Role of sleep quality in the metabolic syndrome

Total dietary antioxidant capacity and food groups and their relationship with the sleep time of Brazilian graduates (CUME Study)

To investigate the association between the Dietary Total Antioxidant Capacity (dTAC) and the Total Antioxidant Capacity of food groups (fgTAC) with the sleep time of Brazilian graduates participating in the Cohort of Universities of Minas Gerais (CUME Study). This cross-sectional study analyzed 6,387 graduates (2,052 men, 4,335 women, 35.3 ± 9.3 years old) from the CUME Study. Data was collected online, and dTAC was obtained by the Ferric Reduction Antioxidant Power (FRAP) method. Daily sleep time was classified as short sleep, normal sleep, and long sleep (≤6, 7-8, and ≥9 h, respectively). Multinomial logistic regression models were used to estimate the Odds Ratio (OR) and its 95% Confidence Interval (95% CI) between short sleep and long sleep with quartiles of dTAC and the fgTAC. Lower odds of short sleep was observed for the third quartile of dTAC and for fourth quartile of fgTAC of fruits, beans, and lentils, and for the third quartile of fgTAC of vegetables and oils and fats. Higher odds of short sleep for the fourth quartile of fgTAC of teas and coffees. For long sleep, inverse associations were observed for the fourth quartile of fgTAC of oilseeds and the third quartile of fgTAC of teas and coffees. Higher odds of long sleep were observed for the third quartile of artificial juices and sodas. We cannot independently assert an association between higher dTAC and sleep time. In turn, the associations between sleep time and fgTAC show the importance of the food matrix that antioxidants are inserted, requiring longitudinal studies to observe the direction of associations.

Association of Sleep Patterns and Respiratory Disturbance Index with Physiological Parameters in Pediatric Patients with Self-Perceived Short Stature

OBJECTIVE

To investigate the relationships of sleep patterns and respiratory disturbance index (RDI) with key physiological parameters (height, body mass index (BMI), bone age (BA), and IGF-1 levels) in children aged 6 to 16 years with self-perceived short stature.

METHODS

For this cross-sectional study, conducted from October 2019 to November 2021, 238 children aged 6 to 16 years with self-perceived short stature were enrolled. The primary outcomes of sleep patterns and the RDI were non-invasively collected at home using the LARGAN Health AI-Tech Sleep Apnea and Sleep Quality Examination System, which operates based on polygraphy. Additionally, various physiological parameters, including height, BMI, bone age, and IGF-1 levels, were measured to assess their associations with sleep patterns and RDI.

RESULTS

Significant age-related reductions were observed in both the total and deep sleep durations. Children aged 6-9 years averaged 8.5 ± 1.0 h of total sleep, which decreased to 8.1 ± 1.1 h in ages 10-11 and further to 7.5 ± 0.9 h in ages 12-16 (p < 0.0001). Deep sleep followed a similar pattern, decreasing from 4.4 ± 1.1 h in the youngest group to 3.3 ± 1.0 h in the oldest (p < 0.0001). Notably, girls experienced significantly longer deep sleep than boys, averaging 4.0 ± 1.2 h compared to 3.6 ± 1.2 h (p = 0.0153). In a multivariable regression analysis, age (beta = 4.89, p < 0.0001) and RDI (beta = -0.54, p = 0.0022) were significantly associated with body height. Age and deep sleep duration (beta = -0.02, p = 0.0371) were significantly associated with BMI.

CONCLUSIONS

The results demonstrate significant age-related decreases in the total and deep sleep duration among children with self-perceived short stature, along with a notable association between RDI and body height and an association between deep sleep duration and BMI. These findings suggest that sleep disturbances in pediatric endocrine patients are intricately linked with physiological growth parameters. The identified correlations underline the importance of monitoring sleep patterns in this demographic to better understand the impact of endocrine disorders on developmental health. Further research is needed to explore interventions that could alleviate these sleep disturbances, thereby potentially improving outcomes for the affected children.

Elevated oxidative stress biomarkers in adults with segmented sleep patterns

STUDY OBJECTIVES

We investigated the association between different sleep patterns and inflammatory and oxidative stress biomarkers in adults.

METHODS

A total of 321 consented adults who fulfilled the inclusion criteria were recruited in this cross-sectional study. The inclusion criteria were mainly based on apparently healthy adults aged 18-59 years. To identify sleep patterns, participants were requested to wear the actigraph for 1 week for 24 hours a day. Fasting blood was collected from each participant at day 8. The blood serum was analyzed for inflammatory and oxidative stress biomarkers. Sleep patterns were defined as monophasic (1 episode of night sleep) biphasic (2 episodes of sleep; night and aternoon siesta), and polyphasic sleep pattern (3 or more sleep episodes).

RESULTS

There was no correlation between night sleep duration, total sleep in 24 hours, and napping among inflammatory and oxidative stress biomarkers: high-sensitivity C-reactive protein, malondialdehyde, total glutathione, and basal oxidizability status. Actigraphy reports showed 3 sleep patterns in this cohort, monophasic (24.3%), biphasic-napping (45.2%) and polyphasic (30.5%). Individuals with segmented sleep patterns were significantly associated with oxidative stress biomarkers. A polyphasic sleep pattern was significantly associated with higher basal oxidizability status (P = .023), whereas a biphasic sleep pattern showed higher malondialdehyde (P = .036) as compared to a monophasic sleep pattern. Total glutathione was significantly higher in monophasic sleepers (P = .046). There was no difference in serum high-sensitivity C-reactive protein among all sleep patterns.

CONCLUSIONS

Segmented sleep in polyphasic and biphasic sleep patterns is associated with higher serum malondialdehyde and basal oxidizability status in particular. Further studies are recommended on the cardiometabolic impact of oxidative stress biomarkers in individuals with segmented sleep.

CITATION

Al Lawati I, Zadjali F, Al-Abri MA. Elevated oxidative stress biomarkers in adults with segmented sleep patterns. J Clin Sleep Med. 2024;20(6):959-966.

Learning from circadian rhythm to transform cancer prevention, prognosis, and survivorship care

Circadian timekeeping mechanisms and cell cycle regulation share thematic biological principles in responding to signals, repairing cellular damage, coordinating metabolism, and allocating cellular resources for optimal function. Recent studies show interactions between cell cycle regulators and circadian clock components, offering insights into potential cancer treatment approaches. Understanding circadian control of metabolism informs timing for therapies to reduce adverse effects and enhance treatment efficacy. Circadian adaptability to lifestyle factors, such as activity, sleep, and nutrition sheds light on their impact on cancer. Leveraging circadian regulatory mechanisms for cancer prevention and care is vital, as most risk stems from modifiable lifestyles. Monitoring circadian factors aids risk assessment and targeted interventions across the cancer care continuum.

Hypertension and other vascular risk factors in patients with functional seizures

OBJECTIVE

Recent literature has suggested that functional seizures are associated with an elevated risk for vascular disease and mortality. We investigated the prevalence of risk factors for vascular disease in patients who were admitted to the epilepsy monitoring unit.

METHODS

Patients who were admitted to the epilepsy monitoring unit and received a definitive diagnosis of either functional seizures or epilepsy were identified. Data collected included demographic, clinical characteristics, medication list, comorbidities, and scheduled blood pressure measurements that occurred every 12 h during the admission. The mean blood pressures were calculated and if they were above the American College of Cardiology and the American Heart Association guideline cutoff of 130/80 mm Hg or the patient had a documented history of hypertension the patient was counted as having the condition. A multiple logistic regression model was developed to evaluate the independent association of the patient's diagnosis (i.e., epilepsy or functional seizures) and vascular risk factors that controlled for the number of blood pressure measurements, age, sex, and if the patient was taking antihypertensive medications.

RESULTS

270 patients were included in this study of which 147 patients had epilepsy and 123 had functional seizures. Among those with functional seizures, 57.72 % had either a history of hypertension or a mean blood pressure above 130/80 compared to 38.78 % of those with epilepsy (p = 0.0022). In addition, 30.89 % of functional seizures patients had hyperlipidemia and 63.41 % were obese. The logistic regression model indicated that functional seizures were independently associated with high blood pressure (OR: 2.47, 95 % CI 1.10-5.69), hyperlipidemia (OR: 3.38, 95 % CI 1.35-8.86), and obesity (OR: 4.25, 95 % CI 2.22-8.36) compared to those with epilepsy. There was no significant difference in the prevalence of diabetes (OR: 0.81, 95 % CI 0.24-2.77) or current tobacco use (OR: 1.04, 95 % CI 0.48-2.25) between the groups.

SIGNIFICANCE

Patients with functional seizures had an elevated prevalence of several vascular risk factors. These findings may partially account for complications associated with functional seizures and have implications related to their pathophysiology.

Persistent sleep-disordered breathing independently contributes to metabolic syndrome in prepubertal children

BACKGROUND

Obstructive sleep apnea (OSA) is a risk factor for metabolic syndrome (MetS) in adults, but its association in prepubertal children is still questionable due to the relatively limited cardiometabolic data available and the phenotypic heterogeneity.

OBJECTIVE

To identify the role of OSA as a potential mediator of MetS in prepubertal children.

