Power spectral analysis of EEG activity during sleep in cigarette smokers

The roles of serum vitamin D and tobacco smoke exposure in insomnia: a cross-sectional study of adults in the United States

Aim

Tobacco smoke exposure and vitamin D (VD) status were both associated with insomnia. However, the combined effect of smoking and VD on insomnia has not been discussed. This study aimed to explore the role of VD in the association between tobacco smoke exposure and insomnia.

Methods

Data on adults were extracted from the National Health and Nutrition Examination Surveys (NHANES) database in 2005-2008 for this cross-sectional study. Weighted univariate and multivariate logistic regression analyses were used to explore the associations between serum cotinine, serum VD, and insomnia. A surface diagram was drawn to reflect the effect of VD on the association between serum cotinine and insomnia. In addition, the potential regulating effect of VD in subgroups of smoking status was also performed. The evaluation index was odds ratios (ORs) with 95% confidence intervals (CIs).

Results

Among the eligible participants, 1,766 had insomnia. After adjusting for covariates, we found that elevated serum cotinine levels were associated with higher odds of insomnia [OR = 1.55, 95% CI: (1.22, 1.97)]. However, the relationship between serum VD level and insomnia was not significant (P = 0.553). Higher serum cotinine levels were also associated with higher odds of insomnia [OR = 1.52, 95% CI: (1.17, 1.98)] when serum VD level was <75 nmol/L; however, this relationship became non-significant when serum VD concentration was elevated (P = 0.088). Additionally, the potential regulating effect of VD was also found in adults who were not smoking.

Conclusion

VD may play a potential regulative role in the association between tobacco smoke exposure and insomnia. Further studies are needed to clarify the causal relationships between VD, tobacco smoke exposure, and insomnia.

Effects of smoking on sleep architecture and ventilatory parameters including apneas: Results of the Tab-OSA study

Background

The interaction between smoking and sleep seems appears to be bidirectional, but few studies evaluated the impact of smoking and its cessation on objective sleep parameters. In this context, this new study aimed to assess the impact of smoking and its cessation on sleep architecture and on ventilatory sleep parameters, particularly the presence of sleep apnea syndrome (apnea-hypopnea index (AHI)≥15). Methods: Patients hospitalized for polysomnographic sleep exploration were compared according to their smoking status: active smokers (AS), former smokers (FS), non-smokers (NoNi). Psychiatric and non-psychiatric co-morbidities and treatment or substance use were taken into account in the analyses.

Results

A total of 170 participants were included (N = 37 FS, 39 AS, 86 NoNi). A significant decrease in the mean nocturnal O2 saturation was observed for FS and AS compared to NoNi. No differences were found regarding AHI. Regarding sleep architecture, we observed a significant decrease in the slow wave sleep duration for AS compared to NoNi, and interestingly not between FS and NoNi.

Conclusion

This study suggests that current smokers suffer from alterations in both sleep architecture and ventilatory parameters, the later appears to persist even after smoking cessation.

Nicotine, alcohol, and caffeine use among individuals with untreated obstructive sleep apnea

BACKGROUND

Psychoactive substance use (i.e., nicotine, alcohol, and caffeine) has substantial effects on sleep architecture in healthy individuals, but their effects in those with obstructive sleep apnea (OSA) have not been well described. We aimed to describe the association between psychoactive substance use and sleep characteristics and daytime symptoms in individuals with untreated OSA.

METHODS

We performed a secondary, cross-sectional analysis of The Apnea Positive Pressure Long-term Efficacy Study (APPLES). Exposures included current smoking, alcohol and caffeine use in individuals with untreated OSA. Outcome domains included subjective and objective sleep characteristics, daytime symptoms, and comorbid conditions. Linear or logistic regression assessed the association between substance use and each domain (e.g., self-reported sleep duration, total polysomnographic sleep time, sleepiness, and anxiety).

RESULTS

Of the 919 individuals with untreated OSA, 116 (12.6%) were current cigarette smokers, 585 (63.7%) were moderate or heavy alcohol users, and 769 (83.7%) were moderate or heavy caffeine users. Participants were on average 52.2±11.9 years old, 65.2% were male with a median BMI of 30.6 (IQR: 27.2, 35.9, kg/m2). Current smokers exhibited lower sleep duration (0.3 h), longer sleep latency (5 min) compared with non-smokers (all p-values < 0.05). People with heavy or moderate alcohol use exhibited more REM sleep (2.5 and 5% of total sleep time respectively), as did those with moderate caffeine use (2%, p-values < 0.05). The combined smoker plus caffeine group exhibited shorter sleep duration (0.4 h, p-value < 0.05) and higher risk for chronic pain [Odds Ratio (95%CI) = 4.83 (1.57, 14.9) compared with non-users.

CONCLUSIONS

Psychoactive substance use is associated with sleep characteristics and clinically relevant correlates in people with untreated OSA. Further investigation into the effects that various substances have on this population may present opportunities to understand disease mechanisms more fully and increase the effectiveness of treatment in OSA.

The prevalence and associated factors of sleep deprivation among healthy college students in China: a cross-sectional survey

Background

The prevalence of sleep deprivation among college students is increasing and has a few associated factors.

Methods

The present study analyzed 2,142 college students from 28 provinces in China. The Chinese version of the Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep duration. Binary logistic regression was conducted to explore the sleep deprivation related factors. Age and gender were controlled as covariates.

Results

Among the 2,142 college students (27.7% male, 72.3% female), 1,620 (75.6%) reported the average sleep duration was below 7 h per day for one month, 49.3% (1,055/2,142) slept 6∼7 h (contains 6 h), 21.0% (449/2,142) slept 5∼6 h (contains 5 h), and 5.4% (116/2,142) slept <5 h. Age increased the risk of sleep deprivation, the adjusted odds ratio = 1.05 (95% CI [1.01∼1.10]). The adjusted odds ratio (A-OR) for sleep deprivation was higher for students of more than 60 min nap duration per day (A-OR = 2.35, 95% CI [1.45∼3.80]), and age growth (A-OR = 1.05, 95% CI [1.01∼1.10]). In contrast, A-ORs were lower among sleeping inconsistency between work and rest days (A-OR = 0.61, 95% CI [0.49∼0.75]), accustomed to staying up late (A-OR = 0.45, 95% CI [0.36∼0.57]), staying up late to work or study (A-OR = 0.62, 95% CI [0.49∼0.78]), stress (A-OR = 0.75, 95% CI [0.58∼0.98]), and repeated thoughts in bed had (A-OR = 0.79, 95% CI [0.62∼0.99]).

Conclusions

Sleep deprivation is extremely common among healthy college students in China. It is necessary to perform methods maintaining enough sleep due to the current high incidence of sleep deprivation. Controlling the nap duration and getting enough sleep on rest days to replace missing hours of sleep on workdays might improve college students' sleep.

Association of dual use of cigarettes with obstructive sleep apnea assessed by the STOP-Bang score

INTRODUCTION

Although previous studies have addressed the association between smoking and obstructive sleep apnea (OSA), there are few studies on the association between electronic cigarette use and OSA. Thus, we aimed to evaluate the association between the dual use of electronic and conventional cigarettes and OSA.

METHODS

Data from 7350 participants of the 2019-2021 Korean National Health and Nutrition Examination Survey were analyzed in this population-based study. The STOP-Bang score was calculated using eight items: snoring, tiredness, observed apnea, high blood pressure, body mass index, age, neck circumference, and sex. The main independent variable was smoking behavior. A multiple logistic regression analysis was performed. Subgroup analysis was conducted to analyze the association between smoking behavior in detail and OSA, and stratified analyses were additionally performed.

RESULTS

Of the 7350 participants, 417 (5.7%) had a high risk of OSA, according to the STOP-Bang score. Compared to the non-smoker group, the dual user group had a 2.46-fold increase in the odds of OSA (adjusted odds ratio, AOR = 2.45; 95% CI: 1.04-5.79). Current non-smokers who were dual users in the past had increased odds of having OSA (AOR=3.61; 95% CI: 1.32-9.92). In the stratified analyses, dual cigarette use was significantly associated with OSA in females and those with a low physical activity level.

CONCLUSIONS

Dual users and cigarette-only users had an increased probability of developing OSA. Even if they are not currently smoking or vaping, individuals who were dual users in the past were associated with a higher risk of OSA. The association between dual cigarette use and OSA was more pronounced in females and those with a low physical activity level. While intervening for obstructive sleep apnea or investigating risk factors, new smoking methods such as vaping and dual use should be considered along with conventional smoking.

