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Lin MY, Kang YN, Apriliyasari RW, Tsai PS. Association Between Social Jetlag and Components of Metabolic Syndrome: A Systematic Review and Meta-Analysis. J Nurs Res 2024:00134372-990000000-00109. [PMID: 39158856 DOI: 10.1097/jnr.0000000000000628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2024] Open
Abstract
BACKGROUND A mismatch between biological and social time, often referred to as social jetlag (SJL), can lead to inadequate sleep and activities or taking meals at times that do not align with our biological rhythms, increasing the risk of metabolic abnormalities. Although the association between sleep and metabolic syndrome (MetS) is well established, the effects of SJL on MetS and the components of MetS in adults remain unclear. PURPOSE This study was designed to explore the relationship between SJL and MetS components in adults. METHODS A systematic review and meta-analysis was conducted on studies registered in PubMed, Cochrane, Web of Science, and Embase between the inception of each database until November 15, 2023. We focused on studies designed to evaluate the relationship between SJL and either MetS or its components. Only studies using cross-sectional, prospective, or retrospective designs were considered for inclusion. The relationship between SJL and MetS was depicted as an odds ratio with a corresponding 95% confidence interval (CI). We determined the mean differences and 95% CIs to estimate the associations between SJL and MetS components. The Joanna Briggs Institute Critical Appraisal Checklist was used to evaluate the methodological rigor of the selected studies. Data were analyzed using RevMan software Version 5.4. RESULTS The systematic review included 16 studies, with five analyzed via a meta-analysis covering four outcomes, each based on two to three studies. When comparing SJL of less than 1 hour with SJL of 2 hours or more, the latter showed a higher likelihood of MetS (pooled odds ratio: 1.52). Although a significant decrease in systolic blood pressure (pooled mean differences = -3.52 mmHg, 95% CI [-6.41, -0.64]) and a significant increase in waist circumference (pooled mean differences = 2.17 cm, 95% CI [0.61, 3.73]) were observed, the correlation between SJL and diastolic blood pressure failed to reach statistical significance. CONCLUSIONS/IMPLICATIONS FOR PRACTICE The meta-analysis conducted in this study found an association between SJL and MetS. Healthcare practitioners should prioritize the management of sleep quality and duration, especially for individuals exhibiting substantial SJL. Improving sleep can aid in controlling blood pressure and managing weight and should form part of MetS management strategies.
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Affiliation(s)
- Mei-Yu Lin
- PhD, RN, Assistant Professor, Department of Nursing, Tzu Chi University of Science and Technology, Hualien, Taiwan, ROC
| | - Yi-No Kang
- MS, Doctoral Student, Institute of Health Policy and Management, College of Public Health, National Taiwan University; Researcher, Cochrane Taiwan, Taipei Medical University; Consultant, Evidence-Based Medicine Center, Wan Fang Hospital, Taiwan, ROC
| | | | - Pei-Shan Tsai
- PhD, RN, Professor, School of Nursing, College of Nursing, Taipei Medical University; Department of Nursing and Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University; and Research Center of Sleep Medicine, Taipei Medical University Hospital, Taiwan, ROC
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Marhefkova N, Sládek M, Sumová A, Dubsky M. Circadian dysfunction and cardio-metabolic disorders in humans. Front Endocrinol (Lausanne) 2024; 15:1328139. [PMID: 38742195 PMCID: PMC11089151 DOI: 10.3389/fendo.2024.1328139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 04/16/2024] [Indexed: 05/16/2024] Open
Abstract
The topic of human circadian rhythms is not only attracting the attention of clinical researchers from various fields but also sparking a growing public interest. The circadian system comprises the central clock, located in the suprachiasmatic nucleus of the hypothalamus, and the peripheral clocks in various tissues that are interconnected; together they coordinate many daily activities, including sleep and wakefulness, physical activity, food intake, glucose sensitivity and cardiovascular functions. Disruption of circadian regulation seems to be associated with metabolic disorders (particularly impaired glucose tolerance) and cardiovascular disease. Previous clinical trials revealed that disturbance of the circadian system, specifically due to shift work, is associated with an increased risk of type 2 diabetes mellitus. This review is intended to provide clinicians who wish to implement knowledge of circadian disruption in diagnosis and strategies to avoid cardio-metabolic disease with a general overview of this topic.
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Affiliation(s)
- Natalia Marhefkova
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
- First Faculty of Medicine, Charles University, Prague, Czechia
| | - Martin Sládek
- Institute of Physiology, The Czech Academy of Sciences, Prague, Czechia
| | - Alena Sumová
- Institute of Physiology, The Czech Academy of Sciences, Prague, Czechia
| | - Michal Dubsky
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
- First Faculty of Medicine, Charles University, Prague, Czechia
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3
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Dial MB, Malek EM, Cooper AR, Neblina GA, Vasileva NI, Hines DJ, McGinnis GR. Social jet lag impairs exercise volume and attenuates physiological and metabolic adaptations to voluntary exercise training. J Appl Physiol (1985) 2024; 136:996-1006. [PMID: 38450426 PMCID: PMC11305643 DOI: 10.1152/japplphysiol.00632.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/31/2024] [Accepted: 02/26/2024] [Indexed: 03/08/2024] Open
Abstract
Social jet lag (SJL) is a misalignment between sleep and wake times on workdays and free days. SJL leads to chronic circadian rhythm disruption and may affect nearly 70% of the general population, leading to increased risk for cardiometabolic diseases. This study investigated the effects of SJL on metabolic health, exercise performance, and exercise-induced skeletal muscle adaptations in mice. Ten-week-old C57BL/6J mice (n = 40) were allocated to four groups: control sedentary (CON-SED), control exercise (CON-EX), social jet lag sedentary (SJL-SED), and social jet lag exercise (SJL-EX). CON mice were housed under a 12:12-h light-dark cycle. SJL was simulated by implementing a 4-h phase delay for 3 days to simulate "weekends," followed by a 4-h phase advance back to "weekdays," for 6 wk. EX mice had free access to a running wheel. Graded exercise tests (GXTs) and glucose tolerance tests (GTTs) were performed at baseline and after intervention to monitor the effects of exercise and social jet lag on cardiorespiratory and metabolic health, respectively. SJL led to alterations in activity and running patterns and clock gene expression in skeletal muscle and decreased average running distance (P < 0.05). SJL-SED mice gained significantly more weight compared with CON-SED and SJL-EX mice (P < 0.01). SJL impaired fasting blood glucose and glucose tolerance compared with CON mice (P < 0.05), which was partially restored by exercise in SJL-EX mice. SJL also blunted improvements in exercise performance and mitochondrial content in the quadriceps. These data suggest that SJL blunted some cardiometabolic adaptations to exercise and that proper circadian hygiene is necessary for maintaining health and performance.NEW & NOTEWORTHY In mice, disrupting circadian rhythms with social jet lag for 6 wk caused significant weight gain, higher fasting blood glucose, and impaired glucose tolerance compared with control. Voluntary exercise in mice experiencing social jet lag prevented weight gain, though the mice still experienced increased fasting blood glucose and impaired exercise performance compared with trained mice not experiencing social jet lag. Social jet lag seems to be a potent circadian rhythm disruptor that impacts exercise-induced training adaptations.
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Affiliation(s)
- Michael B Dial
- Department of Kinesiology and Nutrition Sciences, School of Integrated Health Sciences, University of Nevada, Las Vegas, Nevada, United States
| | - Elias M Malek
- Department of Kinesiology and Nutrition Sciences, School of Integrated Health Sciences, University of Nevada, Las Vegas, Nevada, United States
| | - Austin R Cooper
- Department of Kinesiology and Nutrition Sciences, School of Integrated Health Sciences, University of Nevada, Las Vegas, Nevada, United States
| | - Greco A Neblina
- Department of Kinesiology and Nutrition Sciences, School of Integrated Health Sciences, University of Nevada, Las Vegas, Nevada, United States
| | - Nikoleta I Vasileva
- Department of Kinesiology and Nutrition Sciences, School of Integrated Health Sciences, University of Nevada, Las Vegas, Nevada, United States
| | - Dustin J Hines
- Department of Psychology, Psychological and Brain Sciences and Interdisciplinary Neuroscience Programs, University of Nevada, Las Vegas, Nevada, United States
| | - Graham R McGinnis
- Department of Kinesiology and Nutrition Sciences, School of Integrated Health Sciences, University of Nevada, Las Vegas, Nevada, United States
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4
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Núñez-Baila MÁ, Gómez-Aragón A, Marques-Silva AM, González-López JR. Lifestyle in Emerging Adults with Type 1 Diabetes Mellitus: A Qualitative Systematic Review. Healthcare (Basel) 2024; 12:309. [PMID: 38338194 PMCID: PMC10855310 DOI: 10.3390/healthcare12030309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Emerging adulthood is a transitional stage with significant lifestyle changes, making it especially challenging for those living with type 1 diabetes mellitus. This systematic review synthesizes qualitative research to explore how emerging adulthood (18-29 years) influences lifestyle behaviors in individuals with type 1 diabetes mellitus. CINAHL, Cochrane Library, Global Health, Nursing & Allied Health Premium, PsycINFO, PubMed, Scopus, and WOS were searched for original qualitative studies addressing the lifestyle of 18-31-year-olds with type 1 diabetes mellitus, published between January 2010 and March 2021 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Thirty-five studies met the inclusion criteria and their findings were categorized into eight topics (emotions and feelings, nutrition, perceptions, risky behaviors, self-care, sleep, social relationships, and stigma) using meta-aggregation, as outlined in the Joanna Briggs Institute Manual for Evidence Synthesis. The spontaneity characteristic of emerging adulthood can undermine self-care. This is because new environments, schedules, and relationships encountered during this life stage often lead to the neglect of diabetes management, owing to the various social, academic, and occupational demands. This review highlights the necessity of creating health promotion strategies tailored to the unique lifestyle aspects of emerging adults with type 1 diabetes mellitus.
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Affiliation(s)
- María-Ángeles Núñez-Baila
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, Universidad de Sevilla, 41009 Seville, Spain; (M.-Á.N.-B.); (J.R.G.-L.)
| | - Anjhara Gómez-Aragón
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, Universidad de Sevilla, 41009 Seville, Spain; (M.-Á.N.-B.); (J.R.G.-L.)
| | - Armando-Manuel Marques-Silva
- Department of Nursing, Escola Superior de Enfermagem de Coimbra, 3004-011 Coimbra, Portugal;
- Unidade de Investigação em Ciências da Saúde: Enfermagem (UICISA: E), 3004-011 Coimbra, Portugal
| | - José Rafael González-López
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, Universidad de Sevilla, 41009 Seville, Spain; (M.-Á.N.-B.); (J.R.G.-L.)
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Dermanowski MM, Wichniak A, Hejduk A, Kuczyńska J, Dominiak M, Mierzejewski P. Behavioural Parameters of Circadian Rhythm Are Not Correlated with Dim Light Melatonin Onset: An Observational Study on Healthy Volunteers. J Clin Med 2023; 12:7757. [PMID: 38137826 PMCID: PMC10743549 DOI: 10.3390/jcm12247757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/06/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
Dim light melatonin onset (DLMO) is considered the most reliable marker of the circadian rhythm phase in humans. DLMO may moderately correlate with sleep onset and sleep offset time. There are no sufficient data about the correlations between DLMO and clinical scales assessing sleep quality and daytime symptoms of poor night sleep. The aim of the study was to determine the association between DLMO and basic sleep parameters from actigraphy and sleep diaries, as well as the association between DLMO and the following insomnia clinical scales: the Athens Insomnia Scale (AIS), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and chronotype questionnaires: Morningness-Eveningness Questionnaire (MEQ) and Composite Scale of Morningness (CSM). Participants of the study were healthy volunteers. Sleep parameters were measured by sleep diaries and actigraphy, and the following clinical scales: the AIS, ISI, and ESS, and chronotype questionnaires: MEQ and CSM. DLMO was calculated based on plasma melatonin concentration. The blood samples were collected hourly at five time points between 20:00 and 00:00 during the session in dim red light (<50 lux). Melatonin concertation was determined by LC-MS/MS. Twenty-one volunteers participated in the study. DLMO was calculated in 12 participants. There was a significant correlation between DLMO and ISI (r = 0.60, p = 0.038) and ESS (r = 0.61, p = 0.034). The correlation coefficient between the DLMO and the AIS was also high, however insignificant (r = 0.57, p = 0.054). There were no significant correlations between DLMO and chronotype scales MEQ and CSM. DLMO did not correlate with sleep onset and sleep offset; however, DLMO correlated with the Sleep Fragmentation Index (SFI) (r = 0.67, p = 0.017). DLMO is associated with poorer sleep maintenance, a stronger feeling of insomnia, and sleepiness during the day. Simultaneously, chronotype pattern and circadian rhythm parameters do not correlate with DLMO. Biological circadian rhythm does not reflect the real-life sleep-wake rhythm, indicating that the lifestyle is more often disconnected from the biological clock.
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Affiliation(s)
- Michał Mateusz Dermanowski
- Department of Pharmacology, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957 Warsaw, Poland; (M.M.D.); (J.K.); (M.D.)
| | - Adam Wichniak
- Third Department of Psychiatry, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957 Warsaw, Poland;
| | - Arkadiusz Hejduk
- Department of Research and Development, LEK-AM Pharmaceutical Company Ltd., Ostrzykowizna 14A, 05-170 Zakroczym, Poland;
| | - Julita Kuczyńska
- Department of Pharmacology, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957 Warsaw, Poland; (M.M.D.); (J.K.); (M.D.)
| | - Monika Dominiak
- Department of Pharmacology, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957 Warsaw, Poland; (M.M.D.); (J.K.); (M.D.)
| | - Paweł Mierzejewski
- Department of Pharmacology, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957 Warsaw, Poland; (M.M.D.); (J.K.); (M.D.)