METHODS

A total of 255 prepubertal children from the Childhood Adenotonsillectomy Trial were included, with standardized measurements taken before OSA treatment and 7 months later. MetS was defined if three or more of the following criteria were present: adiposity, high blood pressure, elevated glycemia, and dyslipidemia. A causal mediation analysis was conducted to assess the effect of OSA treatment on MetS.

RESULTS

OSA treatment significantly impacted MetS, with the apnea-hypopnea index emerging as mediator (p = .02). This mediation role was not detected for any of the individual risk factors that define MetS. We further found that the relationship between MetS and OSA is ascribable to respiratory disturbance caused by the apnea episodes, while systemic inflammation as measured by C-reactive protein, is mediated by desaturation events and fragmented sleep. In terms of evolution, patients with MetS were significantly more likely to recover after OSA treatment (odds ratio = 2.56, 95% confidence interval [CI] 1.20-5.46; risk ratio = 2.06, 95% CI 1.19-3.54) than the opposite, patients without MetS to develop it.

CONCLUSION

The findings point to a causal role of OSA in the development of metabolic dysfunction, suggesting that persistent OSA may increase the risk of MetS in prepubertal children. This mediation role implies a need for developing screening for MetS in children presenting OSA symptoms.

Screen time is negatively associated with sleep quality and duration only in insufficiently active adolescents: A Brazilian cross-sectional school-based study

Background

Time spent on screen devices affects sleep quality and duration leading to several health impairments in youth. Although physical activity (PA) benefits sleep patterns and decreases screen time in adolescents, it is unclear whether the relationship between sleep quality/duration and screen time could be influenced by PA levels.

Objective

To analyze the association between sleep quality and duration with screen time in Brazilian adolescents according PA levels.

Methods

The sample included 1010 adolescents aged 13.2 ± 2.4 years (n = 556 females - 55 % of the sample). Sleep quality and sleep duration, and PA were assessed by Mini Sleep and Baecke questionnaires, respectively. Participants in the highest quartile were classified as physically active. Screen time was analyzed by the self-reported number of hours spent on different screen devices (i.e., television, computer, videogame, and cellphone/tablet). Participants in the highest tertile were classified as having high screen time. Sex, age, and body mass index were considered covariates in binary logistic regression models.

Results

Poor sleep quality was observed in 52.3 % of the sample, whereas 46.6 % reported sleeping less than eight hours/day. High screen time was associated with poor sleep quality (OR = 1.45; 95 %CI = 1.01-2.12) and insufficient sleep duration (OR = 1.52; 95 %CI = 1.01-2.03) in adolescents insufficiently active. There were no associations between screen time and sleep parameters in active adolescents.

Conclusion

High screen time was associated with poor sleep quality and insufficient sleep duration only in insufficiently active adolescents. These results suggest that high PA levels may contribute to improving sleep patterns in pediatric population.

Sleep hygiene a neglected paediatric identity - A cross-sectional study

Background

Sleep is the physiological need of any human being; its role in paediatric mental and physical development is irreplaceable. However, in recent days, the rising trend of childhood obesity makes it essential to assess the sleep hygiene of the children to know if there is any adjacent association.

Objectives

1. To estimate the prevalence of poor sleep quality using Sleep Hygiene Index Scoring. 2. To determine the association of sleep quality with academic performance and body mass index among the school children.

Materials and Methods

The present cross-sectional study was conducted among 322 children aged between 7 and 12 years attending paediatric OPD of a private tertiary care hospital, Puducherry. Using Sleep Hygeine Index scoring with the cut off 16, prevalence of poor sleep quality was assessed and its association with BMI and academic performance was determined. Frequency, proportion, and Chi-square test were used for analysis; P value < 0.05 was considered statistically significant.

Results

The mean age of the participants was 8.8 ± 2 years, and most of them were boys. Around 53% of the children had poor quality of sleep, and there was a positive association between poor sleep quality with obesity (P value: 0.0003) and unfavourable academic performance (P value: 0.00001).

Conclusion

Sleep hygiene importance should be taught to the parents and periodical assessment helps in predicting the neglected reason for obesity and poor academic performance, which could be managed easily with small lifestyle changes.

Poor Sleep Quality Increases Gestational Weight Gain Rate in Pregnant People: Findings from the MADRES Study

Background

Poor sleep quality is associated with weight gain in non-pregnant populations, but evidence in pregnant people is lacking. Our study examined the association between early-to-mid pregnancy sleep quality and weekly gestational weight gain (GWG) rate during mid-to-late pregnancy by pre-pregnancy body mass index (BMI).

Method

Participants were 316 pregnant participants from the Maternal and Developmental Risks from Environmental and Social Stressors (MADRES) study. During early-to-mid pregnancy, participants reported their sleep quality which was used to construct four categories: very poor, poor, good, and very good. Linear growth curve models examined the association between early-to-mid pregnancy sleep quality and weekly rate of GWG (kg/week) during mid-to-late pregnancy (> 20 weeks gestation), with a three-way cross-level interaction between gestational age, sleep quality, and pre-pregnancy BMI category. Models adjusted for ethnicity by birthplace, hypertensive disorders, perceived stress score, and physical activity level.

Results

Overall, poorer early-to-mid pregnancy sleep quality was associated with increased weekly weight gain during mid-to-late pregnancy. For example, amongst normal weight participants, mid-to-late pregnancy weight gain was, on average, 0.39 kg (95% CI: 0.29, 0.48) per week for those with very good sleep quality, 0.53 kg (95% CI: 0.44, 0.61) per week for those with poor sleep quality, and 0.54 kg (95% CI: 0.46, 0.62) per week for those with very poor sleep quality during early-to-mid pregnancy. This difference in GWG rate was statistically significantly comparing very good to poor sleep (0.14 kg/week, 95% CI: 0.01, 0.26) and very good to very poor sleep (0.15kg/week, 85% CI: 0.02, 0.27). This association between sleep quality and GWG rate did not statistically differ by pre-pregnancy BMI.

Conclusion

Our study found very poor early-to-mid pregnancy sleep quality was associated with higher mid-to-late pregnancy GWG rate. Incorporating pregnancy-specific sleep recommendations into routine obstetric care may be a critical next step in promoting healthy GWG.

The effect of exercise on the risk of metabolic syndrome associated with sleep insufficiency: a cross-sectional study

Introduction

Sleep disturbance and insufficient sleep have been linked to metabolic syndrome, increasing cardiovascular disease and mortality risk. However, few studies investigate the joint effect of sleep and exercise on metabolic syndrome. We hypothesized that regular exercise can mitigate the exacerbation of metabolic syndrome by sleep insufficiency.

Objective

The aim of this study was to investigate whether exercise can attenuate or eliminate the relationship between sleep insufficiency and metabolic syndrome.

Method

A total of 6,289 adults (mean age = 33.96 years; women: 74.81%) were included in the study, a cross-sectional study conducted based on the results of employee health screening questionnaires and databases from a large healthcare system in central Taiwan. Participants reported sleep insufficiency or not. Self-reported exercise habits were classified into 3 levels: no exercise, exercise <150 min/week, and exercise ≧150 min/week. Multiple logistic regression and sensitivity analyses were conducted to understand the joint associations of sleep patterns and exercise with metabolic syndrome with exposure variables combining sleep duration/disturbances and PA.

Results

Compared with the reference group (sufficient sleep), individuals with sleep insufficiency had a higher risk for metabolic syndrome [adjusted odds ratio (AOR) = 1.40, 95% confidence interval (95% CI): 1.01-1.94, p < 0.05] in females aged 40-64 years, but not in other populations. Sleep insufficiency was not associated with the risk of metabolic syndrome among individuals achieving an exercise level of <150 min/week, and in particular among those achieving ≧150 min/week in all populations in our study.

Conclusion

Sleep insufficiency was related to a higher risk of metabolic syndrome in female healthcare staff aged 40-64 years. Being physically active with exercise habits in these individuals, the risk of metabolic syndrome was no longer significant.

The impact of insomnia symptoms on obesity among Mexicans aged 50 and older

OBJECTIVE

To examine the association between insomnia and obesity in Mexican adults aged 50 and older.

MATERIALS AND METHODS

We used data from the Mexican Health and Aging Study (2015-2018). Self-reported insomnia was measured using the modified insomnia severity index with scores ranging from zero to six. Obesity was categorized using body mass index (BMI ≥ 30 kg/m2). We used generalized estimating equations to assess the association between insomnia and obesity over three years.

RESULTS

Insomnia was associated with obesity (odds ratio [OR]: 1.06, 95% confidence interval [CI]: 1.01,1.11), among those with no obesity at baseline. Among those with obesity, insomnia was not associated with changes in BMI. Lastly, obesity was not associated with changes in insomnia symptoms.

CONCLUSION

This work highlights the association between insomnia and obesity among older Mexican adults and demonstrates the importance of further studies on the effects of insomnia within this population.

Metabolic risk factors and psychosocial problems independently explain poor sleep quality and obstructive sleep apnea symptoms among adults in urban India

STUDY OBJECTIVES

To determine if metabolic risk factors are associated with poor sleep quality and obstructive sleep apnea-like symptoms (OSA symptoms) independent of psychosocial problems and demographic and lifestyle factors in older Indian adults.