Tobacco use and incident sleep parameters among a rural ageing population in South Africa

INTRODUCTION

Tobacco use may be associated with incident insomnia. The aim of the study was to investigate the association between tobacco use and incident sleep parameters in a longitudinal study in South Africa.

METHODS

Longitudinal data from two consecutive waves of middle-aged and older adults in 2014-2015 (n=5059) and 2018-2019 (n=4176) in rural South Africa were analyzed. Tobacco use and sleep parameters were assessed by self-report. The associations between tobacco use and incident sleep parameters were estimated with multivariable logistic regression.

RESULTS

The prevalence of baseline sleep parameters was poor sleep quality 6.5%, sleep disturbance 13.6%, restless sleep 32.9%, and breathing stops 7.0%. In the fully adjusted model for people without poor sleep quality at baseline, daily tobacco smoking, smoking ≥10 units of tobacco products, current tobacco use and current smokeless tobacco use did not increase the odds of incident poor sleep quality. Smoking ≥10 units of tobacco products in a day (AOR=3.83; 95% CI: 1.77-8.28), current tobacco use (AOR=1.65; 95% CI: 1.09-2.51), and daily tobacco smoking (AOR=2.16; 95% CI: 1.15-4.07), were significantly positively associated with incident sleep disturbance. Furthermore, incident restless sleep was significantly positively associated with smoking ≥10 units of tobacco products in a day (AOR=3.97; 95% CI: 1.18-13.37), current smokeless tobacco use (AOR=2.78; 95% CI: 1.17-6.62) and current tobacco use (AOR=2.00; 95% CI: 1.00-4.00). Incident breathing stops were significantly positively associated with daily smoking tobacco (AOR=2.08; 95% CI: 1.11-3.34), smoking 1-9 units of tobacco products in a day (AOR=2.17; 95% CI: 1.20-3.94), and current tobacco use (AOR=1.77; 95% CI: 1.16-2.72).

CONCLUSIONS

Higher tobacco use was independently associated with incident sleep disturbance, incident restless sleep, and incident breathing stops, but not with incident poor sleep quality.

Association of sleep abnormalities in older adults with risk of developing Parkinson's disease

STUDY OBJECTIVES

Parkinson's disease (PD) is associated with abnormalities of sleep macro- and microstructure as measured using polysomnography (PSG). Whether these abnormalities precede the development of PD is unknown. This study investigated the association between PSG measured sleep abnormalities in older adults and the risk of incident PD.

METHODS

A total of 2,770 men from the ancillary sleep study of the Osteoporotic Fractures in Men Study (MrOS), a population-based cohort from the United States, who were free from PD baseline and underwent overnight PSG, were included in this longitudinal analysis. Incident PD was based on a clinical diagnosis from a medical professional. Multivariable logistic regression was used to estimate odds ratios (OR) for incident PD by quartiles of PSG measures, with adjustment for sociodemographic characteristics, medical comorbidities, and lifestyle factors.

RESULTS

During a median follow-up of 9.8 years, 70 (2.5%) cases of incident PD were identified. Longer total sleep time, lower rapid eye movement sleep (REM) percentage, a lower α/θ ratio during non-REM sleep and higher minimum oxygen saturations during REM sleep, were each associated with an increased risk of developing PD. Conversely, a higher awakening index was associated with a decreased risk of developing PD. The OR for the highest risk quartiles compared to the lowest risk quartiles, ranged from 2.1 to 3.7 (p's < .05). The associations remained significant when cases occurring within the first two years of follow-up were excluded from the analyses.

CONCLUSIONS

Macro- and micro-structural sleep abnormalities precede the development of PD by several years and can identify individuals at high risk of developing PD in the future.

Does Smoking Affect OSA? What about Smoking Cessation?

The connection between smoking and Obstructive sleep apnea (OSA) is not yet clear. There are studies that have confirmed the effect of smoking on sleep disordered breathing, whereas others did not. Nicotine affects sleep, as smokers have prolonged total sleep and REM latency, reduced sleep efficiency, total sleep time, and slow wave sleep. Smoking cessation has been related with impaired sleep. The health consequences of cigarette smoking are well documented, but the effect of smoking cessation on OSA has not been extensively studied. Smoking cessation should improve OSA as upper airway oedema may reduce, but there is limited data to support this hypothesis. The impact of smoking cessation pharmacotherapy on OSA has been studied, especially for nicotine replacement therapy (NRT). However, there are limited data on other smoking cessation medications as bupropion, varenicline, nortriptyline, clonidine, and cytisine. The aim of this review was to explore the current evidence on the association between smoking and OSA, to evaluate if smoking cessation affects OSA, and to investigate the possible effects of different pharmacologic strategies offered for smoking cessation on OSA.

Difference in spectral power density of sleep electroencephalography between individuals without insomnia and frequent hypnotic users with insomnia complaints

Previous spectral analysis studies on insomnia have shown inconsistent results due to their heterogeneity and small sample sizes. We compared the difference of electroencephalogram (EEG) spectral power during sleep among participants without insomnia, insomniacs with no hypnotic use, hypnotic users with no insomnia complaints, and hypnotic users with insomnia complaints using the Sleep Heart Health Study data, which is large sample size and has good quality control. The fast Fourier transformation was used to calculate the EEG power spectrum for total sleep duration within contiguous 30-s epochs of sleep. For 1985 participants, EEG spectral power was compared among the groups while adjusting for potential confounding factors that could affect sleep EEG. The power spectra during total sleep differed significantly among the groups in all frequency bands (p_corr < 0.001). We found that quantitative EEG spectral power in the beta and sigma bands of total sleep differed (p_corr < 0.001) between participants without insomnia and hypnotic users with insomnia complaints after controlling for potential confounders. The higher beta and sigma power were found in the hypnotic users with insomnia complaints than in the non-insomnia participants. This study suggests differences in the microstructures of polysomnography-derived sleep EEG between the two groups.

Tobacco-induced sleep disturbances: A systematic review and meta-analysis

Even though tobacco-induced sleep disturbances (TISDs) have been reported in previous studies, the present article is the first meta-analysis quantitatively assessing the impact of tobacco on sleep parameters. We conducted a systematic review and meta-analysis of the studies comparing objective (i.e. polysomnography and actigraphy) and/or subjective sleep parameters in chronic tobacco smokers without comorbidities versus healthy controls. Studies were retrieved using PubMed, PsycINFO, and Web of Science. Differences are expressed as standardized mean deviations (SMD) and their 95% confidence intervals (95%CI). Fourteen studies were finally included into the review, among which ten were suitable for meta-analysis. Compared to healthy controls, chronic tobacco users displayed increased N1 percentage (SMD = 0.65, 95%CI: 0.22 to 1.07), N2 percentage (SMD = 1.45, 95%CI: 0.26 to 2.63), wake time after sleep onset (SMD = 6.37, 95%CI: 2.48 to 10.26), and decreased slow-wave sleep (SMD = -2.00, 95%CI: -3.30 to -0.70). Objective TISDs preferentially occurred during the first part of the night. Regarding subjective parameters, only the Pittsburgh Sleep Quality Index (PSQI) total score could be analyzed, with no significant between-groups difference (SMD = 0.53, 95%CI: -0.18 to 1.23). Smoking status should be carefully assessed in sleep medicine, while TISDs should be regularly explored in chronic tobacco users.

Smoking and incidence of insomnia: a systematic review and meta-analysis of cohort studies

OBJECTIVE

This study investigated the impact of smoking on the incidence of insomnia.

STUDY DESIGN

Systematic review and meta-analysis of cohort studies.

METHODS

PubMed, EMBASE, Web of Science, Cochrane Library, and OVID were searched through March 2020. Cohort studies reporting the effect of smoking on the incidence of insomnia were included. We quantitatively analyzed the basic framework and study characteristics and then pooled estimate effects with 95% confidence intervals (CIs) of outcomes of each included study using fixed-effects meta-analyses.

RESULTS

This systematic review included six cohort studies involving 12,445 participants. Quantitatively summarized results suggested that smoking could significantly increase the incidence of insomnia (odds ratio [OR]: 1.07, 95% CI: 1.02, 1.13). Regular smoking was significantly associated with the incidence of insomnia (OR = 1.07, 95% CI: 1.01, 1.13). As for occasional smokers and ex-smokers, the pooled analysis did not indicate a significant association (occasional smoker: OR = 2.09, 95% CI: 0.44, 9.95; ex-smoker; OR = 1.02, 95% CI: 0.67, 1.54). Subgroup analysis by age, gender ratio, and region showed a statistically significant relationship between smoking and the incidence of insomnia in specific groups.

