Interaction effects between sleep-related disorders and depression on hypertension among adults: a cross-sectional study

BACKGROUND

Hypertension, sleep disorders, and depression represent notable public health issues, and their interconnected nature has long been acknowledged. The objective of this study is to explore the interplay between sleep disorders and depression in the context of hypertension.

METHODS

This cross-sectional study involved 42,143 participants aged 18 and above from the NHANES database across seven survey cycles between 2005 and 2018. After excluding those with missing data on depression, sleep disorders, and hypertension, as well as incomplete main variables, 33,383 participants remained. We used weighted logistic regression to examine the relationship between sleep disorders, depression, and hypertension. Additionally, we assessed the interaction between sleep disorders and depression on hypertension using both multiplicative and additive approaches to quantify their combined effect.

RESULTS

Compared to individuals without sleep disorders, those with sleep disorders have an increased risk of hypertension (OR = 1.51, 95% CI: 1.37-1.67). Furthermore, individuals with depression experience a significantly higher risk of hypertension compared to those with sleep disorders alone (OR = 2.34, 95% CI: 1.95-2.80). Our study reveals a positive interaction between sleep disorders and depression in relation to hypertension risk (OR = 1.07, 95% CI: 1.02-1.13). In addition, we observed the quantitative additive interaction indicators (RERI = 0.73, 95% CI: 0.56 ~ 0.92; API = 0.31, 95% CI: 0.11 ~ 0.46; SI = 2.19, 95% CI: 1.08-3.46) influencing hypertension risk. Furthermore, our research also identified that individuals with less than 7 h of sleep, a sleep latency period between 5 and 30 min, or a latency period exceeding 30 min experience a significantly increased risk of hypertension.

CONCLUSIONS

Our research uncovered separate links between sleep disorders, depression, and hypertension prevalence. Moreover, we identified an interaction between depression and sleep disorders in hypertension prevalence. Enhancing mental well-being and tackling sleep disorders could help prevent and manage hypertension. Yet, more investigation is required to establish causation and clarify mechanisms.

Role of gender in explaining metabolic syndrome risk factors in an Iranian rural population using structural equation modelling

Many factors can lead to an increase in the prevalence of metabolic syndrome (MetS) in different populations. Using an advanced structural equation model (SEM), this study is aimed to determine the most important risk factors of MetS, as a continuous latent variable, using a large number of males and females. We also aimed to evaluate the interrelations among the associated factors involved in the development of MetS. This study used data derived from the Fasa PERSIAN cohort study, a branch of the PERSIAN cohort study, for participants aged 35 to 70 years with 10,138 males and females. SEM was used to evaluate the direct and indirect effects, as well as gender effects of influencing factors. Results from the SEM showed that in females most changes in MetS are described by waist circumference (WC), followed by hypertension (HP) and triglyceride (TG), while in males most changes in MetS are described by WC, followed by TG then fasting blood glucose (FBG). Results from the SEM confirmed the gender effects of social status on MetS, mediated by sleep and controlled by age, BMI, ethnicity and physical activity. This study also shows that the integration of TG and WC within genders could be useful as a screening criterion for MetS in our study population.

The association between self-reported nocturnal sleep duration, irregularity in daily energy intake and diet quality in a sample of Iranian adults

OBJECTIVE

Evidence on the relationship between sleep duration and irregularity in daily energy intake with diet quality in Iranian adults is scarce. We aimed to evaluate the association of sleep duration with diet quality and irregularity in daily energy intake.

DESIGN

This is a cross-sectional study.

SETTING

The study was performed in healthcare centres in Tehran.

PARTICIPANTS

739 adults aged 20-59 years were recruited. Dietary intake was assessed by a FFQ and three 24-h dietary recalls. Diet quality was assessed using the Healthy Eating Index-2015 (HEI-2015). An irregularity score of daily energy intake was calculated based on the deviation from the 3-d mean energy intake. Sleep duration was estimated using self-reported nocturnal sleep duration by each person.

RESULTS

The mean age of the study participants was 44·4 ± 10·7 years; 70 % were women. The mean nocturnal sleep duration, HEI score and irregularity score were 6·7 ± 1·22 h/d, 52·5 ± 8·55 and 22·9 + 19, respectively. After adjusting for potential confounders, sleep duration was not associated with adherence to HEI-2015 (OR: 1·16; 95 % CI 0·77, 1·74). Longer sleep duration was marginally associated with a lower odd of irregularity in daily energy intake. However, after adjustment for various confounders, this association was not significant (OR: 0·82; 95 % CI 0·50, 1·33; Ptrend = 0·45). No significant interaction was observed between sleep duration and irregularity in daily energy intake in relation to adherence to HEI-2015 (Pinteraction = 0·48).

CONCLUSIONS

We found that sleep duration was not associated with adherence to HEI-2015 and irregularity in daily energy intake. Further prospective studies are warranted.

Sleep Patterns, Eating Behavior and the Risk of Noncommunicable Diseases

Sleep is extremely important for the homeostasis of the organism. In recent years, various studies have been carried out to address factors related to sleep patterns and their influence on food choices, as well as on the onset of chronic noncommunicable diseases. The aim of this article is to provide a scientific literature review on the possible role of sleep patterns on eating behavior and the risk of noncommunicable diseases. A search was performed on Medline (PubMed interface) using several keywords (e.g., "Factors Influencing Sleep" OR "Sleep and Chronic Diseases"). Articles published between 2000 and the present date that relate sleep to cyclic metabolic processes and changes in eating behavior were selected. Changes in sleep patterns are increasingly detected today, and these modifications are mainly caused by work and lifestyle conditions as well as a growing dependence on electronic devices. Sleep deprivation and the resultant short sleep duration lead to an increased appetite via an increase in the hunger hormone (ghrelin) and a decrease in the satiety hormone (leptin). Nowadays, sleep is undervalued, and thus often impaired, with consequences for the performance of various body systems. Sleep deprivation alters physiological homeostasis and influences eating behavior as well as the onset of chronic diseases.

Investigation of the relationship between sleep-related parameters and metabolic syndrome (MetS) among youths in the Southeast of Iran

BACKGROUND AND AIM

There are few studies and inconsistent findings on the role of sleep-related parameters in the development of metabolic syndrome (MetS) among youths. In this study, we aim to investigate the relationship between sleep-related parameters and MetS among youths in a large sample size in Rafsanjan, a region in the southeast of Iran.

METHODS

The current cross-sectional study was performed on 3,006 young adults aged 15-35, who registered for Rafsanjan Youth Cohort Study (RYCS), as part of Rafsanjan Cohort Study (RCS)). In fact, RCS is a branch of the prospective epidemiological research studies in Iran (PERSIAN). In the present study, we included 2,867 youths after excluding some subjects with missing information on MetS components. MetS was diagnosed based on Adult Treatment Panel III (ATP III) criteria. Besides, data on sleep-related parameters were collected by self-report questionnaires.

RESULTS

The overall prevalence of MetS was 7.74% among the participants. In addition, bedtime, wake time, napping, night shift work, and sleep duration per night and day had no association with the higher odds of having MetS. In contrast, long sleep duration at night was associated with the lower odds of high waist circumference (WC) (OR: 0.82,95% CI :0.67-0.99).

CONCLUSION

In the present study, long sleep duration at night was associated with lower odds of central obesity. However, more longitudinal studies with the objective measurement of sleep-related parameters are needed to verify the associations reported in the current study.

The association between social jetlag and parameters of metabolic syndrome and type 2 diabetes: a systematic review and meta‐analysis

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.

Association of Lifelines Diet Score (LLDS) and metabolically unhealthy overweight/obesity phenotypes in women: a cross-sectional study

Background

Previous studies have shown the association of a number of dietary quality scores with metabolically phenotypes of obesity. Recently, the Lifelines Diet Score (LLDS), which is a fully food-based score based on the 2015 Dutch dietary guidelines and underlying international literature, has been proposed as a tool for assessing the quality of the diet. Therefore, this study was performed to investigate the association between LLDS and metabolically healthy/unhealthy overweight and obesity (MHO/MUHO) phenotypes.

Methods

This study was performed on 217 women, aged 18–48 years old. For each participant anthropometric values, biochemical test and body composition were evaluated by standard protocols and methods. The LLDS was determined based on 12 components using a valid and reliable food frequency questionnaire (FFQ) containing 147 items. The metabolically healthy (MH) was evaluated using the Karelis criteria.

Results

Among the total participants in this study, 31.3% of the subjects were MHO while 68.7% were MUHO. After adjustment for potential confounding variables (age, energy intake, and physical activity), participants in highest LLDS tertile had a lower odds of MUHO compared with those in the lowest tertile (OR: 1.18; 95% CI: 0.23, 5.83; P-trend = 0.03). Also, after further adjustment with BMI, provided only small changes in "OR" and did not attenuate the significance (OR: 1.28; 95% CI: 0.23, 6.91; P-trend = 0.02).