METHODOLOGY

We analyzed baseline data from adults (≥ 50 years) from a population-based cohort, the LoCARPoN study, in India. Variables were grouped as (a) demographic and lifestyle factors such as smoking, alcohol use, and physical activity; (b) psychosocial problems including symptoms of depression, anxiety, and perceived stress; and (c) metabolic risk factors including glycated hemoglobin, high-density lipoprotein, low-density lipoprotein, total cholesterol, body mass index, and hypertension. Variables were examined as predictors of poor sleep quality and OSA symptoms. Groups of variables were added stepwise to a logistic regression. Variance explained by nested models was quantified using McFadden's pseudo R2, and change was formally tested with the log-likelihood ratio test.

RESULTS

Among 7505 adults, the prevalence of poor sleep quality was 16.9% (95% CI: 16.0, 17.7), and OSA symptoms were present in 7.0% (95% CI: 6.4, 7.6). Psychosocial problems had a strong independent association with both poor sleep quality (pseudo R2 increased from 0.10 to 0.15, p < 0.001) and more OSA symptoms (pseudo R2 increased from 0.08 to 0.10, p < 0.001). Metabolic risk factors had a modest independent association with sleep quality (pseudo R2 increased from 0.14 to 0.15, p < 0.01), but a strong association with OSA symptoms (pseudo R2 increased from 0.08 to 0.10, p < 0.001).

CONCLUSION

Psychosocial and metabolic risk factors were independently associated with sleep quality and OSA symptoms. This fact implied that OSA symptoms may affect both mental health and physical health. Our findings have public health implications because the number and proportion of the elderly in India is increasing, while the prevalence of metabolic risk factors and psychosocial problems is high already. These facts have the potential to exacerbate not only the burden of sleep disorders and OSA symptoms but also associated cardiovascular and neurologic sequelae, further stretching the Indian health-care system.

Comparison of Sleep Disturbance, Physical Activity, and Health-Related Quality of Life According to Depressive Symptoms in Patients with Metabolic Syndrome: A Secondary Analysis from the Korea National Health and Nutrition Examination Survey Using a Propensity Score Matching Analysis

Metabolic syndrome has become a global epidemic, and the age of its onset is decreasing. However, its prevalence can be reduced by lifestyle modifications. This study examined the differences in sleep disturbance, physical activity, and health-related quality of life associated with depressive symptoms in patients with metabolic syndrome aged ≥ 40 years. This cross-sectional secondary analysis of data from the 2016 and 2018 Korean National Health and Nutrition Examination Surveys. Of 1404 patients with metabolic syndrome aged ≥ 40 years, depressed and non-depressed patients (103 vs. 103) were matched 1:1 on demographic characteristics using propensity score matching. The outcome variables were then compared between the two groups. We investigated health status, including metabolic syndrome indices, health behaviors, such as sleep disturbances and physical activity, and health-related quality of life. After propensity score matching, health-related quality of life was the only variable that differed significantly between the groups; it was significantly lower in patients with depression (0.77) than in those without depression (0.88) (p = 0.001). Our results suggest that depression with metabolic syndrome is likely to cause a decrease in patients' quality of life; therefore, development of management systems and programs for early intervention to tackle at-risk groups is necessary.

Impaired sleep quality in children with allergic conjunctivitis and their parents

OBJECTIVES

To investigate the sleep quality in children with allergic conjunctivitis (AC) and their parents.

METHODS

Prospective, case-controlled study. Zhongshan Ophthalmic Center, a tertiary referral centre. Participants comprised 73 children aged 4-12 years with AC and their parents, and 81 healthy, age-matched children who served as controls and their parents. General information was recorded and ocular manifestations of children with AC were scored. Sleep quality of the children and parents were assessed using Children's Sleep Habits Questionnaire (CSHQ) and Pittsburgh Sleep Quality Index (PSQI).

RESULTS

Children with AC and their parents had reduced sleep quality (Children's CSHQ: 48.3 ± 6.55 vs. 38.8 ± 4.63; Parental PSQI: 5.62 ± 2.12 vs. 3.40 ± 1.90, both p < 0.001) and significantly higher prevalence of poor sleep quality (CSHQ ≥ 41 in Children: 89.0% vs. 23.5%; PSQI > 7 in Parents: 18.5% vs. 1.23%, both p < 0.001). Children with AC scored worse on subcomponents of CSHQ including sleep onset delay, sleep duration, parasomnia, sleep-disordered breathing, and daytime sleepiness. Parents scored worse on subscores of PSQI including sleep duration, sleep disturbances, use of sleeping medication, and daytime sleepiness. Poor sleep quality in children with AC was associated with follicle formation (OR:3.95; 95% CI: 1.88-8.31, p < 0.001) and keratitis (OR:6.03; 95% CI: 1.29-28.3, p = 0.028). Parental poor sleep quality was associated with follicle formation (OR:7.14; 95% CI: 2.06-24.8, p = 0.002) and keratitis (OR:4.49; 95% CI: 1.27-15.9, p = 0.020) in children.

CONCLUSIONS

AC has a negative association with sleep quality in children and their parents, especially in those children with severe follicle formation and keratitis.

STATE THE DETAILS OF CLINICAL TRIALS

Chictr.org.cn, https://www.chictr.org.cn/showproj.aspx?proj=43511 , ChiCTR1900027486.

STATEMENT OF SIGNIFICANCE

Allergic conjunctivitis is a frequently encountered problem diagnosed and managed by ophthalmologists, paediatricians, allergists, and primary care physicians and has become a major public health issue. Sleep is crucial for learning and effective development in children. Our study discovered a strong association between these two conditions. This is the first study to evaluate the association of allergic conjunctivitis and sleep quality in children and their parents. This case-controlled study found that allergic conjunctivitis had a negative impact on sleep quality not only for children but also for their parents. The findings of this study suggest a multifaceted impact of AC with sleep quality; detailed assessment of sleep quality for improved care of paediatric patients with allergic conjunctivitis would be useful.

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.

Sleep Duration and Metabolic Syndrome among Early Adolescents-A Cross-Sectional Study in Khartoum State, Sudan

Numerous studies have reported that sleep disorders are linked to poor health outcomes. However, studies on these associations in children and adolescents in an African context are limited. The aim of the present study was to analyze the relationship between sleep duration and the presence of metabolic syndrome among early adolescents in Sudan. Methods: A cross-sectional study was conducted on participants aged 10-15 years in Khartoum State, Sudan. Metabolic syndrome (MetS) was diagnosed by increased waist circumference and the presence of two or more metabolic abnormalities (triglycerides [TG], high-density lipoproteins [HDL-C], blood pressure [BP], and fasting plasma glucose [FBG]). Short sleep duration was defined based on National Sleep Foundation (NSF) classification. Data were collected by physical examinations, biochemical analyses, and self-developed standardized questionnaires. Data were analyzed with IBM SPSS Statistics Version 24. A generalized additive model (GAM) was used for the smoothing function between sleep duration and MetS. p < 0.05 was considered as significant. Results: The prevalence of MetS and short sleep among early adolescents aged 10-15 years in Sudan was 2.3% and 55.0%, respectively. A higher prevalence of short sleep was found among overweight and obese participants (p < 0.05). The prevalence of MetS among short sleepers was 2.8%. Binary logistic regression analysis showed that male short sleepers had higher odds of having MetS compared to female short sleepers. The relationship between short sleep and low HDL-C in boys and between short sleep and high TG in girls was statistically significant. The highest risk of MetS was observed at less than 6.5 h of sleep per night. Conclusions: Short sleep duration was significantly associated with overweight/obesity in the total population and with low HDL-C in boys and high triglycerides in girls. A nonlinear curve pattern was observed between sleep duration and prevalence of MetS. Longitudinal studies are needed to further determine the causal relationship between sleep habits and MetS and its components.

Sleep disturbances in individuals with down syndrome: An overview

Down Syndrome, or Trisomy 21, is one of the most common birth defects, with 6,000 babies born annually with Down Syndrome in the U.S. One of many health risk factors individuals with Down Syndrome experience is sleep issues, ranging from poor sleep quality to high prevalence of obstructive sleep apnea. This literature review aims to review these sleep challenges in this population and explore consequences and treatment options.

Prospective Bidirectional Relations Between Depression and Metabolic Health: 30 Year Follow-up from the NHLBI CARDIA Study

Objective

This study investigated prospective bidirectional relationships between depression and metabolic syndrome (MetS), and the moderating effects of race, sex, and health behaviors in a diverse cohort followed for 30 years.

Methods

Data were analyzed from the NHLBI CARDIA study, a 30 year-prospective study of young adults (N = 5113; M age = 24.76 (SD = 3.63) at baseline; 45% male) who were tested every 5 years between 1985-2015. Measures included biological assessments of MetS components, and self-reported depressive symptoms based on the Center for Epidemiologic Studies Depression (CESD) scale. Data analyses included bi-directional general estimating equations analyses of time-lagged associations between depressive symptoms and MetS.

Results

There was a consistent, bi-directional relationship between depressive symptoms and MetS over time. Individuals with more CESD depressive symptoms were more likely to develop MetS over time compared to those reporting fewer symptoms (Wald Chi-Square = 7.09 (1), p < 0.008), and MetS was similarly predictive of CESD. MetS more consistently predicted depressive symptoms at each 5-year exam than depressive symptoms predicted MetS. Race and sex moderated relationships between depression and MetS, with White females, White individuals overall, and females overall demonstrating significant relationships. Health behaviors were not related to depression-MetS associations.