CONCLUSIONS

Integrated longitudinal observational evidence identified smoking as a significant risk factor of insomnia. Considering the limited amount of available studies, more high-quality and prospective cohort studies of large sample sizes are needed to explore details of this association.

Sleep disturbances are associated with cortical and subcortical atrophy in alcohol use disorder

Sleep disturbances are prominent in patients with alcohol use disorder (AUD) and predict relapse. So far, the mechanisms underlying sleep disruptions in AUD are poorly understood. Because sleep-related regions vastly overlap with regions, where patients with AUD showed pronounced grey matter (GM) reduction; we hypothesized that GM structure could contribute to sleep disturbances associated with chronic alcohol use. We combined sleep EEG recording and high-resolution structural brain imaging to examine the GM-sleep associations in 36 AUD vs. 26 healthy controls (HC). The patterns of GM-sleep associations differed for N3 vs. REM sleep and for AUD vs. HC. For cortical thickness (CT), CT-sleep associations were significant in AUD but not in HC and were lateralized such that lower CT in right hemisphere was associated with shorter N3, whereas in left hemisphere was associated with shorter REM sleep. For the GM density (GMD), we observed a more extensive positive GMD-N3 association in AUD (right orbitofrontal cortex, cerebellum, dorsal cingulate and occipital cortex) than in HC (right orbitofrontal cortex), and the GMD-REM association was positive in AUD (midline, motor and paralimbic regions) whereas negative in HC (the left supramarginal gyrus). GM structure mediated the effect of chronic alcohol use on the duration of N3 and the age by alcohol effect on REM sleep. Our findings provide evidence that sleep disturbances in AUD were associated with GM reductions. Targeting sleep-related regions might improve sleep in AUD and enhance sleep-induced benefits in cognition and emotional regulation for recovery.

Impact of smoking on sleep macro- and microstructure

OBJECTIVES

Existing data suggest that smoking may be associated with sleep disturbances. This study aimed to determine the association between smoking and both subjective and objective sleep quality.

METHODS

Cross-sectional analysis of sleep characteristics in 3233 participants from the population-based CoLaus-HypnoLaus cohort (52.2% women, mean age 56.6 ± 10.2 years) who completed questionnaires on sleep quality, of whom 1489 (46%) had a full polysomnography. Smoking data were self-reported; participants were classified by smoking status as current, former or never smokers. Primary outcomes were subjective sleep quality assessed by sleep questionnaires, and objective sleep quality based on polysomnography (sleep macrostructure), including power spectral analysis of the electroencephalogram on C4 electrode (sleep microstructure), quantifying the relative amount of delta power (1-4 Hz), a marker of sleep depth, and arousal-associated alpha power (8-12 Hz).

RESULTS

Current smokers had a shift toward faster sleep electroencephalogram activity with lower delta power in non-REM sleep compared with former and never smokers (-2.8 ± 0.4% and -2.4 ± 0.4%, respectively; both p < 0.001) and higher alpha power (+0.8 ± 0.2%; p < 0.001) compared with never smokers. There was a dose-dependent negative association between electroencephalogram delta power and smoking intensity (r² = -1.2 [-1.9, -0.5]; p = 0.001). Additionally, mean nocturnal oxygen saturation was lower in current smokers.

CONCLUSIONS

Current smokers had decreased objective sleep quality, with a dose-dependent association between smoking intensity and decrease in electroencephalogram delta power during non-REM sleep, in addition to an increase in alpha power. Considering the importance of sleep quality for wellbeing and health, these results provide further data to support smoking cessation.

Effects of Dinner Timing on Sleep Stage Distribution and EEG Power Spectrum in Healthy Volunteers

PURPOSE

Eating time and sleep habits are important modifiable behaviors that affect metabolic health, but the relationship between food intake and sleep remains incompletely understood. Observational data suggest that late food intake is associated with impaired sleep quality. We examined the effect of routine dinner (RD, 5 hours before bedtime) vs late dinner (LD, 1 hour before bedtime) on sleep architecture in healthy volunteers.

PARTICIPANTS AND METHODS

This was a post hoc analysis of a randomized crossover study of RD vs LD with a fixed sleep opportunity in a laboratory setting. On each of the two visits, 20 healthy adult volunteers (10 women) received an isocaloric meal followed by overnight polysomnography. Sleep architecture over the course of the night was assessed using visual sleep staging and EEG spectral power analysis and was compared between RD and LD. We modeled the proportions of spectral power in alpha, beta, delta, and theta bands as functions of dinner timing, time of night, and their interaction with mixed-effect spline regression.

RESULTS

Conventional sleep stages were similar between the 2 visits. LD caused a 2.5% initial increase in delta power and a reciprocal 2.7% decrease in combined alpha and beta power (p<0.0001). These effects diminished as sleep continued with a reversal of these patterns in the latter part of the night.

CONCLUSION

Contrary to the existing literature, shifting dinner timing from 5 hours before sleep to 1 hour before sleep in healthy volunteers did not result in significant adverse changes in overnight sleep architecture. In fact, LD was associated with deeper sleep in the beginning of the night and lighter sleep in the latter part of the night in healthy volunteers. This novel manifestation of postprandial hypersomnia may have therapeutic potential in patients with sleep disorders.

Sleep structure and electroencephalographic spectral power of middle-aged or older adults: Normative values by age and sex in the Korean population

The fine structure of sleep electrocortical activity reflects health and disease. The current study provides normative data for sleep structure and electroencephalography (EEG) spectral power measures derived from overnight polysomnography (PSG) and examines the effect of age and sex among Korean middle-aged and older adults with or without obstructive sleep apnea (OSA). We analysed home PSG data from 1,153 adult participants of an ongoing population-based cohort study, the Korean Genome and Epidemiology Study. Sleep stages were visually scored and spectral power was measured on a single-channel EEG (C4-A1). We computed spectral power for five frequency ranges. The EEG power was reported in relative (%) and log-transformed absolute values (µV² ). With ageing, the proportion of N1 sleep increased, whereas N3 decreased, which is more noticeable in men than in women. The amount of N3 was relatively low in this cohort. With ageing, relative delta power decreased and alpha and sigma power increased for the whole sleep period, which was more pronounced during REM sleep in non-OSA. For men compared with women, relative theta power was lower during REM and sigma and beta were higher during N1 sleep. The differences of relative powers by age and sex in OSA were comparable to those in non-OSA. In a community-based Korean population, we present normative data of sleep structure and spectral power for middle-aged or older adults of a non-Caucasian ethnicity. The values varied with age and sex and were not influenced by sleep apnea.

Stress, Sleep and Psychological Impact in Healthcare Workers During the Early Phase of COVID-19 in India: A Factor Analysis

Background: Risks to healthcare workers have escalated during the pandemic and they are likely to experience a greater level of stress. This cross-sectional study investigated mental distress among healthcare workers during the early phase of Coronavirus disease-2019 (COVID-19) outbreak in India. Method: 140 healthcare workers of a tertiary care hospital in India were assessed for perceived stress and insomnia. A factor analysis with principal component method reduced these questions to four components which were categorized as insomnia, stress-related anxiety, stress-related irritability, and stress-related hopelessness. Further statistical analyses were done on these factor scores to identify the predictors and investigate the differences between the different categories of healthcare workers. Result: Doctors had the highest level of anxiety among the healthcare workers. Both doctors and nurses perceived a greater level of irritability than the other HCWs. Compared to doctors and nurses, other HCWs were more likely to experience insomnia. Lower age, higher education, female gender, and urban habitat were associated with greater perception of anxiety. Older age, being quarantined, and single marital status were the significant predictors of irritability. Female gender, single marital-status, and higher number of medical ailments contributed to perceived hopelessness. Quarantine significantly predicted insomnia. Conclusion: Different categories of healthcare workers are experiencing varied mental health problems owing to their heterogeneous socio-demographic backgrounds. Tailored and personalized care, as well as policies, might help in alleviating their problems. Further research is warranted to explore the psychological distress and remedies among these frontline workers during and after the ongoing pandemic crisis.

Spectral Power Analysis of Sleep Electroencephalography in Subjects with Different Severities of Obstructive Sleep Apnea and Healthy Controls

PURPOSE

Previous spectral analysis studies on obstructive sleep apnea (OSA) involved small samples, and the results were inconsistent. We performed a spectral analysis of sleep EEG based on different severities of OSA using the Sleep Heart Health Study data. This study aimed to determine the difference in EEG spectral power during sleep in the non-OSA group and with different severities of OSA in the general population.

