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Sulu C, Senel GB, Koca O, Alaylioglu M, Demir AN, Durcan E, Ak DG, Dursun E, Konukoglu D, Ozkaya HM, Karadeniz D, Kadioglu P. The relations of circulating agouti-related peptide and leptin with altered sleep architecture in patients with active Cushing's disease: a pilot study. J Endocrinol Invest 2024; 47:167-178. [PMID: 37306895 DOI: 10.1007/s40618-023-02133-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/05/2023] [Indexed: 06/13/2023]
Abstract
AIM To evaluate sleep architecture of patients with Cushing's disease (CD) and to explore whether agouti-related peptide (AgRP) and/or leptin play a permissive role in sleep alterations in patients with active CD. METHODS We performed polysomnography on 26 patients with active CD and age 26 age- and sex-matched control subjects. Blood samples were obtained from all participants for the analyzes of AgRP and leptin. The laboratory and sleep-related parameters were compared. RESULTS The groups were similar in age, gender, and body mass index. The CD group had reduced sleep efficiency (71.6 ± 12.1% vs. 78.8 ± 12.6%, p = 0.042) and increased wake after sleep onset (WASO%) (24.7 ± 13.1% vs. 17.4 ± 11.6%, p = 0.040) as compared to control group. Seventeen patients with CD (65.4%) and 18 control subjects (69.2%) had obstructive sleep apnea. Serum AgRP (13.2 ± 7.4 pg/ml vs. 9 ± 3.1, p = 0.029), leptin (59.5 mcg/l, [IQR] 32.6-94.6 vs. 25.3 mcg/l, [IQR] 12.9-57.5, p = 0.007) were higher in CD group. AgRP and leptin correlated negatively with total sleep time, sleep efficiency, stage N2 sleep (%), and positively with WASO%. In multiple regression analyses, serum cortisol (ß = - 0.359, p = 0.042) and AgRP (ß = - 0.481, p = 0.01) were significant predictor of sleep efficiency. AgRP was also significant predictor of WASO% (ß = 0.452 and p < 0.05). CONCLUSIONS Active CD carries an increased risk of impaired sleep efficiency and continuity which may worsen health-related quality of life. Elevated circulating AgRP and, to a lesser extent, leptin may be associated with decreased sleep efficiency and continuity in patients with CD. Patients with CD who have subjective sleep symptoms should be screened with polysomnography.
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Affiliation(s)
- C Sulu
- Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Kocamustafapasa Street No:53, Fatih, 34098, Istanbul, Turkey
| | - G B Senel
- Sleep and Disorders Unit, Department of Neurology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - O Koca
- Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - M Alaylioglu
- Department of Neuroscience, Institute of Neurological Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - A N Demir
- Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Kocamustafapasa Street No:53, Fatih, 34098, Istanbul, Turkey
| | - E Durcan
- Department of Endocrinology, Bagcilar Training Hospital, Istanbul, Turkey
| | - D G Ak
- Department of Neuroscience, Institute of Neurological Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - E Dursun
- Department of Neuroscience, Institute of Neurological Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - D Konukoglu
- Department of Biochemistry, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - H M Ozkaya
- Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Kocamustafapasa Street No:53, Fatih, 34098, Istanbul, Turkey
- Pituitary Center, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - D Karadeniz
- Sleep and Disorders Unit, Department of Neurology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - P Kadioglu
- Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Kocamustafapasa Street No:53, Fatih, 34098, Istanbul, Turkey.
- Pituitary Center, Istanbul University-Cerrahpasa, Istanbul, Turkey.
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Kianersi S, Redline S, Mongraw-Chaffin M, Huang T. Associations of Slow-Wave Sleep With Prevalent and Incident Type 2 Diabetes in the Multi-Ethnic Study of Atherosclerosis. J Clin Endocrinol Metab 2023; 108:e1044-e1055. [PMID: 37084404 PMCID: PMC10686689 DOI: 10.1210/clinem/dgad229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 04/17/2023] [Accepted: 04/17/2023] [Indexed: 04/23/2023]
Abstract
CONTEXT N3 sleep (i.e., slow-wave sleep), a marker of deep restorative sleep, is implicated in hormonal and blood pressure regulation and may impact cardiometabolic health. OBJECTIVE We conducted cross-sectional and prospective analyses to test whether a higher proportion and longer duration of N3 sleep are associated with reduced type 2 diabetes risk. METHODS A subsample of participants from the Multi-Ethnic Study of Atherosclerosis completed 1-night polysomnography at Exam 5 (2010-2013) and were prospectively followed until Exam 6 (2016-2018). We used modified Poisson regression to examine the cross-sectional associations of N3 proportion and duration with prevalent diabetes and Cox proportional hazards models to estimate risk of diabetes according to N3 measures. RESULTS In cross-sectional analyses (n = 2026, mean age: 69 years), diabetes prevalence was 28% (n = 572). Compared with the first quartile (Q1) of the N3 proportion (<2.0%), participants in Q4 (≥15.4%) were 29% (95% CI 0.58, 0.87) less likely to have prevalent diabetes (P trend = .0016). The association attenuated after adjustment for demographics, lifestyles, and sleep-related factors (P trend = .3322). In prospective analyses of 1251 participants and 129 incident cases over 6346 person-years of follow-up, a curvilinear relationship was observed between N3 proportion and incident diabetes risk. In the fully adjusted model, the hazard ratio (95% CI) of developing diabetes vs Q1 was 0.47 (0.26, 0.87) for Q2, 0.34 (0.15, 0.77) for Q3, and 0.32 (0.10, 0.97) for Q4 (P nonlinearity = .0213). The results were similar for N3 duration. CONCLUSION Higher N3 proportion and longer N3 duration were prospectively associated with lower type 2 diabetes risk in a nonlinear fashion among older American adults.
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Affiliation(s)
- Sina Kianersi
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Susan Redline
- Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115, USA
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Morgana Mongraw-Chaffin
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Tianyi Huang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115, USA
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Nakajima S, Kaneko Y, Fujii N, Kizuki J, Saitoh K, Nagao K, Kawamura A, Yoshiike T, Kadotani H, Yamada N, Uchiyama M, Kuriyama K, Suzuki M. Transdiagnostic association between subjective insomnia and depressive symptoms in major psychiatric disorders. Front Psychiatry 2023; 14:1114945. [PMID: 37168089 PMCID: PMC10165079 DOI: 10.3389/fpsyt.2023.1114945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 03/27/2023] [Indexed: 05/13/2023] Open
Abstract
In psychiatric disorders, comorbid depressive symptoms are associated with clinically important issues such as reduced quality of life, a poor prognosis, and increased suicide risk. Previous studies have found a close relationship between insomnia and depressive symptoms in major depressive disorder (MDD), and that actively improving insomnia heightens the improvement of depressive symptoms. This study aimed to investigate whether the association between insomnia and depressive symptoms is also found in other psychiatric disorders besides MDD. The subjects were 144 patients with MDD (n = 71), schizophrenia (n = 25), bipolar disorder (n = 22), or anxiety disorders (n = 26). Sleep status was assessed subjectively and objectively using the Athens Insomnia Scale (AIS) and sleep electroencephalography (EEG), respectively. Sleep EEG was performed using a portable EEG device. Depressive symptoms were assessed using the Beck Depression Inventory. Subjective insomnia, as defined by the AIS, was associated with depressive symptoms in all disorders. Moreover, in schizophrenia, a relation between depressive symptoms and insomnia was also found by objective sleep assessment methods using sleep EEG. Our findings suggest that the association between subjective insomnia and depressive symptoms is a transdiagnostic feature in major psychiatric disorders. Further studies are needed to clarify whether therapeutic interventions for comorbid insomnia can improve depressive symptoms in major psychiatric disorders, similar to MDD.
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Affiliation(s)
- Suguru Nakajima
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshiyuki Kaneko
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
| | - Nobukuni Fujii
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
| | - Jun Kizuki
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
- Department of Sleep-Wake Disorders, National Center of Neurology and Psychiatry, National Institute of Mental Health, Tokyo, Japan
| | - Kaori Saitoh
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
| | - Kentaro Nagao
- Department of Sleep-Wake Disorders, National Center of Neurology and Psychiatry, National Institute of Mental Health, Tokyo, Japan
| | - Aoi Kawamura
- Department of Sleep-Wake Disorders, National Center of Neurology and Psychiatry, National Institute of Mental Health, Tokyo, Japan
| | - Takuya Yoshiike
- Department of Sleep-Wake Disorders, National Center of Neurology and Psychiatry, National Institute of Mental Health, Tokyo, Japan
| | - Hiroshi Kadotani
- Department of Psychiatry, Shiga University of Medical Science, Shiga, Japan
| | | | - Makoto Uchiyama
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
- Tokyo Adachi Hospital, Tokyo, Japan
| | - Kenichi Kuriyama
- Department of Sleep-Wake Disorders, National Center of Neurology and Psychiatry, National Institute of Mental Health, Tokyo, Japan
| | - Masahiro Suzuki
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
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Suárez-Torres I, García-García F, Morales-Romero J, Melgarejo-Gutiérrez M, Demeneghi-Marini VP, Luna-Ceballos RI, Hernández-Trejo C, Carmona-Cortés DA. Poor quality of sleep in Mexican patients with type 2 diabetes and its association with lack of glycemic control. Prim Care Diabetes 2023; 17:155-160. [PMID: 36781364 DOI: 10.1016/j.pcd.2023.01.011] [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: 08/27/2022] [Revised: 01/13/2023] [Accepted: 01/30/2023] [Indexed: 02/13/2023]
Abstract
AIMS To determine the association between sleep quality and lack of glycemic control in a Mexican population of type 2 diabetes patients. METHODS Cross-sectional study. Two hundred two patients between 20 and 60 years old with a previous diagnosis of diabetes were included. Sleep quality was assessed with the Pittsburgh Sleep Quality Index and lack of glycemic control as a glycated hemoglobin A1c level ≥ 7 %. Univariate and multivariate analyses using logistic regression were performed. RESULTS The study population showed poor sleep quality and a lack of glycemic control of 70.3 % and 69.8 %, respectively. The prevalence of patients with both conditions was 52.5 %. In multivariate analysis, poor sleep quality was significantly associated with a lack of glycemic control (OR = 2.3, p = 0.030). Other associated variables were napping (p = 0.015), diabetes duration (p = 0.011), insulin use (p = 0.024), and diastolic blood pressure ≥ 85 mmHg (p = 0.029). CONCLUSIONS The prevalence of lack of glycemic control in the study population is high. Poor sleep quality significantly doubles the risk of lack of glycemic control, even in the presence of other risk factors.
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Affiliation(s)
- Irene Suárez-Torres
- Health Sciences Ph.D. Program, Health Sciences Institute, University of Veracruz, Mexico
| | | | | | | | | | | | - Cirenia Hernández-Trejo
- Clinical Analysis Laboratory of the University Clinic for Reproductive and Sexual Health, University of Veracruz, Mexico
| | - Diana Aurora Carmona-Cortés
- Clinical Analysis Laboratory of the University Clinic for Reproductive and Sexual Health, University of Veracruz, Mexico
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The Relationship between Sleep Duration and Metabolic Syndrome Severity Scores in Emerging Adults. Nutrients 2023; 15:nu15041046. [PMID: 36839404 PMCID: PMC9965711 DOI: 10.3390/nu15041046] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Research suggests sleep duration can influence metabolic systems including glucose homeostasis, blood pressure, hormone regulation, nervous system activity, and total energy expenditure (TEE), all of which are related to cardiometabolic disease risk, even in young adults. The purpose of this study was to examine the relationship between sleep duration and metabolic syndrome severity scores (MSSS) in a sample of emerging adults (18-24 y/o). METHODS Data were collected between 2012 and 2021 from the College Health and Nutrition Assessment Survey, an ongoing, cross-sectional study conducted at a midsized northeastern university. Anthropometric, biochemical, and clinical measures were obtained following an overnight fast and used to assess the prevalence of metabolic syndrome (MetS). MetS severity scores (MSSS) were calculated using race- and sex-specific formulas. Sleep duration was calculated from the difference in self-reported bedtime and wake time acquired through an online survey. ANCOVA was used to examine the relationship between sleep duration and MetS severity score while adjusting for covariates (age, sex, BMI, physical activity level, smoking status, alcohol consumption, and academic major). RESULTS In the final sample (n = 3816), MetS (≥3 criteria) was present in 3.3% of students, while 15.4% of students presented with ≥2 MetS criteria. Mean MSSS was -0.65 ± 0.56, and the reported sleep duration was 8.2 ± 1.3 h/day. MSSS was higher among low sleepers (<7 h/day) and long sleepers (>9 h/day) compared to the reference sleepers (7-8 h/day) (-0.61 ± 0.02 and -0.63 ± 0.01 vs. -0.7 ± 0.02, respectively, p < 0.01). CONCLUSIONS Our findings suggest short (<7 h/day) and long (>9 h/day) sleep durations raise the risk of MetS in a sample of emerging adults. Further research is needed to elucidate the impact of improving sleep habits on future disease risk.
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Woods NP, Tangpukdee J, Thepa T, Methakanchanasak N. Consequences of Sleep Deprivation in Adult Diabetes Mellitus Type 2 Patients: An Integrative Review. Open Access Maced J Med Sci 2023. [DOI: 10.3889/oamjms.2023.10029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND: Sleep deprivation in individuals with diabetes mellitus type 2 is more prevalent than in ordinary people. At present, the adverse effects of diabetes type 2 people with sleep disorders and sleep deprivation on blood sugar control are irrefutable. Thorough assessments covering the whole structure should be of concern in health-care treatment. It is precipitated and delivered to the physical, mental health, and social environment, but no systematic review or minimal data were published. Furthermore, it may significantly affect the system more than existing research.
AIM: An integrative review aims to clarify the results or consequences of sleep disturbance/deprivation or insomnia symptoms among diabetes mellitus type 2 patients.