Conclusion

In a diverse young adult population prospectively followed into late middle age, MetS more consistently predicted depression over time than depression predicted MetS. The relation between MetS and depressive symptoms was moderated by race and sex, but not health behaviors.

Factors associated with poor sleep quality in patients with pre-dialysis chronic kidney disease: A systematic review

AIMS

To determine factors associated with poor sleep quality among patients with pre-dialysis chronic kidney disease.

DESIGN

This is a systematic review study guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses statements and checklist.

DATA SOURCES

Empirical evidence was sought in major electronic databases, including Embase, MEDLINE, CINAHL and Airiti library from March to September 2022.

REVIEW METHODS

Studies investigating factors associated with poor sleep quality among adult patients with chronic kidney disease were included. Study participants who received renal replacement therapy and had sleep disorders and serious illnesses such as cancer were excluded. Of the 526 studies that resulted from the search after removing duplicate articles, 20 studies were assessed for quality by using Joanna Briggs Institute and Newcastle-Ottawa Scale by two doctorial prepared nursing scientists.

RESULTS

A total of 20 studies were included in this review. The prevalence of poor sleep quality in these studies ranged from 11% to 97.5%. Demographics (older age and female), physiological conditions (higher body mass index, higher hip circumferences, higher systolic blood pressure, poor cardiovascular function, dyspnoea, pain, cramps, itchiness or moderate to extreme pruritus, lower fasting plasma glucose, electrolyte imbalance, higher total cholesterol and gastrointestinal symptoms), depression, smoking, arousal-related and cognitive arousal behaviours were associated with poor sleep quality.

CONCLUSION

Poor sleep quality was prevalent and influenced kidney function, increased mortality as well as decreased quality of life in patients with pre-dialysis chronic kidney disease. This review synthesizes factors associated with poor sleep quality. Managing these factors can mitigate and prevent poor sleep quality.

IMPACT

Healthcare providers, especially nurses, can assess the risk factors of poor sleep quality and reinforce patients' self-management. Future research should elucidate the assessment and management of risk factors and transfer these into widespread use in the routine care of patients with chronic kidney disease.

Ameliorative effects of Portulaca oleracea L. (purslane) on the metabolic syndrome: A review

ETHNOPHARMACOLOGICAL RELEVANCE

The metabolic syndrome, which comprises hyperglycemia, dyslipidemia, abdominal obesity, and hypertension, is a worldwide problem. This disorder is a significant risk factor for insulin resistance, diabetes mellitus, cardiovascular disease incidence, and mortality. The value of herbs and natural products in the treatment of human ailments has been documented in several inquiries. An annual herbaceous plant called Portulaca oleracea L. (purslane) is used both as a traditional medicine and an edible plant to treat various ailments including gastrointestinal diseases and liver inflammation. Purslane contains a variety of secondary metabolites such as organic acids, flavonoids, terpenoids, and alkaloids.

AIM OF THE STUDY

In the current work, our team aims to shed light on the potential efficacy of purslane and its main components in treating metabolic syndrome and its complications.

STUDY DESIGN

Scopus, Google Scholar, and PubMed databases have been used to gather the most relevant in vitro, in vivo studies, and clinical trials from the time of inception up to February 2022.

RESULTS

The effects of purslane on metabolism are among its most significant pharmacological properties. In patients with metabolic syndrome, purslane could significantly lower blood glucose and balance lipid profiles. This indicates that purslane might have a potential role in the management of metabolic syndrome through different underlying mechanisms including antioxidant, anti-inflammatory, anti-hyperlipidemic, anti-obesity, and antidiabetic.

CONCLUSION

According to previous investigations, purslane can control metabolic syndrome and its complications. However, further preclinical and clinical studies are required to approve the advantageous effects of purslane on metabolic syndrome.

Couples-based interventions to promote PAP adherence among older adults: a qualitative study of patients, partners, and providers

STUDY OBJECTIVES

Bed partners play a critical role in the treatment of obstructive sleep apnea and are affected by the treatment (or lack thereof) of their partner's obstructive sleep apnea, but few studies have included partners formally in treatment. In this qualitative study, we examine key stakeholder perspectives (patient, bedpartner, and sleep medicine provider) to inform the development of a novel, couples-based intervention to promote adherence to positive airway pressure (PAP) and sleep health among older adult couples.

METHODS

We conducted 3 focus group discussions with patients with obstructive sleep apnea/using PAP and their partners and 3 focus group discussions with sleep medicine providers. A standard interview guide was used to gather stakeholder input: (1) to understand interdependence of sleep among couples with sleep apnea; (2) to understand collaborative strategies that couples are currently using to address their sleep health challenges, including their perceptions of what is helpful vs not helpful; and (3) feasibility of the intervention design and delivery. Interviews were transcribed and thematically analyzed.

RESULTS

Participants (n = 25) included 9 patients, 7 partners, and 9 providers. Analysis of the discussion identified themes within the 3 topics addressed in the focus group discussions: (1) interdependence of sleep health among couples, (2) collaboration and other dyadic strategies for increasing PAP use, and (3) facilitators and barriers to a couples-based PAP adherence intervention. Results of the focus group discussions provided new insights into collaborative strategies that could be used to enhance the sleep health of both patients and partners. Patient/partners reported that a couples-based treatment could reduce common frustrations experienced by new PAP users, thereby benefiting their relationship. However, barriers to couples-based treatment included patients and partners feeling overwhelmed and reluctance to discuss intimacy. Providers recognized the benefits of involving partners but reported concern about exacerbating conflict in the couple.

CONCLUSIONS

Results indicate that couples and providers are enthusiastic about couples-based treatment that addresses their individual and dyadic sleep health challenges and identified important barriers that will need to be addressed to enhance uptake by clinicians and participation/retention of couples.

CITATION

Baron KG, Troxel WM, Galway S, et al. Couples-based interventions to promote PAP adherence among older adults: a qualitative study of patients, partners, and providers. J Clin Sleep Med. 2022;18(11):2627-2634.

A latent class approach to understanding longitudinal sleep health and the association with alcohol and cannabis use during late adolescence and emerging adulthood

OBJECTIVE

Sleep is a multi-dimensional health behavior associated with elevated risk of substance use. This is the first study to utilize a latent class approach to characterize sleep health across multiple dimensions and across time from late adolescence to emerging adulthood, and to examine associations with alcohol and cannabis use trajectories.

METHODS

The sample included 2995 emerging adults (mean ages = 18 to 24 years across six waves of data collection; 54% female) who provided data on sleep dimensions (quality, duration, and social jetlag) and frequency and consequences of alcohol and cannabis use. Longitudinal latent class analysis (LLCA) models characterized participants according to the three sleep dimensions. Latent growth models examined trajectories of frequency and consequences of alcohol or cannabis use over time among emergent sleep classes, with and without controlling for covariates.

RESULTS

LLCA models identified four sleep classes: good sleepers (n = 451; 15.2%); untroubled poor sleepers (n = 1024; 34.2%); troubled, moderately good sleepers (n = 1056; 35.3%); and suboptimal sleepers (n = 460; 15.4%). Good sleepers reported significantly lower levels of alcohol or cannabis use and consequences, and less of an increase in alcohol consequences as compared to suboptimal sleepers.

CONCLUSIONS

Persistent poor sleep health was associated with higher levels of alcohol and cannabis use and consequences, and greater increases in alcohol-related consequences during the transition from late adolescence to emerging adulthood. Findings have important clinical implications, highlighting that addressing multi-dimensional sleep health may be an important, novel target of intervention to reduce substance use frequency and consequences.

Emergency Medical Services Clinicians Have a High Prevalence of Metabolic Syndrome

Background: Metabolic syndrome is a constellation of risk factors associated with the development of cardiovascular disease and increased all-cause mortality. Data examining the prevalence of metabolic syndrome among emergency medical services (EMS) clinicians are limited.Methods: We conducted a cross-sectional study of EMS clinicians and firefighters from three fire departments with transport-capable EMS divisions. Data were collected from compulsory annual physical exams for 2021 that included age, sex, race, body mass index (BMI), waist circumference, blood pressure, cholesterol levels, and hemoglobin A1c level. These data were used to determine the prevalence of meeting metabolic syndrome criteria. We calculated descriptive statistics of demographics, anthropometrics, and metabolic syndrome criteria for EMS clinicians and firefighters. We used chi-square tests to compare the proportion of EMS clinicians and firefighters meeting criteria for the whole group and among age groups of <40 years old, 40 to 59 years old, and ≥60 years old. We used logistic regression to estimate the odds of meeting criteria in EMS clinicians compared to firefighters, adjusted for age, sex, race, and BMI.Results: We reviewed data for 65 EMS clinicians and 239 firefighters. For the combined cohort, 13.2% (40/304) were female and 95.1% (289/304) were White. The median age for EMS clinicians was 34 years versus 45 years in firefighters (p < 0.0001). Metabolic syndrome criteria were met in 27.3% (83/304) of the entire group. The prevalence of meeting criteria among EMS clinicians and firefighters was 33.9% (22/65) and 25.5% (61/239), respectively (p = 0.18). Of the participants who were younger than age 40, 36.6% (15/41) of EMS clinicians versus 9.1% (7/74) of firefighters met criteria for metabolic syndrome (p < 0.001). EMS clinicians had significantly higher odds of meeting criteria [OR 4.62 (p = 0.001)] compared to firefighters when adjusted for age, sex, race, and BMI.Conclusion: EMS clinicians had a high prevalence of metabolic syndrome at an early age, and had a higher adjusted odds of having metabolic syndrome compared to firefighters.