PATIENTS AND METHODS

The participants (n = 5,804) underwent polysomnography, and they were classified into non-OSA, mild OSA, moderate OSA, and severe OSA groups. The fast Fourier transformation was used to compute the EEG power spectrum for total sleep duration within contiguous 30-second epochs of sleep. The EEG spectral powers of the groups were compared using 4,493 participants after adjusting potential confounding factors that could affect sleep EEG.

RESULTS

The power spectra differed significantly among the groups for all frequency bands (p corr < 0.001). We found that the quantitative EEG spectral powers in the beta and sigma bands of total sleep differed (p corr < 0.001) among the participants in the non-OSA group and with different severities of OSA, controlling for covariates. The beta power was higher and the sigma power was lower in the OSA groups than in the non-OSA group. The beta power decreased in the order of severe OSA, moderate OSA, mild OSA, and non-OSA.

CONCLUSION

This study suggests that there are differences between the microstructures of PSG-derived sleep EEG of non-OSA participants and those with different severities of OSA.

Sleep disordered breathing and chronic obstructive pulmonary disease: a narrative review on classification, pathophysiology and clinical outcomes

Chronic obstructive pulmonary disease (COPD) causes load-capacity-drive imbalance in both wakefulness and sleep, principally driven by expiratory flow limitation and hyperinflation. Sleep imposes additional burdens to the respiratory muscle pump, driven by changes in respiratory muscle tone, neural respiratory drive and consequences of the supine position. COPD patients are therefore at higher risk of decompensation during sleep, which may manifest as altered sleep architecture, isolated nocturnal desaturation, sleep hypoventilation and restless legs. Each form of sleep disordered breathing in COPD is associated with adverse clinical and patient-reported outcomes, including increased risk of exacerbations, hospitalisation, cardiovascular events, reduced survival and poorer quality of life. COPD-obstructive sleep apnoea (OSA) overlap syndrome represents a distinct clinical diagnosis, in which clinical outcomes are significantly worse than in either disease alone, including increased mortality, risk of cardiovascular events, hospitalisation and exacerbation frequency. Sleep disordered breathing is under-recognised by COPD patients and their clinicians, however early diagnosis and management is crucial to reduce the risk of adverse clinical outcomes. In this narrative review, we describe the pathophysiology of COPD and physiological changes that occur during sleep, manifestations and diagnosis of sleep disordered breathing in COPD and associated clinical outcomes.

Sleep Disturbance in Indonesia: How Much Does Smoking Contribute?

Objective: To examine the linkage between smoking and sleep disturbance in Indonesia Methods: This study used data from the 2014 Indonesia Family Life Survey (IFLS), drawn from a sample of 38,879 individuals from 15,067 households living in 262 communities. Sleep disturbance was measured by ten validated indicators of sleep quality and sleep deprivation adopted from the PROMIS (Patient Recorded Outcomes Measurement Information System), developed by the USC Center for Economic and Social Research (CESR), USA. Hierarchical ordered logistic regression was used to account for unobserved factors in village communities. Results: In 2014, the prevalence of smoking in Indonesia remained high at thirty-two percent of the population, or about ninety million active smokers. Nearly half of smokers were young adult males. Eight of every ten males who reported sleep disturbance were smokers. Current smokers' odds of facing sleep disturbance were almost one-and-one-half times higher than those of nonsmokers (OR = 1.39, p-value < 0.01), and among heavy smokers, the odds were almost double (OR = 1.91, p-value < 0.01). These findings were controlled for stressors, chronic diseases, social support and sociodemographic characteristics as well as unobserved factors in village communities. Conclusion: The substantial relationship between smoking and sleep disturbance suggests that policies that address the issue of sleep disturbance through preventing tobacco use among young adults should be a public health priority in Indonesia.

Active smoking, sleep quality and cerebrospinal fluid biomarkers of neuroinflammation

BACKGROUNDS

Cigarette smoking has been shown to be associated with sleep disorders and the related neuropathogenesis including neuroinflammation. Previous studies showed that pro- and anti-inflammatory cytokines are physiologically important in maintaining circadian function. In addition, sleep deprivation leads to immune dysregulations. However, no study has been published yet by using cerebrospinal fluid (CSF) biomarkers of neuroinflammation to investigate the relationship between active cigarette smoking and sleep disorders.

METHODS

CSF tissues from subjects of 191 male subjects (non-smokers n = 104; active smokers n = 87) receiving local anesthesia before surgery for anterior cruciate ligament injuries were obtained after the assessment of clinical information and Pittsburgh Sleep Quality Index (PSQI). The levels of tumor necrosis factor alpha (TNFα), Interleukin (IL) 1 beta (IL1β), IL2, IL4, IL6 and IL10 were measured using radioimmunoassay and ELISA.

RESULTS

PSQI scores were significantly higher in active smokers than that in non-smokers (p < 0.001, Cohen's d = 0.63). Significantly higher levels of CSF TNFα were found in active smokers compared to non-smokers (28 ± 1.97 vs. 22.97 ± 2.48, p < 0.05, Cohen's d = 2.23). There was a positive correlation between CSF IL1β levels and PSQI scores in non-smokers (r = 0.31, p = 0.01, adjustment R-Squared = 0.11).

DISCUSSION

This is the first study to reveal the association between higher CSF TNFα levels and poorer sleep quality in active smoking. In addition, CSF IL1β levels might be a potential biomarker in central nervous system for circadian dysregulation.

Efficacy of a sleep health intervention to optimize standard smoking cessation treatment response: results from a pilot randomized controlled trial

Background

We tested if an adjunctive sleep health (SH) intervention improved smoking cessation treatment response by increasing quit rates. We also examined if baseline sleep, and improvements in sleep in the first weeks of quitting, were associated with quitting at the end of treatment.

Methods

Treatment-seeking smokers (N = 29) aged 21–65 years were randomized to a SH intervention (n = 16), or general health (GH) control (n = 13) condition. Participants received six counseling sessions across 15-weeks: SH received smoking cessation + SH counseling; GH received smoking cessation + GH counseling. Counseling began 4-weeks before the target quit date (TQD), and varenicline treatment began 1-week prior to TQD. Smoking status and SH were assessed at baseline (week 1), TQD (week 4), 3 weeks after cessation (week 7), week 12, and at the end of treatment (EOT; week 15).

Results

SH versus GH participants had higher Carbon Monoxide (CO) -verified, 7-day point prevalence abstinence at EOT (69% vs. 54%, respectively; adjusted odds ratio (aOR) = 2.10, 95% confidence interval (CI) = 0.40–10.69, P = 0.77). Higher baseline sleep efficiency (aOR = 1.42, 95% CI = 1.03–1.96, P = 0.03), predicted higher EOT cessation. Models were adjusted for age, sex, education, and baseline nicotine dependence.

Conclusions

Improving SH in treatment-seeking smokers prior to cessation warrants further examination as a viable strategy to promote cessation.

Differences in sleep architecture according to body mass index in children with type 1 diabetes

Slow wave sleep (SWS), or deep sleep, is thought to be the most restorative stage of sleep and may be of a particular interest in the pathophysiology of obesity. The aim of this study was to investigate differences in sleep architecture based on body mass index (BMI) among a pediatric population with type 1 diabetes mellitus (T1DM). We hypothesized that children with T1DM who are obese would have less SWS than those who are not obese. Of 105 children with T1DM (mean age 13.54 years, 49.5% females) in this study, 19% were obese, 22% were overweight, and 59% had a normal BMI (81% non-obese). The overall SWS% among the participants was 13.2%. In contrast to our hypothesis, there was no significant difference in SWS% between obese and non-obese participants. However, the percent of time spent in rapid eye movement (REM) sleep among obese participants was significantly lower than those who were not obese (P = .022), which remained after adjusting the result for multiple covariates. While we found no significant association between the SWS time and BMI, obese adolescents with T1DM spent less time in REM sleep than those who were not obese. This study adds to the growing body of evidence supporting the importance of addressing sleep in clinical care of youth with T1DM.

Apnea-Hypopnea Event Duration Predicts Mortality in Men and Women in the Sleep Heart Health Study

RATIONALE

Obstructive sleep apnea is a risk factor for mortality, but its diagnostic metric-the apnea-hypopnea index-is a poor risk predictor. The apnea-hypopnea index does not capture the range of physiological variability within and between patients, such as degree of hypoxemia and sleep fragmentation, that reflect differences in pathophysiological contributions of airway collapsibility, chemoreceptive negative feedback loop gain, and arousal threshold.