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6
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Reutrakul S, Irsheed GA, Park M, Steffen AD, Burke L, Pratuangtham S, Baron KG, Duffecy J, Perez R, Quinn L, Withington MHC, Saleh AH, Loiacono B, Mihailescu D, Martyn-Nemeth P. Association between sleep variability and time in range of glucose levels in patients with type 1 diabetes: Cross-sectional study. Sleep Health 2023; 9:968-976. [PMID: 37709596 PMCID: PMC10840618 DOI: 10.1016/j.sleh.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/16/2023] [Accepted: 07/10/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE Sleep and circadian disturbances emerge as novel factors influencing glycemic control in type 1 diabetes (T1D). We aimed to explore the associations among sleep, behavioral circadian parameters, self-care, and glycemic parameters in T1D. METHODS Seventy-six non-shift-working adult T1D patients participated. Blinded 7-day continuous glucose monitoring (CGM) and hemoglobin A1C (A1C) were collected. Percentages of time-in-range (glucose levels 70-180 mg/dL) and glycemic variability (measured by the coefficient of variation [%CV]) were calculated from CGM. Sleep (duration and efficiency) was recorded using 7-day actigraphy. Variability (standard deviation) of midsleep time was used to represent sleep variability. Nonparametric behavioral circadian variables were derived from actigraphy activity recordings. Self-care was measured by diabetes self-management questionnaire-revised. Multiple regression analyses were performed to identify independent predictors of glycemic parameters. RESULTS Median (interquartile range) age was 34.0 (27.2, 43.1) years, 48 (63.2%) were female, and median (interquartile range) A1C was 6.8% (6.2, 7.4). Sleep duration, efficiency, and nonparametric behavioral circadian variables were not associated with glycemic parameters. After adjusting for age, sex, insulin delivery mode/CGM use, and ethnicity, each hour increase in sleep variability was associated with 9.64% less time-in-range (B = -9.64, 95% confidence interval [-16.29, -2.99], p ≤ .001). A higher diabetes self-management questionnaire score was an independent predictor of lower A1C (B = -0.18, 95% confidence interval [-0.32, -0.04]). CONCLUSION Greater sleep timing variability is independently associated with less time spent in the desirable glucose range in this T1D cohort. Reducing sleep timing variability could potentially lead to improved metabolic control and should be explored in future research. DATA AVAILABILITY STATEMENT Data are available upon a reasonable request to the corresponding author.
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Affiliation(s)
- Sirimon Reutrakul
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Illinois Chicago, Chicago, Illinois, USA.
| | - Ghada Abu Irsheed
- College of Nursing, Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois, USA
| | - Minsun Park
- College of Nursing, Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois, USA
| | - Alana D Steffen
- College of Nursing, Department of Population Health Nursing Science, University of Illinois Chicago, Chicago, Illinois, USA
| | - Larisa Burke
- Office of Research Facilitation, College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
| | - Sarida Pratuangtham
- Department of Bioengineering, University of California San Diego, San Diego, California, USA
| | - Kelly Glazer Baron
- Division of Public Health, Department of Family and Preventive Medicine, The University of Utah, Salt Lake City, Utah, USA
| | - Jennifer Duffecy
- Department of Psychiatry, College of Medicine, University of Illinois Chicago, Chicago, llinois, USA
| | - Rose Perez
- College of Nursing, Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois, USA
| | - Laurie Quinn
- College of Nursing, Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois, USA
| | - Margaret H Clark Withington
- College of Nursing, Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois, USA
| | - Adam Hussain Saleh
- College of Nursing, Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois, USA
| | - Bernardo Loiacono
- College of Nursing, Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois, USA
| | - Dan Mihailescu
- Division of Endocrinology, Cook County Health, Chicago, Illinois, USA
| | - Pamela Martyn-Nemeth
- College of Nursing, Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois, USA
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7
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Velazquez-Arcelay K, Colbran LL, McArthur E, Brand CM, Rinker DC, Siemann JK, McMahon DG, Capra JA. Archaic Introgression Shaped Human Circadian Traits. Genome Biol Evol 2023; 15:evad203. [PMID: 38095367 PMCID: PMC10719892 DOI: 10.1093/gbe/evad203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2023] [Indexed: 12/17/2023] Open
Abstract
When the ancestors of modern Eurasians migrated out of Africa and interbred with Eurasian archaic hominins, namely, Neanderthals and Denisovans, DNA of archaic ancestry integrated into the genomes of anatomically modern humans. This process potentially accelerated adaptation to Eurasian environmental factors, including reduced ultraviolet radiation and increased variation in seasonal dynamics. However, whether these groups differed substantially in circadian biology and whether archaic introgression adaptively contributed to human chronotypes remain unknown. Here, we traced the evolution of chronotype based on genomes from archaic hominins and present-day humans. First, we inferred differences in circadian gene sequences, splicing, and regulation between archaic hominins and modern humans. We identified 28 circadian genes containing variants with potential to alter splicing in archaics (e.g., CLOCK, PER2, RORB, and RORC) and 16 circadian genes likely divergently regulated between present-day humans and archaic hominins, including RORA. These differences suggest the potential for introgression to modify circadian gene expression. Testing this hypothesis, we found that introgressed variants are enriched among expression quantitative trait loci for circadian genes. Supporting the functional relevance of these regulatory effects, we found that many introgressed alleles have associations with chronotype. Strikingly, the strongest introgressed effects on chronotype increase morningness, consistent with adaptations to high latitude in other species. Finally, we identified several circadian loci with evidence of adaptive introgression or latitudinal clines in allele frequency. These findings identify differences in circadian gene regulation between modern humans and archaic hominins and support the contribution of introgression via coordinated effects on variation in human chronotype.
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Affiliation(s)
| | - Laura L Colbran
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Evonne McArthur
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Colin M Brand
- Department of Epidemiology and Biostatistics, University of California, SanFrancisco, California, USA
- Bakar Computational Health Sciences Institute, University of California, SanFrancisco, California, USA
| | - David C Rinker
- Department of Biological Sciences, Vanderbilt University, Nashville, Tennessee, USA
| | - Justin K Siemann
- Department of Biological Sciences, Vanderbilt University, Nashville, Tennessee, USA
| | - Douglas G McMahon
- Department of Biological Sciences, Vanderbilt University, Nashville, Tennessee, USA
| | - John A Capra
- Department of Epidemiology and Biostatistics, University of California, SanFrancisco, California, USA
- Bakar Computational Health Sciences Institute, University of California, SanFrancisco, California, USA
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Bermingham KM, Stensrud S, Asnicar F, Valdes AM, Franks PW, Wolf J, Hadjigeorgiou G, Davies R, Spector TD, Segata N, Berry SE, Hall WL. Exploring the relationship between social jetlag with gut microbial composition, diet and cardiometabolic health, in the ZOE PREDICT 1 cohort. Eur J Nutr 2023; 62:3135-3147. [PMID: 37528259 PMCID: PMC10611873 DOI: 10.1007/s00394-023-03204-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 06/30/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE In this study, we explore the relationship between social jetlag (SJL), a parameter of circadian misalignment, and gut microbial composition, diet and cardiometabolic health in the ZOE PREDICT 1 cohort (NCT03479866). METHODS We assessed demographic, diet, cardiometabolic, stool metagenomics and postprandial metabolic measures (n = 1002). We used self-reported habitual sleep (n = 934) to calculate SJL (difference in mid-sleep time point of ≥ 1.5 h on week versus weekend days). We tested group differences (SJL vs no-SJL) in cardiometabolic markers and diet (ANCOVA) adjusting for sex, age, BMI, ethnicity, and socio-economic status. We performed comparisons of gut microbial composition using machine learning and association analyses on the species level genome bins present in at least 20% of the samples. RESULTS The SJL group (16%, n = 145) had a greater proportion of males (39% vs 25%), shorter sleepers (average sleep < 7 h; 5% vs 3%), and were younger (38.4 ± 11.3y vs 46.8 ± 11.7y) compared to the no-SJL group. SJL was associated with a higher relative abundance of 9 gut bacteria and lower abundance of 8 gut bacteria (q < 0.2 and absolute Cohen's effect size > 0.2), in part mediated by diet. SJL was associated with unfavourable diet quality (less healthful Plant-based Diet Index), higher intakes of potatoes and sugar-sweetened beverages, and lower intakes of fruits, and nuts, and slightly higher markers of inflammation (GlycA and IL-6) compared with no-SJL (P < 0.05 adjusted for covariates); rendered non-significant after multiple testing adjustments. CONCLUSIONS Novel associations between SJL and a more disadvantageous gut microbiome in a cohort of predominantly adequate sleepers highlight the potential implications of SJL for health.
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Affiliation(s)
- Kate M Bermingham
- Department of Nutritional Sciences, King's College London, London, UK
- ZOE Ltd, London, UK
| | - Sophie Stensrud
- Department of Nutritional Sciences, King's College London, London, UK
| | | | - Ana M Valdes
- School of Medicine, University of Nottingham, Nottingham, UK
- Nottingham NIHR Biomedical Research Centre, Nottingham, UK
| | - Paul W Franks
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | | | | | | | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Nicola Segata
- Department CIBIO, University of Trento, Trento, Italy
| | - Sarah E Berry
- Department of Nutritional Sciences, King's College London, London, UK.
| | - Wendy L Hall
- Department of Nutritional Sciences, King's College London, London, UK
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9
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Velazquez-Arcelay K, Colbran LL, McArthur E, Brand C, Rinker D, Siemann J, McMahon D, Capra JA. Archaic Introgression Shaped Human Circadian Traits. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.02.03.527061. [PMID: 36778254 PMCID: PMC9915721 DOI: 10.1101/2023.02.03.527061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Introduction When the ancestors of modern Eurasians migrated out of Africa and interbred with Eurasian archaic hominins, namely Neanderthals and Denisovans, DNA of archaic ancestry integrated into the genomes of anatomically modern humans. This process potentially accelerated adaptation to Eurasian environmental factors, including reduced ultra-violet radiation and increased variation in seasonal dynamics. However, whether these groups differed substantially in circadian biology, and whether archaic introgression adaptively contributed to human chronotypes remains unknown. Results Here we traced the evolution of chronotype based on genomes from archaic hominins and present-day humans. First, we inferred differences in circadian gene sequences, splicing, and regulation between archaic hominins and modern humans. We identified 28 circadian genes containing variants with potential to alter splicing in archaics (e.g., CLOCK, PER2, RORB, RORC), and 16 circadian genes likely divergently regulated between present-day humans and archaic hominins, including RORA. These differences suggest the potential for introgression to modify circadian gene expression. Testing this hypothesis, we found that introgressed variants are enriched among eQTLs for circadian genes. Supporting the functional relevance of these regulatory effects, we found that many introgressed alleles have associations with chronotype. Strikingly, the strongest introgressed effects on chronotype increase morningness, consistent with adaptations to high latitude in other species. Finally, we identified several circadian loci with evidence of adaptive introgression or latitudinal clines in allele frequency. Conclusions These findings identify differences in circadian gene regulation between modern humans and archaic hominins and support the contribution of introgression via coordinated effects on variation in human chronotype.
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Affiliation(s)
| | - Laura L. Colbran
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania
| | | | - Colin Brand
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- Bakar Computational Health Sciences Institute, University of California, San Francisco
| | - David Rinker
- Department of Biological Sciences, Vanderbilt University
| | - Justin Siemann
- Department of Biological Sciences, Vanderbilt University
| | | | - John A. Capra
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- Bakar Computational Health Sciences Institute, University of California, San Francisco
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10
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Griggs S, Irani E, Strohl KP, Al-Kindi S, Rajagopalan S, Crawford SL, Margevicius S, Hickman RL. Sleep health dimensions are associated with next-day symptoms in young adults with type 1 diabetes. Sleep Health 2023; 9:339-345. [PMID: 36567195 PMCID: PMC10287843 DOI: 10.1016/j.sleh.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 10/06/2022] [Accepted: 11/07/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE We investigated intra-individual reciprocal associations between sleep health dimensions (individual and composite) and symptoms among young adults with type 1 diabetes (T1D). DESIGN AND MEASUREMENTS Cross-lagged multilevel models were used to analyze electronic diary-reported sleep and symptom patterns over 7 days at waketime in 42 young adults with T1D. Sleep health dimensions included regularity, satisfaction, alertness, timing, efficiency (percentage of time spent asleep), and duration (total sleep time) and symptoms included mood, fatigue, and pain. Covariates included biological sex and age. SETTING AND PARTICIPANTS We recruited young adults (mean age 21.5 ± 2.1 years, HbA1c 6.8%, 85% female, 10% gender minority) with T1D for at least 6 months and no other major medical or psychiatric comorbidity from social media platforms, the College Diabetes Network, and ResearchMatch. RESULTS On days with a better sleep health composite, participants reported lower next-day symptoms (higher mood, lower fatigue, and lower pain) and on days when participants reported lower symptoms, participants reported better sleep health (as a composite). Several individual sleep health dimensions led to lower next-day symptoms (eg, higher satisfaction, alertness, and efficiency and higher mood); however, symptoms were no longer predictive of next-day sleep when controlling for prior day sleep. CONCLUSIONS Optimal sleep health is an antecedent of fewer next day symptoms. Sleep health dimensions likely have positive additive effects on lower symptoms as some of the individual sleep health dimensions were not significantly associated with some symptoms among young adults with T1D.
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Affiliation(s)
- Stephanie Griggs
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, Ohio, USA.
| | - Elliane Irani
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, Ohio, USA
| | - Kingman P Strohl
- Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA
| | - Sadeer Al-Kindi
- Center for Vascular Metabolic Disease, School of Medicine, Cleveland, Ohio, USA; Cardiovascular Research Institute, Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA
| | - Sanjay Rajagopalan
- Cardiovascular Research Institute, Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA
| | - Sybil L Crawford
- UMass Chan Medical School, Tan Chingfen Graduate School of Nursing, Worcester, Massachusetts, USA
| | - Seunghee Margevicius
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Case Comprehensive Cancer Center, School of Medicine, Cleveland, Ohio, USA
| | - Ronald L Hickman
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, Ohio, USA
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11
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Griggs S, Pignatiello G, Hickman RL. A composite measure of sleep health is associated with glycaemic target achievement in young adults with type 1 diabetes. J Sleep Res 2023; 32:e13784. [PMID: 36372966 PMCID: PMC10176021 DOI: 10.1111/jsr.13784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022]
Abstract
We investigated whether sleep health (each individual dimension and a composite measure) was associated with better glycaemia among a cohort of young adults with type 1 diabetes (mean age 21.5 years, mean body mass index 24.55 kg m-2 ). Multiple validated self-report questionnaires were completed, and raw continuous glucose monitor data were shared. One self-reported sleep characteristic for each of the five sleep health dimensions was selected. A composite score was calculated by summing the number of "good" sleep health dimensions. We evaluated the associations between sleep health and glycaemia, and whether covariates, including age, type 1 diabetes duration and sleep apnea risk, influenced the relationships among the study variables using multivariable linear regression. Individual dimensions of sleep satisfaction (β = 0.380, p = 0.019; β = -0.414, p = 0.010), timing (β = 0.392, p = 0.015; β = -0.393, p = 0.015) and sleep efficiency (β = 0.428, p = 0.007) were associated with higher achievement of glycaemic targets (J-index and time in range); however, these associations did not persist after considering covariates. A better Sleep Health Composite score was associated with higher achievement of glycaemic targets even after considering covariates. Using a multidimensional framework can guide future research on causal pathways between sleep and diabetes health, interventions to target sleep health profiles, and may improve sleep screening in routine diabetes care.