Childhood Obesity: Position Statement of Polish Society of Pediatrics, Polish Society for Pediatric Obesity, Polish Society of Pediatric Endocrinology and Diabetes, the College of Family Physicians in Poland and Polish Association for Study on Obesity

Childhood obesity is one of the most important problems of public health. Searching was conducted by using PubMed/MEDLINE, Cochrane Library, Science Direct, MEDLINE, and EBSCO databases, from January 2022 to June 2022, for English language meta-analyses, systematic reviews, randomized clinical trials, and observational studies from all over the world. Five main topics were defined in a consensus join statement of the Polish Society of Pediatrics, Polish Society for Pediatric Obesity, Polish Society of Pediatric Endocrinology and Diabetes and Polish Association for the Study on Obesity: (1) definition, causes, consequences of obesity; (2) treatment of obesity; (3) obesity prevention; (4) the role of primary care in the prevention of obesity; (5) Recommendations for general practitioners, parents, teachers, and regional authorities. The statement outlines the role of diet, physical activity in the prevention and treatment of overweight and obesity, and gives appropriate recommendations for interventions by schools, parents, and primary health care. A multisite approach to weight control in children is recommended, taking into account the age, the severity of obesity, and the presence of obesity-related diseases. Combined interventions consisting of dietary modification, physical activity, behavioral therapy, and education are effective in improving metabolic and anthropometric indices. More actions are needed to strengthen the role of primary care in the effective prevention and treatment of obesity because a comprehensive, multi-component intervention appears to yield the best results.

Trends in Metabolic Phenotypes According to Body Mass Index Among US Adults, 1999-2018

OBJECTIVE

To examine the prevalence, distribution, and temporal trends of metabolic phenotypes that are jointly determined by obesity and metabolic health status among US adults, overall and in key population subgroups.

PARTICIPANTS AND METHODS

A nationally representative sample of civilian, noninstitutionalized US adults aged 20 years and older from the National Health and Nutrition Examination Survey between 1999-2000 and 2017-2018 were included. Metabolic phenotypes were characterized jointly by body mass index and metabolic health: metabolically healthy underweight, normal weight, overweight, and obese (MH-OB); and metabolically unhealthy underweight, normal weight, overweight, and obese (MU-OB). Metabolic health was defined using the 2009 joint scientific statement for metabolic syndrome from the International Diabetes Federation Task Force on Epidemiology and Prevention, National Heart, Lung, and Blood Institute, American Heart Association, World Heart Federation, International Atherosclerosis Society, and International Association for the Study of Obesity as having 2 or less components (primary analysis) or no components (secondary analysis) of the following: waist circumference of 102 cm or greater in men and 88 cm or greater in women, fasting plasma glucose level of 100 mg/dL or greater, blood pressure of 130/85 mm Hg or greater, triglyceride level of 150 mg/dL or greater, and high-density lipoprotein cholesterol level of less than 40 mg/dL in men and less than 50 mg/dL in women.

RESULTS

Of 19,941 adults, the mean age was 46.9 years; 10,005 (50.6%) were female. From 1999 to 2018, the prevalence in primary analysis declined from 33.2% (465465 of 1646) to 25.1% (454454 of 2058) (difference, -8.09%; 95% CI, -12.5% to -3.70%) for metabolically healthy normal weight, whereas it increased from 9.92% (178178 of 1646) to 14.1% (277277 of 2058) (difference, 4.17%; 95% CI, 1.13% to 7.21%) for MH-OB (both P<.001 for trend). The prevalence of metabolically healthy underweight and overweight remained stable at about 1.62% (298298 of 19,94119,941) (95% CI, 1.38% to 1.89%; P=.34 for trend) and 22.2% (4,275 of 19,941) (95% CI, 21.4% to 23.0%; P=.14 for trend), respectively. The prevalence declined from 3.77% (72 of 1646) to 2.10% (68 of 2058) (difference, -1.67%; 95% CI, -3.22% to -0.12%; P=.006 for trend) for metabolically unhealthy normal weight, whereas it increased from 19.0% (343 of 1646) to 26.4% (574 of 2058) (difference, 7.41%; 95% CI, 2.67% to 12.2%; P<.001 for trend) for MU-OB. The prevalence of metabolically unhealthy underweight and overweight remained stable at 0.06% (11 of 19,941) (95% CI, 0.03% to 0.15%; P=.84 for trend) and 11.2% (2528 of 19,941) (95% CI, 10.6% to 11.8%; P=.29 for trend), respectively. Persistent differences in the prevalence of metabolic phenotypes were identified across multiple sociodemographic subgroups. For example, the prevalence of MH-OB increased from 7.58% (53 of 754) to 12.0% (79 of 694) (P<.001 for trend) for non-Hispanic Whites and 12.2% (60 of 567) to 18.4% (76 of 493) for Hispanics (P=.01 for trend) and remained stable at 22.6% (756 of 3,825) for non-Hispanic Blacks (P=.62 for trend and P=.05 for interaction). Results in secondary analyses revealed similar patterns.

CONCLUSION

From 1999 to 2018, US adults experienced major increases in the prevalence of both MH-OB and MU-OB, largely due to decreases in MH-N. The prevalence of MU-OB increased across all subgroups, with higher values observed in older adults and those with lower education and income levels.

Metabolic, behavioral health, and disordered eating comorbidities associated with obesity in pediatric patients: An Obesity Medical Association (OMA) Clinical Practice Statement 2022

Background

This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) details metabolic, behavioral health, and disordered eating comorbidities associated with obesity in children. This CPS will be followed by a companion CPS covering further comorbidities, including genetics and social consequences related to overweight and obesity. These CPSs are intended to provide clinicians with an overview of clinical practices applicable to children and adolescents with body mass indices greater than or equal to the 95th percentile for their ages, particularly those with adverse consequences resulting from increased body mass. The information in this CPS is based on scientific evidence, supported by the medical literature, and derived from the clinical experiences of members of the OMA.

Methods

The scientific information and clinical guidance in this CPS is based upon referenced evidence and derived from the clinical perspectives of the authors.

Results

This OMA statement details metabolic, behavioral health, and disordered eating comorbidities associated with obesity in children. It provides clinical information regarding identifying and treating metabolic, behavioral health, and disordered eating comorbidities associated with obesity in children over the 95th percentile of weight/height for age.

Conclusions

This OMA clinical practice statement details metabolic, behavioral health, and disordered eating comorbidities associated with obesity in children and provides an overview of current recommendations. These recommendations lay out a roadmap to the improvement of the health of children and adolescents with obesity, especially those with metabolic, physiological, and psychological complications.

Lifestyle Factors Associated with Metabolic Syndrome in Urban Cambodia

This study aimed to identify lifestyle factors associated with metabolic syndrome (MetS) in urban Cambodia. In this cross-sectional study, we used existing health checkup data from a private hospital in Phnom Penh, Cambodia. The participants comprised 5459 Cambodians aged ≥20 years who underwent health checkups between 2017 and 2019. The harmonized diagnostic definition was used as the MetS criteria. The prevalence of MetS was 56.6% overall, 60.4% in men and 52.6% in women. The lifestyle factor significantly associated with MetS in both sexes were "eating quicker than others", (men: odds ratio [OR]= 2.25, 95% confidence interval [CI] = 1.68-3.03, women: OR = 1.92, 95%CI = 1.41-2.60), "walking faster than others", (men: OR = 0.78, 95% CI = 0.67-0.92, women: OR = 0.75, 95% CI = 0.62-0.89) and "drinking alcohol" (men: OR = 1.33, 95% CI = 1.10-1.61, women: OR = 1.33, 95% CI = 1.09-1.62). Other significant associations with MetS for men was "eating speed is normal", (OR = 1.73, 95%CI = 1.30-2.31), and, for women, "eating food after dinner at least 3 days a week", (OR = 1.25, 95%CI = 1.01-1.55), "skipping breakfast at least 3 days a week", (OR = 0.83, 95%CI = 0.69-0.99) and "getting enough rest from sleep" (OR = 1.19, 95% CI = 1.01-1.42) were significantly associated with MetS. Lifestyle interventions through health education and guidance may be effective in preventing MetS in Cambodia.

Rationale and study protocol for We-PAP: a randomized pilot/feasibility trial of a couples-based intervention to promote PAP adherence and sleep health compared to an educational control

BACKGROUND

Obstructive sleep apnea (OSA) is a serious health condition that affects approximately 30-50% of older adults and contributes to risk for cardiometabolic disorders and dementia. Despite the well-documented role of partners in treatment seeking and adherence to positive airway pressure (PAP), treatments for OSA have nearly exclusively focused on the patient and current treatments for OSA do not address co-existing sleep problems such as insomnia that are prevalent in both patients with OSA and their partners. Therefore, the goal of this study is to develop and test a novel couples-based sleep health intervention to promote adherence to PAP and improve sleep health of the couple.

