018] [Indexed: 01/07/2023] Open
Abstract
Sedatives target just a handful of receptors and ion channels. But we have no satisfying explanation for how activating these receptors produces sedation. In particular, do sedatives act at restricted brain locations and circuitries or more widely? Two prominent sedative drugs in clinical use are zolpidem, a GABAA receptor positive allosteric modulator, and dexmedetomidine (DEX), a selective α2 adrenergic receptor agonist. By targeting hypothalamic neuromodulatory systems both drugs induce a sleep-like state, but in different ways: zolpidem primarily reduces the latency to NREM sleep, and is a controlled substance taken by many people to help them sleep; DEX produces prominent slow wave activity in the electroencephalogram (EEG) resembling stage 2 NREM sleep, but with complications of hypothermia and lowered blood pressure—it is used for long term sedation in hospital intensive care units—under DEX-induced sedation patients are arousable and responsive, and this drug reduces the risk of delirium. DEX, and another α2 adrenergic agonist xylazine, are also widely used in veterinary clinics to sedate animals. Here we review how these two different classes of sedatives, zolpidem and dexmedetomideine, can selectively interact with some nodal points of the circuitry that promote wakefulness allowing the transition to NREM sleep. Zolpidem enhances GABAergic transmission onto histamine neurons in the hypothalamic tuberomammillary nucleus (TMN) to hasten the transition to NREM sleep, and DEX interacts with neurons in the preoptic hypothalamic area that induce sleep and body cooling. This knowledge may aid the design of more precise acting sedatives, and at the same time, reveal more about the natural sleep-wake circuitry.
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Affiliation(s)
- Xiao Yu
- Department of Life Sciences, Imperial College London, London, United Kingdom
| | - Nicholas P Franks
- Department of Life Sciences, Imperial College London, London, United Kingdom.,Centre for Neurotechnology, Imperial College London, London, United Kingdom.,UK Dementia Research Institute, Imperial College London, London, United Kingdom
| | - William Wisden
- Department of Life Sciences, Imperial College London, London, United Kingdom.,Centre for Neurotechnology, Imperial College London, London, United Kingdom.,UK Dementia Research Institute, Imperial College London, London, United Kingdom
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Kim J, Lee SL, Kang I, Song YA, Ma J, Hong YS, Park S, Moon SI, Kim S, Jeong S, Kim JE. Natural Products from Single Plants as Sleep Aids: A Systematic Review. J Med Food 2018; 21:433-444. [PMID: 29356580 DOI: 10.1089/jmf.2017.4064] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Insufficient sleep, insomnia, and sleep-related problems are important health issues, as their overall prevalence accounts for about 30% of the general population. The aim of this study was to systematically review previous studies investigating the effects of orally administered single plant-derived extracts on sleep-related outcomes in humans. Data sources were PubMed, Google Scholar, and Cochrane Library. The data search was conducted in two steps: step 1, names of plants which have been studied as sleep aids in humans were searched and retrieved; and step 2, each ingredient listed in step 1 was then added into the search term. Only original articles or reviews were applicable to the scope of this review. Studies on human subjects, with or without sleep-related disorders, were included. Sleep-related disorders refer to not only insomnia or sleep behavior disorders but also diseases with sleep-related symptoms. Studies were considered eligible for this review when the plant extracts were administered orally. Outcome measures relevant to sleep quality, duration, or other sleep-related problems were included. Twenty-one plants were listed in the first step of the search as potential candidates for natural sleep aids. Seventy-nine articles using these single plant-derived natural products were included in the final review. Although valerian was most frequently studied, conflicting results were reported, possibly due to the various outcome measures of each study. Other plants were not as rigorously tested in human studies. There was limited evidence with inconclusive results regarding the effects of single plant-derived natural products on sleep, warranting further studies.