Conclusions

The present evidence indicates that individuals with higher adherence to the LLDS had lower odds of metabolically unhealthy (MUH).

Examining negative affect, sleep duration, and using food to cope as predictors of weight in midlife women

Midlife women are vulnerable to developing obesity. Behavioral and psychosocial factors including sleep duration, stress eating, and negative emotionality are risk factors. However, little is known about the complex daily interplay between sleep, eating, emotion, and weight among midlife women. The current study examined how daily sleep, using food to cope, and negative emotionality are associated with weight using a daily process research design. An archival analysis was performed using the Midlife in the United States-II study (MIDUS II). The sample consisted of 489 midlife women (40-64 years of age). Variables included ecological momentary assessments of daily sleep duration, using food to cope, and negative affect (means and intraindividual variability) and a standardized measurement of BMI. Sleep duration variability was a significant predictor of BMI, albeit the model only accounted for .8% of the variance in BMI (b = .019, p < .05). In the final adjusted model, sleep duration variability, using food to cope, age, and physical activity were all significant predictors of BMI F(5, 559) = 21.503, p < .001, R² = .161, ⨂R² = .024, p = .001. Variability in negative affect, mean sleep duration or negative affect and the interactions between sleep duration (mean, variability) and negative affect (mean, variability) were not significant. Greater variability in sleep duration and greater use of food to cope predicted higher BMI in this sample across age and physical activity levels. Results highlight that daily health and psychosocial factors play an important role in weight.

The association between modified Nordic diet with sleep quality and circadian rhythm in overweight and obese woman: a cross-sectional study

OBJECTIVE

Previous studies have shown an association between diet quality and sleep quality. The objective of this study was to investigate the association between modified Nordic diet with sleep quality and circadian rhythm in overweight and obese woman.

METHODS

We enrolled 399 overweight and obese women (body mass index (BMI): 25-40 kg/m²), aged 18-48 years, in this cross-sectional study. For each participant, anthropometric measurements, biochemical tests, and food intake were evaluated. Sleep quality and circadian rhythm was measured by Pittsburgh Sleep Quality Index (PSQI) and morning-evening questionnaire (MEQ) questionnaire. Modified Nordic diet score was measured using a validated 147-item food frequency questionnaire (FFQ).

RESULTS

Overall, 51.7% of the subjects were good sleepers (the Pittsburgh Sleep Quality Index (PSQI) < 5) while 48.3% were poor sleepers (PSQI ≥ 5). Moreover, participants were divided into five groups of MEQ, namely, completely morning 8 (2.4%), rarely morning 82 (24.8%), normal 196 (59.2%), rarely evening 43 (13%), and completely evening 2 (0.6%). After controlling for confounders, there was a significant association between poor sleep quality and the modified Nordic diet (OR = 0.80, %95 CI = 0.66-0.98, P = 0.01). Moreover, a significant positive association was observed between the completely morning and modified Nordic diet (OR = 1.80, %95 CI = 0.54-6.00, P = 0.03), in addition to a significant inverse association between the completely evening type and modified Nordic diet (OR = 0.16, %95 CI = 0.002-5.41, P = 0.02).

CONCLUSIONS

The present study indicated that higher adherence to a modified Nordic diet reduces poor sleep quality. Also, the completely morning type was associated with higher adherence to a modified Nordic diet, and completely evening type was associated with lower adherence to a modified Nordic diet.

LEVELS OF EVIDENCE

Level IV, evidence obtained from multiple time series analysis.

The Effect of the Dietary Approaches to Stop Hypertension (DASH) Diet on Sleep, Mental Health, and Hormonal Changes: A Randomized Clinical Trial in Women With Type 2 Diabetes

Background

Some dietary patterns may improve diabetes complications through scavenging oxidants and anti-inflammatory properties. This study evaluated the effect of the Dietary Approaches to Stop Hypertension (DASH) diet on sleep status, mental health, and hormonal changes among Iranian women with type 2 diabetes.

Methods

This randomized controlled trial (RCT) included 66 diabetic women. Participants were randomly divided into the two different diet groups (the DASH diet and control diet; 33 patients in each group) for 3 months. The Pittsburgh Sleep Quality Index and the Depression, Anxiety, and Stress Scale-21 items were used to assess sleep and mental disorders, respectively. Fasting blood sugar, hemoglobin A1c (HbA1c), advanced glycation end products (AGEs), as well as several sex hormones were evaluated at the beginning and the end of the trial.

Results

Anthropometric indices, HbA1c (control: 8.77 ± 0.82 vs. 8.04 ± 1.03; the DASH diet 8.70 ± 1.05 vs.7.41 ± 1.03), and follicle-stimulating hormone (FSH) (control: 72.16 ± 26.02 vs. 68.12 ± 27.63; the DASH diet: 72.99 ± 25.19 vs. 67.43 ± 27.63) significantly decreased over 12 weeks in both the groups (P &lt; .0001). Testosterone, 2-h postprandial glucose (2hPPG), and AGEs significantly decreased over 12 weeks in the DASH diet group. Sleep, depression, and anxiety scores significantly decreased over 12 weeks in the DASH diet group. Night sleep duration significantly increased over 12 weeks in the DASH diet group (P &lt; 0.0001).

Conclusion

A 12-week DASH diet significantly decreases testosterone, 2hPPG, AGEs level, as well as sleep, depression, and anxiety scores in women with type 2 diabetes. However, more RCTs are needed to confirm these findings.

Diet quality indices are associated with sleep and mental health status among diabetic women: a cross-sectional study

OBJECTIVE

Diabetes is a common chronic disease with many complications. Controlling these complexities may enhance the quality of life. This study was conducted to investigate the association between diet quality indices and sleep, stress, anxiety, and depression among diabetic women.

DESIGN

Cross-sectional study.

SETTING

A validated and reliable food frequency questionnaire was filled to assess the dietary intake and adherence to the diet quality indices. Pittsburgh Sleep Quality Index and 21 items Depression, Anxiety, and Stress Scale were used to assess the sleep and mental disorders, respectively.

PARTICIPANTS

This study was conducted on 230 Tehrani women with type 2 diabetes.

RESULTS

Patients who were in the top tertile of diet quality index consumed less fat, saturated mono-and poly-unsaturated fatty acids, and sodium (P < 0.05). Participants who were in top tertile of diet quality indices consumed more fruits, and vegetables. Patients in the highest tertile of diet quality index-international had less risk of depression (OR: 0.17; 95% CI: 0.07; 0.41), anxiety (OR: 0.36; 95% CI: 0.16; 0.80), stress (OR: 0.09; 95% CI: 0.04; 0.21), and poor sleep (OR: 0.12; 95% CI: 0.04; 0.36). Patients in the highest tertile of healthy eating index-international had less risk of depression (OR: 0.06; 95% CI: 0.02; 0.21), anxiety (OR: 0.10; 95% CI: 0.04; 0.26), stress (OR: 0.11; 95% CI: 0.05; 0.26), and poor sleep (OR: 0.08; 95% CI: 0.03; 0.20).

CONCLUSION

Patients with higher adherence to diet quality indices were likely less to have mental disorders or poor sleep.

LEVEL OF EVIDENCE

Level V: based on descriptive studies (a Cross-sectional study).

Relationship between self-reported sleep duration during week-/work-days and metabolic syndrome from NHANES 2013 to 2016

PURPOSE

This research aimed at determining the relationship between self-reported sleep duration during week-/work-days and metabolic syndrome (MetS) from NHANES 2013 to 2016.

METHODS

This study analyzed data from 11,181 people aged 16 or older who took part in the NHANES (National Health and Nutrition Examination Surveys) from 2013 to 2016. A standard questionnaire was used to define self-reported sleep duration, and MetS was defined on the basis of the NCEP (National Cholesterol Education Program)/ATP III revised diagnostic criteria. Logistic regression and restricted cubic splines (RCS) models were used to assess the relationship between self-reported sleep duration and MetS.

RESULTS

The overall prevalence of MetS in the study cohort was 26.1%, with 24.8% for males and 27.3% for females. After adjusting for potential confounding factors, MetS was significantly associated with self-reported short sleep duration (odds ratio = 1.16, 95% confidence interval = 1.03-1.31, P = 0.013) but not with long sleep duration (P = 0.117). RCS regression revealed that self-reported sleep duration was nonlinearly related to MetS (P for nonlinearity = 0.0026). The risk of MetS decreased with increased sleep duration for durations of less than 7 h/day, while there was no association for longer sleep durations.