METHODS: The writers implemented a literature search in PubMed, CINAHL, and Medline using the terms DM type 2, insomnia, adult, effect, DM, sleep disturbance, sleep disorder, and a consequence between 2012 and 2022. Inclusion criteria selected through considering the entire article, and providing an abstract, were 20 articles.
RESULTS: Integrative data extraction and information were analyzed thematically. Identified were nine ideas: Association with blood sugar control, blood pressure control, risk of CVD, diabetes self-care behavior, weight gained and Obstructive Sleep Apnea (OSA), lifestyle and physical activity, mood/depression and anxiety symptoms, daily calories distribution, cholesterol/triglyceride, and liver enzyme levels.
CONCLUSION: The adverse effects of sleep deprivation in type 2 diabetes significantly affect all pathophysiologically, mentally, and lifestyle modifications, including diabetes self-care. Therefore, to highlight the importance of promoting optimum sleep in diabetes type2 patients, a health-care system is inevitably as necessary as diet and exercise management.
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Amiri-Ardekani E, Kazemi A, Sasani N, Fanfulla F, Clark CC. The association of meal glycemic index/load with quantitative and qualitative indicators of sleep: a systematic review. Minerva Med 2022; 113:1008-1016. [PMID: 33949181 DOI: 10.23736/s0026-4806.21.07444-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION We sought to systematically review the association between meal glycemic index or glycemic load and sleep indicators. EVIDENCE ACQUISITION PubMed, Scopus, Web of Science, and Embase were searched up to March 2021. Both observational and clinical trials studies, with both male and female participants of all ages, were included. EVIDENCE SYNTHESIS A total of 10 studies were included in this review; six with clinical trial and four with cross-sectional design. Among the six clinical trial, three studies indicated a significant effect of high glycemic index on sleep (two in young male athletes [N.=8 and N.=9] and one in adults [N.=8]), while three others failed to detect any significant effect (young males [N.=12], children [N.=8], toddlers [N.=56]). Among the cross-sectional studies, high glycemic index meals were associated with improved sleep duration or quality in two studies (594 toddlers and 1848 adults), however, contrastingly, were also associated with sleep disturbances (108 students and 53,069 postmenopausal women). CONCLUSIONS High glycemic index meals likely improve sleep onset latency in young males. For other indicators of sleep quality and other population groups, the results are equivocal. Most of the available studies were conducted in special population groups and were inadequately designed; whilst clinical trials were of short duration and small sample sizes. Therefore, further well-designed clinical trials are required before further definitive conclusions can be made.
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Affiliation(s)
- Ehsan Amiri-Ardekani
- Department of Phytopharmaceuticals (Traditional Pharmacy), Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Association of Indigenous Knowledge, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Asma Kazemi
- Nutrition Research Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran -
| | - Najmeh Sasani
- Nutrition Research Center, Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Francesco Fanfulla
- Respiratory Function and Sleep Unit, Scientific Institute of Pavia and Montescano, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Cain C Clark
- Center for Intelligent Healthcare, Coventry University, Coventry, UK
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Benton D, Bloxham A, Gaylor C, Brennan A, Young HA. Carbohydrate and sleep: An evaluation of putative mechanisms. Front Nutr 2022; 9:933898. [PMID: 36211524 PMCID: PMC9532617 DOI: 10.3389/fnut.2022.933898] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
Sleep problems are extremely common in industrialized countries and the possibility that diet might be used to improve sleep has been considered. The topic has been reviewed many times, resulting in the frequent suggestion that carbohydrate increases the uptake of tryptophan by the brain, where it is metabolized into serotonin and melatonin, with the suggestion that this improves sleep. An alternative mechanism was proposed based on animal literature that has been largely ignored by those considering diet and sleep. The hypothesis was that, as in the hypothalamus there are glucose-sensing neurons associated with the sleep-wake cycle, we should consider the impact of carbohydrate-induced changes in the level of blood glucose. A meta-analysis found that after consuming a lower amount of carbohydrate, more time was spent in slow-wave sleep (SWS) and less in rapid-eye-movement sleep. As the credibility of alternative mechanisms has tended not to have been critically evaluated, they were considered by examining their biochemical, nutritional, and pharmacological plausibility. Although high carbohydrate consumption can increase the uptake of tryptophan by the brain, it only occurs with such low levels of protein that the mechanism is not relevant to a normal diet. After entering the brain tryptophan is converted to serotonin, a neurotransmitter known to influence so many different aspects of sleep and wakefulness, that it is not reasonable to expect a uniform improvement in sleep. Some serotonin is converted to melatonin, although the exogenous dose of melatonin needed to influence sleep cannot be credibly provided by the diet. This review was registered in the International Prospective Register of Systematic Reviews (CRD42020223560).
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Ura M, Fujimoto K, Kanai M. Association between sleep quality, hypertensive disorders of pregnancy, and sleep-disordered breathing in pregnant women with and without obesity: An observational cross-sectional study. J Obstet Gynaecol Res 2022; 48:2774-2789. [PMID: 35920333 DOI: 10.1111/jog.15376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 07/09/2022] [Accepted: 07/14/2022] [Indexed: 11/28/2022]
Abstract
AIM To elucidate whether pregnancy and obesity are associated with poor sleep quality, and to investigate if sleep quality is associated with hypertensive disorders of pregnancy in pregnant women with obesity. METHODS This observational cross-sectional study examined 15 obese pregnant women (body mass index ≥30 kg/m2 ) (p-Ob group), 15 nonobese pregnant women (p-nOb group), and 30 nonobese nonpregnant women (n-Pr group), using home recording devices to monitor sleep-disordered breathing (SDB): respiratory disturbance index, oxygen saturation, and sleep stage and quality. These variables were compared among the groups. Moreover, obese women with and without hypertensive disorders of pregnancy were compared. RESULTS Significant differences in respiratory disturbance index (median: 10.3 [p-Ob], 7.1 [p-nOb], 3.5 [n-Pr]) and oxygen saturation (95.1%, 96.5%, and 96.6%) were observed among the groups. Seven participants in the p-Ob group experienced hypertensive disorders of pregnancy with SDB before or after sleep examination. Particularly, those who developed hypertensive disorders of pregnancy before sleep examination showed a lower delta power throughout the night than those without this condition. CONCLUSION Pregnant women had poor sleep quality; those with obesity had higher frequency of SDB with worsened respiratory conditions that might cause complications. Our findings suggest that the development of hypertensive disorders of pregnancy in some obese pregnant women might be associated with insufficient delta power. Focusing on delta power may reflect subtle changes in sleep quality that occur in pregnant women. Future longitudinal studies with larger sample sizes are required to confirm these findings and investigate causality.
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Affiliation(s)
- Midori Ura
- Department of Medical Laboratory Science, Faculty of Health Sciences, Junshin Gakuen University, Fukuoka, Japan
| | - Keisaku Fujimoto
- Department of Clinical Laboratory Sciences, Shinshu University School of Health Sciences, Nagano, Japan
| | - Makoto Kanai
- Department of Family and Child Nursing, and Midwifery, Shinshu University School of Health Sciences, Nagano, Japan
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Katsube M, Watanabe H, Suzuki K, Ishimoto T, Tatebayashi Y, Kato Y, Murayama N. Food-derived antioxidant ergothioneine improves sleep difficulties in humans. J Funct Foods 2022. [DOI: 10.1016/j.jff.2022.105165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Johnson JM, Durrant SJ, Law GR, Santiago J, Scott EM, Curtis F. The effect of slow-wave sleep and rapid eye-movement sleep interventions on glycaemic control: a systematic review and meta-analysis of randomised controlled trials. Sleep Med 2022; 92:50-58. [DOI: 10.1016/j.sleep.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/04/2022] [Accepted: 03/02/2022] [Indexed: 11/30/2022]
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Hu Y, Yan Z, Fu Z, Pan C. Associations of Insomnia With Hypertension and Coronary Artery Disease Among Patients With Type 2 Diabetes Mellitus. Front Cardiovasc Med 2021; 8:730654. [PMID: 34869629 PMCID: PMC8639702 DOI: 10.3389/fcvm.2021.730654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/18/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose: This study aimed to determine whether insomnia is associated with hypertension (HBP) and coronary artery disease (CAD) in a hospital-based sample of patients with type 2 diabetes mellitus (T2DM). Methods: Our present study included 354 patients with T2DM. According to the diagnostic criteria of insomnia, the participants were assigned to three groups based on the duration of T2DM and insomnia diagnosis. Patients with T2DM alone were placed in group A; patients with T2DM longer than insomnia were placed in group B; and patients with insomnia longer than T2DM were placed in group C. Medical history was collected from all the patients in detail. Besides, the participants underwent thorough physical examinations and laboratory measurements. Propensity score matching (PSM) was applied to evaluate the associations of insomnia with HBP and CAD. The univariate and multivariate logistic regression analysis was used to explore whether insomnia was a risk factor for HBP and CAD in patients with T2DM. Results: Of 354 patients, 225 patients were included in group A, 62 patients were included in group B, and 67 patients were included in group C. Compared with groups B and C, group A showed a lower prevalence of HBP and CAD (p < 0.05). In addition, compared with group B, group C showed no difference in the prevalence of HBP and CAD (p > 0.05). After PSM was performed, groups B and C had a higher prevalence of HBP and CAD (p < 0.05) than group A with no significant difference between groups B and C (p > 0.05). In the univariate and multivariate logistic regression analysis, insomnia was a risk factor for HBP [univariate: odds ratio (OR) = 3.376, 95% CI 2.290–6.093, p < 0.001; multivariate: OR = 2.832, 95% CI 1.373–5.841, p = 0.005] and CAD (univariate: OR = 5.019, 95% CI 3.148–8.001, p < 0.001; multivariate: OR = 5.289, 95% CI 2.579–10.850, p < 0.001). Conclusion: T2DM combined with insomnia was related to HBP and CAD and insomnia was a risk factor for HBP and CAD in patients with T2DM. However, larger, prospective studies are required to confirm our findings.
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Affiliation(s)
- Yonghui Hu
- National Health Commission (NHC), Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Zhiyue Yan
- National Health Commission (NHC), Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Zhenrui Fu
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Southeast University, Nanjing, China
| | - Congqing Pan
- National Health Commission (NHC), Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
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Nouripour F, Mazloom Z, Fararouei M, Zamani A. Effect of protein and carbohydrate distribution among meals on quality of life, sleep quality, inflammation, and oxidative stress in patients with type 2 diabetes: A single-blinded randomized controlled trial. Food Sci Nutr 2021; 9:6176-6185. [PMID: 34760248 PMCID: PMC8565242 DOI: 10.1002/fsn3.2570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/30/2021] [Accepted: 08/09/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND/OBJECTIVES Patients with diabetes mellitus have a lower quality of life and sleep compared with healthy individuals. Nutrition therapy has an important role in the management of diabetes and can improve inflammation and quality of life in patients with diabetes. The present study aimed to evaluate the effect of high-protein versus high-carbohydrate intake during evening meal on quality of life, sleep quality, inflammation, and oxidative stress in subjects with type 2 diabetes. SUBJECTS/METHODS This is a 10-week randomized controlled trial. 96 adult patients with type 2 diabetes were assigned into one of the following three groups: standard evening meal (ST), high-carbohydrate evening meal (HC), and high-protein evening meal (HP). The effect of these diets was examined on high-sensitivity C-reactive protein, malondialdehyde, quality of life, and sleep quality. RESULTS Sleep quality improved significantly in all groups (p < .05). The quality of life and high-sensitivity C-reactive protein improved in all groups except for the HP group (p < .05). Serum malondialdehyde level did not change significantly throughout the study (p > .05). CONCLUSIONS Small manipulation of protein and carbohydrate distribution among the meals might not affect sleep quality. A diet with an even distribution of macronutrients among the meals or with a higher percentage of carbohydrates in the evenings can improve the quality of life and reduce inflammation in patients with type 2 diabetes, while a diet with a higher percentage of protein in the evenings may not improve it.
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Affiliation(s)
- Fatemeh Nouripour
- Department of Clinical NutritionSchool of Nutrition and Food SciencesShiraz University of Medical SciencesShirazIran
| | - Zohreh Mazloom
- Department of Clinical NutritionSchool of Nutrition and Food SciencesShiraz University of Medical SciencesShirazIran
| | - Mohammad Fararouei
- Department of EpidemiologySchool of HealthShiraz University of Medical SciencesShirazIran
| | - Ali Zamani
- Department of Internal medicineSchool of Medicine, Endocrinology and Metabolism Research CenterShiraz University of Medical SciencesShirazIran
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Rafati S, Isheh M, Azarbad A, Ghadiri Soufi F, Rahimi A, Kheirandish M. The association of sleep duration and metabolic syndrome in the Bandare-Kong cohort study, a cross-sectional survey (finding from PERSIAN cohort study). Diabetol Metab Syndr 2021; 13:114. [PMID: 34670597 PMCID: PMC8527607 DOI: 10.1186/s13098-021-00737-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 10/12/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND A variety of health problems, such as metabolic syndrome (MetS), have been linked to sleep disorders. While numerous epidemiological studies have shown a U-shaped relationship between sleep duration and poor health outcomes, the results were limited and inconsistent. This study was designed to evaluate the relationship between sleep duration and MetS. METHODS This population-based study was conducted on the participants aged 35-70 of Bandare-Kong Non-Communicable Diseases (BKNCD) Cohort Study, a part of Prospective Epidemiological Research Studies in IrAN (PERSIAN). MetS was diagnosed according to the National Cholesterol Education Program (NCEP) criteria and the Iranian-specific cut-off for waist circumference (≥ 95 cm). Sleep information was extracted through a standard questionnaire based on self-reported information. Data were analyzed by R software using generalized additive models (GAMs). A statistically significant level was considered as P < 0.05. RESULTS A total of 3695 participants were included in the analyses. The mean age was 48.05 years (SD 9.36), and 2067 (55.9%) were female. The estimated Prevalence of MetS was 35.9%, and women appeared to be more likely to have MetS than men (P < 0.001). There was a non-linear and linear association between sleep duration and the risk of MetS in women and men, respectively. The lowest risk was observed among those with 7-7.5 h of sleep duration per night. CONCLUSION Long sleep duration was associated with increased risk of MetS and higher MetS severity score in both genders, while the short sleep duration increased the risk of Mets as well as MetS severity score just in women. The longitudinal studies would be suggested to assess the relationship between sleep quality and quantity components and MetS.