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Affiliation(s)
- Stephanie Griggs
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Grant Pignatiello
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ronald L Hickman
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
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12
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Šmon J, Kočar E, Pintar T, Dolenc-Grošelj L, Rozman D. Is obstructive sleep apnea a circadian rhythm disorder? J Sleep Res 2023:e13875. [PMID: 36922163 DOI: 10.1111/jsr.13875] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 02/06/2023] [Accepted: 02/28/2023] [Indexed: 03/17/2023]
Abstract
Obstructive sleep apnea is the most common sleep-related breathing disorder worldwide and remains underdiagnosed. Its multiple associated comorbidities contribute to a decreased quality of life and work performance as well as an increased risk of death. Standard treatment seems to have limited effects on cardiovascular and metabolic aspects of the disease, emphasising the need for early diagnosis and additional therapeutic approaches. Recent evidence suggests that the dysregulation of circadian rhythms, processes with endogenous rhythmicity that are adjusted to the environment through various cues, is involved in the pathogenesis of comorbidities. In patients with obstructive sleep apnea, altered circadian gene expression patterns have been demonstrated. Obstructive respiratory events may promote circadian dysregulation through the effects of sleep disturbance and intermittent hypoxia, with subsequent inflammation and disruption of neural and hormonal homeostasis. In this review, current knowledge on obstructive sleep apnea, circadian rhythm regulation, and circadian rhythm sleep disorders is summarised. Studies that connect obstructive sleep apnea to circadian rhythm abnormalities are critically evaluated. Furthermore, pathogenetic mechanisms that may underlie this association, most notably hypoxia signalling, are presented. A bidirectional relationship between obstructive sleep apnea and circadian rhythm dysregulation is proposed. Approaching obstructive sleep apnea as a circadian rhythm disorder may prove beneficial for the development of new, personalised diagnostic, therapeutic and prognostic tools. However, further studies are needed before the clinical approach to obstructive sleep apnea includes targeting the circadian system.
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Affiliation(s)
- Julija Šmon
- Institute of Clinical Neurophysiology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Centre for Functional Genomics and Bio-Chips, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Eva Kočar
- Centre for Functional Genomics and Bio-Chips, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tadeja Pintar
- Department of Abdominal Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Leja Dolenc-Grošelj
- Institute of Clinical Neurophysiology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Department of Neurology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Damjana Rozman
- Centre for Functional Genomics and Bio-Chips, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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13
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Griggs S, Hernandez E, Bolton PJ, Strohl KP, Grey M, Kashyap SR, Li CSR, Hickman RL. Cognitive Behavioral Sleep Self-Management Intervention for Young Adults With Type 1 Diabetes (NCT04975230). Clin Nurs Res 2023; 32:560-570. [PMID: 36788436 PMCID: PMC10249334 DOI: 10.1177/10547738231154133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The purpose of this study was to explore perceptions of the first dose of a cognitive behavioral sleep self-management intervention (CB-sleep) among young adults aged 18 to 25 years with type 1 diabetes (T1D). We used a qualitative descriptive approach to conduct in-depth semi-structured focused interviews with a purposive sample of 16 young adults with T1D, transitioning from adolescence to early adulthood. Interviews were audio-recorded, transcribed verbatim, and analyzed using qualitative content analysis. Participants described their sleep knowledge (previous, new, and additional), sleep health goals, along with barriers and facilitators of the CB-sleep intervention. Based on these results, we suggest CB-sleep is a useful modality with the potential to support sleep self-management in young adults with T1D during this complex life transition. Furthermore, CB-sleep could be incorporated into an existing diabetes self-management education and support program after pilot testing and determining efficacy to improve sleep and glycemic health.
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14
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Valiensi SM, Folgueira AL, Diez JJ, Gonzalez-Cardozo A, Vera VA, Camji JM, Alvarez AM. Is Being a Lark Healthier for Patients with Type 1 Diabetes Mellitus? Sleep Sci 2023; 16:75-83. [PMID: 37151767 PMCID: PMC10157834 DOI: 10.1055/s-0043-1767749] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 07/27/2022] [Indexed: 05/09/2023] Open
Abstract
Background Sleep quality and mood have been evaluated in type 1 diabetic (T1DM) patients, but chronotypes were not studied. Our objectives were to analyze chronotypes, sleep and mood variables and to describe their association with some metabolic variables in this population. Methods An observational, cross-sectional study was performed. Adults with a diagnosis of T1DM were included. We evaluated chronotypes by the Morningness-Eveningness Questionnaires, sleep quality by Pittsburgh Sleep Quality Index (PSQI), excessive daytime sleepiness by Epworth Sleepiness Scale (ESS), symptoms of depression by Patient Health Questionnaire - 9 (PHQ-9) and emotional well-being by Emotional Well Being Index (IWHO-5). A few metabolic variables were included. Results Ninety-five patients participated. The mean age was 38 years old (range 18-70). The average body mass index (BMI) was 24.4 Kg/m 2 (standard deviation [SD]: 4.6). Out of the total sample, 52.6% were males. The Intermediate chronotype was predominant: n = 56 (55%). We found poor quality of sleep in 67.4% of the sample, excessive daytime sleepiness in 14.7%, depressive symptoms in 6.3% by PHQ9 and low perception of well-being by IWHO-5 in 16.8%. Evening chronotype scored worse in sleep quality ( p = 0.05) and had lower well-being ( p = 0.03) compared with the other chronotypes. Higher MEQ values (morningness) correlated with lower height ( p = 0.043), lower values in the PSQI ( p = 0.021); and higher values in emotional well-being ( p = 0.040). Conclusions We found that the predominant chronotype in T1DM was the intermediate. Two-thirds reported poor quality of sleep and 14,7% excessive daytime sleepiness. Possible diagnosis of a depressive disorder in 6.3% and poor self-perception of emotional well-being in 16. 8% were observed. The morning chronotype had significant correlation with better sleep quality and higher scores in emotional well-being.
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Affiliation(s)
- Stella Maris Valiensi
- Hospital Italiano de Buenos Aires, Neurología, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
- Address for correspondence Stella Maris Valiensi
| | - Agustín Leandro Folgueira
- Hospital Italiano de Buenos Aires, Neurología, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Joaquin Jose Diez
- Instituto Panamericano de Medicina del Sueño y Cronobiología, Psichiatry, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Agustin Gonzalez-Cardozo
- Hospital Italiano de Buenos Aires, Neurología, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Vanesa Antonella Vera
- Hospital Italiano de Buenos Aires, Neurología, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Julieta Marina Camji
- Hospital Italiano de Buenos Aires, Neurología, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Adriana Mabel Alvarez
- Hospital Italiano, Endocrinology, Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
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15
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Botella-Serrano M, Velasco JM, Sánchez-Sánchez A, Garnica O, Hidalgo JI. Evaluating the influence of sleep quality and quantity on glycemic control in adults with type 1 diabetes. Front Endocrinol (Lausanne) 2023; 14:998881. [PMID: 36896174 PMCID: PMC9989462 DOI: 10.3389/fendo.2023.998881] [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: 07/20/2022] [Accepted: 01/19/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Sleep quality disturbances are frequent in adults with type 1 diabetes. However, the possible influence of sleep problems on glycemic variability has yet to be studied in depth. This study aims to assess the influence of sleep quality on glycemic control. MATERIALS AND METHODS An observational study of 25 adults with type 1 diabetes, with simultaneous recording, for 14 days, of continuous glucose monitoring (Abbott FreeStyle Libre system) and a sleep study by wrist actigraphy (Fitbit Ionic device). The study analyzes, using artificial intelligence techniques, the relationship between the quality and structure of sleep with time in normo-, hypo-, and hyperglycemia ranges and with glycemic variability. The patients were also studied as a group, comparing patients with good and poor sleep quality. RESULTS A total of 243 days/nights were analyzed, of which 77% (n = 189) were categorized as poor quality and 33% (n = 54) as good quality. Linear regression methods were used to find a correlation (r =0.8) between the variability of sleep efficiency and the variability of mean blood glucose. With clustering techniques, patients were grouped according to their sleep structure (characterizing this structure by the number of transitions between the different sleep phases). These clusters showed a relationship between time in range and sleep structure. CONCLUSIONS This study suggests that poor sleep quality is associated with lower time in range and greater glycemic variability, so improving sleep quality in patients with type 1 diabetes could improve their glycemic control.
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Affiliation(s)
- Marta Botella-Serrano
- Endocrinology and Nutrition Service, Hospital Universitario Príncipe de Asturias, Madrid, Spain
- *Correspondence: Marta Botella-Serrano, ; Jose Manuel Velasco, ; J. Ignacio Hidalgo,
| | - Jose Manuel Velasco
- Computer Architecture and Automation Department, Universidad Complutense de Madrid, Madrid, Spain
- *Correspondence: Marta Botella-Serrano, ; Jose Manuel Velasco, ; J. Ignacio Hidalgo,
| | | | - Oscar Garnica
- Computer Architecture and Automation Department, Universidad Complutense de Madrid, Madrid, Spain
| | - J. Ignacio Hidalgo
- Computer Architecture and Automation Department, Universidad Complutense de Madrid, Madrid, Spain
- *Correspondence: Marta Botella-Serrano, ; Jose Manuel Velasco, ; J. Ignacio Hidalgo,
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16
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Perfect MM, Silva GE, Chin CN, Wheeler MD, Frye SS, Mullins V, Quan SF. Extending sleep to improve glycemia: The Family Routines Enhancing Adolescent Diabetes by Optimizing Management (FREADOM) randomized clinical trial protocol. Contemp Clin Trials 2023; 124:106929. [PMID: 36441106 DOI: 10.1016/j.cct.2022.106929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 02/06/2023]
Abstract
Sleep deficiencies amongst individuals with type 1 diabetes mellitus (T1DM) have been linked with dysregulated glycemic control and greater morbidities. Sleep extension (EXT) has been identified as a viable intervention target to improve adolescent outcomes. The intervention aims to emphasize collaborative work with families to engage in behaviors that increase the likelihood of the youth increasing their sleep duration consistently. This study will randomize up to 175 youth with T1DM and at least one caregiver to either an EXT intervention or a family routines support (FRS) consultation. It is hypothesized that the EXT condition will lead to improvements in sleep, which in turn, will contribute to improved glycemic control. The primary endpoint is improved glycemic control assessed via a continuous glucose monitor (CGM) to ascertain average glucose levels across a week, glycemic variability, and percent time in the target range at one month and HbA1c at three months. Analyses will control for co-morbid conditions, including sleep-disordered breathing and obesity. This study will provide the needed data to support addressing sleep as part of the standards of care in youth with T1DM.
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Affiliation(s)
- Michelle M Perfect
- Department of Disability and Psychoeducational Studies, College of Education, 1430 E 2nd St., University of Arizona, Tucson, AZ 85721, United States of America.
| | - Graciela E Silva
- College of Nursing, University of Arizona, Tucson, AZ 85721, United States of America
| | - Cindy N Chin
- Pediatrics, Division of Endocrinology, 1501 N. Campbell, Tucson, AZ 85724, United States of America
| | - Mark D Wheeler
- Pediatrics, Division of Endocrinology, 1501 N. Campbell, Tucson, AZ 85724, United States of America
| | - Sara S Frye
- Department of Disability and Psychoeducational Studies, College of Education, 1430 E 2nd St., University of Arizona, Tucson, AZ 85721, United States of America
| | - Vicky Mullins
- Department of Disability and Psychoeducational Studies, College of Education, 1430 E 2nd St., University of Arizona, Tucson, AZ 85721, United States of America
| | - Stuart F Quan
- Asthma and Airway Disease Research Center, University of Arizona College of Medicine, Tucson, AZ 85724, United States of America; Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States of America
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17
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Zhang C, Qin G. Irregular sleep and cardiometabolic risk: Clinical evidence and mechanisms. Front Cardiovasc Med 2023; 10:1059257. [PMID: 36873401 PMCID: PMC9981680 DOI: 10.3389/fcvm.2023.1059257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 01/31/2023] [Indexed: 02/19/2023] Open
Abstract
Sleep regularity is an essential part of the multidimensional sleep health framework. The phenomenon of irregular sleep patterns is widespread in contemporary lifestyles. This review synthesizes clinical evidence to summarize the measures of sleep regularity and discusses the role of different sleep regularity indicators in developing cardiometabolic diseases (coronary heart disease, hypertension, obesity, and diabetes). Existing literature has proposed several measurements to assess sleep regularity, mainly including the standard deviation (SD) of sleep duration and timing, sleep regularity index (SRI), interdaily stability (IS), and social jetlag (SJL). Evidence on associations between sleep variability and cardiometabolic diseases varies depending on the measure used to characterize variability in sleep. Current studies have identified a robust association between SRI and cardiometabolic diseases. In comparison, the association between other metrics of sleep regularity and cardiometabolic diseases was mixed. Meanwhile, the associations of sleep variability with cardiometabolic diseases differ across the population. SD of sleep characteristics or IS may be more consistently associated with HbA1c in patients with diabetes compared with the general population. The association between SJL and hypertension for patients with diabetes was more accordant than in the general population. Interestingly, the age-stratified association between SJL and metabolic factors was observed in the present studies. Furthermore, the relevant literature was reviewed to generalize the potential mechanisms through which irregular sleep increases cardiometabolic risk, including circadian dysfunction, inflammation, autonomic dysfunction, hypothalamic-pituitary-adrenal (HPA) axis disorder, and gut dysbiosis. Health-related practitioners should give more attention to the role of sleep regularity on human cardiometabolic in the future.
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Affiliation(s)
- Chengjie Zhang
- First School of Clinical Medicine, Shanxi Medical University, Taiyuan, China
| | - Gang Qin
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, China
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18
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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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19
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Gauthier P, Desir C, Plombas M, Joffray E, Benhamou P, Borel A. Impact of sleep and physical activity habits on real‐life glycaemic variability in patients with type 2 diabetes. J Sleep Res 2022; 32:e13799. [PMID: 36495012 DOI: 10.1111/jsr.13799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 11/23/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022]
Abstract
The aim of this study was to better characterise whether sleep habits, eating schedule and physical activity in real-life are associated with glycaemic control in patients with type 2 diabetes. A total of 28 patients (aged 60 years [58; 66], 54% female) with type 2 diabetes treated with basal-bolus insulin therapy administered by insulin pumps were analysed. Glycaemic data measured by Flash Glucose Monitor System, physical activity and sleep data measured by accelerometer, and meal schedules were simultaneously collated with insulin pump administration data, for 7 days in real-life. Their respective impact on the time spent in target, in hypoglycaemia, in hyperglycaemia and on glycaemic variability was evaluated. Multiple regressions showed that the total daily dose of meal boluses of insulin was inversely associated with the coefficient of variation (CV; coefficient β = -0.073; 95% confidence interval: -0.130, -0.015; p = 0.016), as well as sleep duration. The higher the sleep duration, the lower the glycaemic variability (coefficient β = -0.012; 95% confidence interval: -0.023, -0.002; p = 0.027). The mean 7 days physical activity of the subjects was very low and was not associated with glycaemic control on the 7 days mean values. However, days with at least 1 hr spent in physical activity higher than 1.5 METs were associated with less glycaemic variability that same day. This real-life observation highlights the importance of sufficient sleep duration and regular physical activity to lessen the glycaemic variability of patients with type 2 diabetes.