CONCLUSION

These results suggest that self-reported short sleep duration is a risk factor for MetS, while long sleep duration is not.

Sleep duration and metabolic syndrome: An updated systematic review and meta-analysis

We examined the association between self-reported sleep duration and metabolic syndrome (MetS). Data were collected from 36 cross-sectional and 9 longitudinal studies with a total of 164,799 MetS subjects and 430,895 controls. Odds ratios (ORs) for prevalent MetS and risk ratios (RRs) for incident MetS were calculated through meta-analyses of adjusted data from individual studies. Short sleep duration was significantly associated with increased prevalent MetS (OR = 1.11, 95% CI = 1.05-1.18) and incident MetS (RR = 1.28, 95% CI = 1.07-1.53) in cross-sectional and longitudinal studies, respectively. Furthermore, long sleep duration was significantly associated with increased prevalent MetS in cross-sectional studies (OR = 1.14, 95% CI = 1.05-1.23), but not incident MetS (RR = 1.16, 95% CI = 0.95-1.41) in longitudinal studies. Interestingly, the association between long sleep and prevalent MetS was found in sleep duration defined by 24-h sleep (including naps) rather than nighttime sleep. Our findings suggest 1) a "U-shape" relationship between sleep duration and MetS in cross-sectional studies and 2) association between short sleep duration, but not long sleep duration with incident MetS. Future studies should shed light on the underlying mechanisms related to the association between sleep duration and MetS and examine if normalizing sleep duration reduces MetS risk in the general population.

Is self-reported short sleep duration associated with obesity? A systematic review and meta-analysis of cohort studies

CONTEXT

A possible association between self-reported short sleep duration and risk of obesity has been studied.

OBJECTIVE

To analyze the association between sleep duration and obesity.

METHODS

The LILACS, Medline, Central, Embase, and OpenGrey databases were searched from inception until July 2020. Two authors screened the studies independently according to the PECO strategy, as follows: participants: > 18 years old; exposure: short sleep duration; control: regular sleep; outcome: obesity). Only cohort studies were included. A total of 3286 studies were retrieved with the search strategy, but only 36 were included. Disagreements were resolved by a third author. The quality of studies was assessed with Newcastle-Ottawa Quality Assessment Form for Cohort Studies. The certainty of the evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation.

RESULTS

Thirty-six studies were included, and 22 contributed quantitative data. Most of the studies (n = 27) assessed sleep by self-report. The meta-analysis showed a significant association between self-reported short sleep and development of obesity, and the chances of developing obesity increased when self-reported sleep duration decreased.

CONCLUSIONS

Self-reported short sleep was significantly associated with a higher incidence of obesity, with moderate quality of evidence.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42019130143.

Adherence to Lifelines Diet Score (LLDS) is associated with better sleep quality in overweight and obese women

PURPOSE

Previous studies have shown the connection between diet quality to sleep quality and weight status, although the relationship between Lifelines Diet Score (LLDS)-a fully food-based score that uses the 2015 Dutch Dietary Guidelines and underlying international literature-and sleep quality has not been evaluated in overweight and obese individuals yet. This observational study was conducted on overweight and obese adult females to assess the relationship between adherence to a LLDS pattern and sleep quality in Iran.

METHODS

A cohort of 278 overweight and obese women aged above 18 years was enrolled and their dietary intake was assessed using a 147-item, semi-quantitative, validated food frequency questionnaire. Pittsburgh Sleep Quality Index (PSQI), a self-reported questionnaire including 19-items, was applied to estimate sleep quality among the target population. Diet quality indices (LLDS) were calculated using the P.C. Vinke, et al. method, based on the 2015 Dutch Dietary Guidelines and the underlying literature.

RESULTS

Subjects in the highest LLDS tertile (those who had adhered closely to the food-based score) were older, compared to the lowest tertile (37.57 ± 7.77 versus 34.57 ± 9; p = 0.01). It was shown that about 25.5% of our subjects have poor quality sleep and 39% have better sleep quality which were mostly in the third tertile with greater LLDS. The parallel values in the first tertile were 29.9% and 46.8%, respectively (p = 0.02). Binary logistic regression was applied to evaluate the association between adherence of LLDS and sleep quality. The result has shown that the LLDS were correlated with lower risk poor sleep quality, wherein those who were in higher tertile (higher adherence to LLDS) had better sleep quality (odds ratio [OR]:0.586, 95% confidence interval [CI] (0.285-1.207), p = 0.009) and the result was not affected by adjusting for potential cofounders including age, education levels, and economic levels, sleep quality remained significantly associated with [OR]: 0.531, 95% confidence interval [CI] (0.248-1.138, p = 0.014).

CONCLUSIONS

From this observational study, the higher LLDS can be related with better sleep quality in overweight and obese women.

LEVEL OF EVIDENCE

Level IV, evidence obtained from multiple time series with or without the intervention, such as case studies.

Associations of sleep duration and fruit and vegetable intake with the risk of metabolic syndrome in Chinese adults

To understand the adverse association of short sleep duration and insufficient fruit and vegetable intake (FVI) with and their combined effect on metabolic syndrome (MetS) in Chinese adults.This cross-sectional study analyzed 7052 adults aged 18∼64 years old in 2009, with fasting blood samples collected. Participants were divided into short/normal/long sleep duration groups and sufficient/insufficient FVI groups in accordance with self-reported information. Metabolic syndrome was defined by National Cholesterol Education Program's Adult Treatment Panel III criteria.The prevalence of MetS among the study subjects was 21.74%. Participants were classified into short (<7 h/d), normal (7∼9 h/d), and long (>9 h/d) groups according to their daily sleep duration. Participants with less than 500 g of FVI per day was considered as insufficient FVI. After adjusting for confounders, the negative effect of short sleep duration on MetS was statistically significant, with an OR of 1.29 (95%CI = 1.06∼1.56); and high fasting glucose levels were significantly associated with insufficient FVI. Compared with subjects with normal sleep duration and sufficient FVI, participants with short sleep time and insufficient FVI had the highest risk of MetS (OR = 1.37, 95% CI: 1.04-1.66).This study revealed that insufficient FVI and short sleep duration were significantly associated with an increased risk of MetS among Chinese adults. Increasing FVI and normal sleep duration during Chinese adults could be significant targets for reducing the prevalence of MetS.

Sleep Duration and the Risk of Metabolic Syndrome in Adults: A Systematic Review and Meta-Analysis

Objective: Epidemiological studies have reported inconsistent findings for the association between sleep duration and metabolic syndrome. We aimed to clarify the effects of short and long sleep durations on metabolic syndrome in adults by performing a meta-analysis. Methods: Adopting random-effects models, this study analyzed the effects of short and long sleep durations based on data from prospective cohort studies and cross-sectional studies retrieved from four electronic databases from inception to May 2020. Results: We collected data from 235,895 participants included in nine prospective cohort studies and 340,492 participants included in 27 cross-sectional studies. In cohort studies, short sleep duration was associated with an increased risk of metabolic syndrome (RR, 1.15; 95% CI, 1.05-1.25, I 2 = 63.1%, P < 0.001) compared with normal sleep duration. While long sleep duration was not associated with new-onset metabolic syndrome (RR, 1.02, 0.85-1.18, I 2 = 38.0%, P = 0.491). In cross-sectional studies, both short (OR, 1.06, 95% CI, 1.01-1.11, I 2 = 66.5%, P < 0.001) and long (OR, 1.11, 95% CI, 1.04-1.17, I 2 = 73.8%, P < 0.001) sleep durations were associated with a high prevalence of metabolic syndrome. Conclusions: Only a short sleep duration was associated with an increased risk of metabolic syndrome. Future studies should address whether the association is casual and modifiable.

Longitudinal association between sleep and 5-year incident metabolic syndrome in older Chinese adults: a community-based cohort study

PURPOSE

Our aim was to investigate the association between sleep and the development of metabolic syndrome (MetS) in Chinese older adults and to accumulate evidence for the prevention of MetS through sleep management.

METHODS

This prospective study followed 3005 participants aged over 60 derived from the Weitang Geriatric Diseases Study who were without MetS at baseline. MetS was defined according to the Adult Treatment Panel III (ATP III) criteria. Logistic regression models were fit to assess the association between sleep and MetS incident and a linear regression model was used to examine the impact of sleep duration on every component of MetS. Data on sleep-related parameters were obtained based on a self-reported questionnaire.