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Affiliation(s)
- Shideh Rafati
- Social Determinants in Health Promotion Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Maryam Isheh
- Student Research Committee, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Abnoos Azarbad
- Department of Pharmacology, Faculty of Pharmacy, Eastern Mediterranean University, via Mersin 10, Famagusta, North Cyprus, Turkey
| | - Farhad Ghadiri Soufi
- Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Arash Rahimi
- Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Masoumeh Kheirandish
- Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
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15
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Changes in subjective sleep quality in patients with type 2 diabetes who did not use Sleep agents: a cross-sectional study according to age and clinical background. Diabetol Int 2021; 13:142-147. [DOI: 10.1007/s13340-021-00516-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
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16
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Shoji S, Inaba M, Yoda K, Okazaki H, Toyokawa M, Norimine K, Yamakawa T, Okuno S. REM sleep latency as an independent risk for cardiovascular events in hemodialysis patients. Physiol Rep 2021; 9:e14837. [PMID: 33991438 PMCID: PMC8123536 DOI: 10.14814/phy2.14837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 01/10/2023] Open
Abstract
Background Clinical significance of objectively measured poor sleep quality (SQ) as a risk for cardiovascular disease (CVD) events is not well known in hemodialysis (HD) patients, independently of sleep‐related breathing disorders (SRBDs) and sleep‐related metabolic abnormality. Methods The present study investigated baseline levels of objective sleep architecture together with obstructive sleep apnea (OSA) and central sleep apnea (CSA) using polysomnography in 88 HD study participants (M/F, 56/32; age 68.4 ± 9.3). Then, HD study participants were monitored for the occurrence of new‐onset CVD events with a median (range) follow‐up period of 33 (1–64) months. Results Among various measures of SQ, log (REM sleep latency [REM‐SL]) (interval between sleep‐onset and the first REM period) alone correlated in negative manners with triglycerides and non‐HDL‐C in all study participants and with fasting plasma glucose and HbA1c in study participants with type‐2 diabetes mellitus. In the Kaplan–Meier analysis, HD study participants with shorter REM‐SL had a significantly higher rate of new‐onset CVD events than those with longer REM‐SL. Stepwise logistic regression analysis and multivariate Cox proportional hazard regression analysis identified shorter REM‐SL as an independent risk factor for the development of a new‐onset CVD events, independent of mean oxygen saturation, log (AHI+1), log (central AHI+1), diabetes mellitus, CVD history, systolic blood pressure, statins use, and non‐HDL‐C. Conclusions The present study demonstrated that reduction of REM‐SL is independently associated with a higher rate of new‐onset of CVD events, independent of SRBDs (OSA and CSA) and diabetes mellitus, non‐HDL‐C in HD study participants, suggesting impaired SQ as a potential CVD risk factor, and thus a definite treatment target to protect against CVD specifically in HD study participants. REM‐SL might be a new risk factor of CVD events in HD patients with SRBDs.
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Affiliation(s)
| | - Masaaki Inaba
- Department of Metabolism, Endocrinology, Molecular Medicine and Nephrology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Koichiro Yoda
- Department of Metabolism, Endocrinology, Molecular Medicine and Nephrology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | | | - Mio Toyokawa
- Department of Metabolism, Endocrinology, Molecular Medicine and Nephrology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kyoko Norimine
- Department of Nephrology, Shirasagi Hospital, Osaka, Japan
| | | | - Senji Okuno
- Department of Nephrology, Shirasagi Hospital, Osaka, Japan
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Circadian Patterns of Patients with Type 2 Diabetes and Obstructive Sleep Apnea. J Clin Med 2021; 10:jcm10020244. [PMID: 33440893 PMCID: PMC7826782 DOI: 10.3390/jcm10020244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/24/2020] [Accepted: 01/05/2021] [Indexed: 01/19/2023] Open
Abstract
Sleep apnea, a condition that modifies sleep and circadian rhythms, is highly prevalent in patients with diabetes. However, it is not known if there is an association between sleep apnea, circadian alterations and glycemic regulation in this type of patient. Here, a polysomnographic study was carried out on 21 women and 25 men (mean age = 64.3 ± 1.46 years) with diagnoses of type 2 diabetes to detect the presence of sleep apnea. Moreover, patients wore an actigraph and a temperature sensor on the wrist for one week, to study the manifestation of the circadian rhythms. The correlations of circadian and polysomnographic variables with the severity of apnea, measured by the apnea-hypopnea index, and with glycemic dysregulation, measured by the percentage of glycated hemoglobin, were analyzed. The mean apnea-hypoapnea index of all the participants was 39.6 ± 4.3. Apnea-hypoapnea index correlated with % N1, negatively with % N3, and also the stability of the active circadian rhythm. However, no significant correlation was found between the apnea-hypopnea index and wrist temperature rhythm and glycated hemoglobin. Glycated hemoglobin levels were negatively associated with the percentage of variance explained by the wrist temperature circadian rhythm (calculated via 24 and 12 h rhythms). This association was independent of body mass index and was strongest in patients with severe apnea. In conclusion, patients with diabetes showed altered circadian rhythms associated with a poor glycemic control and this association could partially be related to the coexistence of sleep apnea.
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Izumida T, Nakamura Y, Sato Y, Ishikawa S. The Association between Sleeping Pill Use and Metabolic Syndrome in an Apparently Healthy Population in Japan: JMS-II Cohort Study. J Epidemiol 2020; 32:145-150. [PMID: 33162423 PMCID: PMC8824657 DOI: 10.2188/jea.je20200361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Sleeping pills are widely used for sleep disorders and insomnia. This population-based study aimed to evaluate the association between the use of sleeping pills and metabolic syndrome (MetS) and metabolic components in an apparently healthy Japanese cohort. Methods We examined baseline cross-sectional data from the JMS-II Cohort Study. The criteria for MetS and its components were based on The National Cholesterol Education Program Adult Treatment Panel III. Sleep habits including the sleep duration of the subjects and the frequency of sleeping pill use were obtained using The Pittsburgh Sleep Quality Index questionnaire. For different sleep durations, the association between sleeping pill use and MetS was assessed. Odds ratios (ORs) and their 95% confidence intervals (CIs) were estimated using multiple logistic regression models to quantify this association. Results Our study included 6,153 individuals (mean age, 63.8 [standard deviation 11.2] years), and 3,348 (54.4%) among them were women. The association between sleep duration and MetS was an inverted J-shaped curve among sleeping pill users and a J-shaped curve among non-users. After adjustment for various confounders, less than 6 h of sleep among sleeping pill users was associated with increased rates of MetS (<6 h, OR 3.08; 95% CI, 1.29–7.34]). The frequency of sleeping pill use in individuals with short sleep duration showed a positive association with the prevalence of MetS and its components. Conclusions Sleeping pill users with a short sleep duration had a 3-fold higher chance of having MetS than non-users with a short sleep duration.
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Affiliation(s)
- Toshihide Izumida
- Division of Community Medicine, Kanawaza Medical University Himi Municipal Hospital
| | - Yosikazu Nakamura
- Division of Public Health, Center for Community Medicine, Jichi Medical University
| | | | - Shizukiyo Ishikawa
- Division of Public Health, Center for Community Medicine, Jichi Medical University
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Yoshikawa F, Shigiyama F, Ando Y, Miyagi M, Uchino H, Hirose T, Kumashiro N. Chronotherapeutic efficacy of suvorexant on sleep quality and metabolic parameters in patients with type 2 diabetes and insomnia. Diabetes Res Clin Pract 2020; 169:108412. [PMID: 32911037 DOI: 10.1016/j.diabres.2020.108412] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 08/06/2020] [Accepted: 08/28/2020] [Indexed: 12/22/2022]
Abstract
AIMS This study aimed to assess the chronotherapeutic efficacy of suvorexant on subjective sleep parameters and metabolic parameters in patients with type 2 diabetes and insomnia. METHODS Thirteen patients with type 2 diabetes who met the Pittsburg Sleep Quality index criteria for primary insomnia took suvorexant 20 mg/day (15 mg/day for ≥65 years) for 14 ± 2 weeks. The following parameters were assessed before and after the treatment: sleep diary for sleep duration and quality (i.e., sleep onset latency, waking after sleep onset, and sleep efficiency [sSE]), Insomnia Severity Index, clinical and biochemical data, continuous glucose monitoring (CGM), and validated self-administered questionnaire on food intake. RESULTS Suvorexant significantly improved sSE, abdominal circumference, and sucrose intake (all p < 0.05), but did not change HbA1c, CGM parameters, or body weight. Correlation analysis revealed that changes in sSE were associated with those in HbA1c and body weight (r = -0.61 and r = -0.66, respectively; both p < 0.05). CONCLUSIONS Suvorexant significantly improved sleep quality and obesity-associated parameters in patients with type 2 diabetes in 14 weeks. Improvements in sleep quality were associated with improvements in glycemic control. Sleep disorder treatment using suvorexant may provide metabolic benefits for patients with type 2 diabetes.
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Affiliation(s)
- Fukumi Yoshikawa
- Division of Diabetes, Metabolism, and Endocrinology, Department of Toho University Graduate School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Fumika Shigiyama
- Division of Diabetes, Metabolism, and Endocrinology, Department of Toho University Graduate School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Yasuyo Ando
- Division of Diabetes, Metabolism, and Endocrinology, Department of Toho University Graduate School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Masahiko Miyagi
- Division of Diabetes, Metabolism, and Endocrinology, Department of Toho University Graduate School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Hiroshi Uchino
- Division of Diabetes, Metabolism, and Endocrinology, Department of Toho University Graduate School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Takahisa Hirose
- Division of Diabetes, Metabolism, and Endocrinology, Department of Toho University Graduate School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Naoki Kumashiro
- Division of Diabetes, Metabolism, and Endocrinology, Department of Toho University Graduate School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan.
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20
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Takahashi A, Anzai Y, Kuroda M, Kokubun M, Kondo Y, Ogata T, Fujita M, Hayashi M, Imaizumi H, Abe K, Tanji N, Ohira H. Effects of sleep quality on non-alcoholic fatty liver disease: a cross-sectional survey. BMJ Open 2020; 10:e039947. [PMID: 33122322 PMCID: PMC7597499 DOI: 10.1136/bmjopen-2020-039947] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The effects of sleep quality on the risk of developing non-alcoholic fatty liver disease (NAFLD) remain uncertain. The purpose of this study was to clarify the association between sleep quality and NAFLD. METHODS The data of 4828 participants who underwent health check-ups at four hospitals were analysed. Sleep quality was evaluated by the Pittsburgh Sleep Quality Index (PSQI), which comprised seven elements scored from 0 to 3. The global PSQI score and the score for each element were compared between NAFLD and non-NAFLD groups separately by sex. Logistic regression analysis was performed to determine the association between NAFLD and each PSQI score. RESULTS In both men and women, the mean PSQI score for sleep medication use was significantly higher in non-NAFLD than in NAFLD. With regard to sleep medication use in men, the OR (95% CI) for NAFLD was lower with a score of 3 (OR 0.60, 95% CI 0.38-0.95) than with a score of 0 on multivariate logistic regression analysis adjusted for age, smoking habits and physical activity. The OR for NAFLD based on daytime dysfunction was also higher with a score of 3 than with a score of 0 in both men (OR 2.82, 95% CI 1.39-5.75) and women (OR 2.08, 95% CI 1.10-3.92). After adjustment for body mass index, the sleep latency scores in men and daytime dysfunction in women were associated with NAFLD. CONCLUSION Sleep quality was associated with NAFLD, and there were sex differences.
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Affiliation(s)
- Atsushi Takahashi
- Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yukio Anzai
- Gastroenterology, Watari Hospital, Fukushima, Japan
| | - Masahito Kuroda
- Gastroenterology, Fukushima Red Cross Hospital, Fukushima, Japan
| | - Masae Kokubun
- Total Medical Checkup, Jusendo Hospital, Koriyama, Fukushima, Japan
| | - Yuichiro Kondo
- Gastroenterology, Fujita General Hospital, Date-gun, Fukushima, Japan
| | - Takashi Ogata
- Gastroenterology, Masu Memorial Hospital, Nihonmatsu, Japan
| | - Masashi Fujita
- Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Manabu Hayashi
- Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hiromichi Imaizumi
- Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kazumichi Abe
- Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Nobuo Tanji
- Gastroenterology, Watari Hospital, Fukushima, Japan
| | - Hiromasa Ohira
- Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
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Takahashi N, Takahashi Y, Tabara Y, Matsumoto T, Kawaguchi T, Kuriyama A, Ueshima K, Matsuda F, Chin K, Nakayama T. Correlates of autonomic nervous system function in a general population with special reference to HbA 1c: The Nagahama study. Diabetes Res Clin Pract 2020; 163:108126. [PMID: 32243903 DOI: 10.1016/j.diabres.2020.108126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 02/25/2020] [Accepted: 03/23/2020] [Indexed: 10/24/2022]
Abstract
AIMS As the glucose tolerance of patients with diabetes worsens, autonomic nervous system (ANS) function decreases. Only a few studies, using plasma glucose, have reported on this relationship in large general populations that include people with wide range of glycemia. This study aimed to examine correlates of ANS function with special reference to HbA1c which is more stable than plasma glucose among community residents. METHODS Spectral analysis was performed to assess heart rate variability (HRV) using 1-minute electrocardiogram RR interval data recordings from 7690 residents aged 35-79 years in Nagahama City, Japan. HRV parameters were log-transformed. Multiple regression analysis was performed using potential correlates. RESULTS lnLF decreased with age (regression coefficient, -0.025; P < 0.001), BMI (-0.010; P = 0.035), and HbA1c (-0.068; P = 0.036). lnHF decreased with age (-0.029; P < 0.001), BMI (-0.032; P < 0.001), and HbA1c (-0.173; P < 0.001). lnLF/HF increased with age (0.003; P = 0.002), BMI (0.023; P < 0.001), and HbA1c (0.105; P < 0.001). Women showed lower lnLF and lnLF/HF than men. Sleep quality assessed by the Pittsburgh Sleep Quality Index, smoking and drinking had almost no relation. CONCLUSIONS Although the associations were weak, age, BMI and HbA1c were inversely correlated with parasympathetic activity, while positively correlated with sympathetic activity among general residents.