OBJECTIVES

To test whether respiratory event duration, a heritable sleep apnea trait reflective of arousal threshold, predicts all-cause mortality.

METHODS

Mortality risk as a function of event duration was estimated by Cox proportional hazards in the Sleep Heart Health Study, a prospective community-based cohort. Gender-specific hazard ratios were also calculated.

MEASUREMENTS AND MAIN RESULTS

Among 5,712 participants, 1,290 deaths occurred over 11 years of follow-up. After adjusting for demographic factors (mean age, 63 yr; 52% female), apnea-hypopnea index (mean, 13.8; SD, 15.0), smoking, and prevalent cardiometabolic disease, individuals with the shortest-duration events had a significant hazard ratio for all-cause mortality of 1.31 (95% confidence interval, 1.11-1.54). This relationship was observed in both men and women and was strongest in those with moderate sleep apnea (hazard ratio, 1.59; 95% confidence interval, 1.11-2.28).

CONCLUSIONS

Short respiratory event duration, a marker for low arousal threshold, predicts mortality in men and women. Individuals with shorter respiratory events may be predisposed to increased ventilatory instability and/or have augmented autonomic nervous system responses that increase the likelihood of adverse health outcomes, underscoring the importance of assessing physiological variation in obstructive sleep apnea.

Sleep as a Target for Optimized Response to Smoking Cessation Treatment

Declining national rates of current tobacco use to an all-time low of 15.1% represents a public health victory. Undermining this progress, however, are smoking rates of up to 50% among high-risk, low-income populations. Current FDA-approved treatments for nicotine dependence are ineffective with between 70-95% of treatment-seekers relapsing within the first year of attempted abstinence. Thus, identification of novel intervention targets to optimize response to currently available treatments for nicotine dependence is a critical next step. One such target may be sleep insomnia. Insomnia is a clinically verified nicotine withdrawal symptom but, to date, addressing insomnia or other sleep disturbance symptoms as an adjunctive smoking cessation therapy has yet to be fully considered. To this end, this manuscript presents a narrative review of: (1) sleep continuity and architecture in smokers versus nonsmokers; (2) effects of nicotine abstinence on sleep; (3) possible mechanisms linking sleep with smoking cessation outcomes; (4) plausible adjunctive sleep therapies to promote smoking cessation; (5) possible treatments for unhealthy sleep in smokers; and (6) directions for future research. Taken together, this will provide conceptual support for sleep therapy as an adjunctive treatment for smoking cessation.

Implications

This narrative literature review presents a comprehensive discussion of the relationship between habitual sleep and cigarette smoking. The extent to which unhealthy sleep in smokers may be a viable intervention target for promoting response to smoking cessation treatment is considered. Ultimately, this review provides conceptual support for sleep therapy as an adjunctive treatment for smoking cessation.

Evening intake of alcohol, caffeine, and nicotine: night-to-night associations with sleep duration and continuity among African Americans in the Jackson Heart Sleep Study

STUDY OBJECTIVES

We examined the night-to-night associations of evening use of alcohol, caffeine, and nicotine with actigraphically estimated sleep duration, sleep efficiency, and wake after sleep onset (WASO) among a large cohort of African American adults.

METHODS

Participants in the Jackson Heart Sleep Study underwent wrist actigraphy for an average of 6.7 nights and completed concurrent daily sleep diary assessments to record any consumption of alcohol, caffeine, and nicotine within 4 hours of bedtime. Linear mixed-effect models were fit and adjusted for age, sex, educational attainment, body mass index, depression, anxiety, stress, and having work/school the next day.

RESULTS

Eligible participants (n = 785) were an average of 63.7 years (SD: 10.6), and were predominantly female (67.9%). There were 5164 days of concurrent actigraphy and sleep diary data. Evening alcohol use was associated with that night's lower sleep efficiency (-0.98% [95% CI: -1.67% to -0.29%], p = 0.005), but not with WASO or sleep duration. Evening nicotine use was associated with that night's lower sleep efficiency [1.74% (95% CI: -2.79 to -0.68), p = 0.001] and 6.09 minutes higher WASO ([95% CI: 0.82 to 11.35], p = 0.02), but was not associated with sleep duration. Evening caffeine use was not associated with any of the sleep parameters.

CONCLUSION

Nicotine and alcohol use within 4 hours of bedtime were associated with increased sleep fragmentation in the associated night, even after controlling for multiple potential confounders. These findings support the importance of sleep health recommendations that promote the restriction of evening alcohol and nicotine use to improve sleep continuity.

HIV status and sleep disturbance in college students and relationship with smoking

OBJECTIVE

Adults with HIV have greater sleep difficulties and are more likely to smoke cigarettes. We tested whether current smoking plays a role in sleep difficulties experienced by young adults with HIV.

DESIGN

Cross-sectional.

SETTING

Data were from the 2011-2014 waves of the National College Health Assessment, an annual survey conducted by the American College Health Association.

PARTICIPANTS

108,159 (including N = 224 HIV positive) college students provided data for this study.

MEASUREMENTS

Health conditions (including HIV positive status) were self-reported. Participants were also asked whether "sleep difficulties" were "traumatic or difficult for you to handle" over the past 12 months. Smoking was self-reported (smokers reported smoking on at least 20 of the last 30 days). Logistic regression models were adjusted for age, sex, survey year, current alcohol use or current marijuana use, diagnosis and/or treatment of anxiety or depression in last year.

RESULTS

HIV positive students were more likely to be smokers (OR = 2.0, SE = 0.43, 95% CI [1.31, 3.05], P = .001) and were more likely to experience sleep difficulties (OR = 2.02, SE = 0.29, 95% CI [1.52, 2.68], P < .0001). While a significant HIV-x-smoking interaction was not found, when models were stratified by smoking, the relationship between HIV status and sleep difficulties was seen among non-smokers (OR = 1.97), and this relationship was stronger among smokers (OR = 2.64).

CONCLUSIONS

Among college students, HIV positive status is associated with increased sleep difficulties. These problems are worse among smokers. Sleep interventions are warranted in this vulnerable group, and could potentially enhance smoking cessation efforts.

Evidence for Genetic Correlations and Bidirectional, Causal Effects Between Smoking and Sleep Behaviors

INTRODUCTION

Cigarette smokers are at increased risk of poor sleep behaviors. However, it is largely unknown whether these associations are due to shared (genetic) risk factors and/or causal effects (which may be bidirectional).

METHODS

We obtained summary-level data of genome-wide association studies of smoking (smoking initiation [n = 74 035], cigarettes per day [n = 38 181], and smoking cessation [n = 41 278]) and sleep behaviors (sleep duration and chronotype, or "morningness" [n = 128 266] and insomnia [n = 113 006]). Using linkage disequilibrium (LD) score regression, we calculated genetic correlations between smoking and sleep behaviors. To investigate causal effects, we employed Mendelian randomization (MR), both with summary-level data and individual-level data (n = 333 581 UK Biobank participants). For MR with summary-level data, individual genetic variants were combined with inverse variance-weighted meta-analysis, weighted median regression, MR-Robust Adjusted Profile Score, and MR Egger methods.

RESULTS

We found negative genetic correlations between smoking initiation and sleep duration (rg = -.14, 95% CI = -0.26 to -0.01) and smoking cessation and chronotype (rg = -.18, 95% CI = -0.31 to -0.06), and positive genetic correlations between smoking initiation and insomnia (rg = .27, 95% CI = 0.06 to 0.49) and cigarettes per day and insomnia (rg = .15, 95% CI = 0.01 to 0.28). MR provided strong evidence that smoking more cigarettes causally decreases the odds of being a morning person, (RAPS) and weak evidence that insomnia causally increases smoking heaviness and decreases smoking cessation odds.

CONCLUSIONS

Smoking and sleep behaviors show moderate genetic correlation. Heavier smoking seems to causally affect circadian rhythm and there is some indication that insomnia increases smoking heaviness and hampers cessation. Our findings point to sleep as a potentially interesting smoking treatment target.

IMPLICATIONS

Using LD score regression, we found evidence that smoking and different sleep behaviors (sleep duration, chronotype (morningness), and insomnia) are moderately genetically correlated-genetic variants associated with less or poorer sleep also increased the odds of smoking (more heavily). MR analyses suggested that heavier smoking causally affects circadian rhythm (decreasing the odds of being a morning person) and there was some indication that insomnia increases smoking heaviness and hampers smoking cessation. Our findings indicate a complex, bidirectional relationship between smoking and sleep behaviors and point to sleep as a potentially interesting smoking treatment target.