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Affiliation(s)
| | | | | | | | - Pierre‐Yves Benhamou
- Laboratory of Fundamental and Applied Bioenergetics, Inserm U1055 Univ. Grenoble Alpes Grenoble France
- Department of Endocrinology Diabetology Nutrition Grenoble Alpes University Hospital Grenoble France
| | - Anne‐Laure Borel
- Department of Endocrinology Diabetology Nutrition Grenoble Alpes University Hospital Grenoble France
- Hypoxia‐physiopathology laboratory, Inserm U1300 Univ. Grenoble Alpes Grenoble France
- Centre Spécialisé de l'Obésité Grenoble Arc Alpin Grenoble France
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20
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Zhu B, Wang Y, Yuan J, Mu Y, Chen P, Srimoragot M, Li Y, Park CG, Reutrakul S. Associations between sleep variability and cardiometabolic health: A systematic review. Sleep Med Rev 2022; 66:101688. [PMID: 36081237 DOI: 10.1016/j.smrv.2022.101688] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 08/02/2022] [Accepted: 08/02/2022] [Indexed: 12/13/2022]
Abstract
This review explored the associations between sleep variability and cardiometabolic health. It was performed following PRISMA guidelines. We identified 63 studies. Forty-one studies examined the association between sleep variability and body composition, with 29 examined body mass index (BMI). Thirteen studies used social jet lag (SJL), n = 30,519, with nine reporting a null association. Eight studies used variability in sleep duration (n = 33,029), with five reporting a correlation with BMI. Fourteen studies (n = 133,403) focused on overweight/obesity; significant associations with sleep variability were found in 11 (n = 120,168). Sleep variability was associated with weight gain (seven studies; n = 79,522). Twenty-three studies examined glucose outcomes. The association with hemoglobin A1c (16 studies, n = 11,755) differed depending on populations, while associations with diabetes or glucose were mixed, and none were seen with insulin resistance (five studies; n = 6416). Sixteen studies examined cardiovascular-related outcomes, with inconsistent results. Overall significant associations were found in five studies focusing on metabolic syndrome (n = 7413). In summary, sleep variability was likely associated with obesity, weight gain, and metabolic syndrome. It might be associated with hemoglobin A1c in people with type 1 diabetes. The associations with other outcomes were mixed. This review highlighted the possible association between sleep variability and cardiometabolic health.
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Affiliation(s)
- Bingqian Zhu
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Yueying Wang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Jinjin Yuan
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Yunping Mu
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Pei Chen
- Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | | | - Yan Li
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, China
| | - Chang G Park
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Sirimon Reutrakul
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Illinois Chicago, Chicago, IL, USA.
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21
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Rutters F, Nefs G. Sleep and Circadian Rhythm Disturbances in Diabetes: A Narrative Review. Diabetes Metab Syndr Obes 2022; 15:3627-3637. [PMID: 36439294 PMCID: PMC9694979 DOI: 10.2147/dmso.s354026] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022] Open
Abstract
Sleep and circadian rhythm disturbances are less-known risk factors for the development and suboptimal outcomes of diabetes. The goal of this narrative review is to highlight the importance of sleep and circadian rhythm disturbances in the development and outcomes of type 1 diabetes (T1D) and type 2 diabetes (T2D), assess current treatment options and the possible mediating mechanisms. We performed a literature search using PubMed and selected relevant English and Dutch papers. Disturbances of sleep and circadian rhythm are common in people with diabetes. They are associated with an increased risk of developing T2D as well as with suboptimal diabetes outcomes (including higher HbA1c levels and reduced quality of life) for T1D and T2D. Preliminary data suggest that treatment of sleep and circadian rhythm disturbances could improve diabetes outcomes in people with T1D and T2D. Finally, the association with medical parameters appears to be mediated by disturbance in hormones, and by suboptimal self-care including forgetting or postponing glucose monitoring or medication use as well as higher consumption of high fat/high sugary foods. Diabetes may also disturb sleep, for example through nocturnal hypoglycemia and nocturia. We concluded that sleep and circadian rhythm disturbances are closely linked with diabetes. More attention to sleep in regular diabetes care is warranted, while further research is needed on treatment of sleep and circadian rhythm disturbances in the prevention of diabetes and its suboptimal outcomes.
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Affiliation(s)
- Femke Rutters
- Department of Epidemiology and Data Science, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Giesje Nefs
- Department of Medical Psychology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
- Diabeter, Center for Type 1 Diabetes Care and Research, Rotterdam, the Netherlands
- Department of Medical and Clinical Psychology, CoRPS - Center of Research on Psychological Disorders and Somatic Diseases, Tilburg University, Tilburg, the Netherlands
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22
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Bouman EJ, Beulens JWJ, Groeneveld L, de Kruijk RS, Schoonmade LJ, Remmelzwaal S, Elders PJM, Rutters F. The association between social jetlag and parameters of metabolic syndrome and type 2 diabetes: a systematic review and meta‐analysis. J Sleep Res 2022; 32:e13770. [PMID: 36351658 DOI: 10.1111/jsr.13770] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 09/20/2022] [Accepted: 09/28/2022] [Indexed: 11/11/2022]
Abstract
This study aims to determine the association between social jetlag and parameters of metabolic syndrome and type 2 diabetes (T2D) in a systematic review and meta-analysis. A systematic literature search was conducted in PubMed/Embase/Scopus until May 2022. Included studies described an association between social jetlag and parameters of the metabolic syndrome and/or T2D, were available full text and written in English or Dutch. Data extraction and quality assessment were performed on pre-piloted forms independently by two reviewers. Results were meta-analysed using random-effects analysis. A total of 6,290 titles/abstracts were screened, 176 papers were read full-text, 68 studies were included. Three studies were rated as low quality, 27 were moderate, and 38 were high quality. High quality studies showed that having social jetlag compared to no social jetlag was significantly associated with higher body mass index in 20 studies (0.49 kg/m2 , 95% confidence interval [CI] 0.21-0.77; I2 = 100%), higher waist circumference in seven studies (1.11 cm, 95% CI 0.42-1.80; I2 = 25%), higher systolic blood pressure in 10 studies (0.37 mmHg, 95% CI 0.00-0.74; I2 = 94%) and higher glycated haemoglobin in 12 studies (0.42%, 95% CI 0.12- 0.72; I2 = 100%). No statistically significant associations were found for obesity, abdominal obesity, high- and low-density lipoprotein levels, cholesterol, triglycerides, diastolic blood pressure, hypertension, fasting glucose, homeostatic model assessment for insulin resistance, metabolic syndrome or T2D. Sensitivity analyses did not reduce heterogeneity. Despite substantial heterogeneity, social jetlag is associated with certain parameters of the metabolic syndrome and T2D, but not with prevalent metabolic syndrome or T2D. These findings should be interpreted with caution as the level of evidence is low and mostly based on cross-sectional data. Longitudinal studies are needed to further assess the direction of causality.
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Affiliation(s)
- Emma J. Bouman
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science Amsterdam Netherlands
- Amsterdam Public Health Health Behaviors & Chronic Diseases Amsterdam The Netherlands
| | - Joline W. J. Beulens
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science Amsterdam Netherlands
- Amsterdam Public Health Health Behaviors & Chronic Diseases Amsterdam The Netherlands
- Julius Centre for Health Sciences and Primary Care University Medical Centre Utrecht Utrecht the Netherlands
| | - Lenka Groeneveld
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science Amsterdam Netherlands
- Amsterdam Public Health Health Behaviors & Chronic Diseases Amsterdam The Netherlands
| | - Rozemarijn S. de Kruijk
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science Amsterdam Netherlands
- Amsterdam Public Health Health Behaviors & Chronic Diseases Amsterdam The Netherlands
| | | | - Sharon Remmelzwaal
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science Amsterdam Netherlands
- Amsterdam Public Health Health Behaviors & Chronic Diseases Amsterdam The Netherlands
| | - Petra J. M. Elders
- Amsterdam Public Health Health Behaviors & Chronic Diseases Amsterdam The Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, General Practice Amsterdam Netherlands
| | - Femke Rutters
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science Amsterdam Netherlands
- Amsterdam Public Health Health Behaviors & Chronic Diseases Amsterdam The Netherlands
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23
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Martyn-Nemeth P, Duffecy J, Quinn L, Reutrakul S, Steffen AD, Burke L, Clark Withington MH, Irsheed GA, Perez R, Park M, Saleh A, Mihailescu D, Baron KG. Sleep optimization to improve glycemic control in adults with type 1 diabetes: study protocol for a randomized controlled parallel intervention trial. Trials 2022; 23:686. [PMID: 35986415 PMCID: PMC9389486 DOI: 10.1186/s13063-022-06565-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/18/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Despite improvements in treatment regimens and technology, less than 20% of adults with type 1 diabetes (T1D) achieve glycemic targets. Sleep is increasingly recognized as a potentially modifiable target for improving glycemic control. Diabetes distress, poor self-management behaviors, and reduced quality of life have also been linked to sleep variability and insufficient sleep duration. A significant gap of knowledge exists regarding interventions to improve sleep and the effects of sleep optimization on glycemic control in T1D. The purpose of this study is to determine the efficacy of a T1D-specific sleep optimization intervention (Sleep-Opt) on the primary outcomes of sleep variability, sleep duration, and glycemic control (A1C); other glycemic parameters (glycemic variability, time-in-range [TIR]); diabetes distress; self-management behaviors; quality of life; and other patient-reported outcomes in adults with T1D and habitual increased sleep variability or short sleep duration. METHODS A randomized controlled parallel-arm study will be employed in 120 adults (aged 18 to 65 years) with T1D. Participants will be screened for habitual sleep variability (> 1 h/week) or insufficient sleep duration (< 6.5 h per night). Eligible subjects will be randomized to the Sleep-Opt intervention group or healthy living attention control group for 12 weeks. A 1-week run-in period is planned, with baseline measures of sleep by actigraphy (sleep variability and duration), glycemia (A1C and related glycemic measures: glycemic variability and TIR using continuous glucose monitoring), and other secondary outcomes: diabetes distress, self-management behaviors, quality of life, and additional patient-reported outcomes. Sleep-Opt is a technology-assisted behavioral sleep intervention that we recently developed that leverages the rapidly increasing public interest in sleep tracking. Our behavioral intervention employs four elements: a wearable sleep tracker, didactic content, an interactive smartphone application, and brief telephone counseling. The attention control group will participate in a healthy living information program. Baseline measures will be repeated at midpoint, program completion, and post-program (weeks 6, 12, and 24, respectively) to determine differences between the two groups and sustainability of the intervention. DISCUSSION A better understanding of strategies to improve sleep in persons with T1D has the potential to be an important component of diabetes. TRIAL REGISTRATION Clinical Trial Registration: NCT04506151 .
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Affiliation(s)
- Pamela Martyn-Nemeth
- grid.185648.60000 0001 2175 0319Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL USA
| | - Jennifer Duffecy
- grid.185648.60000 0001 2175 0319Department of Psychiatry, College of Medicine, University of Illinois Chicago, Chicago, IL USA
| | - Laurie Quinn
- grid.185648.60000 0001 2175 0319Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL USA
| | - Sirimon Reutrakul
- grid.185648.60000 0001 2175 0319Department of Endocrinology, College of Medicine, University of Illinois Chicago, Chicago, IL USA
| | - Alana D. Steffen
- grid.185648.60000 0001 2175 0319Department of Population Health Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL USA
| | - Larisa Burke
- grid.185648.60000 0001 2175 0319Office of Research Facilitation, College of Nursing, University of Illinois Chicago, Chicago, IL USA
| | - Margaret H. Clark Withington
- grid.185648.60000 0001 2175 0319Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL USA
| | - Ghada Abu Irsheed
- grid.185648.60000 0001 2175 0319Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL USA
| | - Rose Perez
- grid.185648.60000 0001 2175 0319Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL USA
| | - Minsun Park
- grid.185648.60000 0001 2175 0319Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL USA
| | - Adam Saleh
- grid.185648.60000 0001 2175 0319Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL USA
| | - Dan Mihailescu
- Department of Endocrinology, Cook County Health, Chicago, IL USA
| | - Kelly Glazer Baron
- grid.223827.e0000 0001 2193 0096Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT USA
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24
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García-Serrano C, Pujol Salud J, Aran-Solé L, Sol J, Ortiz-Congost S, Artigues-Barberà E, Ortega-Bravo M. Enhancing Night and Day Circadian Contrast through Sleep Education in Prediabetes and Type 2 Diabetes Mellitus: A Randomized Controlled Trial. BIOLOGY 2022; 11:biology11060893. [PMID: 35741413 PMCID: PMC9219735 DOI: 10.3390/biology11060893] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/31/2022] [Accepted: 06/08/2022] [Indexed: 05/01/2023]
Abstract
BACKGROUND Evidence supports a causal relationship between circadian disturbance and impaired glucose homeostasis. METHODS To determine the effect of an educational intervention delivered by primary care nurses to improve sleep hygiene, a parallel, open-label clinical trial in subjects aged 18 and older with impaired fasting glucose (IFG) or type 2 diabetes mellitus (T2DM) was performed. Study variables were sex, age, fasting glucose, glycated haemoglobin A1c (HbA1c), Pittsburgh Sleep Quality Index (PSQI), sleep duration and efficiency, body mass index, antidiabetic treatment, diet and physical exercise. An individual informative educational intervention was carried out following a bidirectional feedback method. The intervention aimed to develop skills to improve sleep through nine simple tips. An analysis of covariance was performed on all the mean centred outcome variables controlling for the respective baseline scores. RESULTS In the intervention group, PSQI dropped, the duration and quality of sleep increased, and a decrease in fasting glucose and in HbA1c levels was observed. CONCLUSION The proposed intervention is effective for improving sleep quality, length and efficiency, and for decreasing fasting glucose and HbA1c levels in only 3 months. These findings support the importance of sleep and circadian rhythm education focused on improving IFG and T2DM.