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Affiliation(s)
- Naomi Takahashi
- Department of Health Informatics, School of Public Health, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan.
| | - Yoshimitsu Takahashi
- Department of Health Informatics, School of Public Health, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan.
| | - Yasuharu Tabara
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, 53 Shogoinkawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Takeshi Matsumoto
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoinkawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Takahisa Kawaguchi
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, 53 Shogoinkawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Akira Kuriyama
- Department of Health Informatics, School of Public Health, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan.
| | - Kenji Ueshima
- Department of EBM Research, Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, 54 Shogoinkawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Fumihiko Matsuda
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, 53 Shogoinkawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Kazuo Chin
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoinkawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Takeo Nakayama
- Department of Health Informatics, School of Public Health, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan.
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Shimura A, Sugiura K, Inoue M, Misaki S, Tanimoto Y, Oshima A, Tanaka T, Yokoi K, Inoue T. Which sleep hygiene factors are important? comprehensive assessment of lifestyle habits and job environment on sleep among office workers. Sleep Health 2020; 6:288-298. [PMID: 32360019 DOI: 10.1016/j.sleh.2020.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 01/24/2020] [Accepted: 02/03/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Although several lifestyle habits are associated with sleep, it is unclear which factors are important. Among office workers, the effect of job environment should also be considered. The multivariate analyses on the effects of lifestyle habits and job environment on sleep among office workers was conducted. METHODS A cross-sectional survey of 6,342 employees from 29 companies was conducted in 2017-2019. Complete responses and informed consent were provided by 5,640 participants. The survey examined demographic variables, sleep schedules, Pittsburgh Sleep Quality Index (PSQI), Brief Job Stress Questionnaire (BJSQ), and lifestyle habits. RESULTS Mean values were as follows: age, 36.9 years (±10.2); PSQI, 6.52 (±2.83); and total sleep time, 6h06m (±1h40m) on work days and 7h39m (±1h58m) on free days. After adjusting for job environment and demographic variables, irregular meal time (1.45-2.86), not eating vegetables every day (1.35), nightcap (2.74-3.55), weight gain (1.20-1.42), lack of sunlight in the morning in the bedroom (1.48-1.60), waking up before dawn (2.18), electronic display use in bed (1.50), and daily caffeine intake (1.27) were significantly associated with sleep disturbance. Irregular meal time (1.51-2.37), lack of morning breakfast (1.74-2.95), having dinner within 2 hours before bed time (0.49-0.64), not eating vegetables every day (1.52), lack of sunlight exposure in the morning (1.43-2.01), and caffeine use every day (1.42) were also associated with eveningness (p<.01). CONCLUSION Each sleep hygiene factor had a different effect size. Sleep hygiene interventions to promote worker sleep health should prioritize factors in accordance with effect size.
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Affiliation(s)
- Akiyoshi Shimura
- Department of Psychiatry, Tokyo Medical University, Tokyo, Japan; Department of Sleep and Psychiatry, Kanno Hospital, Saitama, Japan; Sakurajuji Medical Corporation, Tokyo, Japan; Department of R&D, Children and Future Co., Ltd., Tokyo, Japan.
| | - Ko Sugiura
- Department of R&D, Children and Future Co., Ltd., Tokyo, Japan; Department of Economics, University of Houston, Houston TX, USA
| | - Manami Inoue
- Department of R&D, Children and Future Co., Ltd., Tokyo, Japan; Medical Course, Shiga University of Medical Science, Otsu-shi, Shiga, Japan
| | | | | | | | - Tomoko Tanaka
- Department of R&D, Children and Future Co., Ltd., Tokyo, Japan
| | - Katsunori Yokoi
- Department of R&D, Children and Future Co., Ltd., Tokyo, Japan; School of Medicine, International University of Health and Welfare, Chiba, Japan
| | - Takeshi Inoue
- Department of Psychiatry, Tokyo Medical University, Tokyo, Japan
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Brouwer A, van Raalte DH, Rutters F, Elders PJM, Snoek FJ, Beekman ATF, Bremmer MA. Sleep and HbA 1c in Patients With Type 2 Diabetes: Which Sleep Characteristics Matter Most? Diabetes Care 2020; 43:235-243. [PMID: 31719053 DOI: 10.2337/dc19-0550] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 10/07/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Poor sleep has been identified as a risk factor for poor glycemic control in individuals with type 2 diabetes (T2D). As optimal sleep can be characterized in several ways, we evaluated which sleep characteristics are most strongly associated with glycated hemoglobin A1c (HbA1c). RESEARCH DESIGN AND METHODS A total of 172 patients with T2D completed 7-day wrist-actigraphy and sleep questionnaires. Linear regression was used to evaluate associations between sleep measures (total sleep duration, variability in sleep duration, midsleep time, variability in midsleep time, sleep efficiency, subjective sleep quality, and subjective insomnia symptoms) and HbA1c, individually and in concert. RESULTS Variability in sleep duration was individually most strongly associated with HbA1c (β = 0.239; P = 0.002; R 2 = 4.9%), followed by total sleep duration (U-shaped: β = 1.161/β2 = 1.044; P = 0.017/0.032; R 2 = 4.3%), subjective sleep quality (β = 0.191; P = 0.012; R 2 = 3.6%), variability in midsleep time (β = 0.184; P = 0.016; R 2 = 3.4%), and sleep efficiency (β = -0.150; R 2 = 2.3%). Midsleep time and subjective insomnia symptoms were not associated with HbA1c. In combination, variability in sleep duration, total sleep duration, and subjective sleep quality were significantly associated with HbA1c, together explaining 10.3% of the variance in HbA1c. Analyses adjusted for covariates provided similar results, although the strength of associations was generally decreased and showing total sleep duration and subjective sleep quality to be most strongly associated with HbA1c, together explaining 6.0% of the variance in HbA1c. CONCLUSIONS Sleep in general may be a modifiable factor of importance for patients with T2D. The prevention of sleep curtailment may serve as a primary focus in the sleep-centered management of T2D.
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Affiliation(s)
- Annelies Brouwer
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, and GGZ inGeest, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Daniel H van Raalte
- Department of Internal Medicine, Diabetes Center, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Femke Rutters
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Petra J M Elders
- Department of General Practice and Elderly Care Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Frank J Snoek
- Department of Medical Psychology, Amsterdam UMC, Vrije Universiteit and University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, and GGZ inGeest, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Marijke A Bremmer
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, and GGZ inGeest, Amsterdam Public Health research institute, Amsterdam, the Netherlands
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Xu C, Zhang P, Xiang Q, Chang G, Zhang M, Zhang L, Li T, Qiao C, Qin Y, Lou P. Relationship between subjective sleep disturbances and glycaemia in Chinese adults with type 2 diabetes: findings from a 1.5-year follow-up study. Sci Rep 2019; 9:14276. [PMID: 31582790 PMCID: PMC6776506 DOI: 10.1038/s41598-019-50814-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 09/19/2019] [Indexed: 02/06/2023] Open
Abstract
We wanted to determine whether subjective sleep disturbance was associated with serum glycated hemoglobin (HbA1c) in people with type 2 diabetes mellitus. In total, 944 randomly-selected people with diabetes completed the Chinese version of the Pittsburgh Sleep Quality Index (PSQI). Participants' glycaemia was assessed using HbA1c in March 2016 and September 2017. The PSQI score and the change in score(△PSQI), and the HbA1c and its change (△HbAlc) were analysed by sex and age (30-45, 46-60, 61-75, and 76-89 years). Associations between time point PSQI and △PSQI with static HbA1c and △HbA1c were analysed using multiple linear regression. The results showed subjective sleep disturbance among people with diabetes was not correlated with serum HbAlc (β coefficient = 0.032, P = 0.103). However, cross-sectional multiple linear regression showed the relationship was present in women (β coefficient = 0.163, P < 0.01). In multiple linear regression, △PSQI score was correlated with △HbAlc value (β coefficient = 0.142, P < 0.01). The regression coefficient (β) for the relationship between △PSQI score and △HbA1c in men was greater than that in women, and for age was β61-75years < β46-60years < β30-45years. The strongest relationship between △PSQI and △HbA1c was in men aged 30-45 years (β = 0.452, P < 0.01). Subjective sleep disturbance among people with diabetes was not related to glycaemic status in the whole sample, but there was a correlation in women. The change in subjective sleep disturbance correlated with the change in glycaemia, most strongly in younger participants, especially men aged 30-45 years.
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Affiliation(s)
- Chunrong Xu
- Department of Endocrinology, Xuzhou Third People's Hospital, 131 Huancheng Road in Xuzhou City of Jiangsu Province of People's Republic of China, Xuzhou, 221004, China
| | - Pan Zhang
- Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, 142 West Erhuan Road in Xuzhou City of Jiangsu Province of People's Republic of China, Xuzhou, 221006, China
| | - Quanyong Xiang
- Department of Non-communicable Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, 172 Jiangsu Road in Nanjing City of Jiangsu Province of People's Republic of China, Nanjing, 210009, China
| | - Guiqiu Chang
- Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, 142 West Erhuan Road in Xuzhou City of Jiangsu Province of People's Republic of China, Xuzhou, 221006, China
| | - Ming Zhang
- Department of Endocrinology, Xuzhou Third People's Hospital, 131 Huancheng Road in Xuzhou City of Jiangsu Province of People's Republic of China, Xuzhou, 221004, China
| | - Lei Zhang
- Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, 142 West Erhuan Road in Xuzhou City of Jiangsu Province of People's Republic of China, Xuzhou, 221006, China
| | - Ting Li
- Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, 142 West Erhuan Road in Xuzhou City of Jiangsu Province of People's Republic of China, Xuzhou, 221006, China
| | - Cheng Qiao
- Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, 142 West Erhuan Road in Xuzhou City of Jiangsu Province of People's Republic of China, Xuzhou, 221006, China
| | - Yu Qin
- Department of Non-communicable Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, 172 Jiangsu Road in Nanjing City of Jiangsu Province of People's Republic of China, Nanjing, 210009, China
| | - Peian Lou
- Department of Control and Prevention of Chronic Non-communicable Diseases Xuzhou Center for Disease Control and Prevention, School of Public Health, Xuzhou Medical University, Xuzhou, China.
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Hamanishi S, Eguchi E, Ito T, Nagaoka K, Ogino K. Head cooling during sleep improves sleep quality in the luteal phase in female university students: A randomized crossover-controlled pilot study. PLoS One 2019; 14:e0213706. [PMID: 30908497 PMCID: PMC6433270 DOI: 10.1371/journal.pone.0213706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 02/26/2019] [Indexed: 11/25/2022] Open
Abstract
Although selective head-cooling has been reported to decrease scalp and tympanic temperature and improve sleep quality, whether head-cooling during sleep can improve sleep quality in women during the luteal phase has not been elucidated. This randomized, controlled crossover open trial aimed to investigate the effect of head cooling during sleep on sleep quality in women during the luteal phase. Female university students aged 19–25 years with increased daytime sleepiness during the luteal phase were recruited by poster advertisement at their university from May to June 2016 and from May to June 2017. Fourteen women aged 19–22 years participated in this study. The temperature-controllable cooling sheet containing tubes filled with circulating water was used for head-cooling, and the head-cooling and the controlled temperature were set at 25°C and 35°C, respectively. Electroencephalogram data were obtained using a single-channel portable electroencephalogram device. The difference in sleep-related variables and tympanic temperature between head-cooling and control were analyzed using a linear mixed model. The proportion of arousal was lower with head cooling than with the control. In contrast, the proportion of non-REM3 and the delta power were higher with head cooling than with the control. The proportion of non-REM2 and non-REM3 among sleep EEG stages were positively and negatively correlated with the mean tympanic temperature during sleep, respectively. However, arousal and REM were not correlated with tympanic temperature. We considered the reduction of arousal time by head-cooling might be related to scalp temperature rather than tympanic temperature. Further, our results suggested that head-cooling also improved subjective sleep comfort. In conclusion, head-cooling during sleep could improve sleep quality in young women during the luteal phase.
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Affiliation(s)
- Seiji Hamanishi
- Graduate School of Medicine Density and Pharmaceutical Sciences, Okayama University, Okayama, Japan
- Department of Nursing, Kansai University of Social Welfare, Ako, Japan
- * E-mail:
| | - Eri Eguchi
- Graduate School of Medicine Density and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Tatsuo Ito
- Graduate School of Medicine Density and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Kenjiro Nagaoka
- Graduate School of Medicine Density and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Keiki Ogino
- Graduate School of Medicine Density and Pharmaceutical Sciences, Okayama University, Okayama, Japan
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Li H, Ji M, Scott P, Dunbar-Jacob JM. The Effect of Symptom Clusters on Quality of Life Among Patients With Type 2 Diabetes. DIABETES EDUCATOR 2019; 45:287-294. [DOI: 10.1177/0145721719837902] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Purpose The purpose of this study was to examine the collective effect of a symptom cluster (depression, anxiety, fatigue, and impaired sleep quality) at baseline on the quality of life (QOL) of patients with type 2 diabetes (T2DM) over time. Methods This was a secondary data analysis of 302 patients with T2DM who presented with both hypertension and hyperlipidemia. All of the participants were enrolled in a randomized controlled intervention study testing strategies to improve medication adherence. The psychological symptoms and QOL were assessed at baseline, 6 months, and 12 months. Cluster analysis was used to identify subgroups of patients based on the severity of symptoms at baseline. Results Hierarchical cluster analysis identified 4 patient subgroups: all low severity, mild, moderate, and all high severity. There were significant differences in patients’ QOL overall among the 4 subgroups. Compared with the all-low-severity subgroup, subgroups with higher severity of the 4 symptoms had poorer QOL across all 3 time points. QOL was most impacted by trait anxiety across the 3 time points. Conclusion QOL was significantly impacted by psychological symptom clusters among patients with T2DM. Healthcare providers should not neglect psychological symptoms that patients experience. It is important to assess and manage these symptoms to improve QOL among patients with diabetes.