RESULTS

After five-year follow-up, 13.51% participants developed MetS, of which 46.86% were women. The incidence of MetS was highest among adults who slept 6 h or less and lowest among those who slept 7 h after adjusted for multiple variables. Subgroup analyses showed no gender specificity. The variation of fasting plasma glucose (FBG) for ≥9 h per night was significantly lower than that for 7.01-7.99 h per night (β = -0.18, P < 0.05). Sleeping for 8-8.99 h also decreased the variation of diastolic blood pressure (DBP) compared to 7.01-7.99 h (β = -0.84, P < 0.05).

CONCLUSION

We conclude that both short and long sleep duration are risk factors for MetS incident in older adults.

The Association Between Sleep and Metabolic Syndrome: A Systematic Review and Meta-Analysis

PURPOSE

Sleep duration is thought to play a key role in the development of metabolic syndrome. However, the results have been inconsistent.

METHODS

We conducted a systematic review and meta-analysis of cohort studies and searched publications in PubMed, Embase, Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov. The summary relative risks (RRs) were estimated using a random model. The sensitivity analysis was performed by sequentially excluding each study to test the robustness of the pooled estimates.

FINDING

We included 13 studies involving 300,202 patients in which short sleep and long sleep significantly increased the risk of metabolic syndrome 15% (RR = 1.15, 95%CI = 1.09-1.22, p < 0.001) and 19% (RR = 1.19, 95%CI = 1.05-1.35, p < 0.001). Moreover, the relationship between sleep duration and metabolic syndrome risk presented a U-shaped curve. Short and long sleep increased the risk of obesity by 14% (RR = 1.14, 95%CI = 1.07-1.22, p<0.001) and 15% (RR = 1.15, 95%CI = 1.00-1.30, p = 0.04), and high blood pressure 16% (RR = 1.16, 95%CI = 1.02-1.31, p = 0.03) and 13% (RR = 1.13, 95%CI = 1.04-1.24, p = 0.01), respectively. Short sleep can potentially increase the risk of high blood sugar by 12% (RR = 1.12, 95%CI = 1.00-1.15, P = 0.05).

IMPLICATIONS

Based on our findings, sleep is a behavior that can be changed and is economical. Clinically doctors and health professionals should be encouraged to increase their efforts to promote healthy sleep for all people.

Interactive Impact of Sleep Duration and Sleep Quality on the Risk of Developing Metabolic Syndrome in Korean Adults

Sleep quality is important for the normal functioning of hormonal and metabolic processes in the body; however, few studies have considered the effects of both sleep duration and sleep quality on predicting metabolic syndrome risk. We examined the interactive impact of sleep duration and sleep quality on the risk of developing metabolic syndrome using logistic regression analysis with a threshold based on hours of sleep. Data were collected from 411 adults in South Korea and, according to the estimated threshold of 6 h of sleep (95% Confidence Interval, CI = 5–7 h), participants were classified as short (<6 h) or adequate-long (≥6 h) sleepers. The two groups differed significantly on various health measures. While short sleepers were more likely than adequate-long sleepers to experience adverse health conditions, which increased their risk of developing metabolic syndrome, they were not influenced by sleep quality. For adequate-long sleepers, however, a decrease in sleep quality was associated with an increased risk of developing metabolic syndrome (odds ratio = 1.24, 95% CI = 1.07–1.43). Our results suggest that both sleep duration and sleep quality are crucial determinants of the development of metabolic syndrome and that it is important to maintain at least 6 h of sleep.

The association between daily naps and metabolic syndrome: Evidence from a population-based study in the Middle-East

BACKGROUND

Daily naps are a common habit in many Middle Eastern and Asian countries; however, little is known about the association between daily naps and other health consequences, including the presence of metabolic syndrome (MetS).

METHODS

Participants were recruited from the Mashhad stroke and heart atherosclerotic disorders study. We defined MetS according to International Diabetes Federation criteria. Nighttime sleeping hours were categorized into three categories: <6, 6-8, and >8 hours. Using logistic regression models, we analyzed the association between the duration of night-time sleep and daily naps with MetS and its different components.

RESULTS

A total of 9652 individuals were included in the study: 3859 with MetS (40%) and 5793 without MetS (60%), as the control group. Of all, 72% participants had a regular daily nap. Those with daily naps had a higher odd of MetS [Odds ratio:1.19, confidence interval: (1.08-1.33); P < .001]. We also observed significantly higher odds of obesity, central obesity, hypertriglyceridemia, and diabetes or impaired fasting glucose in these subjects. Men sleeping <6 hours per night had a lower odd of MetS. However, we observed higher odds of cardiovascular risk factors in participants sleeping <6 hours, including obesity and diabetes or IFG.

CONCLUSION

Napping is a common habit in middle Eastern countries. Although the cross-sectional design of our study cannot prove causality, we observed a significant association between the presence of MetS and daily naps. The public should be aware of this possibility and be educated about the importance of sleeping patterns.

Dietary total antioxidant capacity and its association with sleep, stress, anxiety, and depression score: A cross-sectional study among diabetic women

BACKGROUND

Diabetes as a common chronic disease leads to several serious disabilities and complications. Patients with type 2 diabetes are involved with psychological and sleep disorders which diet can be effective in the management of these problems. The present study aimed to investigate the association of Dietary Total Antioxidant Capacity (DTAC) and sleep, stress, anxiety, and depression among diabetic women.

METHODS

This cross-sectional study conducted on 265 women with type 2 diabetes. A validated food frequency questionnaire was filled to evaluate dietary intakes. We calculated DTAC based on amounts of antioxidant in each dietary item using the ferric reducing ability of plasma (FRAP) and oxygen radical absorbance capacity (ORAC) databases. Pittsburgh Sleep Quality Index was used to assess sleep quality. Moreover, 21 items Depression, Anxiety, and Stress Scale was used to assess mental disorders.

RESULTS

Subjects in the highest tertile of FRAP and ORAC score compared to those in the lowest tertile of these scores had 94% and 87% lower risk of poor sleep, respectively. The odds of depression were negatively related to the highest tertile of FRAP and ORAC score (OR: 0.21, 95%CI: 0.09-0.50 and OR: 0.21, 95%CI: 0.10-0.48, respectively). Participants with the highest tertile of FRAP compared to those within the lowest tertile of FRAP score had a 59% lower risk of anxiety. The odds of stress were negatively related to the highest tertile of FRAP and ORAC score (OR: 0.10, 95%CI: 0.04-0.23 and OR: 0.13, 95%CI: 0.06-0.29, respectively).

CONCLUSION

There is a significant association between DTAC, sleep status and psychological disorders. However, prospective studies in both genders should be conducted to confirm the actual relationship.

Sleep Apnea and Heart

Scientific investigations in the past few decades have supported the important role of sleep in various domains of health. Sleep apnea is a highly prevalent yet underdiagnosed sleep disorder representing a valid cardiovascular risk factor, particularly for hypertension. While several studies have demonstrated the benefits of sleep apnea treatment on subclinical cardiovascular measures, there is a paucity of studies proving reduction of cardiovascular events and mortality. Sufficient and high-quality sleep is also important in the maintenance of cardiovascular health. Future investigations should focus on improving identification of patients at greatest risk of adverse cardiovascular s sequalae of sleep apnea and testing the therapeutic benefit of sleep apnea treatment in this vulnerable group.

Sleep Duration as an Indirect Link Between Sleep Timing and Weight in Midlife Women

Objective: Midlife women are at risk of obesity. Poor sleep outcomes including inadequate sleep duration and variable sleep timing are risk factors for obesity, but there is a lack of understanding on how specific sleep constructs uniquely or concurrently are associated with weight outcomes in this population. This study examined the unique association of sleep timing with weight outcomes and how sleep timing works in conjunction with sleep duration to influence weight in midlife women. Materials and Methods: An archival analysis was performed using the Midlife in the United States-II study (MIDUS-II). The sample consisted of 132 midlife women (40-64; M = 52.9, standard deviation = 6.94). Sleep timing (mean sleep time, variability) and duration were measured through actigraphy and daily sleep diaries. Weight was assessed using body mass index (BMI) and waist circumference measures. Results: PROCESS mediation and moderation analyses assessed direct, indirect, and moderating pathways. Sleep duration emerged as an indirect link between sleep timing (mean and variability) and weight outcomes (95% CI = 0.0001-0.0123; 95% CI = 0.0007-0.0378; 95% CI = 0.0079-0.1006). Sleep timing (95% CI = -0.0144 to 0.0076; 95% CI = -0.0358 to 0.0219) and sleep time variability (95% CI = -0.0124 to 0.0438; 95% CI = -0.0533 to 0.0939) were not directly associated with BMI or waist circumference. Also, sleep timing and duration did not interact to influence weight outcomes. Conclusions: Sleep duration, rather than sleep timing, is associated with weight outcomes, and is an indirect link in the sleep timing and weight outcomes association. Future work is needed to further disentangle the impact of sleep on weight in midlife women using prospective studies, implementing daily assessments of sleep behavior.