METHODS

We are conducting a two-arm, parallel group, single blind, randomized controlled pilot/feasibility trial to compare our novel couples-based sleep health intervention (We-PAP) to an information control group (IC). We-PAP is based on a transdiagnostic model and uses a dyadic approach including increasing effective partner support, communication skills, and couple-level goal-setting. We-PAP involves 3 sessions and delivered via telehealth in weekly sessions. The IC includes standardized patient educational materials. Both groups receive the usual follow-up with their medical team. The study involves assessments at pre-treatment, post-intervention (approximately 1 month after starting PAP and completing We-PAP sessions or IC) and 3 months after starting PAP. Our main outcomes are feasibility and acceptability ratings. Secondary outcomes include comparing We-PAP to IC for PAP adherence, sleep quality (self-report and objective) and cognitive measures.

DISCUSSION

We-PAP is the first couples-based transdiagnostic sleep health intervention for patients with OSA and their partners. Results of this study will be used to inform the design of a subsequent fully powered clinical trial. If successful, this intervention could significantly advance current clinical practice in the treatment of OSA and sleep health more comprehensively in older adults. Moreover, this intervention may be useful for improving sleep in other aging populations with multiple sleep and other health problems, including patients with chronic illnesses or those at risk for Alzheimer's disease and their caregivers.

TRIAL REGISTRATION

NCT04759157 . Date of registration: February 8, 2021. URL of trial registry record.

Childhood diabetes and sleep

Sleep modulates glucose metabolism, both in healthy states and in disease. Alterations in sleep duration (insufficient and excessive) and obstructive sleep apnea may have reciprocal ties with obesity, insulin resistance and Type 2 diabetes, as demonstrated by emerging evidence in children and adolescents. Type 1 diabetes is also associated with sleep disturbances due to the influence of wide glycemic fluctuations upon sleep architecture, the need to treat nocturnal hypoglycemia, and the need for glucose monitoring and insulin delivery technologies. In this article, we provide an extensive and critical review on published pediatric literature regarding these topics, reviewing both epidemiologic and qualitative data, and provide an overview of the pathophysiology linking sleep with disorders of glucose homeostasis.

The quality of sleep and daytime sleepiness and their association with quality of school life and school achievement among students

BACKGROUND

Sleep quality is an important factor in adolescents' health; physical as well as psychological. The aim of this study was to determine sleep quality and daytime sleepiness and their effect on the quality of school life (QSL) and achievement.

MATERIALS AND METHODS

This cross-sectional study was conducted in high schools. The data collection was done on a random sample of 500 students from 15 to 19 years. The questionnaires included the Pittsburgh Sleep Quality Index (PSQI) to measure sleep quality and the Epworth Sleepiness Scale to measure daytime sleepiness as well as QSL. Data were analyzed by SPSS 25. Linear and logistic regressions were used to obtain adjusted and unadjusted odds ratios as well as predictors.

RESULTS

The mean PSQI score was 6.2 ± 2.4. It was realized that 377 participants (75.4%) were poor sleepers; 6.2% had excessive daytime sleepiness. There was a significant association between age and quality of sleep (P < 0.04). No association between gender and quality of sleep or between the quality of sleep and school achievement was found. Linear regression exhibited a significant relationship between the quality of sleep and daytime sleepiness (β = 0.218; t = 4.982, P = 0.000). There was a significant, inverse correlation between sleepiness and the total score of QSL (P = 0.000). Stepwise linear regression analysis exhibited that daytime sleepiness (P = 0.002) and school achievement (P = 0.001) were predictors of QSL.

CONCLUSION

According to the study results, sleepiness affects school performance and QSL, and on the other hand, daytime sleepiness is under the effect of sleep quality.

Diabetes, Polycystic Ovarian Syndrome, Obstructive Sleep Apnea, and Obesity: A Systematic Review and Important Emerging Themes

Type 2 diabetes mellitus (DM), polycystic ovarian syndrome (PCOS), obstructive sleep apnea (OSA), and obesity represent four large and growing patient populations. A great deal of scientific and clinical knowledge has been developed for them individually, and significant advancements made. Taken as a group, however, the interrelationships are not as well understood. The purpose of this systematic review is to identify the body of existing research that ties them together and then to identify and discuss the prevailing themes, particularly for cause-and-effect mechanisms. PubMed, Google Scholar, and ScienceDirect were used to identify systematic reviews and meta-analysis articles to establish the broadest reach. Initially, 434 articles were carefully screened, out of which 22 most relevant studies were reviewed. Five important themes were distilled from these papers based on continued and consistent emphasis in the literature. These themes include topics such as the importance of considering visceral obesity rather than Body Mass Index (BMI), the most effective treatment approaches, including mounting support for melatonin and circadian rhythm management, the results of OSA in its feed-forward contribution to hormone imbalance, the role of non-obesity-related risk factors to PCOS and OSA such as age and genetic predisposition, and growing evidence to suggest the importance of mental health as a comorbidity in addition to the more traditional ones such as cardiovascular pathology. A new framework for investigating the interaction across these four disorders is offered that includes a revised perspective on the specific role of PCOS, perhaps being further upstream relative to the others. There currently exists a lack of well-designed randomized controlled trials in this particular area of medicine, an endeavor we believe could result in significant value, particularly as it relates to treatment approaches.

Age, Sex, and Profession Difference Among Health Care Workers With Burnout and Metabolic Syndrome in Taiwan Tertiary Hospital-A Cross-Section Study

Background

This cross-sectional study aimed to analyze the association between burnout, work-related factors and metabolic syndrome (MetS) among various health-care workers (HCWs) at a tertiary hospital in Taiwan.

Methods

Relevant demographic data were obtained through written questionnaires. Information about psychosocial and work conditions, including assigned department, working hours, shifts, and sleep condition, was obtained. Burnout was evaluated according to the Chinese version of Maslach Burnout Inventory-Health Services Survey. MetS was analyzed according to the criteria of the National Cholesterol Education Program of Taiwan-Treatment Panel for Adults III.

Results

A total of 1,055 non-doctor/nurse and 2,078 doctor/nurse staff with a median age of 45.2 and 36.1 years participated in this study. The incidence of burnout was nearly 6.42 and 6.68% and that of MetS was 31.4 and 13.5% in non-doctor/nurse and doctor/nurse staff, respectively. The results showed that burnout induced a higher Odds ratio (OR) of MetS in the doctor/nurse group (OR = 1.96, p = 0.01). Other factors, such as night shift and seniority (>10 years), led to a higher OR of MetS, but a decreased risk was observed based on seniority (2-4 years). Further, young female participants and young doctors/nurses with burnout had a higher OR of MetS compare to other groups (OR = 2.43 and 2.32, p < 0.05).

Conclusion

The study results suggested positive relationship between burnout and MetS in young female staffs and young doctors/nurses. For doctor/nurse staff with higher seniority or more night shifts, strategies are needed to prevent burnout and MetS.

Association between Objectively Measured Sedentary Behaviour and Sleep Quality in Japanese Adults: A Population-Based Cross-Sectional Study

The association between sedentary behaviour and sleep quality (SQ) remains unclear, partly due to the limited methodology for assessing sedentary time and the influence of obesity. This study aimed to examine the association between objectively measured sedentary time and poor SQ, as well as the association of visceral fat accumulation. This cross-sectional study used health check-up data obtained from 721 Japanese adults. Sedentary time and physical activity were measured using an accelerometer for ≥7 days, with ≥10 measurement hours per day. Poor SQ was determined by a Pittsburgh Sleep Quality Index score of ≥ 6. Visceral fat was measured using the abdominal bioimpedance method. A logistic regression model was used to analyse the association between sedentary time and SQ. We found that higher sedentary time was associated with poorer SQ. This association remained significant after adjustment for several covariates, including visceral fat. Compared with the lowest tertile of sedentary time, the second and highest tertile had a significantly higher OR of poor SQ (Tertile 2: OR = 2.06 [95% CI 1.14,3,73]; Tertile 3: OR = 2.76 [95% CI 1.49, 5.11]). These results suggest that managing sedentary time itself might contribute to improving SQ.

Mental Health of Canadian Firefighters: The Impact of Sleep

Volunteer and career firefighters are at risk of major depressive disorders, posttraumatic stress disorder (PTSD), alcohol use disorder, and other mental health disorders due to the demanding and unpredictable nature of their employment. The mental health risks are exacerbated by the need to work extended hours, night shifts, and/or rotating schedules, or the competing demands of other employment, especially in volunteer firefighters. The mental health disorders and risk factors interact with altered sleeping patterns. In the current study, we examined volunteer and career firefighters regarding the association between mental health and sleep, drawing from a national Canadian mental health survey of 1217 firefighters. Most (69%) of the firefighters reported less than ideal sleep quality and 21% screened positive for clinical insomnia, with no significant difference between volunteer and career subgroups. Firefighters with insomnia had higher odds ratios (OR) and frequencies for PTSD (OR = 4.98), generalized anxiety disorder (OR = 7.15), panic disorder (OR = 6.88), social phobia (OR = 4.98), and major depressive disorder (OR = 7.91), than firefighters without insomnia. The burden of sleep disorders and their association with mental health disorders suggests that sleep should be considered in health monitoring and self-management, environmental design, fire service work-organization policies, and health programming.