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Affiliation(s)
- Hongjin Li
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, PA (Ms Li)
| | - Meihua Ji
- School of Nursing, Capital Medical University, Beijing, China (Dr Ji)
| | - Paul Scott
- Department of Health & Community Systems, Center for Research & Evaluation, School of Nursing, University of Pittsburgh, Pittsburgh, PA (Dr Scott)
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Chattu VK, Chattu SK, Burman D, Spence DW, Pandi-Perumal SR. The Interlinked Rising Epidemic of Insufficient Sleep and Diabetes Mellitus. Healthcare (Basel) 2019; 7:E37. [PMID: 30841553 PMCID: PMC6473416 DOI: 10.3390/healthcare7010037] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/26/2019] [Accepted: 02/28/2019] [Indexed: 12/15/2022] Open
Abstract
For healthy existence, humans need to spend one-third of their time sleeping. Any qualitative or quantitative disturbances in sleep would result in an increased prevalence of obesity, metabolic disorders, diabetes, cardiovascular diseases, and hypertension. The paper aims to highlight the growing global problem of insufficient sleep and its significant impact on the rising incidence of diabetes mellitus. An extensive literature search was done in all major databases for "insufficient sleep" and "Diabetes Mellitus" for this review. Shorter (<6 h) and longer (>9 h) durations of sleep have been adversely related to insulin resistance. Though the relation between insufficient sleep and diabetes mellitus is more or less understood, little is known about how oversleeping or hypersomnia (10⁻12 h) increases the risk of diabetes. The relationship between sleep disturbances and diabetes is dual-sided, as chronic sleep disturbances would elevate the risk of developing insulin resistance, while diabetes would worsen the quality of sleep. Both the qualitative and quantitative disturbances in sleep significantly increase the risk of developing diabetes, which is supported by numerous community-based and hospital-based epidemiological studies discussed in this review. Obstructive sleep apnea is one of the most common sleep disorders and is characterized by chronic intermittent hypoxia and increased sympathetic activity, thus leading to a higher prevalence of diabetes. Sleep therapy may serve as a low-cost method for fighting against the rising epidemic of diabetes.
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Affiliation(s)
- Vijay Kumar Chattu
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago.
- Global Institute of Public Health, Thiruvananthapuram, Kerala 695024, India.
| | - Soosanna Kumary Chattu
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago.
| | - Deepa Burman
- School of Medicine, University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA 15260, USA.
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Sleep, Autonomic Nervous Function and Atherosclerosis. Int J Mol Sci 2019; 20:ijms20040794. [PMID: 30781734 PMCID: PMC6412503 DOI: 10.3390/ijms20040794] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 02/04/2019] [Accepted: 02/07/2019] [Indexed: 12/12/2022] Open
Abstract
Behavioral and psychosocial factors related to development of cardiovascular disease have been gaining increased attention. Notably, sleep is considered to be one of the most important behavioral factors involved in progression of atherosclerosis and cardiovascular events, with autonomic nervous function a potential mechanism. Several studies have shown associations of sleep and autonomic dysfunction with major surrogate markers of atherosclerosis, such as carotid intima-media thickness and arterial stiffness. Endocrinological, immunological, oxidative, inflammatory, and metabolic responses, as well as endothelial dysfunction may mediate the effects of the autonomic nervous system. For this review, we examined recent findings related to sleep, autonomic nervous dysfunction, and atherosclerosis, with the aim of understanding the involved pathophysiological mechanisms.
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Gorlova S, Ichiba T, Nishimaru H, Takamura Y, Matsumoto J, Hori E, Nagashima Y, Tatsuse T, Ono T, Nishijo H. Non-restorative Sleep Caused by Autonomic and Electroencephalography Parameter Dysfunction Leads to Subjective Fatigue at Wake Time in Shift Workers. Front Neurol 2019; 10:66. [PMID: 30804882 PMCID: PMC6370690 DOI: 10.3389/fneur.2019.00066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 01/17/2019] [Indexed: 01/06/2023] Open
Abstract
Sleep is a physiological state that plays important role in the recovery of fatigue. However, the relationship between the physiological status of sleep and subjective fatigue remains unknown. In the present study, we hypothesized that the non-recovery of fatigue at wake time due to non-restorative sleep might be ascribed to changes in specific parameters of electroencephalography (EEG) and heart rate variability (HRV) in poor sleepers. Twenty healthy female shift-working nurses participated in the study. Subjective fatigue was assessed using the visual analog scale (VAS) at bedtime and wake time. During sleep on the night between 2 consecutive day shifts, the EEG powers at the frontal pole, HRV based on electrocardiograms, and distal-proximal gradient of skin temperature were recorded and analyzed. The results indicated that the subjects with high fatigue on the VAS at wake time exhibited (1) a decrease in deep non-rapid eye movement (NREM) (stageN3) sleep duration in the first sleep cycle; (2) a decrease in REM latency; (3) a decrease in ultra-slow and delta EEG powers, particularly from 30 to 65 min after sleep onset; (4) a decrease in the total power of HRV, particularly from 0 to 30 min after sleep onset; (5) an increase in the very low frequency component of HRV; and (6) a smaller increase in the distal-proximal gradient of skin temperature, than those of the subjects with low fatigue levels. The correlational and structural equation modeling analyses of these parameters suggested that an initial decrease in the total power of HRV from 0 to 30 min after sleep onset might inhibit the recovery from fatigue during sleep (i.e., increase the VAS score at wake time) via its effects on the ultra-slow and delta powers from 30 to 65 min after sleep onset, stageN3 duration in the first sleep cycle, REM latency, and distal-proximal gradient of skin temperature. These findings suggest an important role of these physiological factors in recovery from fatigue during sleep, and that interventions to modify these physiological factors might ameliorate fatigue at wake time.
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Affiliation(s)
- Sofya Gorlova
- System Emotional Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | | | - Hiroshi Nishimaru
- System Emotional Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Yusaku Takamura
- System Emotional Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Jumpei Matsumoto
- System Emotional Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Etsuro Hori
- System Emotional Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | | | - Tsuyoshi Tatsuse
- Department of Epidemiology and Health Policy, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Taketoshi Ono
- System Emotional Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Hisao Nishijo
- System Emotional Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
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Toi N, Inaba M, Kurajoh M, Morioka T, Hayashi N, Hirota T, Miyaoka D, Emoto M, Yamada S. Improvement of glycemic control by treatment for insomnia with suvorexant in type 2 diabetes mellitus. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2018; 15:37-44. [PMID: 30619717 PMCID: PMC6306692 DOI: 10.1016/j.jcte.2018.12.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/12/2018] [Accepted: 12/17/2018] [Indexed: 12/25/2022]
Abstract
Introduction Acute and chronic insomnia can exacerbate type 2 diabetes mellitus (T2DM). We investigated suvorexant (an anti-insomnia drug that targets the orexin system) effects on sleep architecture and glucose metabolism in T2DM patients with insomnia. Materials and methods This 7 day open-label, single-arm, intervention trial included 18 subjects with T2DM and insomnia. After 1 day acclimatization, daily glucose levels, sleep architecture, and autonomic nervous function were evaluated by continuous glucose monitoring (CGM), single-channel electroencephalography, and accelerometry, respectively. Results Suvorexant treatment for 3 days significantly increased total sleep time and sleep efficiency, with partial suppression of sympathetic nerve activity. CGM-measured 24 h mean glucose level decreased significantly from 157.7 ± 22.9 to 152.3 ± 17.8 mg/dL, especially in the early glucose surge after the midnight nadir (from 28.3 ± 15.0 to 18.2 ± 9.9 mg/dL), and until supper with a significant improvement in homeostasis model assessment of insulin resistance from 4.0 ± 2.8 to 2.9 ± 1.6, respectively. Conclusions Suvorexant treatment for insomnia of subjects with T2DM significantly improved CGM-measured daily glycemic control, which was associated with changes in sympathomimetic tone and/or improved insulin sensitivity. The amelioration of insomnia may therefore be a target for improving glycemic control in T2DM patients with insomnia.
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Key Words
- AHI, Apnea–Hypopnea Index
- AUC, area under the curve
- Autonomic nervous function
- BMI, body mass index
- CGM, continuous glucose monitoring
- CPR, C-peptide immunoreactivity
- CVR-R, coefficient of variation of RR intervals
- DSM-5, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
- Dawn phenomenon
- EEG, electroencephalography
- Glycemic control
- HOMA-IR, homeostasis model assessment of insulin resistance
- HR, heart rate
- HRV, heart rate variability
- HbA1c, glycated hemoglobin A1c
- IQR, interquartile range
- IRI, immunoreactive insulin
- Insulin resistance
- PSQI, Pittsburgh Sleep Quality Index
- REM, rapid eye movement
- SAS, Sleep Apnea Syndrome
- SD, standard deviation
- SDNN, standard deviation of the NN (i.e., R-R) intervals
- T2DM, type 2 diabetes mellitus
- Therapy for insomnia
- Type 2 diabetes mellitus
- bpm, beats per minute
- eGFR, estimated glomerular filtration ratio
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Affiliation(s)
- Norikazu Toi
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Masaaki Inaba
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Masafumi Kurajoh
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Tomoaki Morioka
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Noriyuki Hayashi
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Tomoe Hirota
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Daichi Miyaoka
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Masanori Emoto
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Shinsuke Yamada
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
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Sleep quality correlates with the carotid intima-media thickness in stroke-free community-dwelling adults living in rural Ecuador. The Atahualpa Project. Sleep Med 2018; 55:22-25. [PMID: 30743206 DOI: 10.1016/j.sleep.2018.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 11/14/2018] [Accepted: 11/21/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND/OBJECTIVES Evidence of an association between sleep disorders and extracranial atherosclerosis is limited and has not been studied in remote rural settings, where living conditions and cardiovascular risk factors are different than in urban centers. We assessed the relationship between the carotid intima-media thickness (cIMT) and sleep quality in stroke-free individuals aged ≥40 years living in rural Ecuador. METHODS Applying a population-based study design, participants underwent face-to-face interviews using the Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality, and sonographic examinations for measurement of the carotid intima-media thickness (cIMT). The association between the cIMT and sleep quality (as the dependent variable) was assessed by means of generalized linear models, adjusted for relevant confounders. RESULTS The mean age of 561 participants was 60.4 ± 12.6 years (58% women). The mean PSQI was 4.6 ± 2.2 points. Of those, 79 (14%) individuals had an increased cIMT (>1 mm). A model adjusted for demographics showed a significant association between increased cIMT and the PSQI score (β: 0.602; 95% C.I.: 0.027-1.177; p = 0.040). This relationship was reduced when cardiovascular risk factors were added to the model (β: 0.514; 95% C.I.: -0.072 - 1.101; p = 0.086). When the model was adjusted for demographics and psychological distress, the association between increased cIMT and the PSQI score became significant (β: 0.573; 95% C.I.: 0.013-1.133; p = 0.045). In addition, both symptoms of depression (p = 0.032) and anxiety (p < 0.001) remained independently significant. CONCLUSIONS This study shows an association between increased cIMT and the PSQI score, which is, at least, partly mediated by manifestations of psychological distress.
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Umigai N, Takeda R, Mori A. Effect of crocetin on quality of sleep: A randomized, double-blind, placebo-controlled, crossover study. Complement Ther Med 2018; 41:47-51. [DOI: 10.1016/j.ctim.2018.09.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 12/11/2022] Open
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Heizhati M, Zhang Y, Shao L, Wang Y, Yao X, Abulikemu S, Zhang D, Chang G, Zhou L, Li N. Decreased serum potassium may disturb sleep homeostasis in essential hypertensives. Hypertens Res 2018; 42:174-181. [PMID: 30446708 PMCID: PMC8075976 DOI: 10.1038/s41440-018-0131-4] [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] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 05/08/2018] [Accepted: 05/24/2018] [Indexed: 11/09/2022]
Abstract
The aim is to investigate the association between alterations in the serum potassium (K+) concentration and sleep architecture parameters in essential hypertensives. Two hundred ninety-two hypertensives undergoing polysomnography and providing blood samples were recruited. The sleep architecture was composed of sleep stages 1 (N1), 2 (N2), 3 (N3), 4 (N4) and REM. The light sleep stage (LST) was composed of N1 + N2, and the deep sleep stage (DST) was composed of N3 + N4. The potentialrelationships between electrolytes and sleep parameters were determined via univariate and multivariate analyses. The subjects were divided into two groups via the serum K+ median (3.86 mmol/L). The K+ < 3.86 mmol/L group showed significantly decreased N1 (7.10 ± 4.55% vs 8.61 ± 5.23%, p = 0.002), LST (71.48 ± 11.33% vs 75.92 ± 17.08%, p = 0.013), and periodic leg movement during sleep related to microarousals (MA) /arousal (PLMS-A) [4 (1~10) vs 8 (3~15)/night, p < 0.001] and increased REM (17.38 ± 6.43% vs 15.37 ± 6.18%, p = 0.007) compared to the K+ ≥ 3.86 mmol/L group. A subdivided analysis by gender showed that these changes were more statistically significant in men than in women. Significant positive correlations were identified between K+ and N1 (r = 0.169, p = 0.004), as well as PLMS-A (r = 0.222, p < 0.001) in subjects. Compared to women, a significantly strong correlation was identified between K+ and REM sleep in men (r = 0.158, p = 0.028 vs. r = 0.078, p = 0.442). Multiple linear regression analysis indicated that K+ is significantly associated with N1 in all subjects (p = 0.03) and with REM in men (p = 0.008), even after adjusting for confounders. Decreased K+ may disturb the homeostasis of the sleep architecture, and gender may interfere with their links in the hypertensive population.