Association of sleep characteristics with cardiovascular health among women and differences by race/ethnicity and menopausal status: findings from the American Heart Association Go Red for Women Strategically Focused Research Network

BACKGROUND AND OBJECTIVE

Sleep is an emerging risk factor for cardiovascular disease (CVD) that is not currently included as a cardiovascular health (CVH) metric in the American Heart Association's Life's Simple 7 (AHA LS7). Our objective was to evaluate the association of sleep with CVH in women and examine differences by menopausal status and race/ethnicity.

METHODS

Baseline data from the Columbia University AHA Go Red for Women Strategically Focused Research Network were examined. Sleep habits were self-reported using validated questionnaires. A CVH score was computed using AHA LS7 criteria for smoking, diet, physical activity, BMI, blood pressure(BP), total cholesterol, and fasting glucose. Women received a score of 2 (ideal), 1 (intermediate), or 0 (poor) based on their level of meeting each AHA LS7 metric. Multivariable-adjusted regression models were used to evaluate associations of sleep with meeting overall and individual CVH metrics.

RESULTS

The analytical sample consisted of n = 507 women (62% minority/Hispanic, mean age:37 y). Participants with adequate sleep duration (≥7 h), good sleep quality, no insomnia nor snoring, and low risk for OSA were more likely to meet >4 of the AHA LS7 metrics (P < .01). Poorer sleep quality (β = -0.08, P = .002), higher insomnia severity (β = -0.05, P = .002), snoring (β = -0.77, P = .0001), and higher risk for OSA (β = -1.63, P < .0001) were associated with poorer CVH. Insomnia, snoring, and high OSA risk were associated with 69% to >300% higher odds of having poor CVH (P ≤ .03). Associations were stronger in post-menopausal and racial/ethnic minority women.

CONCLUSIONS

Better sleep habits were associated with more favorable CVH among women, suggesting that there may be benefit in incorporating sleep assessment into CVD risk screening.

The Prevalence of Metabolic Syndrome and Its Components among Type 2 Diabetes Mellitus Patients at a Tertiary Hospital, Northwest Ethiopia

Background

Metabolic syndrome is a cluster of risk factors that is responsible for the risk of coronary heart disease and stroke. Therefore, the aim of this study was to assess the prevalence of MetS and its components among T2DM patients.

Methods

A cross-sectional study was conducted at the Diabetes Clinic of the Hospital, from June to July, 2015. Data were entered into EPI INFO software and exported to SPSS 20 for analysis. MetS prevalence was estimated using NCEP ATPIII and IDF criteria. Anthropometric measurements, investigations of serum glucose and lipid profiles were done. Logistic regression analysis was used to evaluate associated factors. A P-value ≤ 0.05 was considered statistically significant.

Result

A total of 159 participants were included in the study; 119 (59.7%) were females with mean (±SD) age of (49.8±8.7) year. The prevalence of MetS was 66.7% in NCEP-ATP III and 53.5% in IDF definitions. The most prevalent component of MetS was elevated triglyceride (56.6% in ATPIII and 62.3% in IDF criteria), followed by abdominal obesity (61%) IDF and elevated blood pressure (55.4%) NCEP-ATPIII criteria. The regression analysis showed that increased age, being female, high BMI, having diabetes for over 5 years and poor glycemic control were significantly associated with metabolic syndrome.

Conclusion

The prevalence of MetS and its components among T2DM patients were high, suggesting that diabetic patients are at increased risk of CVD and other complications. Efforts should be geared towards addressing these abnormalities through lifestyle modification, health awareness and medications in order to reduce this complication.

Multiple poor sleep characteristics and metabolic abnormalities consistent with metabolic syndrome among white, black, and Hispanic/Latina women: modification by menopausal status

BACKGROUND

Poor sleep is a potential risk factor for metabolic syndrome (MetS), and its relationship with MetS may vary by race/ethnicity and menopausal status among women.

METHODS

We used Sister Study enrollment data from 2003 to 2009 to investigate the cross-sectional associations between multiple subjective sleep characteristics and having ≥ 3 prevalent metabolic abnormalities consistent with MetS among white, black, and Hispanic/Latina women. Self-reported sleep characteristics included average sleep duration (short [< 7 h] vs. recommended [7-9 h]), sleep debt (≥ 2-h difference between shortest and longest sleep duration, napping ≥ 3 times/week, and insomnia symptoms (difficulty falling or staying asleep). We used Poisson regression with robust variance to estimate adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs) to compare MetS prevalence between women with poor sleep (e.g., short sleep, sleep debt, frequent napping, or insomnia symptoms [all yes vs. no]) and non-poor sleep within menopausal status categories (premenopausal or postmenopausal). We adjusted for sociodemographic characteristics, mental health, and health behaviors.

RESULTS

Among 38,007 eligible women (13,988 premenopausal, 24,019 postmenopausal), mean age was 55 ± 8.8 years, racial/ethnic composition was 86.63% white, 8.53% black, and 4.84% Hispanic/Latina, and 12% had MetS. Associations between certain poor sleep characteristics [i.e., short sleep (PRpremenopausal = 1.23 [95% CI 1.06-1.42], PRpostmenopausal = 1.09 [1.02-1.16], pshort sleep*menopause = 0.0070) and insomnia symptoms (PRpremenopausal = 1.21 [1.05-1.41], PRpostmenopausal = 1.11 [1.05-1.18], pinsomnia symptoms*menopause = 0.035)] and prevalent MetS were stronger among premenopausal compared to postmenopausal women, but did not vary by race/ethnicity. Associations between concurrent short sleep/insomnia symptoms and MetS were stronger among white and Hispanic/Latina postmenopausal women compared to their black counterparts. Menopausal status and race/ethnicity did not modify positive associations for other poor sleep characteristics.

CONCLUSIONS

Poor sleep was positively associated with MetS prevalence. Associations between individual poor sleep characteristics (i.e., short sleep, insomnia symptoms) were stronger among premenopausal compared to postmenopausal women but did not vary by race/ethnicity.

Longitudinal study of the relationship between sleep duration and hypertension in Chinese adult residents (CHNS 2004-2011)

OBJECTIVE

To determine the associations between sleep duration and hypertension in Chinese adults.

METHODS

This longitudinal study analyzed 9851 adults who had participated in at least two rounds of the CHNS (China Health and Nutrition Survey) during 2004-2011. Sleep duration was classified into ≤7, 8, and ≥9 h. Age, sex, residence location, education level, smoking, drinking alcohol, drinking tea, drinking coffee, activity level, and body mass index were adjusted as confounders in a generalized linear mixed model.

RESULTS

The unadjusted analysis showed that compared with a normal sleep duration (8 h), the odds ratios (ORs) for those with short (≤7 h) and long (≥9 h) sleep durations were 1.24 and 1.17, respectively (95% confidence intervals [CIs] = 1.14-1.36 and 1.06-1.29). After adjusting for confounding factors, the effect of a short sleep duration on hypertension was still statistically significant, with an OR of 1.13 (95% CI = 1.04-1.24), while a long sleep duration no longer had a statistically significant effect.

CONCLUSIONS

A short sleep duration is an independent risk factor for adult hypertension, whereas a long sleep duration is not in Chinese adults. The prevalence of hypertension should be prevented and controlled by improving the sleep status of adults.

Associations Between Unhealthy Lifestyle Behaviors and Metabolic Syndrome by Gender in Young Adults

OBJECTIVE

Unhealthy lifestyle behaviors, such as smoking, drinking, betel-quid chewing, insufficient exercise, and inadequate sleep are significantly correlated with metabolic syndrome (MetS). To further understand this relationship, this study examined the main effect of unhealthy lifestyle behaviors and their interaction on MetS by gender in young adults.

METHOD

A cross-sectional study involving 694 young adults from a national survey was performed in which demographic characteristics, unhealthy lifestyle behaviors, anthropometric measurements, and blood chemistry panels were collected during face-to-face interviews.

RESULTS

The prevalence of MetS among young adults was 17.4% and was greater in males than females (19.0% vs. 7.8%). The unhealthy lifestyle-behavior risk factors associated with MetS included smoking (odds ratio [ OR] = 4.53) and physical activity ( OR = 0.51) among males and betel-quid chewing ( OR = 8.90) and less sleep ( OR = 0.08) among females. Significant interaction effects were observed between the abovementioned behaviors and gender for the risk of developing MetS.

CONCLUSION

These results can guide health-care providers in reducing MetS risk by encouraging young adult males to reduce or quit cigarette smoking and maintain optimum levels of physical activity and young adult females to quit chewing betel quid and obtain appropriate amounts of sleep.