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Affiliation(s)
- Cristina García-Serrano
- Balaguer Primary Care Centre, Institut Català de la Salut (ICS), 25600 Lleida, Spain; (J.P.S.); (L.A.-S.); (S.O.-C.)
- Research Group in Therapies in Primary Care (GRETAPS), Fundació Institut Universitari per a la Recerca en Atenció Primària de Salut Jordi Gol i Gurina (IDIAP JGol), 25007 Lleida, Spain; (E.A.-B.); (M.O.-B.)
- Correspondence:
| | - Jesús Pujol Salud
- Balaguer Primary Care Centre, Institut Català de la Salut (ICS), 25600 Lleida, Spain; (J.P.S.); (L.A.-S.); (S.O.-C.)
- Biomedical Research Institute (IRB Lleida), University of Lleida (UdL), 25198 Lleida, Spain
| | - Lidia Aran-Solé
- Balaguer Primary Care Centre, Institut Català de la Salut (ICS), 25600 Lleida, Spain; (J.P.S.); (L.A.-S.); (S.O.-C.)
| | - Joaquim Sol
- Catalan Health Institute (ICS), Primary Care Lleida, Rambla Ferran, 44, 25007 Lleida, Spain;
- Research Support Unit (USR), Fundació Institut Universitari per a la Recerca en Atenció Primària de Salut Jordi Gol i Gurina (IDIAP JGol), 25007 Lleida, Spain
- Metabolic Phisiopathology Group, Department of Experimental Medicine, Biomedical Research Institute (IRB Lleida), University of Lleida (UdL), 25198 Lleida, Spain
| | - Sònia Ortiz-Congost
- Balaguer Primary Care Centre, Institut Català de la Salut (ICS), 25600 Lleida, Spain; (J.P.S.); (L.A.-S.); (S.O.-C.)
| | - Eva Artigues-Barberà
- Research Group in Therapies in Primary Care (GRETAPS), Fundació Institut Universitari per a la Recerca en Atenció Primària de Salut Jordi Gol i Gurina (IDIAP JGol), 25007 Lleida, Spain; (E.A.-B.); (M.O.-B.)
- Catalan Health Institute (ICS), Primary Care Lleida, Rambla Ferran, 44, 25007 Lleida, Spain;
- Research Support Unit (USR), Fundació Institut Universitari per a la Recerca en Atenció Primària de Salut Jordi Gol i Gurina (IDIAP JGol), 25007 Lleida, Spain
| | - Marta Ortega-Bravo
- Research Group in Therapies in Primary Care (GRETAPS), Fundació Institut Universitari per a la Recerca en Atenció Primària de Salut Jordi Gol i Gurina (IDIAP JGol), 25007 Lleida, Spain; (E.A.-B.); (M.O.-B.)
- Catalan Health Institute (ICS), Primary Care Lleida, Rambla Ferran, 44, 25007 Lleida, Spain;
- Research Support Unit (USR), Fundació Institut Universitari per a la Recerca en Atenció Primària de Salut Jordi Gol i Gurina (IDIAP JGol), 25007 Lleida, Spain
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25
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Giannoumis M, Mok E, Borkhoff CM, Birken CS, Maguire J, Parkin PC, Li P, Constantin E. Association of accelerometry-derived social jetlag and sleep with temperament in children less than 6 years of age. J Clin Sleep Med 2022; 18:1993-1999. [PMID: 35532114 PMCID: PMC9340604 DOI: 10.5664/jcsm.10056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Social jetlag (SJL) measures the discrepancy between circadian and social clocks. Using accelerometry-derived data, our objective was to assess the prevalence of SJL in young healthy children and determine the association of SJL and sleep with temperament. METHODS Of 117 children participating in TARGet Kids!, a Canadian cohort of healthy preschool-aged children, 78 children (39 girls (50%)); mean age [SD]: 35.1[20.5] months) were included. Sleep was measured objectively using accelerometry. Temperament dimensions (surgency, negative affectivity, and effortful control) were assessed with the very short forms of Rothbart's child and infant behavior questionnaires. We examined associations of SJL and sleep with temperament using multivariable linear regression models adjusted for sex, age, ethnicity, and preschool/daycare attendance. RESULTS 20 out of 78 (25.6%) experienced SJL of greater than 30 minutes. SJL was greater in children who attended preschool/daycare compared with children who did not (26.3[18.8]min vs. 17.6[14.8]min; p<0.05). There was no evidence of an association between SJL and any temperament dimension. We found evidence of an association between increased sleep duration and increased negative affectivity scores (longer 24h sleep (ß:0.347, 95% CI:0.182,0.512, p<0.0001); longer nighttime sleep duration (ß:0.413, 95% CI:0.163,0.663, p=0.002)). CONCLUSIONS In our cohort, 1 in 4 preschool-aged children experienced SJL. Increased sleep duration was associated with increased negative affect, which could have implications for children developing internalizing behavior such as depression or low-self-esteem. We found that sleep duration, but not SJL, was associated with temperament and may impact daytime behavior of young children.
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Affiliation(s)
| | - Elise Mok
- Research Institute, McGill University Health Centre, Montreal, Canada
| | - Cornelia M Borkhoff
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Catherine S Birken
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Jonathon Maguire
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada.,Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Department of Pediatrics, St. Michael's Hospital, Toronto, Canada
| | - Patricia C Parkin
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Patricia Li
- Research Institute, McGill University Health Centre, Montreal, Canada.,Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Canada
| | - Evelyn Constantin
- Research Institute, McGill University Health Centre, Montreal, Canada.,Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Canada
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26
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Sleep improvements on days with later school starts persist after 1 year in a flexible start system. Sci Rep 2022; 12:2787. [PMID: 35181701 PMCID: PMC8857191 DOI: 10.1038/s41598-022-06209-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/10/2022] [Indexed: 11/09/2022] Open
Abstract
Early school times fundamentally clash with the late sleep of teenagers. This mismatch results in chronic sleep deprivation posing acute and long-term health risks and impairing students' learning. Despite immediate short-term benefits for sleep, the long-term effects of later starts remain unresolved. In a pre-post design over 1 year, we studied a unique flexible school start system, in which 10–12th grade students chose daily between an 8:00 or 8:50AM-start. Missed study time (8:00–8:50) was compensated for during gap periods or after classes. Based on 2 waves (6–9 weeks of sleep diary each), we found that students maintained their ~ 1-h-sleep gain on later days, longitudinally (n = 28) and cross-sectionally (n = 79). This gain was independent of chronotype and frequency of later starts but attenuated for boys after 1 year. Students showed persistently better sleep quality and reduced alarm-driven waking and reported psychological benefits (n = 93) like improved motivation, concentration, and study quality on later days. Nonetheless, students chose later starts only infrequently (median 2 days/week), precluding detectable sleep extensions in the flexible system overall. Reasons for not choosing late starts were the need to make up lost study time, preference for extra study time and transport issues. Whether flexible systems constitute an appealing alternative to fixed delays given possible circadian and psychological advantages warrants further investigation.
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27
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Griggs S, Grey M, Strohl KP, Crawford SL, Margevicius S, Kashyap SR, Li CSR, Rajagopalan S, Hickman RL. Variations in Sleep Characteristics and Glucose Regulation in Young Adults With Type 1 Diabetes. J Clin Endocrinol Metab 2022; 107:e1085-e1095. [PMID: 34698348 PMCID: PMC8852208 DOI: 10.1210/clinem/dgab771] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Short sleep duration and sleep disruptions are associated with impaired glucoregulation in type 1 diabetes (T1D). However, the mechanistic pathways between sleep and glucose variability remain unclear. OBJECTIVE To determine within- and between-person associations between objective sleep-wake characteristics and glucose variability indices. METHODS Multilevel models were used to analyze concurrent sleep and glucose patterns over 7 days in 42 young adults with T1D in their natural home environment. Young adults with T1D (mean age 22.2 ± 3.0 years, HbA1c 7.2%, 32.6% male) for at least 6 months with no other medical or major psychiatric comorbidity were included. Sleep-wake characteristics were measured via wrist actigraphy and glucose variability indices via a continuous glucose monitor (CGM). RESULTS Lower sleep efficiency predicted higher glucose variability (less time in range β = 0.011 and more time in hyperglycemia β = -0.011) within-person. A longer wake after sleep onset and more sleep disruptions were associated with higher glucose variability between persons (β = 0.28 and 0.31). Higher glucose variability predicted poorer sleep within-person (delayed bedtime, waketime, mid-sleep time, and lower sleep efficiency), while higher glucose variability was associated with poorer sleep and more sleep disruptions between persons (lower sleep efficiency, longer wake after sleep onset, and a higher sleep fragmentation index). CONCLUSION Clinicians can address the reciprocal nature of the sleep-glucose relationship by optimizing sleep and targeting efforts toward a euglycemic range overnight. Sleep habits are a modifiable personal target in diabetes care.
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Affiliation(s)
- Stephanie Griggs
- Assistant Professor, Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH 44106, USA
- Correspondence: Stephanie Griggs, PhD, RN, Assistant Professor, Case Western Reserve University, Frances Payne Bolton School of Nursing, 10900 Euclid Avenue, Cleveland, OH 44106, USA.
| | - Margaret Grey
- Annie Goodrich Professor of Nursing and Professor of Pediatrics, Yale University, School of Nursing and School of Medicine, West Haven, CT 06477, USA
| | - Kingman P Strohl
- Professor of Medicine, and Physiology and Biophysics, Case Western Reserve University, School of Medicine, Cleveland, OH 44106, USA
| | - Sybil L Crawford
- Professor of Nursing, University of Massachusetts Medical School, Graduate School of Nursing, Worcester, MA 01655, USA
| | - Seunghee Margevicius
- Senior Research Associate, Case Western Reserve University, Department of Population and Quantitative Health Sciences, Case Comprehensive Cancer Center, School of Medicine, Cleveland, OH 44106, USA
| | - Sangeeta R Kashyap
- Professor of Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44106, United States
| | - Chiang-Shan R Li
- Professor of Psychiatry and of Neuroscience, Yale University, School of Medicine, West Haven, CT 06477, USA
| | - Sanjay Rajagopalan
- Professor of Medicine, Director, Cardiovascular Research Institute, Case Western Reserve University, School of Medicine, USA
| | - Ronald L Hickman
- Ruth M. Anderson Endowed Professor of Nursing and Associate Dean for Research, Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH 44106, USA
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28
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Kelly RM, Healy U, Sreenan S, McDermott J, Coogan AN. An exploratory study of associations between sleep timing variability and cardiometabolic health in middle-aged adults with type 2 diabetes mellitus. Chronobiol Int 2022; 39:569-578. [PMID: 35016570 DOI: 10.1080/07420528.2021.2005083] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Sleep is increasingly recognised as an important risk factor for metabolic disease, and as an important influence on severity in established metabolic disease. Recent evidence suggests that sleep timing variability (the day-to-day fluctuations of sleep timing) may be an important factor in metabolic diseases such as type 2 diabetes mellitus. In the current study, we explore the associations between measures of sleep timing variability and cardiometabolic measures in a group of healthy middle-aged adults with and without type 2 diabetes mellitus. Healthy controls (N = 27) and adults with well-controlled uncomplicated type 2 diabetes mellitus (N = 30) wore actiwatches for an average of 9 days for objective assessment of sleep timing parameters, and also underwent a detailed clinical assessment. We found greater self-reported social jetlag in the diabetes group, but no groupwise differences in measures of sleep timing variability. In the diabetes patients, HbA1c levels were inversely correlated with variability in the time of sleep onset and midsleep, and with sleep duration. HOMA-IR did not correlate with any sleep timing variability measure, nor were there associations between sleep timing variability and other metabolic biomarkers (cholesterol, LDL, HDL, triglycerides and uric acid). Systolic blood pressure was inversely correlated with actigraphically defined social jetlag in both the control and diabetes groups. The results of this study indicate associations between sleep timing variability and HbA1c, but the direction of these relationships is at variance with some other recent reports. Our results indicate a need for future hypothesis-testing studies to further explore the impact of sleep timing variance on metabolic health.
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Affiliation(s)
- Rachael M Kelly
- Department of Psychology, Maynooth University, National University of Ireland Maynooth, Kildare, Ireland
| | - Ultan Healy
- Academic Department of Endocrinology and Diabetes, Connolly Hospital Blanchardstown, Dublin, Ireland
| | - Seamus Sreenan
- Academic Department of Endocrinology and Diabetes, Connolly Hospital Blanchardstown, Dublin, Ireland
| | - John McDermott
- Academic Department of Endocrinology and Diabetes, Connolly Hospital Blanchardstown, Dublin, Ireland
| | - Andrew N Coogan
- Department of Psychology, Maynooth University, National University of Ireland Maynooth, Kildare, Ireland
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29
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Fitzpatrick R, Davison G, Wilson JJ, McMahon G, McClean C. Exercise, type 1 diabetes mellitus and blood glucose: The implications of exercise timing. Front Endocrinol (Lausanne) 2022; 13:1021800. [PMID: 36246914 PMCID: PMC9555792 DOI: 10.3389/fendo.2022.1021800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 09/12/2022] [Indexed: 11/25/2022] Open
Abstract
The scientific literature shows that exercise has many benefits for individuals with type 1 diabetes. Yet, several barriers to exercise in this population exist, such as post-exercise hypoglycaemia or hyperglycaemia. Several studies suggest that the timing of exercise may be an important factor in preventing exercise-induced hypoglycaemia or hyperglycaemia. However, there is a paucity of evidence solely focused on summarising findings regarding exercise timing and the impact it has on glucose metabolism in type 1 diabetes. This report suggests that resistance or high-intensity interval exercise/training (often known as HIIT) may be best commenced at the time of day when an individual is most likely to experience a hypoglycaemic event (i.e., afternoon/evening) due to the superior blood glucose stability resistance and HIIT exercise provides. Continuous aerobic-based exercise is advised to be performed in the morning due to circadian elevations in blood glucose at this time, thereby providing added protection against a hypoglycaemic episode. Ultimately, the evidence concerning exercise timing and glycaemic control remains at an embryonic stage. Carefully designed investigations of this nexus are required, which could be harnessed to determine the most effective, and possibly safest, time to exercise for those with type 1 diabetes.
