Natural Immunosuppressants as a Treatment for Chronic Insomnia Targeting the Inflammatory Response Induced by NLRP3/caspase-1/IL-1β Axis Activation: A Scooping Review

Chronic insomnia is an inflammatory-related disease with an important pathological basis for various diseases which is a serious threat to a person's physical and mental health. So far, many hypotheses have been proposed to explain the pathogenesis of insomnia, among which inflammatory mechanisms have become the focus of scientific attention. In this regard, the aim of the present scooping review is to evaluate the potential benefits of natural compounds in treatment of chronic insomnia targeting nucleotide-binding oligomerization domain (NOD)-like receptor-pyrin-containing protein 3 (NLRP3)/caspase-1/IL-1β axis as one of the most important activators of inflammatory cascades. The data show that compounds that have the potential to cause inflammation induce sleep disorders, and that inflammatory mediators are key molecules in regulating the sleep-related activity of neurons. In the inflammatory process of insomnia, the role of NLRP3 in the pathogenesis of insomnia has been gradually considered by researchers. NLRP3 is an intracellular sensor that recognizes the widest range of pathogen-associated molecular patterns (PAMPs) and danger-associated molecular patterns (DAMPs). After identification and binding to damage factors, NLRP3 inflammasome is assembled to activate the caspase-1 and IL-1β. Increased production and secretion of IL-1β may be involved in central nervous system dysregulation of physiological sleep. The current scooping review reports the potential benefits of natural compounds that target NLRP3 inflammasome pathway activity and highlights the hypothesis which NLRP3 /caspase-1/IL-1β may serve as a potential therapeutic target for managing inflammation and improving symptoms in chronic insomnia.

Time to Take Sleeping Pills and Subjective Satisfaction among Cancer Patients

OBJECTIVE

We investigated the influence of the time to take hypnotics and daytime activity on patient satisfaction with sleeping pills.

METHODS

Ninety-six cancer patients who were currently taking benzodiazepine or z-drug as hypnotics were grouped into satisfied and dissatisfied groups. The subjects' symptoms, time to take sleeping pills, bedtime, sleep onset time, wake up time, and time in bed within 24 hours (TIB/d) were obtained.

RESULTS

The satisfied group had significantly late sleeping pill ingestion time (p=0.04); significantly early wake up time (p=0.01); and significantly shorter sleep latency, TIB/d, duration from the administration of pills to sleep onset, and duration from the administration of pills to wake up time (PTW). Logistic regression analysis revealed that the significant predictors of patient satisfaction to hypnotics were less severity of insomnia [odds ratio (OR)=0.91] and the time variables, including late sleeping pill administration time (OR=1.53) and early wake up time (OR=0.57). Among the duration variables, short PTW (OR=0.30) and short TIB/d (OR=0.64) were significantly related with the satisfaction to hypnotics.

CONCLUSION

Reducing the duration from the administration of hypnotics to wake up time and TIB/d can influence the satisfaction to sleeping pills.

Association between sleep characteristics and antihypertensive treatment in older adults

AIM

The relationship between sleeping characteristics and antihypertensive medication is little known. We examined the association of sleep quality or duration and the use of sleeping pills with the number of antihypertensive drugs used in older adults.

METHODS

This was a prospective cohort study of treated hypertensive patients aged ≥60 years participating in a seniors cohort, followed from 2008 to 2010 through 2012 to 2013. Self-reported sleep duration, sleep quality (usually having difficulty falling asleep or staying asleep) and sleeping pills use were ascertained at baseline, and the change in the number of antihypertensive drugs (active agents) between 2008-2010 and 2012-2013 was calculated. Analyses were carried out with logistic regression, and adjusted for demographics, lifestyle, comorbidity, baseline number of antihypertensive drugs and hypertension control.

RESULTS

Among the 752 participants at baseline (mean age 69.9 years, 49.2% men), the mean sleep duration was 6.9 h/day, 37% had poor sleep quality, 16.5% usually consumed sleeping pills and the mean number of antihypertensive drugs was 1.8. During the follow-up period, 156 (20.7%) patients increased the number of antihypertensive drugs. No association was found between sleep duration or quality and the change in antihypertensive drug use. Usual sleeping pills consumption was associated with a higher risk of increasing (vs decreasing/maintaining) the number of antihypertensive drugs (odds ratio 1.85; 95% confidence interval 1.12-3.07, P-value 0.02).

CONCLUSIONS

Consumption of sleeping pills was prospectively linked to an increased number of antihypertensive drugs. "Sleeping pill use" might be an indicator of future needs of antihypertensive treatment, and a warning indicator to investigate underlying sleep disorders or unhealthy lifestyles. Geriatr Gerontol Int 2019; 19: 537-540.