Effect of Restricted Feeding on Metabolic Health and Sleep-Wake Rhythms in Aging Mice

Aging, an irreversible and unavoidable physiological process in all organisms, is often accompanied by obesity, diabetes, cardiovascular diseases, sleep disorders, and fatigue. Thus, older adults are more likely to experience metabolic symptoms and sleep disturbances than are younger adults. Restricted feeding (RF) is a dietary regimen aimed at improving metabolic health and extending longevity, as well as reorganizing sleep-wake cycles. However, the potential of RF to improve metabolic health and sleep quality in older adults who are known to show a tendency toward increased weight gain and decreased sleep is unknown. To elucidate this issue, aged mice were assigned to an RF protocol during the active phase for 2 h per day for 2 weeks. Sleep-wake cycles were recorded during the RF regime in RF group and control mice. At the end of this period, body weight and blood biochemistry profiles, including blood glucose, cholesterol, and enzyme activity, in addition to dopamine concentrations in the brain, were measured in the RF group and age-matched controls. RF for 2 weeks improved the metabolic health of aged mice by reducing their body weights and blood glucose and cholesterol levels. At the beginning of the RF regime, sleep decreased in the dark period but not in the light period. After stable food entrainment was achieved (7 days post-RF commencement), the amount of time spent in wakefulness during the light period dramatically increased for 2 h before food availability, thereby increasing the mean duration of awake episodes and decreasing the number of wakefulness episodes. There was no significant difference in the sleep-wake time during the dark period in the RF group, with similar total amounts of wakefulness and sleep in a 24-h period to those of the controls. During the RF regime, dopamine levels in the midbrain increased in the RF group, pointing to its potential as the mechanism mediating metabolic symptoms and sleep-wake regulation during RF. In conclusion, our study suggested that RF during aging might prohibit or delay the onset of age-related diseases by improving metabolic health, without having a severe deleterious effect on sleep.

The association between chronotype and sleep quality, and cardiometabolic markers in patients with schizophrenia

Current data on chronotype and sleep quality and their relationship with clinical characteristics of schizophrenia are insufficient to evaluate whether these variables are associated with cardiometabolic risk. We aimed to identify the interplay between chronotype, sleep quality and metabolic indices that can potentially predict negative cardiometabolic outcomes in schizophrenia patients. One-hundred schizophrenia patients who were under a stable antipsychotic regime were enrolled in the study. Clinical information, anthropometric measurements, as well as recent metabolic parameters including serum lipids, atherogenic, and metabolic indices suggestive of cardiometabolic risk were recorded. High and low sleep quality groups (HSQ and LSQ) were determined via the Pittsburgh Sleep Quality Index and chronotypes were evaluated with the Morningness-Eveningness Questionaire. Patients with eveningness chronotype had poorer sleep quality compared to intermediate or morningness (p = .017) patients. The LSQ group had higher total cholesterol (p = .004) and low-density lipoprotein (LDL) (p = .041) compared to the HSQ group. Mean blood pressure was higher in the eveningness chronotype patients compared to intermediate or morningness patients (p = .015). According to a logistic regression model, total cholesterol, disposition index, and having an eveningness chronotype significantly predicted LSQ in schizophrenia. Eveningness chronotype may lead to impaired cardiometabolic regulation with the mediation of poor sleep quality in schizophrenia patients. Cardiovascular diseases, sleep quality, and sleep patterns can influence each other; thus, this complex relationship in schizophrenia should be considered while configuring both pharmacological and behavioral interventions.

Effectiveness of a complex psychosocial intervention to reduce metabolic syndrome in psychiatric outpatients with severe/persistent mental illness

The prevalence of metabolic syndrome among individuals with severe mental illness is considerably higher than in the general population, contributing to the 15–20-year shorter life expectancy of this client population. The aim of this pilot study was to evaluate the effectiveness of a novel, complex psychosocial program to reduce metabolic syndrome. Members of both the intervention (n = 78) and control (n = 31) group were psychiatric outpatients with severe/persistent mental illness struggling with one or more symptoms of metabolic syndrome. Beyond the default elements of similar programs such as diet and exercise, the intervention covered medication use, sleep hygiene, stress management, as well as addressing spiritual needs, mindfulness, addictions, and self-care. Assessment of metabolic indicators were completed at baseline, at the end of the 11-week intervention, and 6 months post-intervention. The trajectory of change over time was significantly more favorable in the treatment than in the control group in terms of waist circumference (p = 0.013, η² = 0.093) and a positive trend emerged in relation to blood glucose level (p = 0.082, η² = 0.057). However, no statistically reliable difference was observed between the intervention and the control group regarding the other outcome variables (body mass index, systolic and diastolic blood pressure, serum triglyceride level, serum HDL cholesterol level, overall metabolic syndrome severity). These findings suggest that to produce more robust benefits, psychosocial interventions targeting the metabolic health of individuals with complex mental health needs should be either longer in duration if resources permit or narrower in focus (diet and exercise mainly) if resources are scarce.

Perinatal antecedents of sleep disturbances in schoolchildren

STUDY OBJECTIVES

Prematurity has been associated with an increased risk for sleep apnea. However, sleep disturbances in children born preterm have not been extensively investigated. Considering that determinants of sleep may originate early in life, the potential impact of prematurity on sleep disturbances later in life could be important. To establish the role of prematurity on sleep disturbances in a cohort of schoolchildren that were born preterm and compare them with healthy controls.

METHODS

A cohort of 147 schoolchildren, 45 born at term (≥37 weeks) and 102 very preterm (<32 weeks), was recruited and evaluated at school age (5-9 years). The Pediatric Sleep Questionnaire (PSQ) and the Sleep Disturbance Scale for Children (SDSC) were used to assess sleep disturbances in different domains.

RESULTS

PSQ score was significantly higher in former preterm children (0.26 ± 0.18 vs. 0.18 ± 0.14 in controls; p = 0.004), and SDSC total score was also significantly different among groups (21.7 ± 11.6 vs. 14.1 ± 12.6; p < 0.001). Regression models showed significant mean differences in PSQ score, total SDSC score, and two SDSC subscale scores (i.e. sleep-wake transition disorders, sleep-breathing disorders, and sleep hyperhidrosis) even after adjustment for confounders. Maternal age and type of delivery were not significantly associated with total PSQ scores.

CONCLUSIONS

Sleep disturbances may originate early in life since children born preterm exhibit an increased risk for developing long-term sleep problems. These findings may have important implications for management of preterm children and for implementation of early interventions focused on optimizing sleep habits.

Youth Beverage Intake and Reported Prediabetes: Choice and Frequency Matter

INTRODUCTION

Sugar sweetened beverage (SSB) consumption among U.S. adolescents exceeds current recommendations. This study examines relationships between SSB intake and reported prediabetes.

METHOD

Data are from the 2019 Minnesota Student Survey (N = 125,375). Logistic regression was used to examine relationships between frequencies for SSB intake and youth reported prediabetes in analytic models adjusting for demographic and other cardiometabolic indicators. Additional analyses examined relationships between consumption of fruit juice, milk, and water, and prediabetes.

RESULTS

One in four youth reported consumption of at least one SSB daily. In fully adjusted models, a range of SSB intake frequencies were significantly associated with increased odds of reported prediabetes. All intake frequencies for water were associated with reduced odds of prediabetes.

DISCUSSION

Efforts to reduce SSB intake among adolescents are warranted to support cardiometabolic health. Study findings are consistent with current guidance identifying water as the preferred drink for adolescents' hydration needs.

Sleep quality does not mediate the negative effects of chronodisruption on body composition and metabolic syndrome in healthcare workers in Ecuador

BACKGROUND AND AIMS

The objective of the present work was to determine to what extent sleep quality may mediate the association between chronodisruption (CD) and metabolic syndrome (MS), and between CD and body composition (BC).

METHODOLOGY

Cross-sectional study which included 300 adult health workers, 150 of whom were night shift workers and thereby exposed to CD. Diagnosis of MS was made based on Adult Treatment Panel III criteria. Sleep quality was measured using the Pittsburgh Sleep Quality Index. Body mass index (BMI), fat mass percentage, and visceral fat percentage were measured as indicators of body composition (BC). Data were analyzed using logistic, linear regression and structural equation models.

RESULTS

The odds of health workers exposed to CD to suffer MS was 22.13 (IC₉₅ 8.68-66.07) when the model was adjusted for age, gender, physical activity and energy consumption. CD was also significantly associated with an increase in fat mass and visceral fat percentages, but not to BMI. Surprisingly, there was not enough evidence supporting the hypothesis that sleep quality contributes to the association between CD and MS or between CD and BC.

CONCLUSIONS

Sleep quality does not mediate the negative effects of CD on MS nor on BC.

Association of sleep quality with insulin resistance in obese or overweight subjects

Introduction

Obesity or overweight are two factors associated with insulin resistance (IR). There are limited studies with regard to the role of some non-traditional factors such as sleep quality in level of IR in obese individuals. The current study aimed at investigating the association of sleep quality with IR in overweight or obese people.