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30
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Caliandro R, Streng AA, van Kerkhof LWM, van der Horst GTJ, Chaves I. Social Jetlag and Related Risks for Human Health: A Timely Review. Nutrients 2021; 13:nu13124543. [PMID: 34960096 PMCID: PMC8707256 DOI: 10.3390/nu13124543] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/11/2021] [Accepted: 12/15/2021] [Indexed: 11/16/2022] Open
Abstract
The term social jetlag is used to describe the discrepancy between biological time, determined by our internal body clock, and social times, mainly dictated by social obligations such as school or work. In industrialized countries, two-thirds of the studying/working population experiences social jetlag, often for several years. Described for the first time in 2006, a considerable effort has been put into understanding the effects of social jetlag on human physiopathology, yet our understanding of this phenomenon is still very limited. Due to its high prevalence, social jetlag is becoming a primary concern for public health. This review summarizes current knowledge regarding social jetlag, social jetlag associated behavior (e.g., unhealthy eating patterns) and related risks for human health.
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Affiliation(s)
- Rocco Caliandro
- Department of Molecular Genetics, Erasmus MC Cancer Institute, Erasmus University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands; (R.C.); (A.A.S.); (G.T.J.v.d.H.)
| | - Astrid A. Streng
- Department of Molecular Genetics, Erasmus MC Cancer Institute, Erasmus University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands; (R.C.); (A.A.S.); (G.T.J.v.d.H.)
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands;
| | - Linda W. M. van Kerkhof
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands;
| | - Gijsbertus T. J. van der Horst
- Department of Molecular Genetics, Erasmus MC Cancer Institute, Erasmus University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands; (R.C.); (A.A.S.); (G.T.J.v.d.H.)
| | - Inês Chaves
- Department of Molecular Genetics, Erasmus MC Cancer Institute, Erasmus University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands; (R.C.); (A.A.S.); (G.T.J.v.d.H.)
- Correspondence: ; Tel.: +31-10-704-3456; Fax: +31-10-704-4743
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Abstract
PURPOSE OF REVIEW To review the relationship between sleep and hypoglycemia, sleep characteristics, and their associations with glycemic control in persons with type 1 diabetes (T1D). The effects of sleep interventions and diabetes technology on sleep are summarized. RECENT FINDINGS Nocturnal hypoglycemia affects objective and subjective sleep quality and is related to behavioral, psychological, and physiological factors. Sleep disturbances are common, including inadequate sleep, impaired sleep efficiency, poor subjective satisfaction, irregular timing, increased daytime sleepiness, and sleep apnea. Some have a bidirectional relationship with glycemic control. Preliminary evidence supports sleep interventions (e.g., sleep extension and sleep coach) in improving sleep and glycemic control, while diabetes technology use could potentially improve sleep. Hypoglycemia and sleep disturbances are common among persons with T1D. There is a need to develop sleep promotion programs and test their effects on sleep, glucose, and related outcomes (e.g., self-care, psychological health).
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Affiliation(s)
- Bingqian Zhu
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Ghada Mohammed Abu Irsheed
- College of Nursing, Department of Biobehavioral Nursing Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Pamela Martyn-Nemeth
- College of Nursing, Department of Biobehavioral Nursing Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Sirimon Reutrakul
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Illinois at Chicago, 835 S. Wolcott Ave, Suite 625E, M/C 640, IL, 60612, Chicago, USA.
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Mota MC, Silva CM, Balieiro LCT, Fahmy WM, Marqueze EC, Moreno CRDC, Crispim CA. Social Jetlag Is Associated With Impaired Metabolic Control During a 1-Year Follow-Up. Front Physiol 2021; 12:702769. [PMID: 34539431 PMCID: PMC8445111 DOI: 10.3389/fphys.2021.702769] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/30/2021] [Indexed: 11/13/2022] Open
Abstract
Previous studies have identified social jetlag (SJL) as a risk factor for non-communicable chronic diseases (NCCDs), but its association with metabolic control over time is unclear in the literature. Therefore, we examined the influence of SJL on metabolic parameters and blood pressure (BP) in patients with NCCDs over a 1-year follow-up. This retrospective, longitudinal study included 625 individuals (age: 56.0 +12.0 years; 76% female) with NCCDs [type 2 diabetes mellitus (TD2), systemic arterial hypertension (SHA), obesity, or dyslipidemia]. SJL was calculated based on the absolute difference between mid-sleep time on weekends and weekdays. Current metabolic parameters and BP of the patients were compared with data from a year prior. Generalized estimating equations (GEE) and multiple linear regression analyses were used to examine the association among SJL, metabolic parameters, and BP. Multiple linear regression analyses adjusted for confounders showed that SJL was positively associated with the delta difference of fasting glucose (β = 0.11, p = 0.02) and triglyceride levels (β = 0.09, p = 0.04) among all subjects with NCCDs, and with fasting glucose (β = 0.30, p = 0.0001) and triglyceride levels (β = 0.22, p = 0.01) in the TD2 group. GEE analysis demonstrated an isolated effect of SJL on diastolic BP. High SJL impaired clinical and metabolic control in individuals with NCCDs, leading to a worse profile after a 1-year follow-up, particularly among type II diabetics.
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Affiliation(s)
- Maria Carliana Mota
- Faculty of Medicine of the Federal University of Uberlândia, Uberlândia, Brazil
| | | | | | | | - Elaine Cristina Marqueze
- Public Health Graduate Program, Department of Epidemiology, Catholic University of Santos, Santos, Brazil.,Department of Health, Life Cycles and Society, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Claudia Roberta de Castro Moreno
- Department of Health, Life Cycles and Society, School of Public Health, University of São Paulo, São Paulo, Brazil.,Stress Research Institute, Department of Psychology, Stockholm University, Stockholm, Sweden
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Griggs S, Strohl KP, Grey M, Barbato E, Margevicius S, Hickman RL. Circadian characteristics of the rest-activity rhythm, executive function, and glucose fluctuations in young adults with type 1 diabetes. Chronobiol Int 2021; 38:1477-1487. [PMID: 34128443 DOI: 10.1080/07420528.2021.1932987] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Circadian alignment is an important element in individual health, and one behavioral marker, rest-activity rhythm, could influence self-management in young adults with type 1 diabetes (T1D). Little is known about the rest-activity rhythms, executive function, and glycemia among young adults with type 1 diabetes (T1D). The purpose of this study was to evaluate parametric and nonparametric circadian characteristics of the rest-activity rhythm and the associations between these variables, sleep-wake behavior, executive function, and glycemia among young adults with T1D. Young adults with T1D, recruited from diabetes clinics, wore wrist actigraphs and a continuous glucose monitor (CGM) concurrently for 6-14 days. Participants completed a 3-minute Trail Making Test on paper and electronic questionnaires - 8-item PROMIS v1.0 Emotional Distress Scale, 17-item Diabetes Distress Scale, including twice-daily Pittsburgh sleep diaries. Cosinor and nonparametric analyses were used to compute the rest-activity rhythm parameters, and linear regression modeling procedures were performed to determine the associations among the study variables. The sample included 46 young adults (mean age 22.3 ± 3.2; 32.6% male; 84.8% non-Hispanic White, HbA1c mean 7.2 ± 1.1%, BMI mean 27.0 ± 4.4 kg/m2). A number of parametric associations were observed between a stronger rhythm, better objective sleep-wake characteristics, and less daytime sleepiness. Nonparametric circadian parameters were significantly associated with several outcomes: a stronger rhythm adherence (higher inter-daily stability) with better objective sleep-wake characteristics, better executive function, lower diabetes distress, less hyperglycemia risk, and more time spent in hypoglycemia/hypoglycemia risk; and a more robust rhythm (higher relative amplitude) with better objective sleep-wake characteristics and more time spent in hypoglycemia/higher hypoglycemia risk. Future work should be directed at designs that test causality, such as interventions directed at the strength and stability of rest-activity rhythms, for the potential to improve glucoregulation and other diabetes outcomes.
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Affiliation(s)
- Stephanie Griggs
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Kingman P Strohl
- Department of Physiology and Biophysics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Margaret Grey
- School of Nursing and School of Medicine, Yale University, West Haven, Connecticut, USA
| | - Eric Barbato
- Department of Genetics and Genome Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Seunghee Margevicius
- Department of Population and Quantitative Health Sciences, School of Medicine, Cleveland, Ohio, USA
| | - Ronald L Hickman
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
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Griggs S, Hickman RL, Strohl KP, Redeker NS, Crawford SL, Grey M. Sleep-wake characteristics, daytime sleepiness, and glycemia in young adults with type 1 diabetes. J Clin Sleep Med 2021; 17:1865-1874. [PMID: 33949941 DOI: 10.5664/jcsm.9402] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The purpose of this study was to describe objective sleep-wake characteristics and glycemia over 7 - 14 days in young adults with type 1 diabetes (T1D). Additionally, person level associations among objective sleep-wake characteristics (total sleep time, sleep variability, and sleep fragmentation index), daytime sleepiness, and glycemia (glycemic control and glucose variability) were examined. METHODS In this cross-sectional study, objective sleep-wake characteristics were measured via actigraphy and glucose variability via continuous glucose monitoring (CGM) over 6-14 days. At baseline, participants completed a psychomotor vigilance test (PVT), Trail Making Test, and questionnaires on daytime sleepiness, sleep quality, and sleep disturbance including sleep diaries. RESULTS Forty-six participants (mean age 22.3 ± 3.2 years) wore a wrist actigraph and CGM concurrently for 6-14 days. Greater sleep variability was directly associated with greater glucose variability (mean of daily differences) (r = 0.33, p = .036). Higher daytime sleepiness was directly associated with greater glucose variability (mean of daily differences) (r = 0.50, p = .001). The association between sleep variability and glucose variability (mean of daily differences) was no longer significant when accounting for daytime sleepiness and controlling for T1D duration (p > .05). A higher sleep fragmentation index was associated with greater glucose variability (B = 1.27, p = .010, pr2 = .40) after controlling for T1D duration and accounting for higher daytime sleepiness. CONCLUSIONS Sleep-wake variability, sleep fragmentation, daytime sleepiness, and the associations with glycemia are new dimensions to consider in young adults with T1D. Sleep habits in this population may explain higher glucose variability and optimizing sleep may improve overall diabetes management.
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Affiliation(s)
- Stephanie Griggs
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH
| | - Ronald L Hickman
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH
| | - Kingman P Strohl
- School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Nancy S Redeker
- School of Nursing and School of Medicine, Yale University, West Haven, Connecticut
| | - Sybil L Crawford
- Graduate School of Nursing, University of Massachusetts Medical School, Worcester, MA
| | - Margaret Grey
- School of Nursing and School of Medicine, Yale University, West Haven, Connecticut
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Malone SK, Peleckis AJ, Grunin L, Yu G, Jang S, Weimer J, Lee I, Rickels MR, Goel N. Characterizing Glycemic Control and Sleep in Adults with Long-Standing Type 1 Diabetes and Hypoglycemia Unawareness Initiating Hybrid Closed Loop Insulin Delivery. J Diabetes Res 2021; 2021:6611064. [PMID: 33628834 PMCID: PMC7896863 DOI: 10.1155/2021/6611064] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/18/2020] [Accepted: 02/05/2021] [Indexed: 01/11/2023] Open
Abstract
Nocturnal hypoglycemia is life threatening for individuals with type 1 diabetes (T1D) due to loss of hypoglycemia symptom recognition (hypoglycemia unawareness) and impaired glucose counter regulation. These individuals also show disturbed sleep, which may result from glycemic dysregulation. Whether use of a hybrid closed loop (HCL) insulin delivery system with integrated continuous glucose monitoring (CGM) designed for improving glycemic control, relates to better sleep across time in this population remains unknown. The purpose of this study was to describe long-term changes in glycemic control and objective sleep after initiating hybrid closed loop (HCL) insulin delivery in adults with type 1 diabetes and hypoglycemia unawareness. To accomplish this, six adults (median age = 58 y) participated in an 18-month ongoing trial assessing HCL effectiveness. Glycemic control and sleep were measured using continuous glucose monitoring and wrist accelerometers every 3 months. Paired sample t-tests and Cohen's d effect sizes modeled glycemic and sleep changes and the magnitude of these changes from baseline to 9 months. Reduced hypoglycemia (d = 0.47-0.79), reduced basal insulin requirements (d = 0.48), and a smaller glucose coefficient of variation (d = 0.47) occurred with medium-large effect sizes from baseline to 9 months. Hypoglycemia awareness improved from baseline to 6 months with medium-large effect sizes (Clarke score (d = 0.60), lability index (d = 0.50), HYPO score (d = 1.06)). Shorter sleep onset latency (d = 1.53; p < 0.01), shorter sleep duration (d = 0.79), fewer total activity counts (d = 1.32), shorter average awakening length (d = 0.46), and delays in sleep onset (d = 1.06) and sleep midpoint (d = 0.72) occurred with medium-large effect sizes from baseline to 9 months. HCL led to clinically significant reductions in hypoglycemia and improved hypoglycemia awareness. Sleep showed a delayed onset, reduced awakening length and onset latency, and maintenance of high sleep efficiency after initiating HCL. Our findings add to the limited evidence on the relationships between diabetes therapeutic technologies and sleep health. This trial is registered with ClinicalTrials.gov (NCT03215914).
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Affiliation(s)
- Susan Kohl Malone
- Rory Meyers College of Nursing, New York University, New York, NY 10010, USA
| | - Amy J. Peleckis
- Institute for Diabetes, Obesity, and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Laura Grunin
- Rory Meyers College of Nursing, New York University, New York, NY 10010, USA
| | - Gary Yu
- Rory Meyers College of Nursing, New York University, New York, NY 10010, USA
| | - Sooyong Jang
- PRECISE Center, Department of Computer and Information Science, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - James Weimer
- PRECISE Center, Department of Computer and Information Science, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Insup Lee
- PRECISE Center, Department of Computer and Information Science, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Michael R. Rickels
- Institute for Diabetes, Obesity, and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Namni Goel
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL 60612, USA
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Andersen PAK, Petrenko V, Rose PH, Koomen M, Fischer N, Ghiasi SM, Dahlby T, Dibner C, Mandrup-Poulsen T. Proinflammatory Cytokines Perturb Mouse and Human Pancreatic Islet Circadian Rhythmicity and Induce Uncoordinated β-Cell Clock Gene Expression via Nitric Oxide, Lysine Deacetylases, and Immunoproteasomal Activity. Int J Mol Sci 2020; 22:E83. [PMID: 33374803 PMCID: PMC7795908 DOI: 10.3390/ijms22010083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 12/11/2022] Open
Abstract
Pancreatic β-cell-specific clock knockout mice develop β-cell oxidative-stress and failure, as well as glucose-intolerance. How inflammatory stress affects the cellular clock is under-investigated. Real-time recording of Per2:luciferase reporter activity in murine and human pancreatic islets demonstrated that the proinflammatory cytokine interleukin-1β (IL-1β) lengthened the circadian period. qPCR-profiling of core clock gene expression in insulin-producing cells suggested that the combination of the proinflammatory cytokines IL-1β and interferon-γ (IFN-γ) caused pronounced but uncoordinated increases in mRNA levels of multiple core clock genes, in particular of reverse-erythroblastosis virus α (Rev-erbα), in a dose- and time-dependent manner. The REV-ERBα/β agonist SR9009, used to mimic cytokine-mediated Rev-erbα induction, reduced constitutive and cytokine-induced brain and muscle arnt-like 1 (Bmal1) mRNA levels in INS-1 cells as expected. SR9009 induced reactive oxygen species (ROS), reduced insulin-1/2 (Ins-1/2) mRNA and accumulated- and glucose-stimulated insulin secretion, reduced cell viability, and increased apoptosis levels, reminiscent of cytokine toxicity. In contrast, low (<5,0 μM) concentrations of SR9009 increased Ins-1 mRNA and accumulated insulin-secretion without affecting INS-1 cell viability, mirroring low-concentration IL-1β mediated β-cell stimulation. Inhibiting nitric oxide (NO) synthesis, the lysine deacetylase HDAC3 and the immunoproteasome reduced cytokine-mediated increases in clock gene expression. In conclusion, the cytokine-combination perturbed the intrinsic clocks operative in mouse and human pancreatic islets and induced uncoordinated clock gene expression in INS-1 cells, the latter effect associated with NO, HDAC3, and immunoproteasome activity.