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Affiliation(s)
- Mulalibieke Heizhati
- The Center of Hypertension of People's Hospital of Xinjiang Uygur Autonomous Region China; The Center of Diagnosis, Treatment and Research of Hypertension in Xinjiang, China. No. 91 Tianchi Road, Tianshan District, Urumqi, Xinjiang, CN, 830001, China
| | - Yu Zhang
- The Center of Hypertension of People's Hospital of Xinjiang Uygur Autonomous Region China; The Center of Diagnosis, Treatment and Research of Hypertension in Xinjiang, China. No. 91 Tianchi Road, Tianshan District, Urumqi, Xinjiang, CN, 830001, China
| | - Liang Shao
- The Center of Hypertension of People's Hospital of Xinjiang Uygur Autonomous Region China; The Center of Diagnosis, Treatment and Research of Hypertension in Xinjiang, China. No. 91 Tianchi Road, Tianshan District, Urumqi, Xinjiang, CN, 830001, China
| | - Yingchun Wang
- The Center of Hypertension of People's Hospital of Xinjiang Uygur Autonomous Region China; The Center of Diagnosis, Treatment and Research of Hypertension in Xinjiang, China. No. 91 Tianchi Road, Tianshan District, Urumqi, Xinjiang, CN, 830001, China
| | - Xiaoguang Yao
- The Center of Hypertension of People's Hospital of Xinjiang Uygur Autonomous Region China; The Center of Diagnosis, Treatment and Research of Hypertension in Xinjiang, China. No. 91 Tianchi Road, Tianshan District, Urumqi, Xinjiang, CN, 830001, China
| | - Suofeiya Abulikemu
- The Center of Hypertension of People's Hospital of Xinjiang Uygur Autonomous Region China; The Center of Diagnosis, Treatment and Research of Hypertension in Xinjiang, China. No. 91 Tianchi Road, Tianshan District, Urumqi, Xinjiang, CN, 830001, China
| | - Delian Zhang
- The Center of Hypertension of People's Hospital of Xinjiang Uygur Autonomous Region China; The Center of Diagnosis, Treatment and Research of Hypertension in Xinjiang, China. No. 91 Tianchi Road, Tianshan District, Urumqi, Xinjiang, CN, 830001, China
| | - Guijuan Chang
- The Center of Hypertension of People's Hospital of Xinjiang Uygur Autonomous Region China; The Center of Diagnosis, Treatment and Research of Hypertension in Xinjiang, China. No. 91 Tianchi Road, Tianshan District, Urumqi, Xinjiang, CN, 830001, China
| | - Ling Zhou
- The Center of Hypertension of People's Hospital of Xinjiang Uygur Autonomous Region China; The Center of Diagnosis, Treatment and Research of Hypertension in Xinjiang, China. No. 91 Tianchi Road, Tianshan District, Urumqi, Xinjiang, CN, 830001, China
| | - Nanfang Li
- The Center of Hypertension of People's Hospital of Xinjiang Uygur Autonomous Region China; The Center of Diagnosis, Treatment and Research of Hypertension in Xinjiang, China. No. 91 Tianchi Road, Tianshan District, Urumqi, Xinjiang, CN, 830001, China.
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Hirota T, Morioka T, Yoda K, Toi N, Hayashi N, Maruo S, Yamazaki Y, Kurajoh M, Motoyama K, Yamada S, Shoji T, Emoto M, Inaba M. Positive association of plasma leptin with sleep quality in obese type 2 diabetes patients. J Diabetes Investig 2018; 9:1100-1105. [PMID: 29479862 PMCID: PMC6123027 DOI: 10.1111/jdi.12826] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 01/25/2018] [Accepted: 02/20/2018] [Indexed: 01/03/2023] Open
Abstract
AIMS/INTRODUCTION Poor sleep quality is associated with obesity and diabetes. The adipocyte-derived hormone, leptin, was recently shown to underlie the link between abnormal sleep and obesity. We aimed to investigate the association between leptin and sleep quality in type 2 diabetes patients. MATERIALS AND METHODS In the present cross-sectional study, we studied 182 type 2 diabetes patients, among whom 113 were diagnosed with obesity (body mass index ≥25 kg/m2 ). Fasting plasma leptin levels were measured, and sleep architecture was assessed using single-channel electroencephalography. RESULTS Using unadjusted analyses, the obese type 2 diabetes patients, but not their non-obese counterparts, showed a positive correlation between plasma leptin levels and a parameter for deep sleep assessed by delta power during the first sleep cycle. Multivariate analysis showed that plasma leptin levels were positively associated with delta power, but not with the total sleep time, after adjusting for potential confounders including age, body mass index and the apnea-hypopnea index, in the obesity group. However, neither delta power nor total sleep time was associated with leptin in the non-obesity group. CONCLUSIONS Plasma leptin levels are independently associated with sleep quality in obese, but not in non-obese, type 2 diabetes patients. The present study indicates a favorable relationship between leptin and sleep quality in obese type 2 diabetes patients.
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Affiliation(s)
- Tomoe Hirota
- Department of Metabolism, Endocrinology and Molecular MedicineOsaka City University Graduate School of MedicineOsakaJapan
| | - Tomoaki Morioka
- Department of Metabolism, Endocrinology and Molecular MedicineOsaka City University Graduate School of MedicineOsakaJapan
| | - Koichiro Yoda
- Department of Metabolism, Endocrinology and Molecular MedicineOsaka City University Graduate School of MedicineOsakaJapan
| | - Norikazu Toi
- Department of Metabolism, Endocrinology and Molecular MedicineOsaka City University Graduate School of MedicineOsakaJapan
| | - Noriyuki Hayashi
- Department of Metabolism, Endocrinology and Molecular MedicineOsaka City University Graduate School of MedicineOsakaJapan
| | - Saori Maruo
- Department of Metabolism, Endocrinology and Molecular MedicineOsaka City University Graduate School of MedicineOsakaJapan
| | - Yuko Yamazaki
- Department of Metabolism, Endocrinology and Molecular MedicineOsaka City University Graduate School of MedicineOsakaJapan
| | - Masafumi Kurajoh
- Department of Metabolism, Endocrinology and Molecular MedicineOsaka City University Graduate School of MedicineOsakaJapan
| | - Koka Motoyama
- Department of Metabolism, Endocrinology and Molecular MedicineOsaka City University Graduate School of MedicineOsakaJapan
| | - Shinsuke Yamada
- Department of Metabolism, Endocrinology and Molecular MedicineOsaka City University Graduate School of MedicineOsakaJapan
| | - Tetsuo Shoji
- Department of Vascular MedicineOsaka City University Graduate School of MedicineOsakaJapan
| | - Masanori Emoto
- Department of Metabolism, Endocrinology and Molecular MedicineOsaka City University Graduate School of MedicineOsakaJapan
| | - Masaaki Inaba
- Department of Metabolism, Endocrinology and Molecular MedicineOsaka City University Graduate School of MedicineOsakaJapan
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Kim CE, Shin S, Lee HW, Lim J, Lee JK, Shin A, Kang D. Association between sleep duration and metabolic syndrome: a cross-sectional study. BMC Public Health 2018; 18:720. [PMID: 29895272 PMCID: PMC5998453 DOI: 10.1186/s12889-018-5557-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 05/10/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Both short and long sleep duration have been consistently studied as a risk factor for obesity, hyperglycemia and hypertension. In this cross-sectional study, we provide an updated analysis of the Health Examinees (HEXA) study on the association between sleep duration and metabolic syndrome (MetS) occurrence among Koreans age 40-69 year olds. METHODS A total of 133,608 subjects (44,930 men, 88,678 women) were enrolled in the HEXA study 2004-2013. Sleep duration was categorized into 4 sleep categories (< 6 h, 6 to < 8 h, 8 to < 10 h, ≥10 h). MetS criterion was based on the National Cholesterol Education Program, Adult Treatment Panel III. Logistic regression was used to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Compared with individuals sleeping 6 to < 8 h per day, less than 6 h of sleep was associated with MetS (multivariable adjusted OR: 1.12, 95% CI: 1.05-1.19) and elevated waist circumference (1.15, 1.08-1.23) among men; with elevated waist circumference (1.09, 1.04-1.14) among women. Greater than 10 h of sleep was associated with MetS (1.28, 1.08-1.50) and elevated triglycerides (1.33, 1.14-1.56) among men; with MetS (1.40, 1.24-1.58), elevated waist circumference (1.14, 1.02-1.27), elevated triglycerides (1.41, 1.25-1.58), reduced high-density lipoprotein cholesterol (HDL-C) (1.24, 1.12-1.38), and elevated fasting glucose (1.39, 1.23-1.57) among women. CONCLUSIONS Less than 6 h of sleep is associated with elevated waist circumference among both men and women and with MetS among men only. Greater than 10 h of sleep is associated with MetS and elevated triglycerides among both men and women and with elevated waist circumference, reduced HDL-C, and elevated fasting glucose among women only.
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Affiliation(s)
- Claire E. Kim
- Department of Preventive Medicine, Seoul National University College of Medicine, 102 Daehak-ro, Jongno-gu, Seoul, 03080 Korea
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
| | - Sangah Shin
- Department of Food and Nutrition, Chung-Ang University, Seoul, Gyeonggi-do 17546 Korea
| | - Hwi-Won Lee
- Department of Preventive Medicine, Seoul National University College of Medicine, 102 Daehak-ro, Jongno-gu, Seoul, 03080 Korea
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
| | - Jiyeon Lim
- Department of Preventive Medicine, Seoul National University College of Medicine, 102 Daehak-ro, Jongno-gu, Seoul, 03080 Korea
| | - Jong-koo Lee
- JW Lee Center for Global Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Aesun Shin
- Department of Preventive Medicine, Seoul National University College of Medicine, 102 Daehak-ro, Jongno-gu, Seoul, 03080 Korea
| | - Daehee Kang
- Department of Preventive Medicine, Seoul National University College of Medicine, 102 Daehak-ro, Jongno-gu, Seoul, 03080 Korea
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
- Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul, Korea
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Effects of night-time on-call work on heart rate variability before bed and sleep quality in visiting nurses. Int Arch Occup Environ Health 2018; 91:695-704. [DOI: 10.1007/s00420-018-1317-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 05/22/2018] [Indexed: 01/17/2023]
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Zhu B, Xie M, Park CG, Kapella MC. Adaptation of the Pittsburgh Sleep Quality Index in Chinese adults with type 2 diabetes. J Chin Med Assoc 2018; 81:242-247. [PMID: 29258729 PMCID: PMC6873698 DOI: 10.1016/j.jcma.2017.06.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/01/2017] [Accepted: 06/03/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Sleep disturbance is a major health issue in people with type 2 diabetes (T2DM). The Pittsburgh Sleep Quality Index (PSQI) has been the most widely used instrument to measure subjective sleep disturbance. Nevertheless, its factor structure in the context of T2DM has not been examined. The purpose of the study is to evaluate the factor structure of the PSQI in Chinese adults with T2DM and thereby to facilitate its use in clinical practice and research. METHODS The PSQI (Chinese version) was administered to 240 patients with T2DM. Confirmatory factor analysis was conducted to examine the one-factor, adapted one-factor by removing the component "use of sleep medication", and the three-factor structure of the PSQI. Goodness-of-fit indices were used to evaluate the fit of the model. Construct validity of the resultant model was further examined using contrasted groups. Cronbach's α of the resultant model was obtained to evaluate its internal consistency. RESULTS The three-factor model proposed by Cole et al. did not fit the sleep data. Confirmatory factor analysis supported the adapted one-factor model with the PSQI global score as an indicator of overall sleep quality, and the goodness-of-fit indices for the adapted model were better compared to the original one-factor model. As expected, women, older adults, and patients with poor glycemic control had higher adapted PSQI global score (p < 0.01). Cronbach's α of the adapted PSQI was 0.78. CONCLUSION The adapted PSQI was similar to the original PSQI in that only the component "use of sleep medication" was removed from the original scale and the one-factor scoring worked better. In contrast, the three-factor model has limited usefulness in this population.
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Affiliation(s)
- Bingqian Zhu
- College of Nursing, The University of Illinois at Chicago, Chicago, IL, USA.
| | - Meng Xie
- Department of Spinal Surgery, Changzheng Hospital, Second Military Medical University of China, Shanghai, China
| | - Chang G Park
- College of Nursing, The University of Illinois at Chicago, Chicago, IL, USA
| | - Mary C Kapella
- College of Nursing, The University of Illinois at Chicago, Chicago, IL, USA
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Association of usual sleep quality and glycemic control in type 2 diabetes in Japanese: A cross sectional study. Sleep and Food Registry in Kanagawa (SOREKA). PLoS One 2018; 13:e0191771. [PMID: 29364963 PMCID: PMC5783416 DOI: 10.1371/journal.pone.0191771] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 12/13/2017] [Indexed: 12/16/2022] Open
Abstract
Objectives Excessively short and long sleep durations are associated with type 2 diabetes, but there is limited information about the association between sleep quality and diabetes. Accordingly, the present study was performed to investigate this relationship. Materials and methods The subjects were 3249 patients with type 2 diabetes aged 20 years or older. Sleep quality was assessed by using the Pittsburgh Sleep Quality Index (PSQI). A higher global PSQI score indicates worse sleep quality, and a global PSQI score >5 differentiates poor sleepers from good sleepers. Results The mean global PSQI score was 5.94 ± 3.33, and 47.6% of the patients had a score of 6 or higher. Regarding the components of the PSQI, the score was highest for sleep duration, followed by subjective sleep quality and then sleep latency in decreasing order. When the patients were assigned to HbA1c quartiles (≤ 6.5%, 6.6–7.0%, 7.1–7.8%, and ≥ 7.9%), the top quartile had a significantly higher global PSQI score than the other quartiles. The top HbA1c quartile had a sleep duration of only 6.23 ± 1.42 hours, which was significantly shorter than in the other quartiles. Also, sleep latency was 25.3 ± 31.8 minutes in the top quartile, which was significantly longer (by approximately 20 minutes) than in the other quartiles. When analysis was performed with adjustment for age, gender, BMI, smoking, and other confounders, the global PSQI score was still significantly higher and sleep duration was shorter in the top HbA1c quartile (HbA1c ≥ 7.9%). Conclusions Japanese patients with type 2 diabetes were found to have poor subjective sleep quality independently of potential confounders, especially those with inadequate glycemic control. Impairment of sleep quality was associated with both increased sleep latency and a shorter duration of sleep.