Anxiety sensitivity and daily cigarette smoking in relation to sleep disturbances in treatment-seeking smokers

Although the association between anxiety and sleep disturbance is well-documented, the underlying mechanisms are less clear. Anxiety sensitivity (AS), the fear of physiological arousal and bodily sensations, is a risk factor for anxiety and poor sleep. Smoking also contributes to poor sleep and may compound the effects of AS on sleep quality. This study evaluated the main and interactive effects of AS and cigarettes/day on sleep quality among smokers. Participants (n = 190) were adult treatment-seeking daily smokers who completed a baseline assessment as part of a larger smoking cessation trial. Sleep quality was self-reported. Results indicated that AS was significantly correlated with greater disturbance in sleep duration, subjective sleep quality, sleep onset latency, sleep disturbance, daytime dysfunction, and sleep medication use. There was a significant interaction between AS and cigarettes/day in terms of sleep onset latency, but not other sleep quality indices. AS was associated with significantly longer sleep onset latency minutes among heavier smokers, but not lighter smokers. Specifically, the association between AS and sleep onset latency was significant for those who smoked ≥ 33 cigarettes/day. AS is a psychological factor that may contribute to poor sleep quality, especially in heavy smokers, and thus may be a promising intervention target.

The effects of oral nicotine administration and abstinence on sleep in male C57BL/6J mice

BACKGROUND

Sleep disturbances are common in smoking cessation attempts and are predictive of relapse. Despite this knowledge, there is no established animal model to study the effect of nicotine abstinence on sleep and EEG parameters.

OBJECTIVES

The present study was conducted to characterize sleep and wakefulness in male C57BL/6J mice during periods of oral nicotine administration and abstinence.

METHODS

Male C57BL/6J mice were implanted with EEG/EMG recording devices. EEG/EMG data were recorded continuously for a period of 4 weeks. At the beginning of week 2, 200 μg/ml of nicotine was added to the 0.2% saccharin vehicle drinking solution. Following a 2-week period of oral nicotine administration, abstinence was initiated by excluding the nicotine from the 0.2% saccharin vehicle drinking solution. EEG/EMG were analyzed at pre-nicotine baseline, during nicotine administration, and on days 1, 2, and 5 of abstinence from nicotine.

RESULTS

Oral nicotine administration decreased total sleep time during the active phase, consistent with the stimulant actions of nicotine. In contrast, NREM sleep quantity was increased during the active phase on nicotine abstinence day 1 and REM sleep was decreased during days 2 and 5 of abstinence. Further, sleep fragmentation was increased during the inactive phase on all days of abstinence. Oral nicotine administration and abstinence from nicotine also altered EEG relative power frequencies during the inactive and active phase.

CONCLUSIONS

Both oral nicotine administration and abstinence lead to sleep disturbances in mice. Similarities between this model and human reports on the effect of nicotine/nicotine withdrawal on sleep support its utility in examining the molecular mechanisms that modulate the relationship between sleep, nicotine, and nicotine abstinence/withdrawal.

Tobacco exposure and sleep disturbance in 498 208 UK Biobank participants

Background

The prevalence of sleep disturbance is high and increasing. The study investigated whether active, former and passive smoking were associated with sleep disturbance.

Methods

This cross-sectional study used data from the UK Biobank: a cohort study of 502 655 participants, of whom 498 208 provided self-reported data on smoking and sleep characteristics. Multivariable multinomial and logistic regression models were used to examine the associations between smoking and sleep disturbance.

Results

Long-sleep duration (>9 h) was more common among current smokers [odds ratio (OR): 1.47; 95% confidence interval (CI): 1.17-1.85; probability value (P) = 0.001] than never smokers, especially heavy (>20/day) smokers (OR: 2.85; 95% CI: 1.66-4.89; P < 0.001). Former heavy (>20/day) smokers were also more likely to report short (<6 h) sleep duration (OR: 1.41; 95% CI: 1.25-1.60; P < 0.001), long-sleep duration (OR: 1.99; 95% CI: 1.47-2.71; P < 0.001) and sleeplessness (OR: 1.47; 95% CI: 1.38-1.57; P < 0.001) than never smokers. Among never smokers, those who lived with more than one smoker had higher odds of long-sleep duration than those not cohabitating with a smoker (OR: 2.71; 95% CI: 1.26-5.82; P = 0.011).

Conclusions

Active and passive exposure to high levels of tobacco smoke are associated with sleep disturbance. Existing global tobacco control interventions need to be enforced.

Association of active/passive smoking and urinary 1-hydroxypyrene with poor sleep quality: A cross-sectional survey among Chinese male enterprise workers

INTRODUCTION

Tobacco use has been implicated as an important factor for poor sleep quality. However, in most studies, the sleep quality of smokers was only assessed though a self-reported questionnaire, without measuring any internal biomarkers that reflect the levels of tobacco exposure. We examined the association of active and passive smoking with sleep quality, assessed smoking exposure using urinary 1-hydroxypyrene (1-HOP) as an internal biomarker, and further explored the relationship between 1-HOP and sleep quality.

METHODS

A cross-sectional survey was conducted in Liuzhou city, Guangxi, China. A total of 1787 male enterprise workers were enrolled. The smoking attribute data were collected by self-reported questionnaire, and individual sleep quality was evaluated through the Pittsburgh Sleep Quality Index (PSQI). The concentration of urinary 1-HOP was measured by high-performance liquid chromatography.

RESULTS

Compared with non-smoking, active smoking and passive smoking were significantly associated with long sleep latency (odds ratio, OR=1.84, 95% confidence interval, CI=1.28–2.64; 1.45, 1.00–2.11, respectively), short sleep duration (OR=2.72, 95% CI=1.45–5.09; 1.94, 1.01–3.71, respectively), daytime dysfunction (OR=1.54, 95% CI=1.10–2.17; 1.44, 1.02–2.03, respectively), and overall poor sleep quality with PSQI total score >5 (OR=1.41, 95% CI=1.05–1.88; 1.34, 1.00–1.79, respectively). Compared with non-smokers, active smokers had higher urinary 1-OHP concentrations that were significant (p=0.004), while passive smokers had no significant difference in urinary 1-OHP concentration (p=0.344). The high concentration group was significantly associated with daytime dysfunction and overall poor sleep quality with PSQI total score >5 (OR = 1.73, 95% CI=1.06–2.81; 1.76, 1.18–2.63, respectively).

CONCLUSIONS

Both active smoking and passive smoking are risk factors for poor sleep quality among Chinese male enterprise workers. Active smokers had significantly higher levels of urinary 1-OHP than non-smokers, and high concentration of 1-OHP was associated with daytime dysfunction and overall poor sleep quality.

The effect of continuous positive airway pressure on spectral encephalogram characteristics in stroke patients with obstructive sleep apnea

OBJECTIVES

To evaluate if treatment with continuous positive airway pressure (CPAP) compared to usual care in stroke patients with obstructive sleep apnea (OSA) over one month reduces delta and alpha oscillations on quantitative electroencephalography (EEG) in association with improvements in cognitive or functional outcomes.

METHODS

Spectral EEG analysis was performed in patients with subacute stroke and OSA randomized to usual care or CPAP treatment from a previous study.

RESULTS

A total of 23 subjects were included. Compared to CPAP (n = 14), those in the control (n = 9) group demonstrated a significant increase in alpha power (p = 0.042). There was no between group differences for delta, theta or beta power. No significant correlation was demonstrated between the change in alpha power and indices of OSA severity or sleepiness. The increase in alpha power did not correlate with improvements in outcomes.

CONCLUSION

Contrary to expectations CPAP treatment of OSA did not significantly decrease alpha and delta oscillations in stroke subjects.

Transdermal Nicotine Patch Effects on EEG Power Spectra and Heart Rate Variability During Sleep of Healthy Male Adults

OBJECTIVE

The effect of transdermal nicotine patch on sleep physiology is not well established. The current study aimed to examine the influence of nicotine patch on homeostatic sleep propensity and autonomic nervous system.

METHODS

We studied 16 non-smoking young healthy volunteers with nocturnal polysomnography in a double blind crossover design between sleep with and without nicotine patch. We compared the sleep variables, sleep EEG power spectra, and heart rate variability.

RESULTS

The night with nicotine patch showed significant increase in sleep latency, wake after sleep onset, and stage 1 sleep; and decrease in total sleep time, sleep efficiency, and percentage of REM sleep. Also, spectral analysis of the sleep EEG in the night with nicotine patch revealed decreased slow wave activity in stage 2 and REM sleep and increased alpha activity in the first NREM-REM sleep cycle. Heart rate variability showed no differences between the 2 nights, but the low to high ratio (a parameter indicative of sympathetic nervous system activity) positively correlated with wake after sleep onset in night with nicotine patch.