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Affiliation(s)
- Phillip Alexander Keller Andersen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 3 Blegdamsvej, DK-2200 Copenhagen N, Denmark; (P.A.K.A.); (P.H.R.); (M.K.); (N.F.); (S.M.G.); (T.D.)
| | - Volodymyr Petrenko
- Division of Endocrinology, Diabetes, Nutrition and Patient Education, Department of Cell Physiology and Metabolism, Diabetes Center, Faculty of Medicine, University of Geneva, D05.2147c Rue Michel-Servet, 1 CH-1211 Geneva 4, Switzerland; (V.P.); (C.D.)
| | - Peter Horskjær Rose
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 3 Blegdamsvej, DK-2200 Copenhagen N, Denmark; (P.A.K.A.); (P.H.R.); (M.K.); (N.F.); (S.M.G.); (T.D.)
| | - Melissa Koomen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 3 Blegdamsvej, DK-2200 Copenhagen N, Denmark; (P.A.K.A.); (P.H.R.); (M.K.); (N.F.); (S.M.G.); (T.D.)
| | - Nico Fischer
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 3 Blegdamsvej, DK-2200 Copenhagen N, Denmark; (P.A.K.A.); (P.H.R.); (M.K.); (N.F.); (S.M.G.); (T.D.)
| | - Seyed Mojtaba Ghiasi
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 3 Blegdamsvej, DK-2200 Copenhagen N, Denmark; (P.A.K.A.); (P.H.R.); (M.K.); (N.F.); (S.M.G.); (T.D.)
| | - Tina Dahlby
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 3 Blegdamsvej, DK-2200 Copenhagen N, Denmark; (P.A.K.A.); (P.H.R.); (M.K.); (N.F.); (S.M.G.); (T.D.)
| | - Charna Dibner
- Division of Endocrinology, Diabetes, Nutrition and Patient Education, Department of Cell Physiology and Metabolism, Diabetes Center, Faculty of Medicine, University of Geneva, D05.2147c Rue Michel-Servet, 1 CH-1211 Geneva 4, Switzerland; (V.P.); (C.D.)
| | - Thomas Mandrup-Poulsen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 3 Blegdamsvej, DK-2200 Copenhagen N, Denmark; (P.A.K.A.); (P.H.R.); (M.K.); (N.F.); (S.M.G.); (T.D.)
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Griggs S, Redeker NS, Crawford SL, Grey M. Sleep, self-management, neurocognitive function, and glycemia in emerging adults with Type 1 diabetes mellitus: A research protocol. Res Nurs Health 2020; 43:317-328. [PMID: 32639059 PMCID: PMC7382362 DOI: 10.1002/nur.22051] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 05/22/2020] [Accepted: 06/24/2020] [Indexed: 12/16/2022]
Abstract
Type 1 Diabetes (T1D) affects 1.6 million Americans, and only 14% of emerging adults ages 18-25 years achieve targets for glycemic control (A1C < 7.0%). Sleep deficiency, including habitual short sleep duration (<6.5 hr total sleep time and high within-person variability in total sleep time), is associated with poorer glycemic control. Emerging adults with T1D have a more pronounced sleep extension on weekends compared with matched controls, consistent with sleep deficiency; however, associations among sleep variability and glycemic control have not been explored in this population. Sleep deficiency may affect the complex higher-order neurocognitive functioning needed for successful diabetes self-management (DSM). We report the protocol for an ongoing study designed to characterize sleep and the associations among sleep deficiency, neurocognitive function, DSM, diabetes quality of life, and glycemia among a sample of 40 emerging adults with T1D. We monitor sleep via wrist-worn actigraphy and glucose via continuous glucose monitoring concurrently over 14 days. We are collecting data on self-report and objective sleep, a 10-min psychomotor vigilance test on a PVT-192 device, a 3-min Trail Making Test on paper, and questionnaires, including twice-daily Pittsburgh sleep diaries using Research Electronic Data Capture (REDCap)TM . Results from this study will be used to support the development and testing of the efficacy of a tailored sleep self-management intervention that may improve total sleep time, sleep variability, neurocognitive function, DSM, glycemic control, and glucose variability among emerging adults with T1D.
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Affiliation(s)
- Stephanie Griggs
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
| | - Nancy S Redeker
- School of Nursing and School of Medicine, Yale University, West Haven, Connecticut
| | - Sybil L Crawford
- Graduate School of Nursing, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Margaret Grey
- School of Nursing and School of Medicine, Yale University, West Haven, Connecticut
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38
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Greater social jetlag associates with higher HbA1c in adults with type 2 diabetes: a cross sectional study. Sleep Med 2020; 66:1-9. [DOI: 10.1016/j.sleep.2019.07.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/02/2019] [Accepted: 07/12/2019] [Indexed: 11/21/2022]
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Perfect MM. Sleep-related disorders in patients with type 1 diabetes mellitus: current insights. Nat Sci Sleep 2020; 12:101-123. [PMID: 32104119 PMCID: PMC7023878 DOI: 10.2147/nss.s152555] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 01/21/2019] [Indexed: 12/11/2022] Open
Abstract
Type 1 diabetes mellitus (T1DM) is an autoimmune condition that results from destruction of beta cells in the pancreas. Several reviews have concluded that sleep contributes to poor glycemic control, diabetes management, and diabetes-related complications in individuals with T1DM and represents an untapped opportunity for intervention. However, at the current juncture, the American Diabetes Association's Standards of Medical Care are devoid of recommendations about how to address sleep in the management of T1DM. This article summarizes reviews of sleep in youth and adults with T1DM and empirical studies that have examined various sleep parameters ranging from sleep disturbances (general, perceived sleep quality, sleepiness, awakenings, and sleep efficiency), sleep duration, sleep consistency, sleep-disordered breathing (SDB), and sleep architecture. The data show that many individuals with T1DM sleep less than recommendations; individuals with the poorest sleep have difficulties with diabetes management; and sleep deficiency including SDB often corresponds to several disease morbidities (neuropathy, nephropathy, etc). Mixed findings exist regarding direct associations of various sleep parameters and glycemic control. SDB appears to be just as prevalent, if not more, than other conditions that have been recommended for universal screening in individuals with T1DM. The article concludes with recommendations for collaborative research efforts to further elucidate the role of sleep in diabetes-related outcomes; investigations to test behavioral strategies to increase sleep quantity and consistency; and considerations for clinical care to address sleep.
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Affiliation(s)
- Michelle M Perfect
- Department of Disability and Psychoeducational Studies, University of Arizona, Tucson, AZ, USA
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40
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Winnebeck EC, Vuori-Brodowski MT, Biller AM, Molenda C, Fischer D, Zerbini G, Roenneberg T. Later school start times in a flexible system improve teenage sleep. Sleep 2019; 43:5678526. [DOI: 10.1093/sleep/zsz307] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/15/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Sleep deprivation in teenage students is pervasive and a public health concern, but evidence is accumulating that delaying school start times may be an effective countermeasure. Most studies so far assessed static changes in schools start time, using cross-sectional comparisons and one-off sleep measures. When a high school in Germany introduced flexible start times for their senior students—allowing them to choose daily between an 8 am or 9 am start (≥08:50)—we monitored students’ sleep longitudinally using subjective and objective measures. Students (10–12th grade, 14–19 y) were followed 3 weeks prior and 6 weeks into the flexible system via daily sleep diaries (n = 65) and a subcohort via continuous wrist-actimetry (n = 37). Satisfaction and perceived cognitive outcomes were surveyed at study end. Comparisons between 8 am and ≥9 am-starts within the flexible system demonstrated that students slept 1.1 h longer when starting school later—independent of gender, grade, chronotype, and frequency of later starts; sleep offsets were delayed but, importantly, onsets remained unchanged. Sleep quality was increased and alarm-driven waking reduced. However, overall sleep duration in the flexible system was not extended compared to baseline—likely because students did not start later frequently enough. Nonetheless, students were highly satisfied with the flexible system and reported cognitive and sleep improvements. Therefore, flexible systems may present a viable alternative for implementing later school starts to improve teenage sleep if students can be encouraged to use the late-option frequently enough. Flexibility may increase acceptance of school start changes and speculatively even prevent delays in sleep onsets through occasional early starts.
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Affiliation(s)
- Eva C Winnebeck
- Institute of Medical Psychology, Ludwig Maximilian University Munich, Munich, Germany
| | | | - Anna M Biller
- Institute of Medical Psychology, Ludwig Maximilian University Munich, Munich, Germany
| | - Carmen Molenda
- Institute of Medical Psychology, Ludwig Maximilian University Munich, Munich, Germany
| | - Dorothee Fischer
- Department of Sleep and Human Factors Research, German Aerospace Center, Cologne, Germany
- Division of Sleep Medicine, Brigham and Women’s Hospital, Boston, MA
- Division of Sleep and Circadian Disorders, Harvard Medical School, Boston, MA
| | - Giulia Zerbini
- Institute of Medical Psychology, Ludwig Maximilian University Munich, Munich, Germany
| | - Till Roenneberg
- Institute of Medical Psychology, Ludwig Maximilian University Munich, Munich, Germany
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Zhu B, Kapella MC, Zhao X, Fritschi C. Intra-individual variability in sleep is related to glycaemic control in adults with type 2 diabetes. J Adv Nurs 2019; 76:991-998. [PMID: 31823392 DOI: 10.1111/jan.14290] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/24/2019] [Accepted: 12/03/2019] [Indexed: 11/27/2022]
Abstract
AIMS To examine whether there were significant differences in sleep during weekdays/weekends and whether the intra-individual variability in sleep was related to glycaemic control in patients with type 2 diabetes. DESIGN Correlational, longitudinal design. METHODS Data were collected between February 2017-January 2018. In all, 56 adults with type 2 diabetes were included (60.7 years, 55.4% female). Sleep was measured using the Consensus Sleep Diary over 8 days. Intra-individual variability of sleep was calculated as the standard deviation of sleep variables. Standard deviations of sleep duration, sleep efficiency, sleep quality, and mid-sleep time were obtained. Glycaemic control was measured by haemoglobin A1C. Paired t test and multiple regression analysis were used. RESULTS Overall, there were no differences in sleep parameters between weekdays and weekends. Participants slept 20 min more over the weekends than during weekdays. The mid-sleep time during weekends was about 35 min later than during weekdays. Intra-individual variability of sleep duration and mid-sleep ranged from 27.6-167.4 min and 13-137 min, respectively. Controlling for covariates (e.g., distress, symptoms, and self-care), larger variability in sleep duration, and mid-sleep were significantly related to higher A1C levels. CONCLUSION Diabetes educators are recommended to include the assessment of intra-individual variability in sleep. Maintaining a regular sleep habit (e.g., sleep duration and sleep timing) should be highlighted during patient education. IMPACT Intra-individual variability in sleep is an alternative dimension for sleep assessment. This study examined whether intra-individual variability in sleep was related to glycaemic control in an older sample of type 2 diabetes patients using a sleep diary across 8 days. This sample had a similar sleep pattern during weekdays and weekends. Larger intra-individual variabilities in sleep duration and mid-sleep time were independently related to worse glycaemic control. Diabetes patients are recommended to maintain a regular sleep routine.
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Affiliation(s)
- Bingqian Zhu
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Mary C Kapella
- College of Nursing, The University of Illinois at Chicago, Chicago, IL, USA
| | - Xiangxiang Zhao
- Department of Neurology, Changhai Hospital, The Second Military Medical University of China, Shanghai, China
| | - Cynthia Fritschi
- College of Nursing, The University of Illinois at Chicago, Chicago, IL, USA
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Sleep Apnea and Sleep Habits: Relationships with Metabolic Syndrome. Nutrients 2019; 11:nu11112628. [PMID: 31684029 PMCID: PMC6893600 DOI: 10.3390/nu11112628] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/01/2019] [Accepted: 10/16/2019] [Indexed: 12/19/2022] Open
Abstract
Excess visceral adiposity is a primary cause of metabolic syndrome and often results from excess caloric intake and a lack of physical activity. Beyond these well-known etiologic factors, however, sleep habits and sleep apnea also seem to contribute to abdominal obesity and metabolic syndrome: Evidence suggests that sleep deprivation and behaviors linked to evening chronotype and social jetlag affect eating behaviors like meal preferences and eating times. When circadian rest and activity rhythms are disrupted, hormonal and metabolic regulations also become desynchronized, and this is known to contribute to the development of metabolic syndrome. The metabolic consequences of obstructive sleep apnea syndrome (OSAS) also contribute to incident metabolic syndrome. These observations, along with the first sleep intervention studies, have demonstrated that sleep is a relevant lifestyle factor that needs to be addressed along with diet and physical activity. Personalized lifestyle interventions should be tested in subjects with metabolic syndrome, based on their specific diet and physical activity habits, but also according to their circadian preference. The present review therefore focuses (i) on the role of sleep habits in the development of metabolic syndrome, (ii) on the reciprocal relationship between sleep apnea and metabolic syndrome, and (iii) on the results of sleep intervention studies.