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Sakimura K, Maekawa T, Kume SI, Ohta T. Spontaneously Diabetic Torii (SDT) Fatty Rat, a Novel Animal Model of Type 2 Diabetes Mellitus, Shows Blunted Circadian Rhythms and Melatonin Secretion. Int J Endocrinol 2018; 2018:9065690. [PMID: 30344606 PMCID: PMC6174757 DOI: 10.1155/2018/9065690] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 08/14/2018] [Indexed: 01/05/2023] Open
Abstract
In patients with diabetes mellitus (DM), impairments of circadian rhythms, including the sleep-wake cycle, blood pressure, and plasma melatonin concentrations, are frequently observed. Animal models of DM are also reported to show aberrant circadian rhythms. However, the changes in the circadian rhythms of plasma soluble substances, including melatonin, in diabetic animals are controversial. In the present study, we investigated the circadian rhythms of spontaneous locomotor activity, metabolic parameters (plasma glucose, triglyceride, and total cholesterol), and plasma melatonin concentrations in Spontaneously Diabetic Torii (SDT) fatty rats, a novel animal model of type 2 DM. Although SDT fatty rats exhibited low locomotor activity in the dark phase, no phase shifts were observed. The circadian variations of plasma metabolic parameters were more apparent in the SDT fatty rats compared with control Sprague-Dawley (SD) rats. The circadian rhythms of plasma melatonin concentrations were significantly impaired in SDT fatty rats. To get an insight into the mechanism underlying the impaired melatonin secretion in SDT fatty rats, the expression of arylalkylamine N-acetyltransferase (Aanat) and acetylserotonin O-methyltransferase (Asmt) mRNA, which encode the rate-limiting enzymes for melatonin synthesis, was investigated in the pineal gland. There were no significant differences in Aanat and Asmt expression between the control SD and SDT fatty rats. These results suggest that SDT fatty rats show impaired circadian rhythms and dysregulated melatonin secretion.
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Affiliation(s)
- Katsuya Sakimura
- Biological/Pharmacological Research Laboratories, Central Pharmaceutical Research Institute, Japan Tobacco Inc., 1-1 Murasaki-cho, Takatsuki, Osaka, Japan
| | - Tatsuya Maekawa
- Biological/Pharmacological Research Laboratories, Central Pharmaceutical Research Institute, Japan Tobacco Inc., 1-1 Murasaki-cho, Takatsuki, Osaka, Japan
| | - Shin-ichi Kume
- Laboratory of Animal Physiology and Functional Anatomy, Graduate School of Agriculture, Kyoto University, Kitashirakawa Oiwake-cho, Sakyo-ku, Kyoto, Japan
| | - Takeshi Ohta
- Biological/Pharmacological Research Laboratories, Central Pharmaceutical Research Institute, Japan Tobacco Inc., 1-1 Murasaki-cho, Takatsuki, Osaka, Japan
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Takada M, Nishida K, Gondo Y, Kikuchi-Hayakawa H, Ishikawa H, Suda K, Kawai M, Hoshi R, Kuwano Y, Miyazaki K, Rokutan K. Beneficial effects of Lactobacillus casei strain Shirota on academic stress-induced sleep disturbance in healthy adults: a double-blind, randomised, placebo-controlled trial. Benef Microbes 2017; 8:153-162. [PMID: 28443383 DOI: 10.3920/bm2016.0150] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The present study examined whether Lactobacillus casei strain Shirota (LcS) improves sleep quality under psychological stress. A double-blind, placebo-controlled trial was conducted in healthy 4th year medical students exposed to academic examination stress. The trial was repeated over two consecutive years in different groups of students, and the data were pooled. For 8 weeks prior to and 3 weeks after a national standardised examination, a total of 48 and 46 subjects received a daily dose of 100 ml of LcS-fermented milk or non-fermented placebo milk, respectively. Study measures included subjective anxiety, overnight single-channel electroencephalography (EEG) recordings, and the Oguri-Shirakawa-Azumi (OSA) sleep inventory scores of subjective sleep quality. Total OSA scores were significantly lower than baseline on the day before the exam and recovered after the exam, indicating a stress-induced decline in sleep quality. There was a significant positive effect of LcS treatment on OSA factors for sleepiness on rising and sleep length. Sleep latency measured by EEG lengthened as the exam approached in the placebo group but was significantly suppressed in the LcS group. The percentage of stage 3 non-REM (N3) sleep decreased in the placebo group as the exam approached, whereas it was maintained in the LcS group throughout the trial. Delta power during the first sleep cycle, measured as an index of sleep intensity, increased as the exam approached in the LcS group and was significantly higher than in the placebo group. These findings suggest that daily consumption of LcS may help to maintain sleep quality during a period of increasing stress. The observed retention of N3 sleep and increased delta power in the LcS group may have contributed to higher perceived sleep satisfaction.
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Affiliation(s)
- M Takada
- 1 Yakult Central Institute, 5-11 Izumi, Kunitachi, Tokyo 186-8650, Japan
| | - K Nishida
- 2 Department of Pathophysiology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, Tokushima 770-8503, Japan
| | - Y Gondo
- 1 Yakult Central Institute, 5-11 Izumi, Kunitachi, Tokyo 186-8650, Japan
| | - H Kikuchi-Hayakawa
- 1 Yakult Central Institute, 5-11 Izumi, Kunitachi, Tokyo 186-8650, Japan
| | - H Ishikawa
- 1 Yakult Central Institute, 5-11 Izumi, Kunitachi, Tokyo 186-8650, Japan
| | - K Suda
- 1 Yakult Central Institute, 5-11 Izumi, Kunitachi, Tokyo 186-8650, Japan
| | - M Kawai
- 1 Yakult Central Institute, 5-11 Izumi, Kunitachi, Tokyo 186-8650, Japan
| | - R Hoshi
- 3 Faculty of Research and Development, Yakult Honsha Co., Ltd., 1-1-19 Higashi-Shimbashi, Minato, Tokyo 105-8660, Japan
| | - Y Kuwano
- 2 Department of Pathophysiology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, Tokushima 770-8503, Japan
| | - K Miyazaki
- 1 Yakult Central Institute, 5-11 Izumi, Kunitachi, Tokyo 186-8650, Japan
| | - K Rokutan
- 2 Department of Pathophysiology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, Tokushima 770-8503, Japan
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Zhu B, Hershberger PE, Kapella MC, Fritschi C. The relationship between sleep disturbance and glycaemic control in adults with type 2 diabetes: An integrative review. J Clin Nurs 2017; 26:4053-4064. [PMID: 28544107 PMCID: PMC5702275 DOI: 10.1111/jocn.13899] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2017] [Indexed: 12/19/2022]
Abstract
AIMS AND OBJECTIVES To explore and synthesise current research to assess the state of science about the relationship between sleep disturbance and glycaemic control in adults with type 2 diabetes. BACKGROUND Sleep disturbance is suggested a risk factor for type 2 diabetes. Diabetes alone is a leading cause of death, but when coupled with sleep disturbance poses additional health risks. However, little is known about the relationship between sleep disturbance and glycaemic control in people with overt diabetes. DESIGN An integrative review. METHODS Whittemore and Knafl's methodology guided this integrative review. Original studies published before October 2016 were identified through systematic searches of seven databases using terms: diabet*; sleep or insomnia; glycem* or glucose or A1C or HbA1c or sugar; and their combinations. The matrix and narrative synthesis were employed to organise and synthesise the findings, respectively. The Crowe Critical Appraisal Tool was used to evaluate the study quality. RESULTS A total of 26 studies were identified; 17 of which reported significant relationships between sleep measures and glycaemic control. In 13 studies, sleep duration was associated with glycaemic control in both linear (n = 2) and nonlinear (n = 3) relationships; however, eight studies reported no significant relationships. Sleep quality was significantly related to glycaemic control in 14 of 22 studies. Nine studies found no relationship between any measure of sleep and glycaemic control. CONCLUSIONS There is strong evidence supporting the relationship between sleep quality and glycaemic control but further examination of the relationship between sleep duration and glycaemic control is warranted. Sleep disturbance, particularly impaired sleep quality, could potentially influence glycaemic control in adults with type 2 diabetes. RELEVANCE TO CLINICAL PRACTICE Nurses who treat patients with diabetes should include assessment of sleep, education for healthy sleep, and referral for treatment of sleep disturbance in order to maximise the potential for achieving good glycaemic control.
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Affiliation(s)
- Bingqian Zhu
- College of Nursing, University of Illinois at Chicago, Chicago, IL
| | - Patricia E. Hershberger
- College of Nursing, University of Illinois at Chicago, Chicago, IL
- College of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Mary C. Kapella
- College of Nursing, University of Illinois at Chicago, Chicago, IL
| | - Cynthia Fritschi
- College of Nursing, University of Illinois at Chicago, Chicago, IL
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Igaki M, Suzuki M, Sakamoto I, Ichiba T, Kuriyama K, Uchiyama M. Effects of bedtime periocular and posterior cervical cutaneous warming on sleep status in adult male subjects: a preliminary study. Sleep Biol Rhythms 2017; 16:77-84. [PMID: 29367835 PMCID: PMC5754422 DOI: 10.1007/s41105-017-0129-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 10/03/2017] [Indexed: 02/04/2023]
Abstract
Appropriate warming of the periocular or posterior cervical skin has been reported to induce autonomic or mental relaxation in humans. To clarify the effects of cutaneous warming on human sleep, eight male subjects with mild sleep difficulties were asked to try three experimental conditions at home, each lasting for 5 days, in a cross-over manner: warming of the periocular skin with a warming device for 10 min before habitual bedtime, warming of the posterior cervical skin with a warming device for 30 min before habitual bedtime, and no treatment as a control. The warming device had a heat- and steam-generating sheet that allowed warming of the skin to 40 °C through a chemical reaction with iron. Electroencephalograms (EEGs) were recorded during nocturnal sleep using an ambulatory EEG device and subjected to spectral analysis. All the participants reported their sleep status using a visual analog scale. We found that warming of the periocular or posterior cervical skin significantly improved subjective sleep status relative to the control. The EEG delta power density in the first 90 min of the sleep episode was significantly increased under both warming of the periocular or posterior cervical skin relative to the control. These results suggest that warming of appropriate skin regions may have favorable effects on subjective and objective sleep quality.
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Affiliation(s)
- Michihito Igaki
- Personal Health Care Laboratory, Kao Corporation, 2-1-3, Bunka, Sumida-ku, Tokyo, 131-8501 Japan
| | - Masahiro Suzuki
- Department of Psychiatry, Nihon University School of Medicine, Oyaguchi Kamicho, Itabashi-ku, Tokyo, 173-8610 Japan
| | - Ichiro Sakamoto
- Personal Health Care Laboratory, Kao Corporation, 2-1-3, Bunka, Sumida-ku, Tokyo, 131-8501 Japan
| | - Tomohisa Ichiba
- Personal Health Care Laboratory, Kao Corporation, 2-1-3, Bunka, Sumida-ku, Tokyo, 131-8501 Japan
- Department of Psychiatry, Nihon University School of Medicine, Oyaguchi Kamicho, Itabashi-ku, Tokyo, 173-8610 Japan
| | - Kenichi Kuriyama
- Department of Psychiatry, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192 Japan
| | - Makoto Uchiyama
- Department of Psychiatry, Nihon University School of Medicine, Oyaguchi Kamicho, Itabashi-ku, Tokyo, 173-8610 Japan
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Thurston RC, Chang Y, von Känel R, Barinas-Mitchell E, Jennings JR, Hall MH, Santoro N, Buysse DJ, Matthews KA. Sleep Characteristics and Carotid Atherosclerosis Among Midlife Women. Sleep 2017; 40:2666709. [PMID: 28364498 DOI: 10.1093/sleep/zsw052] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction Midlife, which encompasses the menopause transition in women, can be a time of disrupted sleep and accelerated atherosclerosis accumulation. Short or poor sleep quality has been associated with cardiovascular disease (CVD) risk; few studies have investigated relations among midlife women. We tested whether shorter actigraphy sleep time or poorer subjective sleep quality was associated with carotid atherosclerosis among midlife women. Aims and Methods Two hundred fifty-six peri- and postmenopausal women aged 40-60 years completed 3 days of wrist actigraphy, hot flash monitoring, questionnaires (Pittsburgh Sleep Quality Index [PSQI], Berlin), a blood draw, and carotid ultrasound [intima media thickness (IMT), plaque]. Associations of objective (actigraphy) and subjective (PSQI) sleep with IMT/plaque were tested in regression models (covariates: age, race, education, body mass index, blood pressure, lipids, insulin resistance, medications, snoring, depressive symptoms, sleep hot flashes, and estradiol). Results Shorter objective sleep time was associated with higher odds of carotid plaque (for each hour shorter sleep, plaque score ≥ 2, odds ratio (OR) [95% confidence interval, CI] = 1.58 [1.11-2.27], p = .01; plaque score = 1, OR [95% CI] = 0.95 [0.68-1.32], p = .75, vs. no plaque, multivariable). Poorer subjective sleep quality was associated with higher mean IMT [β, b (standard error, SE) = 0.004 (0.002), p = .03], maximal IMT [b (SE) = 0.009 (0.003), p = .005], and plaque [plaque score ≥ 2, OR (95% CI) = 1.23 (1.09-1.40), p = .001; score = 1, OR (95% CI) = 1.06 (0.93-1.21), p = .37, vs. no plaque] in multivariable models. Findings persisted additionally adjusting for sleep hot flashes and estradiol. Conclusions Shorter actigraphy-assessed sleep time and poorer subjective sleep quality were associated with increased carotid atherosclerosis among midlife women. Associations persisted adjusting for CVD risk factors, hot flashes, and estradiol.