CONCLUSION

Transdermal nicotine patch significantly disrupts sleep continuity, sleep architecture, and homeostatic sleep propensity. The overactivation of the sympathetic nervous system may be responsible for these changes.

Continuous Positive Airway Pressure Mitigates Opioid-induced Worsening of Sleep-disordered Breathing Early after Bariatric Surgery

BACKGROUND

Bariatric surgery patients are vulnerable to sleep-disordered breathing (SDB) early after recovery from surgery and anesthesia. The authors hypothesized that continuous positive airway pressure (CPAP) improves postoperative oxygenation and SDB and mitigates opioid-induced respiratory depression.

METHODS

In a randomized crossover trial, patients after bariatric surgery received 30% oxygen in the postanesthesia care unit (PACU) under two conditions: atmospheric pressure and CPAP (8 to 10 cm H2O). During 1 h of each treatment, breathing across cortical arousal states was analyzed using polysomnography and spirometry. Arousal state and respiratory events were scored in accordance with American Academy of Sleep Medicine guidelines. Data on opioid boluses in the PACU were collected. The primary and secondary outcomes were the apnea hypopnea index (AHI) and apnea after self-administration of opioids in the PACU. Linear mixed model analysis was used to compare physiologic measures of breathing.

RESULTS

Sixty-four percent of the 33 patients with complete postoperative polysomnography data demonstrated SDB (AHI greater than 5/h) early after recovery from anesthesia. CPAP treatment decreased AHI (8 ± 2/h vs. 25 ± 5/h, P < 0.001), decreased oxygen desaturations (5 ± 10/h vs. 16 ± 20/h, P < 0.001), and increased the mean oxygen saturation by 3% (P = 0.003). CPAP significantly decreased the respiratory-depressant effects observed during wakefulness-sleep transitions without affecting hemodynamics. The interaction effects between CPAP treatment and opioid dose for the dependent variables AHI (P < 0.001), inspiratory flow (P = 0.002), and minute ventilation (P = 0.015) were significant.

CONCLUSIONS

This pharmacophysiologic interaction trial shows that supervised CPAP treatment early after surgery improves SDB and ameliorates the respiratory-depressant effects of opioids without undue hemodynamic effects.

Effects of subacute ingestion of chlorogenic acids on sleep architecture and energy metabolism through activity of the autonomic nervous system: a randomised, placebo-controlled, double-blinded cross-over trial

Chlorogenic acids (CGA) are the most abundant polyphenols in coffee. Continuous consumption of CGA reduces body fat and body weight. Since energy metabolism and sleep are controlled by common regulatory factors, consumption of CGA might modulate sleep. Lack of sleep has been identified as a risk factor for obesity, hypertension and type 2 diabetes. The aim of this study was to determine the effects of ingesting CGA over 5 d on energy metabolism and sleep quality in humans. A total of nine healthy subjects (four male and five female) completed a placebo-controlled, double-blinded, cross-over intervention study. Subjects consumed a test beverage containing 0 or 600 mg of CGA for 5 d. On the fifth night, subjects stayed in a whole-room metabolic chamber to measure energy metabolism; sleep was evaluated using polysomnographic recording. It was found that CGA shortened sleep latency (9 (sem 2) v. 16 (sem 4) min, P<0·05) compared with the control, whereas no effect on sleep architecture, such as slow-wave sleep, rapid eye movement or waking after sleep onset, was observed. Indirect calorimetry revealed that consumption of CGA increased fat oxidation (510 (sem 84) kJ/8 h (122 (sem 20) kcal/8 h) v. 331 (sem 79) kJ/8 h (81 (sem 19) kcal/8 h), P<0·05) but did not affect energy expenditure during sleep. Consumption of CGA enhanced parasympathetic activity assessed from heart-rate variability during sleep (999 (sem 77) v. 919 (sem 54), P<0·05). A period of 5-d CGA consumption significantly increased fat oxidation during sleep, suggesting that beverages containing CGA may be beneficial to reduce body fat and prevent obesity. Consumption of CGA shortened sleep latency and did not adversely affect sleep quality.

Depression, anxiety, and tobacco use: Overlapping impediments to sleep in a national sample of college students

OBJECTIVES

To examine how tobacco use and depression/anxiety disorders are related to disturbed sleep in college students.

PARTICIPANTS

85,138 undergraduate respondents (66.3% female, 74.5% white, non-Hispanic, ages 18-25) from the Spring 2011 American College Health Association-National College Health Assessment II database.

METHODS

Multivariate analyses of tobacco use (none, intermediate, daily) and mental health (diagnosed and/or symptomatic depression or anxiety) were used to predict sleep disturbance.

RESULTS

Daily tobacco use was associated with more sleep problems than binge drinking, illegal drug use, obesity, gender, and working >20 hours/week. Students with depression or anxiety reported more sleep disturbances than individuals without either disorder, and tobacco use in this population was associated with the most sleep problems.

CONCLUSIONS

Tobacco use and depression/anxiety disorders are both independently associated with more sleep problems in college students. Students with depression and/or anxiety are more likely to be daily tobacco users, which likely exacerbates their sleep problems.

Insomnia symptoms as a risk factor for cessation failure following smoking treatment

Insomnia symptoms are associated with smoking, and may interfere with smoking cessation. Specifically, studies have shown that smoking-related sleep problems are associated with long-term smoking relapse, and longer sleep duration is associated with successful smoking cessation. However, it is currently unclear whether pre- or post-quit insomnia symptoms are associated with smoking cessation outcomes. As such, the current study aimed to extend previous findings by using a measure of insomnia symptoms as a predictor of smoking cessation failure by month 3 following smoking cessation treatment. Additionally, we examined whether post-quit insomnia symptoms predicted cessation outcomes. Results indicated that pre-, but not post-quit insomnia, predicted smoking cessation failure by 3 months post-cessation, after covarying for depressive symptoms, anxiety sensitivity, alcohol use disorder severity, treatment condition, and number of cigarettes per day. These findings add to the literature on insomnia symptoms as a risk factor for difficulties with smoking cessation, and suggest it may be a worthy clinical target for smoking populations who are interested in quitting smoking.

Exercise intervention as a protective modulator against metabolic disorders in cigarette smokers

[Purpose] assess the impact of exercise intensity on desire to smoke, serum cotinine, stress hormones, total antioxidant capacity, and oxidative free radicals as potential markers of cardiopulmonary metabolic disorders were measured.in cigarette smokers. [Subjects and Methods] The participants (150 randomly selected healthy men, aged 18–55 years) were classified into 4 smoking groups: control (non-smokers; N= 30); mild (N = 33); moderate (N = 42), and heavy (N = 45). The participants were assigned to either moderate (8 weeks) or short-term (20–45 min) exercise training. The desire to smoke, Mood and Physical Symptoms Scale, and Subjective Exercise Experiences Scale scores, cotinine, stress hormones (cortisol and testosterone), free radicals (malondialdehyde, nitric oxide), and total antioxidant capacity were evaluated. [Results] Significant increases in serum cotinine, cortisol, testosterone, nitric oxide, and malondialdehyde levels and a reduction in total antioxidant capacity activity were observed in all smoker groups; heavy smokers showed a higher change in metabolites. In all smoker groups, both short and moderate- intensity exercises significantly reduce cotinine, cortisol, testosterone, and malondialdehyde and increased nitric oxide levels and total antioxidant capacity activity; further, the desire to smoke, Mood and Physical Symptoms Scale, and Subjective Exercise Experiences Scale scores were reduced. This supports the ability of exercise to increase nitric oxide bioavailability, enhance of blood vessels function and ultimately decrease the incidence of cardiopulmonary disorders. [Conclusion] Exercise interventions with varying intensities may be used as nicotine replacement therapy or protective aids against smoking-related cardiopulmonary disorders.

Trajectories of Cigarette Smoking Beginning in Adolescence Predict Insomnia in the Mid Thirties

BACKGROUND

Insomnia is increasingly recognized as a public health concern in modern society. Insomnia diagnoses appear to be increasing and are associated with poor health outcomes. They may cost $100 billion annually in health services.

OBJECTIVE

Given the adverse consequences of insomnia such as cardiovascular disease, diabetes, and depression, the present study was designed to examine the relationship of the trajectories of earlier cigarette smoking and later insomnia. The ultimate goal is to reduce the prevalence of insomnia.