Sleep duration and excess heart age among US adults

OBJECTIVES

Insufficient sleep negatively impacts the cardiovascular system. No study has examined the association between sleep duration and heart age (person's predicted vascular age based on cardiovascular disease [CVD] risk profile). This study examines association between sleep duration and excess heart age (EHA; difference between heart age and chronological age) among US adults.

DESIGN AND PARTICIPANTS

Cross-sectional 2007-2014 National Health and Nutrition Examination Survey data for respondents aged 30-74 years without CVD or stroke (n = 12,775).

MEASUREMENTS

Self-reported sleep duration was classified into 5 categories (≤5, 6, 7, 8, and ≥9 hours). We used sex-specific Framingham heart age algorithm to calculate heart age and multivariable linear regression to examine association between sleep duration and EHA.

RESULTS

A total of 13.4% (95% confidence interval 12.5-14.3), 24.2% (23.1-25.2), 31.0% (29.8-32.3), 25.9% (25.0-26.9), and 5.5% (5.0-6.1) reported sleeping ≤5, 6, 7, 8, and ≥9 hours, respectively. We observed a nonlinear relationship between sleep duration and EHA using 7 hours as reference: EHA (adjusted for sociodemographics, body mass index, physical activity, Healthy Eating Index-2010, sleep disorder, and depression status) was 5.1 (4.8-5.8), 4.5 (3.9-5.1), 3.7 (3.3-4.0), 4.5 (4.1-5.0), and 4.1 (3.3-4.9) years for sleep durations of ≤5, 6, 7, 8 and ≥9 hours, respectively (P = .015 for quadratic trend). EHA was significantly higher among participants with lower education, lower income, and obesity.

CONCLUSION

Mean adjusted EHA was lowest among adults who reported sleeping 7 hours per night and increased as adults reported sleeping fewer or more hours. Discussing sleep duration in the context of EHA may be helpful for patients and clinicians.

Sleep Duration and Hypertension: Analysis of > 700,000 Adults by Age and Sex

STUDY OBJECTIVES

The objective of this study was to evaluate the cross-sectional relationship between sleep duration and hypertension in a large, nationally-representative dataset that spans 10 years. This analysis may provide detailed information with high resolution about how sleep duration is related to hypertension and how this differs by demographic group.

METHODS

Data were aggregated from the 2013 Behavioral Risk Factor Surveillance System (n = 433,386) and the combined 2007-2016 National Health Interview Surveys (n = 295,331). These data were collected by the Centers for Disease Control and Prevention from nationally-representative samples. Surveys were combined, and survey-specific weights were used in all analyses. Sleep duration was assessed with the item, "On average, how many hours of sleep do you get in a 24-hour period?" in both surveys. Hypertension was assessed as self-reported history. Covariates were assessed identically in both datasets and included, age (in 5-year groupings), sex, race/ethnicity, and employment status.

RESULTS

In adjusted analyses, compared to 7 hours, increased risk of hypertension was seen among those sleeping ≤ 4 hours (odds ratio [OR] = 1.86, P < .0005), 5 hours (OR = 1.56, P < .0005), 6 hours (OR = 1.27, P < .0005), 9 hours (OR = 1.19, P < .0005), and ≥ 10 hours (OR = 1.41, P < .0005). When stratified by age, sex, and race/ethnicity groups, short sleep was associated with increased risk for all age groups < 70 years, and long sleep (≥ 10 hours only) was associated with risk for all except < 24 years and > 74 years. Findings for short sleep were relatively consistent across all race/ethnicities, although findings for long sleep were less pronounced among Black/African-American and Other/Multiracial groups. A significant sleep by 3-way sleep × age × sex interaction (P < .0005) suggests that the relationship depends on both age and sex. For both men and women, the OR of having hypertension associated with short sleep decreases with increasing age, but there is a higher association between short sleep and hypertension for women, throughout the adult lifespan.

CONCLUSIONS

Both short and long sleep duration are associated with increased hypertension risk across most age groups. The influence of covariates is stronger upon long sleep relationships. Relationships with short sleep were stronger among younger adults and women.

Association of sleep quality components and wake time with metabolic syndrome: The Qazvin Metabolic Diseases Study (QMDS), Iran

PURPOSE

The aim of this study was to determine the association of sleep quality and sleep quantity with metabolic syndrome in Qazvin, Iran.

METHODS

this cross sectional study was conducted in 1079 residents of Qazvin selected by multistage cluster random sampling method in 2011. Metabolic syndrome was defined according to the criteria proposed by the national cholesterol education program third Adult treatment panel. Sleep was assessed using the Pittsburgh sleep quality index (PSQI). A logistic regression analysis was used to examine the association of sleep status and metabolic syndrome.

RESULTS

Mean age was 40.08±10.33years. Of 1079, 578 (52.2%) were female, and 30.6% had metabolic syndrome. The total global PSQI score in the subjects with metabolic syndrome was significantly higher than subjects without metabolic syndrome (6.30±3.20 vs. 5.83±2.76, P=0.013). In logistic regression analysis, sleep disturbances was associated with 1.388 fold increased risk of metabolic syndrome after adjustment for age, gender, and body mass index.

CONCLUSION

Sleep disturbances component was a predictor of metabolic syndrome in the present study. More longitudinal studies are necessary to understand the association of sleep quality and its components with metabolic syndrome.

Circadian Influence on Metabolism and Inflammation in Atherosclerosis

Many aspects of human health and disease display daily rhythmicity. The brain's suprachiasmic nucleus, which interprets recurring external stimuli, and autonomous molecular networks in peripheral cells together, set our biological circadian clock. Disrupted or misaligned circadian rhythms promote multiple pathologies including chronic inflammatory and metabolic diseases such as atherosclerosis. Here, we discuss studies suggesting that circadian fluctuations in the vessel wall and in the circulation contribute to atherogenesis. Data from humans and mice indicate that an impaired molecular clock, disturbed sleep, and shifting light-dark patterns influence leukocyte and lipid supply in the circulation and alter cellular behavior in atherosclerotic lesions. We propose that a better understanding of both local and systemic circadian rhythms in atherosclerosis will enhance clinical management, treatment, and public health policy.

Changes in sleep duration and risk of metabolic syndrome: the Kailuan prospective study

Using a large longitudinal data set spanning 4 years, we examined whether a change in self-reported sleep duration is associated with metabolic syndrome (MetS). Current analysis included 15,753 participants who were free of MetS during both 2006–2007 and 2010–2011. Sleep duration was categorized into seven groups: ≤5.5 h, 6.0–6.5 h, 7.0 h, 7.5–8.0 h, ≥8.5 h, decrease ≥2 h, and increase ≥2 h. Cox proportional hazards models were used to calculate hazard ratios (HRs) and their confidence intervals (CI) for MetS, according to sleep duration. Compared to the reference group of persistent 7-h sleepers, a decrease of ≥2 h sleep per night was associated with a higher risk of incident MetS (HR = 1.23, 95% CI = 1.05–1.44) in analyses adjusted for age, sex, sleep duration at baseline, marital status, monthly income per family member, education level, smoking status, drinking status, physical activity, body mass index, snoring status and resting heart rate. An increased risk of MetS incidence was also observed in persistent short sleepers (average ≤5.5 h/night; HR = 1.22, 95% CI = 1.01–1.50). This study suggests individuals whose sleep duration decreases ≥2 h per night are at an increased risk of MetS.

Women Who Sleep More Have Reduced Risk of Peptic Ulcer Disease; Korean National Health and Nutrition Examination Survey (2008-2009)

Sleep is integral to life and sleep duration is important in sleep quality, physical, and psychological health. Disturbances in sleep duration have been associated with increased risk of metabolic disorders, hypertension, and overall mortality. Sleep disturbance has also been linked with various gastrointestinal disorders. However, the association between sleep and peptic ulcer disease (PUD) has not been evaluated. We investigated the association between sleep duration and PUD. Subjects were included from the fifth Korean National Health and Nutrition Examination Survey conducted from 2008-2009. Individuals with PUD were defined as those with a physician diagnosis of PUD. Daily sleep duration was established by asking participants the amount of time that they slept per day. Multiple logistic regression models were used to evaluate the association of PUD and sleep duration. This study included 14,290 participants (8,209 women). The prevalence of PUD was 5.7% and was higher in men (6.8%) than in women (4.9%). Women who slept ≥9 hours were significantly less likely to have PUD compared to women who slept 7 hours. In men, longer sleep duration (≥9 hours) had a tendency toward PUD prevention. Our results suggest that longer sleep duration may play a protective role for PUD development.