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Affiliation(s)
- Rebecca C Thurston
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213.,Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA 15213.,Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260
| | - Yuefang Chang
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213
| | - Roland von Känel
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, 3010 Bern, Switzerland
| | - Emma Barinas-Mitchell
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA 15213
| | - J Richard Jennings
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213
| | - Martica H Hall
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213.,Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Denver, CO 80238
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213
| | - Karen A Matthews
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213.,Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA 15213.,Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260
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Full KM, Schmied EA, Parada H, Cherrington A, Horton LA, Ayala GX. The Relationship Between Sleep Duration and Glycemic Control Among Hispanic Adults With Uncontrolled Type 2 Diabetes. DIABETES EDUCATOR 2017; 43:519-529. [DOI: 10.1177/0145721717724564] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose The purpose of this study was to examine the relationship between sleep duration and glycemic control in adult Hispanic patients with uncontrolled type 2 diabetes. Methods This cross-sectional study used baseline data from 317 Hispanic adults with uncontrolled type 2 diabetes who participated in a randomized controlled trial testing a peer support intervention to improve diabetes control. To be eligible, participants had to be 18 years or older and have A1C >7% in the 3 months prior to randomization. Glycemic control was assessed by A1C ascertained through medical chart review; higher A1C levels reflected poorer glycemic control. Sleep duration (hours/night), diabetes control behaviors, and demographics were obtained by interviewer-administered questionnaire. We used multivariable generalized linear models to estimate the association between sleep duration and glycemic control. Results Forty-three percent of participants reported sleeping fewer than 7 hours per night. Sleep duration (hours/night) was inversely associated with A1C levels; however, the relationship was no longer statistically significant after adjusting for insulin status. Conclusions Sleep duration was not significantly associated with glycemic control in this sample of Hispanic adults with uncontrolled type 2 diabetes when adjusting for insulin. Future research should continue to explore this relationship among Hispanic adults with diabetes using an objective measure of sleep duration and a larger sample of Hispanic adults with both controlled and uncontrolled type 2 diabetes to determine if these results hold true.
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Affiliation(s)
- Kelsie M. Full
- San Diego State University/University of California, San Diego Joint Doctoral Program in Public Health (Health Behavior), San Diego, California (Miss Full)
- Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California (Miss Full, Dr Schmied, Miss Horton, Dr Ayala)
- University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, North Carolina (Dr Parada)
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (Dr Cherrington)
- College of Health and Human Services, San Diego State University, San Diego, California (Dr Ayala)
| | - Emily A. Schmied
- San Diego State University/University of California, San Diego Joint Doctoral Program in Public Health (Health Behavior), San Diego, California (Miss Full)
- Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California (Miss Full, Dr Schmied, Miss Horton, Dr Ayala)
- University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, North Carolina (Dr Parada)
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (Dr Cherrington)
- College of Health and Human Services, San Diego State University, San Diego, California (Dr Ayala)
| | - Humberto Parada
- San Diego State University/University of California, San Diego Joint Doctoral Program in Public Health (Health Behavior), San Diego, California (Miss Full)
- Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California (Miss Full, Dr Schmied, Miss Horton, Dr Ayala)
- University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, North Carolina (Dr Parada)
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (Dr Cherrington)
- College of Health and Human Services, San Diego State University, San Diego, California (Dr Ayala)
| | - Andrea Cherrington
- San Diego State University/University of California, San Diego Joint Doctoral Program in Public Health (Health Behavior), San Diego, California (Miss Full)
- Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California (Miss Full, Dr Schmied, Miss Horton, Dr Ayala)
- University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, North Carolina (Dr Parada)
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (Dr Cherrington)
- College of Health and Human Services, San Diego State University, San Diego, California (Dr Ayala)
| | - Lucy A. Horton
- San Diego State University/University of California, San Diego Joint Doctoral Program in Public Health (Health Behavior), San Diego, California (Miss Full)
- Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California (Miss Full, Dr Schmied, Miss Horton, Dr Ayala)
- University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, North Carolina (Dr Parada)
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (Dr Cherrington)
- College of Health and Human Services, San Diego State University, San Diego, California (Dr Ayala)
| | - Guadalupe X. Ayala
- San Diego State University/University of California, San Diego Joint Doctoral Program in Public Health (Health Behavior), San Diego, California (Miss Full)
- Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California (Miss Full, Dr Schmied, Miss Horton, Dr Ayala)
- University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, North Carolina (Dr Parada)
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (Dr Cherrington)
- College of Health and Human Services, San Diego State University, San Diego, California (Dr Ayala)
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Nocturia, Other Lower Urinary Tract Symptoms and Sleep Dysfunction in a Community-Dwelling Cohort of Men. Urology 2016; 97:219-226. [DOI: 10.1016/j.urology.2016.06.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 06/01/2016] [Accepted: 06/14/2016] [Indexed: 11/20/2022]
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Denic-Roberts H, Costacou T, Orchard TJ. Subjective sleep disturbances and glycemic control in adults with long-standing type 1 diabetes: The Pittsburgh's Epidemiology of Diabetes Complications study. Diabetes Res Clin Pract 2016; 119:1-12. [PMID: 27415404 PMCID: PMC5024530 DOI: 10.1016/j.diabres.2016.06.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 05/06/2016] [Accepted: 06/06/2016] [Indexed: 11/19/2022]
Abstract
AIMS To date, studies on sleep disturbances in type 1 diabetes (T1D) have been limited to youth and/or small samples. We therefore assessed the prevalence of subjective sleep disturbances and their associations with glycemia and estimated insulin sensitivity in individuals with long-standing T1D. METHODS We conducted a cross-sectional study including 222 participants of the Epidemiology of Diabetes Complications study of childhood-onset T1D attending the 25-year examination (mean age=52years, diabetes duration=43years). The Berlin Questionnaire (risk of obstructive sleep apnea, OSA), the Epworth Sleepiness Scale (daytime sleepiness), and the Pittsburgh Sleep Quality Index (sleep quality, bad dreams presence, and sleep duration) were completed. Associations between sleep disturbances and poor glycemic control (HbA1c⩾7.5%/58mmol/mol), log-transformed HbA1c, and estimated insulin sensitivity (estimated glucose disposal rate, eGDR, squared) were assessed in multivariable regression. RESULTS The prevalences of high OSA risk, excessive daytime sleepiness, poor sleep quality, and bad dreams were 23%, 13%, 41%, and 26%, respectively, with more women (51%) reporting poor sleep quality than men (30%, p=0.004). Participants under poor glycemic control were twice as likely to report bad dreams (p=0.03), but not independently (p=0.07) of depressive symptomatology. Sleep duration was directly associated with HbA1c among individuals with poor glycemic control, but inversely in their counterparts (interaction p=0.002), and inversely associated with eGDR (p=0.002). CONCLUSIONS These findings suggest important interrelationships between sleep, gender, depressive symptomatology, and glycemic control, which may have important clinical implications. Further research is warranted to examine the mechanism of the interaction between sleep duration and glycemic control.
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Affiliation(s)
- Hristina Denic-Roberts
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 3512 Fifth Ave, Pittsburgh, PA 15213, USA.
| | - Tina Costacou
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 3512 Fifth Ave, Pittsburgh, PA 15213, USA.
| | - Trevor J Orchard
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 3512 Fifth Ave, Pittsburgh, PA 15213, USA.
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Tsuneki H, Sasaoka T, Sakurai T. Sleep Control, GPCRs, and Glucose Metabolism. Trends Endocrinol Metab 2016; 27:633-642. [PMID: 27461005 DOI: 10.1016/j.tem.2016.06.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 06/29/2016] [Accepted: 06/29/2016] [Indexed: 12/29/2022]
Abstract
Modern lifestyles prolong daily activities into the nighttime, disrupting circadian rhythms, which may cause sleep disturbances. Sleep disturbances have been implicated in the dysregulation of blood glucose levels and reported to increase the risk of type 2 diabetes (T2D) and diabetic complications. Sleep disorders are treated using anti-insomnia drugs that target ionotropic and G protein-coupled receptors (GPCRs), including γ-aminobutyric acid (GABA) agonists, melatonin agonists, and orexin receptor antagonists. A deeper understanding of the effects of these medications on glucose metabolism and their underlying mechanisms of action is crucial for the treatment of diabetic patients with sleep disorders. In this review we focus on the beneficial impact of sleep on glucose metabolism and suggest a possible strategy for therapeutic intervention against sleep-related metabolic disorders.
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Affiliation(s)
- Hiroshi Tsuneki
- Department of Clinical Pharmacology, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan
| | - Toshiyasu Sasaoka
- Department of Clinical Pharmacology, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan.
| | - Takeshi Sakurai
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan.
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Circulating soluble form of LR11, a regulator of smooth muscle cell migration, is a novel marker for intima-media thickness of carotid arteries in type 2 diabetes. Clin Chim Acta 2016; 457:137-41. [PMID: 27095609 DOI: 10.1016/j.cca.2016.04.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 03/18/2016] [Accepted: 04/14/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND Smooth muscle cell (SMC) migration from the media to the intima, a process affecting plaque stability in advanced-stage atherosclerosis, is under the control of LR11. To delineate the clinical significance of the circulating soluble form of LR11 (sLR11) in patients with type 2 diabetes (T2D), we analyzed the correlation of sLR11 levels with intima-media thickness (IMT) of carotid arteries. METHODS Plasma sLR11 levels were measured in 165 patients with T2D (mean age 56.2±10.4 y, 58.2% males, and BMI 24.6±3.6) by ELISA. Averaged IMT levels of common carotid arteries were determined by ultrasonography. RESULTS Circulating sLR11 levels were 9.8±3.5ng/ml, and correlated positively with the classical atherosclerosis risk factors age, sex, systolic blood pressure, low-density lipoprotein-cholesterol (LDL-C), fasting plasma-glucose (FPG), and glycosylated hemoglobin. Multivariate linear regression analysis indicated that only FPG was associated with sLR11; sLR11 correlated positively with IMT, together with age and FPG, but less with LDL-C. Among the serum risk factors for IMT, multivariate linear regression analysis uncovered that sLR11 was independently associated with IMT. Subsequent logistic analysis revealed that FPG correlated best with IMT values at a cut-off of 0.80mm and sLR11 at a cut-off of 0.90mm, respectively, while LDL-C showed lower discriminatory power at any IMT cut-off values. CONCLUSION Increased sLR11 concentrations are highly associated with increased IMT as well as with FPG in middle-aged, non-obese patients with T2D. Circulating sLR11 may be a novel marker representing the pathophysiology of intimal SMCs in patients with T2D.
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Nakakita Y, Tsuchimoto N, Takata Y, Nakamura T. Effect of dietary heat-killed Lactobacillus brevis SBC8803 (SBL88™) on sleep: a non-randomised, double blind, placebo-controlled, and crossover pilot study. Benef Microbes 2016; 7:501-9. [PMID: 27013460 DOI: 10.3920/bm2015.0118] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We previously reported that dietary heat-killed Lactobacillus brevis SBC8803 affects sleep rhythms in mice. The present study evaluated the effect of consumption of heat-killed SBC8803 on sleep architecture in humans. A non-randomised, placebo-controlled, double blind, and crossover pilot study was conducted using volunteers who scored at a slightly high level (i.e. ≥6) on the Athens Insomnia Scale (AIS). Male subjects (n=17; age 41-69 y) consumed placebo or SBC8803 capsules (25 mg/day of heat-killed SBC8803) for 10 days. Electroencephalograms (EEG) were recorded using a mobile, one-channel system, providing objective data on sleep. Subjects' sleep journals and administration of the AIS provided subjective data on sleep. Three subjects were excluded from the statistical analysis. Analysis of the remaining 14 volunteers revealed no significant differences between placebo and SBC8803 consumption in either the AIS or the sleep EEG. The sleep journals revealed an improvement in 'waking' for the SBC8803 consumption periods (P=0.047), and there was a marginally significant effect on 'drowsiness during the following day' (P=0.067). Effects on the EEG delta power value (μV(2)/min) were revealed by a stratified analysis based on age, AIS, and the Beck Depression Inventory (BDI). Specifically, effects were found among subjects in their 40s who consumed the SBC8803 capsules (P=0.049) and among subjects with a BDI score less than the all-subjects average (13.3) (P=0.045). A marginally significant effect was found among subjects with an AIS score less than the all-subjects average (11.6) (P=0.065). The delta power value of 5 subjects with both BDI and AIS scores less than the average increased significantly (P=0.017). While the number of subjects was limited, a beneficial effect on sleep due to consumption of heat-killed L. brevis SBC8803 was found in subjects with slightly challenged sleep.
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Affiliation(s)
- Y Nakakita
- 1 Frontier Laboratories of Value Creation, Sapporo Breweries Ltd., 10 Okatohme, Yaizu, Shizuoka 425-0013, Japan
| | - N Tsuchimoto
- 1 Frontier Laboratories of Value Creation, Sapporo Breweries Ltd., 10 Okatohme, Yaizu, Shizuoka 425-0013, Japan
| | - Y Takata
- 1 Frontier Laboratories of Value Creation, Sapporo Breweries Ltd., 10 Okatohme, Yaizu, Shizuoka 425-0013, Japan
| | - T Nakamura
- 1 Frontier Laboratories of Value Creation, Sapporo Breweries Ltd., 10 Okatohme, Yaizu, Shizuoka 425-0013, Japan
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