METHODS

674 participants (53% African Americans, 47% Puerto Ricans, 60% females) were surveyed at 6 points in time. We employed the growth mixture model to obtain the trajectories of cigarette smoking from age 14 to 32. We used logistic regression analyses to examine the associations between the trajectories of smoking and insomnia.

RESULTS

Males were less likely to have insomnia than females (Adjusted odds ratio: AOR = 0.34, p < .05). A higher Bayesian posterior probability (BPP) for the chronic smoking trajectory group (AOR = 2.69, p < .05) and for the moderate smoking trajectory group (AOR = 5.33, p < .01) was associated with an increased likelihood of having insomnia at age 36 compared with the BPP of the no or low smoking trajectory group.

CONCLUSIONS

Prevention and treatment programs for individuals who suffer from insomnia should be implemented in parallel with programs for smoking cessation. From a public health perspective, our longitudinal study that examined the association between earlier smoking trajectories and later insomnia suggests that treatments designed to reduce or cease smoking may lessen the occurrence of symptoms of insomnia.

Insomnia in adults: the impact of earlier cigarette smoking from adolescence to adulthood

OBJECTIVES

This study examined the role of cigarette smoking beginning in adolescence and extending to the fifth decade of life on insomnia at an average age of 43 years in the Children and Adults in the Community Study.

METHODS

Participants were originally assessed in 1983 and came from a community-based random sample of individuals living in 2 upstate New York counties. Participants were assessed over 7 waves of data collection that spanned approximately 29 years, from mean ages 14.1 years (T2) to 42.9 years (T8). We classified the longitudinal trajectories of cigarette use. Five cigarette use trajectory groups were identified: heavy/continuous smokers, late starters, occasional smokers, quitters/decreasers, and nonsmokers.

RESULTS

The result of the logistic regression analysis of adult insomnia for the Bayesian posterior probability of the heavy/continuous smokers when compared with the Bayesian posterior probability of nonsmokers was statistically significant-adjusted odds ratio of 3.35 [95% confidence interval (1.06-10.56; P < 0.05)]-after adjustment for control variables.

CONCLUSIONS

The findings highlight the importance of heavy chronic smoking as contributing to insomnia. Clinicians should focus their efforts on smoking prevention and treatment of younger individuals, as well as promoting cessation among older adult smokers to decrease the likelihood of insomnia.

Sleep hygiene and its association with mood and quality of life in people with epilepsy

OBJECTIVES

We determined whether sleep hygiene is directly related to mood and quality of life (QoL) in people with epilepsy and, if not, documented the indirect effects of sleep hygiene through sleep quality.

METHODS

Data were collected from 150 adults with epilepsy. The Sleep Hygiene Index (SHI), Quality of Life in Epilepsy-10 (QOLIE-10), Hospital Anxiety and Depression Scale (HADS), Sleep Problems Index-2 (SPI-2) of the Medical Outcomes Study-Sleep Scale, and Epworth Sleepiness Scale (ESS) were used. To determine the direct and indirect associations between SHI, mood, and QoL, multiple linear regression analyses and the Sobel test were performed.

RESULTS

Inadequate sleep hygiene behaviors were answered affirmatively by ≥15% of the participants represented by 6 out of 13 items of the SHI. A younger age was independently related to higher SHI scores (p=0.013). The higher SHI scores were directly related to lower QoL independent of sleep quality, anxiety, and depressive symptoms (p<0.05) but not independently related to anxiety and depressive symptoms. The Sobel test confirmed that the SHI scores were associated with anxiety and depressive symptoms through sleep quality (p<0.001).

CONCLUSIONS

Inadequate sleep hygiene is independently related to low QoL but indirectly related to anxiety and depressive symptoms through sleep quality. Patients of a younger age are at risk of poorer sleep hygiene.

Sleep changes in smokers before, during and 3 months after nicotine withdrawal

Nicotine may affect sleep by influencing sleep-regulating neurotransmitters. Sleep disorders can increase the risk for depression and substance dependency. To detect the influence of sleep disturbances on the effect of smoking cessation, we investigated polysomnographically (PSG) the sleep of smoking subjects during a period of smoking, during withdrawal and after a period of abstinence from nicotine. Thirty-three smokers (23 male, 10 female, median age 29 years, Fagerström Test for Nicotine Dependence score 6.3) were examined during smoking, 24-36 hours after smoking and 3 months after cessation. All subjects had an adaptation night followed by the PSG night. Compared with the smoking state, we found increased arousal index and wake time during nicotine withdrawal. Smokers who later relapsed (11) presented a higher degree of nicotine dependence and more withdrawal symptoms than those who abstained (22) and were characterized by less rapid eye movement (REM) sleep, a longer REM latency as well as by more intense sleep impairments in the subjective sleep rating during the withdrawal. Impairments of sleep during the withdrawal phase may reflect more severe nicotine dependence and may contribute to earlier relapse into smoking behaviours.

Combined effect of obstructive sleep apnea and chronic smoking on cognitive impairment

OBJECTIVES

Little is known about combined effect of obstructive sleep apnea (OSA) and chronic smoking on cognitive impairment. We aimed to determine whether smoking synergizes with OSA in deteriorating cognitive function and whether smoking cessation contributes to cognitive benefits.

METHODS

One hundred and eighteen male patients were enrolled in the study and asked to complete neurocognitive function tests including Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), clock drawing test (CDT), and verbal fluency test (VFT). Variables of those neurocognitive function tests were analyzed with two factors: OSA and smoking.

RESULTS

After adjustment of potential confounding factors, an OSA-by-smoking interaction was found in CDT-C scores and a main smoking effect were showed in MoCA scores. Smoking patients with OSA had the worst performance in the four tests compared with the other three groups (smoking patients without OSA, non-smoking patients with and without OSA). Ex-smokers with OSA tended to perform better than current smokers, but still worse than never-smokers with OSA in those tests.

CONCLUSION

The results suggested that the coexistence of OSA and chronic smoking resulted in more pronounced cognitive deficits than either factor along. Smoking cessation may benefit cognitive function to some extents in patients with OSA.

Associations between sleep difficulties and risk factors for cardiovascular disease in veterans and active duty military personnel of the Iraq and Afghanistan conflicts

Recent evidence suggests that sleep disturbance may play an important role in the development of cardiovascular disease (CVD). Despite the prevalence of sleep complaints among service members of recent military conflicts, few studies have examined associations between sleep and risk factors for CVD in this population. Symptom checklist items regarding distress about "trouble falling asleep" and "restless/disturbed sleep" were used as proxies for sleep onset and maintenance difficulties to examine these associations in US military service members of recent conflicts. Veterans having both sleep onset and maintenance difficulties had greater odds of being a current smoker and having psychiatric symptoms and diagnoses. Increased odds of a self-reported hypertension diagnosis and elevated systolic blood pressure were also found in certain subsets of this sample. Findings highlight the need for greater recognition of sleep difficulties as a CVD risk factor in a population known to be at increased risk for this condition.

The impact of active and former smoking on the severity of obstructive sleep apnea

PURPOSE

Although obstructive sleep apnea (OSA) syndrome is a common disorder; the connection between OSA and smoking habits is still controversial. In this study, we investigated whether active smoking and pack × years of smoking have an impact on the severity of the disease regarding the patients with OSA.

METHODS

This study included 964 patients referred to the Sleep Disorders Clinic between 01.01.2007 and 01.03.2013 with an overnight polysomnographic diagnosis of OSA. The correlation between smoking habits and polysomnographic parameters has been studied in detail.

RESULTS

There were 684 male (79 %) and 280 female (21 %) patients, 367 (50.6 %) of whom never smoked. Of all, 20.7 % of the smokers were current smokers (n = 150) while 28.2 % were former smokers (n = 208). Active smokers had a mean age of 49.53 (SD 10.17) while former smokers and never smokers had a mean age of 51.37 (SD 10.62), 54.2 (SD 11.56), respectively, which was statistically significant (p < 0.0001). There was a significant male predominance in smoking (p < 0.0001). In addition, male patients displayed more severe OSA than female patients. (p = 0.001). Desaturation time during sleep was found to be significantly longer in the group of former smokers in comparison to never smokers (73.84 SD 97.1-52 SD 85.8) (p = 0.005). Besides, as the apnea hypopnea index increased, the mean pack × years rose significantly (p = 0.01). Severe smokers compared to mild smokers had higher AHI, lower NREM 3, higher NREM1-2 stages (p = 0. 017, p = 0.007, p < 0.001).

CONCLUSION

In this study, we found that cigarette smoking was associated with early age disease; heavy smokers had more severe OSA.