Sleep Duration and Midday Napping with 5-Year Incidence and Reversion of Metabolic Syndrome in Middle-Aged and Older Chinese

STUDY OBJECTIVES

Prospective evidence on the association of sleep duration and midday napping with metabolic syndrome (MetS) is limited. We aimed to examine the associations of sleep duration and midday napping with risk of incidence and reversion of MetS and its components among a middle-aged and older Chinese population.

METHODS

We included 14,399 subjects from the Dongfeng-Tongji (DFTJ) Cohort Study (2008-2013) who were free of coronary heart disease, stroke, and cancer at baseline. Baseline data were obtained by questionnaires and health examinations. Odds ratios (ORs) and 95% confidence interval (CI) were derived from multivariate logistic regression models.

RESULTS

After controlling for potential covariates, longer sleep duration (≥ 9 h) was associated with a higher risk of MetS incidence (OR, 1.29; 95% CI, 1.08-1.55) and lower reversion of MetS (OR, 0.80; 95% CI, 0.66-0.96) compared with sleep duration of 7 to < 8 h; whereas shorter sleep duration (< 6 h) was not related to incidence or reversion of MetS. For midday napping, subjects with longer napping (≥ 90 min) was also associated with a higher risk of MetS incidence and a lower risk of MetS reversion compared with those with napping of 1 to < 30 min (OR, 1.48; 95% CI, 1.05-2.10 and OR, 0.70; 95% CI, 0.52-0.94, respectively). Significance for incidence or reversion of certain MetS components remained in shorter and longer sleepers but disappeared across napping categories.

CONCLUSIONS

Both longer sleep duration and longer midday napping were potential risk factors for MetS incidence, and concurrently exert adverse effects on MetS reversion.

Sleep Duration and Quality: Impact on Lifestyle Behaviors and Cardiometabolic Health: A Scientific Statement From the American Heart Association

Sleep is increasingly recognized as an important lifestyle contributor to health. However, this has not always been the case, and an increasing number of Americans choose to curtail sleep in favor of other social, leisure, or work-related activities. This has resulted in a decline in average sleep duration over time. Sleep duration, mostly short sleep, and sleep disorders have emerged as being related to adverse cardiometabolic risk, including obesity, hypertension, type 2 diabetes mellitus, and cardiovascular disease. Here, we review the evidence relating sleep duration and sleep disorders to cardiometabolic risk and call for health organizations to include evidence-based sleep recommendations in their guidelines for optimal health.

Restriction of rapid eye movement sleep during adolescence increases energy gain and metabolic efficiency in young adult rats

NEW FINDINGS

What is the central question of this study? Sleep curtailment in infancy and adolescence may lead to long-term risk for obesity, but the mechanisms involved have not yet been determined. This study examined the immediate and long-term metabolic effects produced by sleep restriction in young rats. What is the main finding and its importance? Prolonged sleep restriction reduced weight gain (body fat stores) in young animals. After prolonged recovery, sleep-restricted rats tended to save more energy and to store more fat, possibly owing to increased gross food efficiency. This could be the first step to understand this association. Sleep curtailment is associated with obesity and metabolic changes in adults and children. The aim of the present study was to evaluate the immediate and long-term metabolic alterations produced by sleep restriction in pubertal male rats. Male Wistar rats (28 days old) were allocated to a control (CTL) group or a sleep-restricted (SR) group. This was accomplished by the single platform technique for 18 h per day for 21 days. These groups were subdivided into the following four time points for assessment: sleep restriction and 1, 2 and 4 months of recovery. Body weight and food intake were monitored throughout the experiment. At the end of each time period, blood was collected for metabolic profiling, and the carcasses were processed for measurement of body composition and energy balance. During the period of sleep restriction, SR animals consumed less food in the home cages. This group also displayed lower body weight, body fat, triglycerides and glucose levels than CTL rats. At the end of the first month of recovery, despite eating as much as CTL rats, SR animals showed greater energy and body weight gain, increased gross food efficiency and decreased energy expenditure. At the end of the second and fourth months of recovery, the groups were no longer different, except for energy gain and gross food efficiency, which remained higher in SR animals. In conclusion, sleep restriction affected weight gain of young animals, owing to reduction of fat stores. Two months were sufficient to recover this deficit and to reveal that SR rats tended to save more energy and to store more fat.

[Sleep duration and metabolism]

Sleep duration has gradually diminished during the last decade while obesity and type 2 diabetes have become epidemics. Experimental sleep curtailment leads to increased appetite, hormonal disturbances and, especially, insulin resistance. Numerous epidemiological studies have therefore examined whether habitual short sleep is associated with obesity and type 2 diabetes. A large majority of cross-sectional studies have confirmed an association between short, and also long sleep duration and obesity in adults more than in the elderly. Short sleep is strongly associated to obesity in children and adolescents. Prospective studies, including studies in children, are not conclusive with regard to the effect of short sleep on the incidence of obesity. Both short and long sleep durations are associated with diabetes, but only short sleep duration seems predictive of future diabetes. Insomnia seems to be a strong contributor to short sleep duration but the association of insomnia with obesity is not clear. Insomnia is associated with type 2 diabetes and also predictive of a higher incidence. Other studies have shown that short sleep duration and insomnia are associated with, and sometime predictive of, other components of the metabolic syndrome, especially hypertension and the risk of coronary disease. The treatment of short sleep duration and insomnia with regard to their effects on the metabolic syndrome merits further study.

Associations of Short Sleep and Shift Work Status with Hypertension among Black and White Americans

Objective. The purpose of this study was to investigate whether short sleepers (<6 hrs) who worked the non-day-shift were at greater likelihood of reporting hypertension and if these associations varied by individuals' ethnicity. Methods. Analysis was based on the 2010 National Health Interview Survey (NHIS). A total of 59,199 American adults provided valid data for the present analyses (mean age = 46.2 ± 17.7 years; 51.5% were female). Respondents provided work schedule and estimated habitual sleep durations as well as self-report of chronic conditions. Results. Of the sample, 30.8% reported a diagnosis of hypertension, 79.1% reported daytime shift work, 11.0% reported rotating shift work, and 4.0% reported night shift work. Logistic regression analysis showed that shift work was significantly associated with hypertension among Blacks [OR = 1.35, CI: 1.06–1.72. P < 0.05], but not among Whites [OR = 1.01, CI: 0.85–1.20, NS]. Black shift workers sleeping less than 6 hours had significantly increased odds of reporting hypertension [OR = 1.81, CI: 1.29–2.54, P < 0.01], while their White counterparts did not [OR = 1.17, CI: 0.90–1.52, NS]. Conclusions. Findings suggest that Black Americans working the non-day-shift especially with short sleep duration have increased odds of reporting hypertension.

Nonalcoholic fatty liver disease: a precursor of the metabolic syndrome

The conventional paradigm of nonalcoholic fatty liver disease representing the "hepatic manifestation of the metabolic syndrome" is outdated. We identified and summarized longitudinal studies that, supporting the association of nonalcoholic fatty liver disease with either type 2 diabetes mellitus or metabolic syndrome, suggest that nonalcoholic fatty liver disease precedes the development of both conditions. Online Medical databases were searched, relevant articles were identified, their references were further assessed and tabulated data were checked. Although several cross-sectional studies linked nonalcoholic fatty liver disease to either diabetes and other components of the metabolic syndrome, we focused on 28 longitudinal studies which provided evidence for nonalcoholic fatty liver disease as a risk factor for the future development of diabetes. Moreover, additional 19 longitudinal reported that nonalcoholic fatty liver disease precedes and is a risk factor for the future development of the metabolic syndrome. Finally, molecular and genetic studies are discussed supporting the view that aetiology of steatosis and lipid intra-hepatocytic compartmentation are a major determinant of whether fatty liver is/is not associated with insulin resistance and metabolic syndrome. Data support the novel paradigm of nonalcoholic fatty liver disease as a strong determinant for the development of the metabolic syndrome, which has potentially relevant clinical implications for diagnosing, preventing and treating metabolic syndrome.

Associations of exercise, sedentary time and insomnia with metabolic syndrome in Taiwanese older adults: A 1-year follow-up study

BACKGROUND

Understanding the risk factors of metabolic syndrome (MetS) is important to public health, since individuals with MetS have an increased risk of health problems. This study examined the associations of exercise, sedentary time and insomnia with incident MetS among older adults 1 year later.

METHOD

A total of 1,359 older adults receiving hospital health examinations in 2012 were studied, and 779 subjects had a follow-up after 1 year. The components of MetS (waist, blood pressure, high-density lipoprotein cholesterol, fasting glucose and triglyceride) were defined by the Program's Adult Treatment Panel III report. Exercise, sedentary time and insomnia data were obtained through self-report questionnaires. Physical fitness (body fatness, balance and hand grip strength) was measured. Two logistic regressions were computed to examine the associations of exercise/physical fitness, sedentary time and insomnia at baseline with incident MetS 1 year later. The first regression included age, sex, smoking and alcohol as covariates. The second regression was further adjusted with the components of MetS.