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Affiliation(s)
- Jungyoon Kim
- 1 Ewha Brain Institute, Ewha Womans University , Seoul, South Korea
- 2 Department of Brain and Cognitive Sciences, Division of Convergence, Scranton College, Ewha Womans University , Seoul, South Korea
| | - Suji L Lee
- 1 Ewha Brain Institute, Ewha Womans University , Seoul, South Korea
- 2 Department of Brain and Cognitive Sciences, Division of Convergence, Scranton College, Ewha Womans University , Seoul, South Korea
| | - Ilhyang Kang
- 1 Ewha Brain Institute, Ewha Womans University , Seoul, South Korea
- 2 Department of Brain and Cognitive Sciences, Division of Convergence, Scranton College, Ewha Womans University , Seoul, South Korea
| | - Youme A Song
- 1 Ewha Brain Institute, Ewha Womans University , Seoul, South Korea
| | - Jiyoung Ma
- 1 Ewha Brain Institute, Ewha Womans University , Seoul, South Korea
- 3 Interdisciplinary Program in Neuroscience, College of Natural Sciences, Seoul National University , Seoul, South Korea
| | - Young Sun Hong
- 4 Department of Internal Medicine, School of Medicine, Ewha Womans University , Seoul, South Korea
| | - Shinwon Park
- 1 Ewha Brain Institute, Ewha Womans University , Seoul, South Korea
- 2 Department of Brain and Cognitive Sciences, Division of Convergence, Scranton College, Ewha Womans University , Seoul, South Korea
| | - Seog In Moon
- 1 Ewha Brain Institute, Ewha Womans University , Seoul, South Korea
| | - Soojeong Kim
- 1 Ewha Brain Institute, Ewha Womans University , Seoul, South Korea
| | - Semi Jeong
- 1 Ewha Brain Institute, Ewha Womans University , Seoul, South Korea
| | - Jieun E Kim
- 1 Ewha Brain Institute, Ewha Womans University , Seoul, South Korea
- 2 Department of Brain and Cognitive Sciences, Division of Convergence, Scranton College, Ewha Womans University , Seoul, South Korea
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Lin CL, Liu TC, Chung CH, Chien WC. Risk of pneumonia in patients with insomnia: A nationwide population-based retrospective cohort study. J Infect Public Health 2017; 11:270-274. [PMID: 28916233 DOI: 10.1016/j.jiph.2017.08.002] [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] [Received: 04/13/2017] [Accepted: 08/05/2017] [Indexed: 02/06/2023] Open
Abstract
Evidence is lacking regarding whether insomnia increases the risk of infectious disease. Accordingly, the present study examined the risk of pneumonia in patients with insomnia. This study was a population-based retrospective cohort study on a cohort of 8061 patients with insomnia and a control cohort of 16,112 patients (matched by age, sex, and year of diagnosis) from the Taiwan National Health Insurance Research Database for the 2000-2010 period. Overall incidence of pneumonia was 50.6 per 1000 person-years in the insomnia cohort, which was significantly higher than that in the control cohort (30.9 per 1000 person-years). Overall, the insomnia cohort exhibited a higher risk of pneumonia (HR=2.43; CI, 2.24-2.62). By age group, the risk of pneumonia was significantly higher in the insomnia cohort for those aged ≤40 years (HR=3.23, CI: 1.38-7.57), 41-65 years (HR=2.62, CI: 2.07-3.32), and >65years (CI: 2.21-2.61). Compared with the controls, the insomnia cohort exhibited a higher risk of pneumonia, particularly in young adults.
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Affiliation(s)
- Chia-Ling Lin
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Ta-Chun Liu
- Department of Stem Cell Biology and Regenerative Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Chi-Hsiang Chung
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan; School of Public Health, National Defense Medical Center, Taipei, Taiwan.
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Thygesen LC, Pottegård A, Ersbøll AK, Friis S, Stürmer T, Hallas J. External adjustment of unmeasured confounders in a case-control study of benzodiazepine use and cancer risk. Br J Clin Pharmacol 2017; 83:2517-2527. [PMID: 28599067 DOI: 10.1111/bcp.13342] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/18/2017] [Accepted: 05/26/2017] [Indexed: 12/17/2022] Open
Abstract
AIMS Previous studies have reported diverging results on the association between benzodiazepine use and cancer risk. METHODS We investigated this association in a matched case-control study including incident cancer cases during 2002-2009 in the Danish Cancer Registry (n = 94 923) and age- and sex-matched (1:8) population controls (n = 759 334). Long-term benzodiazepine use was defined as ≥500 defined daily doses 1-5 years prior to the index date. We implemented propensity score (PS) calibration using external information on confounders available from a survey of the Danish population. Two PSs were used: The error-prone PS using register-based confounders and the calibrated PS based on both register- and survey-based confounders, retrieved from the Health Interview Survey. RESULTS Register-based data showed that cancer cases had more diagnoses, higher comorbidity score and more co-medication then population controls. Survey-based data showed lower self-rated health, more self-reported diseases, and more smokers as well as subjects with sedentary lifestyle among benzodiazepine users. By PS calibration, the odds ratio for cancer overall associated with benzodiazepine use decreased from 1.16 to 1.09 (95% confidence interval 1.00-1.19) and for smoking-related cancers from 1.20 to 1.10 (95% confidence interval 1.00-1.21). CONCLUSION We conclude that the increased risk observed in the solely register-based study could partly be attributed to unmeasured confounding.
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Affiliation(s)
- Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Anton Pottegård
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense C, Denmark.,Department of Clinical Chemistry & Pharmacology, Odense University Hospital, Odense C, Denmark
| | - Annette Kjaer Ersbøll
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Søren Friis
- Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen Ø, Denmark
| | - Til Stürmer
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jesper Hallas
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense C, Denmark.,Department of Clinical Chemistry & Pharmacology, Odense University Hospital, Odense C, Denmark
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Reynolds SA, Ebben MR. The Cost of Insomnia and the Benefit of Increased Access to Evidence-Based Treatment. Sleep Med Clin 2017; 12:39-46. [DOI: 10.1016/j.jsmc.2016.10.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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