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43
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Bae SA, Fang MZ, Rustgi V, Zarbl H, Androulakis IP. At the Interface of Lifestyle, Behavior, and Circadian Rhythms: Metabolic Implications. Front Nutr 2019; 6:132. [PMID: 31555652 PMCID: PMC6722208 DOI: 10.3389/fnut.2019.00132] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 08/06/2019] [Indexed: 12/29/2022] Open
Abstract
Nutrient metabolism is under circadian regulation. Disruption of circadian rhythms by lifestyle and behavioral choices such as work schedules, eating patterns, and social jetlag, seriously impacts metabolic homeostasis. Metabolic dysfunction due to chronic misalignment of an organism's endogenous rhythms is detrimental to health, increasing the risk of obesity, metabolic and cardiovascular disease, diabetes, and cancer. In this paper, we review literature on recent findings on the mechanisms that communicate metabolic signals to circadian clocks and vice versa, and how human behavioral changes imposed by societal and occupational demands affect the physiological networks integrating peripheral clocks and metabolism. Finally, we discuss factors possibly contributing to inter-individual variability in response to circadian changes in the context of metabolic (dys)function.
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Affiliation(s)
- Seul-A Bae
- Chemical and Biochemical Engineering Department, Rutgers University, Piscataway, NJ, United States
| | - Ming Zhu Fang
- Department of Environmental and Occupational Medicine, Robert Wood Johnson Medical School, Piscataway, NJ, United States.,National Institute for Environmental Health Sciences (NIEHS) Center for Environmental Exposures and Disease, Environmental and Occupational Health Sciences Institute, Piscataway, NJ, United States.,Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, Piscataway, NJ, United States
| | - Vinod Rustgi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Helmut Zarbl
- Department of Environmental and Occupational Medicine, Robert Wood Johnson Medical School, Piscataway, NJ, United States.,National Institute for Environmental Health Sciences (NIEHS) Center for Environmental Exposures and Disease, Environmental and Occupational Health Sciences Institute, Piscataway, NJ, United States.,Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, Piscataway, NJ, United States
| | - Ioannis P Androulakis
- Chemical and Biochemical Engineering Department, Rutgers University, Piscataway, NJ, United States.,Biomedical Engineering Department, Rutgers University, Piscataway, NJ, United States.,Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
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44
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Diabetes management mediates the association between sleep duration and glycemic control in youth with type 1 diabetes mellitus. Sleep Med 2019; 60:132-138. [DOI: 10.1016/j.sleep.2019.01.043] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/28/2018] [Accepted: 01/31/2019] [Indexed: 01/28/2023]
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45
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Rusu A, Bala C, Ciobanu D, Cerghizan A, Roman G. Sleep quality and sleep duration, but not circadian parameters are associated with decreased insulin sensitivity in Type 1 diabetes. Chronobiol Int 2019; 36:1148-1155. [DOI: 10.1080/07420528.2019.1615501] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Adriana Rusu
- Department of Diabetes and Nutrition Diseases, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cornelia Bala
- Department of Diabetes and Nutrition Diseases, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Clinical Diabetes Center, Emergency County Hospital Cluj, Cluj-Napoca, Romania
| | - Dana Ciobanu
- Department of Diabetes and Nutrition Diseases, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Anca Cerghizan
- Clinical Diabetes Center, Emergency County Hospital Cluj, Cluj-Napoca, Romania
| | - Gabriela Roman
- Department of Diabetes and Nutrition Diseases, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Clinical Diabetes Center, Emergency County Hospital Cluj, Cluj-Napoca, Romania
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46
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Rusu A, Ciobanu D, Bala C, Cerghizan A, Roman G. Social jetlag, sleep-related parameters, and glycemic control in adults with type 1 diabetes: Results of a cross-sectional study. J Diabetes 2019; 11:394-401. [PMID: 30302947 DOI: 10.1111/1753-0407.12867] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 09/02/2018] [Accepted: 10/01/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Social jetlag (SJL) is a small recurrent circadian rhythm disruption and the most frequent form of circadian rhythm misalignment. The main aim of this study was to investigate the effect of SJL on glycemic control, as assessed by HbA1c, in real-life settings. METHODS In all, 115 consecutive patients with type 1 diabetes (T1D) were analyzed cross-sectionally. Data on bedtime, sleep onset latency, and wake up time on weekdays and weekends during the previous month were collected from all participants and used to calculate SJL, chronotype, and sleep duration. Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI). A PSQI score > 5 was considered as an indicator of poor sleep quality. RESULTS Patients with SJL ≥ 1 hour had significantly higher adjusted values of HbA1c than those with SJL <1 hour (8.7% vs 8.0%; P = 0.029). In unadjusted multivariate regression analysis, SJL ≥ 1 hour and poor sleep quality were significant predictors of HbA1c values, explaining 22.7% and 23.5%, respectively, of the increase in HbA1c. After adjusting for age, sex, diabetes duration, insulin dose (kg/d), insulin regimen and body mass index, only SJL ≥ 1 hour remained associated with HbA1c (β = 0.253; P = 0.026). There was no significant interaction between SJL ≥ 1 hour and poor sleep quality in either the unadjusted or adjusted models (Pinteraction = 0.914). CONCLUSIONS In patients with T1D, SJL is associated with poor glycemic control, acting independently of sleep quality, sleep duration, and chronotype to exert a deleterious effect on glycemic control.
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Affiliation(s)
- Adriana Rusu
- Department of Diabetes and Nutrition Diseases, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dana Ciobanu
- Department of Diabetes and Nutrition Diseases, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cornelia Bala
- Department of Diabetes and Nutrition Diseases, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Clinical Diabetes Center, Emergency County Hospital Cluj, Cluj-Napoca, Romania
| | - Anca Cerghizan
- Clinical Diabetes Center, Emergency County Hospital Cluj, Cluj-Napoca, Romania
| | - Gabriela Roman
- Department of Diabetes and Nutrition Diseases, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Clinical Diabetes Center, Emergency County Hospital Cluj, Cluj-Napoca, Romania
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47
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Gasperoni F, Turini P, Agostinelli E. A novel comprehensive paradigm for the etiopathogenesis of multiple sclerosis: therapeutic approaches and future perspectives on its treatment. Amino Acids 2019; 51:745-759. [PMID: 30887124 DOI: 10.1007/s00726-019-02718-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 03/01/2019] [Indexed: 12/19/2022]
Abstract
It is well recognized that variation in the geographical distribution of prevalence of multiple sclerosis (MS) exists: increasing the latitude its prevalence increases as well, but the underlying causes of such dissimilarity still remained elusive as of today. Currently, the most accredited hypothesis is that the closer to the equator the more pronounced is the amount of sunlight which, in turn, increases the production of vitamin D. Cholecalciferol is indeed deficient in MS patients, but this factor does not explain by itself the etiopathogenesis of the disease. In the present study, to search for a pattern and provide a model of the disease's etiology consistent with this regional factor, as well with its changing ethnic, sex-ratio, lifestyle variations and the other unexplained aspects of MS, an extensive analysis of peer-reviewed literature and data was conducted. The arisen hypothesis was that, increasing the latitude, the factor that varies and can have the stronger effect on the human organism, is the continuous and ever-increasing diversity of the natural light-dark cycle. The consequent effort of the suprachiasmatic nucleus to entrain the organism's circadian rhythm affects the hypothalamic-pituitary-adrenal axis resulting in desynchronizing the central and peripheral circadian clocks and pathologizing the immunitary system. To verify such hypothesis, a theoretical framework of the etiopathogenesis, coherent with the gathered literature, was conceived and a demonstration to corroborate it was eventually devised and performed. The results underscored that people living in countries subjected to a further circadian disruptive factor, as daylight saving time, have a 6.35 times higher prevalence of MS than States placed on their same latitude that do not observe it, thus strongly supporting the hypothesis. As further reinforcement of the conclusions, it is worth mentioning that the levels of polyamines rise abruptly in autoimmune diseases. Moreover, among their numerous roles, these polycations participate to the regulation of the circadian clock so their sudden variation might disrupt it. Following these interesting findings, new perspectives in therapies are, therefore, proposed.
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Affiliation(s)
- Francesco Gasperoni
- Department of Biochemical Sciences "A. Rossi Fanelli", Sapienza University of Rome, Piazzale Aldo Moro, 5, 00185, Rome, Italy.,International Polyamines Foundation-ONLUS, Via del Forte Tiburtino 98, 00159, Rome, Italy
| | - Paola Turini
- Department of Biochemical Sciences "A. Rossi Fanelli", Sapienza University of Rome, Piazzale Aldo Moro, 5, 00185, Rome, Italy.,International Polyamines Foundation-ONLUS, Via del Forte Tiburtino 98, 00159, Rome, Italy
| | - Enzo Agostinelli
- Department of Biochemical Sciences "A. Rossi Fanelli", Sapienza University of Rome, Piazzale Aldo Moro, 5, 00185, Rome, Italy. .,International Polyamines Foundation-ONLUS, Via del Forte Tiburtino 98, 00159, Rome, Italy.
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48
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Mota MC, Silva CM, Balieiro LCT, Gonçalves BF, Fahmy WM, Crispim CA. Association between social jetlag food consumption and meal times in patients with obesity-related chronic diseases. PLoS One 2019; 14:e0212126. [PMID: 30753224 PMCID: PMC6372231 DOI: 10.1371/journal.pone.0212126] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 01/27/2019] [Indexed: 12/11/2022] Open
Abstract
Chronic disruption of the synchronous relationship between endogenous and exogenous circadian timing is associated with the development of obesity and metabolic disease. Social jetlag is a measure of circadian misalignment and has been identified as a risk factor for overweight and related diseases. However, the mechanisms involved in this relationship remain underexplored. The objective of this study was to investigate the association between social jetlag and food consumption at late meal timing in patients with obesity-related chronic diseases. This study included 792 individuals (73% female; age 55.9 ± 12.4 years) in which the prevalence of social jetlag (>1h) was 24.4% (n = 194). Participants with social jetlag reported late meal timing for breakfast, early afternoon snack and dinner. Individuals with social jetlag also reported a higher intake of total calories (kcal), protein, total fat, saturated fat, cholesterol, and servings of meat and eggs and sweets in relation to those without social jetlag. Regarding the consumption during each meal of the day, participants with social jetlag had consumed more calories, saturated fat and cholesterol during dinner; more protein, total fat, saturated fat, and cholesterol during lunch; and more total fat and saturated fat during morning snack. In addition, individuals with social jetlag had a higher risk of inadequate consumption of total fat, saturated fat and cholesterol intake when compared with those without social jetlag. We conclude that social jetlag is associated with a poor diet and later meal times, which should be avoided in individuals with obesity-related chronic diseases. More studies are needed to confirm these findings.
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Affiliation(s)
- Maria Carliana Mota
- Faculty of Medicine of the Federal University of Uberlândia, Minas Gerais, Brazil
| | | | | | | | - Walid Makin Fahmy
- Hospital e Maternidade Municipal de Uberlândia, Department of Obstetrics, Uberlândia, Brazil
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49
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Saylor J, Ji X, Calamaro CJ, Davey A. Does sleep duration, napping, and social jetlag predict hemoglobin A1c among college students with type 1 diabetes mellitus? Diabetes Res Clin Pract 2019; 148:102-109. [PMID: 30641174 PMCID: PMC7274839 DOI: 10.1016/j.diabres.2019.01.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 12/12/2018] [Accepted: 01/04/2019] [Indexed: 12/11/2022]
Abstract
AIMS The first aim examined the relationship between sleep behaviors (duration, napping, and social jetlag) and hemoglobin A1c (HbA1c) among emerging young adults (EYAs) with T1DM between 18 and 25 years old, who are living on a college campus. The second aim characterized the gender differences in glucose management, sleep behaviors, caffeine intake, and nighttime technology. METHODS A cross-sectional study of eligible participants used a convenience sample of eligible participants. Using Research Electronic Data Capture (REDCap), participants completed surveys about diabetes management, caffeine intake, nighttime technology use, and sleep-related behaviors. Data were analyzed using correlation and multiple linear regression to predict HbA1c from sleep behaviors, adjusting for covariates. RESULTS Participants (N = 76) average years with T1DM was 10.25 ± 5.70. Compared to females, males had a longer sleep duration lower HbA1c levels. HbA1c levels were negatively correlated with weekday sleep (r = -0.24, p = 0.03) and positively correlated with napping (r = 0.34, p = 0.003). After adjusting for covariates, participants who napped had a higher HbA1c level (β = 0.74, p = 0.03) compared with non-nappers. CONCLUSIONS Higher HbA1c levels were found among EYAs with T1DM in college who were nappers and had a longer sleep duration. Modifying sleep behaviors may be an appropriate target to improve glycemic control.
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Affiliation(s)
- Jennifer Saylor
- University of Delaware, Tower at STAR, 5th Floor, 100 Discovery Blvd, Newark, DE 19713, USA.
| | - Xiaopeng Ji
- University of Delaware, Tower at STAR, 5th Floor, 100 Discovery Blvd, Newark, DE 19713, USA.
| | | | - Adam Davey
- University of Delaware, Carpenter Sports Building, 26 North College Avenue, Newark, DE 19713, USA.
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50
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Monzon A, McDonough R, Meltzer LJ, Patton SR. Sleep and type 1 diabetes in children and adolescents: Proposed theoretical model and clinical implications. Pediatr Diabetes 2019; 20:78-85. [PMID: 30447038 DOI: 10.1111/pedi.12797] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 10/17/2018] [Accepted: 10/23/2018] [Indexed: 01/01/2023] Open
Abstract
Youth with type 1 diabetes mellitus (T1D) experience more sleep disturbances and shorter sleep durations compared to their healthy peers. Researchers have now uncovered the negative mental health and physical health outcomes associated with poor sleep in youth with T1D. The field of T1D sleep research currently operates under the broad notion that sleep behaviors impact treatment adherence, which ultimately lead to worse long-term health outcomes. This model however does not explain how behavior influences T1D management and sleep outcomes on a day-to-day basis, leading to difficulties in providing tailored treatment recommendations. In this review, we present a theoretical framework that describes the recursive cycle between sleep behaviors, T1D outcomes, and symptoms of negative affect/stress over a 24-hour period. This model is guided by the sleep literature, showing a clear relationship between poor sleep and negative affect, and the T1D literature demonstrating a link between poor sleep and disease management for youth with T1D. Further, emerging literature indicates a need for additional parent sleep assessment considering that T1D management and fear of hypoglycemia negatively impact parent sleep behaviors. Recommendations are provided to move the field toward effective intervention studies and new areas of research to evaluate and modify the proposed model.
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Affiliation(s)
- Alexandra Monzon
- Clinical Child Psychology Program, University of Kansas, Lawrence, Kansas
| | - Ryan McDonough
- Division of Endocrinology & Diabetes, Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, Missouri
| | - Lisa J Meltzer
- Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - Susana R Patton
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, Kansas
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