RESULTS

Sex, exercise/balance, sedentary time and insomnia were significant predictors of MetS. The risk of MetS incidence was 3.36 (95% CI 1.96-5.77) for women, 1.92 (95% CI 1.01-3.63) for those who did not exercise, 2.52 (95% CI 1.37-4.63) for those who sat more than 5 h/day, and 2.17 (95% CI 1.13-4.15) for those with insomnia. Poor balance was significantly associated with greater risk of MetS (AOR = 1.07, 95% CI 1.02-1.12). Sex, sedentary time, insomnia and balance remained significant after adjusting with the components of MetS.

CONCLUSIONS

Cultivating exercise habits, reducing sedentary time and improving sleep quality may be important strategies for MetS prevention among older adults.

Impact of menstrual cycle phase on endocrine effects of partial sleep restriction in healthy women

There is extensive evidence that sleep restriction alters endocrine function in healthy young men, increasing afternoon cortisol levels and modifying levels of other hormones that regulate metabolism. Recent studies have confirmed these effects in young women, but have not investigated whether menstrual cycle phase influences these responses. The effects on cortisol levels of limiting sleep to 3h for one night were assessed in two groups of women at different points in their menstrual cycles: mid-follicular and mid-luteal. Eighteen healthy, young women, not taking oral contraceptives (age: 21.8±0.53; BMI: 22.5±0.58 [mean±SEM]), were studied. Baseline sleep durations, eating habits and menstrual cycles were monitored. Salivary samples were collected at six times of day (08:00, 08:30, 11:00, 14:00, 17:00, 20:00) during two consecutive days: first after a 10h overnight sleep opportunity (Baseline) and then after a night with a 3h sleep opportunity (Post-sleep restriction). All were awakened at the same time of day. Women in the follicular phase showed a significant decrease (p=0.004) in their cortisol awakening responses (CAR) after sleep restriction and a sustained elevation in afternoon/evening cortisol levels (p=0.008), as has been reported for men. Women in the luteal phase showed neither a depressed CAR, nor an increase in afternoon/evening cortisol levels. Secondary analyses examined the impact of sleep restriction on self-reported hunger and mood. Menstrual cycle phase dramatically altered the cortisol responses of healthy, young women to a single night of sleep restriction, implicating effects of spontaneous changes in endocrine status on adrenal responses to sleep loss.

A population-based survey of sleep disturbances in middle-aged women--associations with health, health related quality of life and health behavior

OBJECTIVE

To evaluate the prevalence of sleep disturbances and the contributing factors in middle-aged women.

METHODS

In a cross-sectional design of the long-term, prospective follow-up study project of 1278 families from a random population sample, the mothers of 15 year-olds were asked to fill in a questionnaire about sleep, health, health related quality of life, and health behavior.

RESULTS

Quality of sleep was reported by 32% of women as good, 43% quite good, 12% average, 10% quite poor and 3% as poor. The most frequent sleep disturbance was awakenings in the night, which 60% of the women experienced at least once a week. Difficulty falling asleep and waking too early in the morning were reported as a weekly occurrence by 16% and 20%, respectively. Morning sleepiness was experienced by 42% and daytime sleepiness by 32%. Chronic diseases and use of medications was associated with various sleep disturbances. Both somatic and mental symptoms increased the risk for sleep disturbances.

CONCLUSIONS

Almost one-quarter of middle-aged women is dissatisfied with their quality of sleep. Women who have chronic disease or use of medications for basic diseases often suffer from sleep disturbance, which is also associated with the health related quality of life. Further analysis of the risk factors is needed to improve the sleep health of middle-aged women.

Short sleep duration as a risk factor for the development of the metabolic syndrome in adults

OBJECTIVE

The objective of this study was to investigate the association between self-reported sleep duration and the incidence of features of the metabolic syndrome in adults.

METHODS

A longitudinal analysis from the Quebec Family Study (Canada) was conducted on 293 participants, aged 18 to 65 years, followed for a mean of 6 years (until 2001). Participants were categorized as short (≤6 h), adequate (7-8 h) or long (≥9 h) sleepers. The metabolic syndrome was defined according to the American Heart Association/National Heart, Lung, and Blood Institute's criteria. The hypertriglyceridemic waist phenotype was defined as high waist circumference (≥90 cm in men and ≥85 cm in women) combined with high fasting triglyceride level (≥2.0 mmol/L in men and ≥1.5 mmol/L in women).

RESULTS

The incidence rates of metabolic syndrome and hypertriglyceridemic waist phenotype were 9.9% and 7.5%, respectively. Short sleepers were significantly more at risk of developing the metabolic syndrome (relative risk (RR): 1.74; 95% confidence interval (CI): 1.05-2.72) and the hypertriglyceridemic waist phenotype (RR: 1.82; 95% CI: 1.16-2.79), compared to those sleeping 7 to 8h per night after adjusting for covariates. However, long sleep duration was not associated with an increased risk of developing the metabolic syndrome or the hypertriglyceridemic waist phenotype (either unadjusted or adjusted models).

CONCLUSION

Short sleep duration is associated with an increased risk of developing features of the metabolic syndrome in adults.

The influence of sex and age on the relationship between sleep duration and metabolic syndrome in Korean adults

AIMS

To investigate the influence of sex and age on the relationship between sleep duration and metabolic syndrome in a nationally representative population.

METHODS

We used data from the Korea National Health and Nutrition Examination Survey (2001-2010) and enrolled 24,511 participants aged 20-79 years. Sleep duration was categorized into five groups: ≤5, 6, 7 (referent), 8, and ≥9h/day. Age was categorized into three groups: younger (20-39y), middle-aged (40-59y), and older (60-79y). The association between sleep duration and metabolic syndrome was assessed in the total, separately in men and women, then in six groups based on sex and age.

RESULTS

The prevalence of metabolic syndrome by sleep category demonstrated a U-shaped pattern in the total population. However, after adjusting for age, education, occupation, exercise, smoking, alcohol, and body mass index, the prevalence of metabolic syndrome increased in long sleepers (OR 1.31; 95% CI 1.14-1.51) but not in short sleepers (OR 1.00; 95% CI 0.89-1.11). The relationship between sleep duration and metabolic syndrome varied by sex and age-long sleep (≥9h/day) was positively associated with metabolic syndrome only in younger (OR 2.13; 95% CI 1.38-3.28) and middle-aged (OR 1.63; 95% CI 1.21-2.21) women. Short sleep (≤5h/day) was not associated with metabolic syndrome in any sex and age groups. However, extremely short sleep (≤4h/day) was associated with metabolic syndrome in middle-aged men (OR 1.76, 95% CI 1.05-2.96).

CONCLUSION

These data suggest that sex and age significantly modify the relationship between sleep duration and metabolic syndrome.

Seven to eight hours of sleep a night is associated with a lower prevalence of the metabolic syndrome and reduced overall cardiometabolic risk in adults

Background

Previous studies looking at the relationship between sleep duration and the metabolic syndrome have only used a dichotomous approach (presence/absence) and failed to adjust for important confounding factors. The objective of the present study was to examine the association between self-reported sleep duration and features of the metabolic syndrome in adults.

Methods

A cross-sectional analysis from the Quebec Family Study (Canada) was conducted on 810 participants aged 18 to 65 years. Participants were categorized as short (≤6 h), adequate (7–8 h) or long (≥9 h) sleepers. The metabolic syndrome was defined according to the American Heart Association/National Heart, Lung, and Blood Institute’s criteria.

Results

Overall, 24.6% of the sample had the metabolic syndrome. A U-shaped relationship between sleep duration and the prevalence of metabolic syndrome (33.3%, 22.0% and 28.8% in short, adequate and long sleepers, respectively) was observed (P<0.01). Only short sleepers had a significant increase in the odds of having the metabolic syndrome (OR = 1.76, 95% CI = 1.08–2.84) compared to adequate sleepers after adjustment for age, sex, smoking habits, highest education level, total annual family income, alcohol consumption, coffee intake, menopausal status, daily caloric intake, and moderate-to-vigorous physical activity. Likewise, the clustered cardiometabolic risk score (i.e. continuous risk score based on the metabolic syndrome components) was significantly higher in short sleepers compared to adequate sleepers after adjustment for covariates (P<0.05).

Conclusion

Sleeping ≤6 h per night is associated with an elevated cardiometabolic risk score and an increase in the odds of having the metabolic syndrome after adjusting for possible confounders. These results strongly suggest that short sleep duration is a risk factor for the metabolic syndrome.