Material and Methods

In this cross-sectional study, 612 obese or overweight participants of the Qazvin metabolic disease study (QMDS) were evaluated. Sleep quality was measured using the Pittsburgh sleep quality index (PSQI) and compared between two groups of participants with and without IR.

Results

Our findings showed that the total score of sleep quality in the IR group was significantly lower than that in the non-insulin resistant group (8.78±2.78 vs. 8.13±2.70, p=0.008). After adjustment, each unit increase of the sleep latency and subjective sleep quality scores was associated with a 1.23 and 1.33 times increased risk of IR, respectively (p<0.05).

Conclusion

In the obese or overweight people, sleep quality is associated with IR.

Transcriptomic Changes of Murine Visceral Fat Exposed to Intermittent Hypoxia at Single Cell Resolution

Intermittent hypoxia (IH) is a hallmark of obstructive sleep apnea (OSA) and induces metabolic dysfunction manifesting as inflammation, increased lipolysis and insulin resistance in visceral white adipose tissues (vWAT). However, the cell types and their corresponding transcriptional pathways underlying these functional perturbations are unknown. Here, we applied single nucleus RNA sequencing (snRNA-seq) coupled with aggregate RNA-seq methods to evaluate the cellular heterogeneity in vWAT following IH exposures mimicking OSA. C57BL/6 male mice were exposed to IH and room air (RA) for 6 weeks, and nuclei from vWAT were isolated and processed for snRNA-seq followed by differential expressed gene (DEGs) analyses by cell type, along with gene ontology and canonical pathways enrichment tests of significance. IH induced significant transcriptional changes compared to RA across 14 different cell types identified in vWAT. We identified cell-specific signature markers, transcriptional networks, metabolic signaling pathways, and cellular subpopulation enrichment in vWAT. Globally, we also identify 298 common regulated genes across multiple cellular types that are associated with metabolic pathways. Deconvolution of cell types in vWAT using global RNA-seq revealed that distinct adipocytes appear to be differentially implicated in key aspects of metabolic dysfunction. Thus, the heterogeneity of vWAT and its response to IH at the cellular level provides important insights into the metabolic morbidity of OSA and may possibly translate into therapeutic targets.

Prediction of metabolic syndrome based on sleep and work-related risk factors using an artificial neural network

BACKGROUND

Metabolic syndrome (MetS) is a major public health concern due to its high prevalence and association with heart disease and diabetes. Artificial neural networks (ANN) are emerging as a reliable means of modelling relationships towards understanding complex illness situations such as MetS. Using ANN, this research sought to clarify predictors of metabolic syndrome (MetS) in a working age population.

METHODS

Four hundred sixty-eight employees of an oil refinery in Iran consented to providing anthropometric and biochemical measurements, and survey data pertaining to lifestyle, work-related stressors and sleep variables. National Cholesterol Education Programme Adult Treatment Panel ІІI criteria was used for determining MetS status. The Management Standards Indicator Tool and STOP-BANG questionnaire were used to measure work-related stress and obstructive sleep apnoea respectively. With 17 input variables, multilayer perceptron was used to develop ANNs in 16 rounds of learning. ANNs were compared to logistic regression models using the mean squared error criterion for validation.

RESULTS

Sex, age, exercise habit, smoking, high risk of obstructive sleep apnoea, and work-related stressors, particularly Role, all significantly affected the odds of MetS, but shiftworking did not. Prediction accuracy for an ANN using two hidden layers and all available input variables was 89%, compared to 72% for the logistic regression model. Sensitivity was 82.5% for ANN compared to 67.5% for the logistic regression, while specificities were 92.2 and 74% respectively.

CONCLUSIONS

Our analyses indicate that ANN models which include psychosocial stressors and sleep variables as well as biomedical and clinical variables perform well in predicting MetS. The findings can be helpful in designing preventative strategies to reduce the cost of healthcare associated with MetS in the workplace.

Poor Quality of Sleep Among HIV-Positive Persons in Ethiopia

BACKGROUND

In comparison to the general population, persons living with HIV show a higher prevalence of poor quality of sleep, with estimates from 24.1-100% vs in the normal population 10-40%. There are not enough data on the poor quality of sleep among HIV-infected persons in Ethiopia.

METHODS

Hospital-based cross-sectional study design was conducted among 336 HIV-infected persons in Mettu Karl Referral Hospital. Pittsburgh sleep quality index (PSQI), social phobia inventory (SPIN), changes in sexual functioning questionnaire short-form (CSFQ-14), Fagerstrom test for nicotine dependence (FTND), severity of dependence scale (SDS), and CAGE questionnaire (cut down, annoyed, guilty, eye opener) was used. Data were analyzed by SPSS 20 version. Bivariate and multivariable regressions were computed, and a significance level was declared at a point P-value of <0.05.

RESULTS

A total of 336 respondents completed all questionnaires with response rate 98.53%. A total of 192 participants (57.1%) had poor sleep quality. Concerning associated factors; positive for social phobia, sexual dysfunction, living alone, poor antiretroviral (ARV) treatment adherence, and drunken alcohol had a positive association with poor sleep quality.

CONCLUSION

Of the persons living with HIV (PLWH) in Mettu Karl Referral Hospital, 57.1% experienced poor sleep quality. Social phobia, living arrangement, sexual dysfunction, poor ARV treatment adherence, and use of alcohol showed a significant association with poor quality of sleep. The findings suggest that a longitudinal study will be needed to elucidate the causal relationship of variables, and routine screening of poor sleep quality among PLWH is highly recommended. Furthermore, integrating and launching mental health services at ART clinic is greatly important.

Association of self-reported sleep disturbances with ideal cardiovascular health in Brazilian adults: A cross-sectional population-based study

OBJECTIVE

To examine the association between sleep disturbances and cardiovascular health in Brazilian adults.

METHODS

We analyzed cross-sectional data from a nationally representative sample of 36,480 Brazilian adults ages 18 and over. Multivariate Poisson regression models were used to assess the association between sleep disturbances (difficulty falling asleep, frequent interruptions in sleep, or sleeping more than usual) and Life's Simple 7 (LS7) cardiovascular health (CVH) scores through consideration of four behaviors (smoking, physical activity, body mass index, and diet) and three biological factors (hypercholesterolemia, hypertension, and diabetes).

RESULTS

Adults with no sleep disturbances had better CVH, with higher mean LS7 CVH scores (4.2, 95% confidence interval [CI]: 4.1; 4.2) when compared to those experiencing some level of sleep disturbance within a 2-week timespan (3.8, 95% CI: 3.7; 3.8). Specifically, compared to those with no sleep disturbance, adults reporting sleep disturbances for half of the weekdays had significantly lower LS7 CVH mean scores (β = -0.02, 95% CI: -0.04; 0.01). Adults who had disturbances more than half of the weekdays had even lower scores (β = -0.06, 95% CI: -0.09; -0.02), followed by those who reported disturbances almost every day (β = -0.08, 95% CI: -0.11; -0.04), even after adjusting for age, sex, education status, depressive symptoms, and night shift work.

CONCLUSION

Brazilian adults with sleep disturbances are less likely to achieve ideal CVH. Given that sleep disturbances seem to be increasingly common in Brazil, recent gains in CVH mortality may be affected.

Selective suppression of rapid eye movement sleep increases next-day negative affect and amygdala responses to social exclusion

Healthy sleep, positive general affect, and the ability to regulate emotional experiences are fundamental for well-being. In contrast, various mental disorders are associated with altered rapid eye movement (REM) sleep, negative affect, and diminished emotion regulation abilities. However, the neural processes mediating the relationship between these different phenomena are still not fully understood. In the present study of 42 healthy volunteers, we investigated the effects of selective REM sleep suppression (REMS) on general affect, as well as on feelings of social exclusion, cognitive reappraisal (CRA) of emotions, and their neural underpinnings. Using functional magnetic resonance imaging we show that, on the morning following sleep suppression, REMS increases general negative affect, enhances amygdala responses and alters its functional connectivity with anterior cingulate cortex during passively experienced experimental social exclusion. However, we did not find effects of REMS on subjective emotional ratings in response to social exclusion, their regulation using CRA, nor on functional amygdala connectivity while participants employed CRA. Our study supports the notion that REM sleep is important for affective processes, but emphasizes the need for future research to systematically investigate how REMS impacts different domains of affective experience and their neural correlates, in both healthy and (sub-)clinical populations.

Evening types have social jet lag and metabolic alterations in school-age children

Chronotype has been mostly assessed with subjective scales. Objective assessment has been undertaken with actigraphy, although problems may occur in classifying chronotype. The aims of the study were to assess chronotype in school-age children using a novel integrative measurement (TAP) derived from non-invasive assessments of wrist temperature (T) physical activity (A) and body position (P) and to explore associations between chronotype, sleep disturbances, and metabolic components. Four-hundred-thirty-two children of 8-12 years were recruited from a Mediterranean area of Spain. Measurements were: (a) Chronotype objectively (7-day-rhythms of TAP) and subjectively measured (Munich-chronotype-self-reported questionnaire); (b) sleep rhythms and light exposition; (c) 7-day-diaries of food intake; (d) anthropometry and metabolic parameters; (e) academic scores. TAP acrophase was able to assess eveningness. As compared to more morning-types, more evening-types displayed lower amplitude in temperature rhythms, increased physical activity in the evening, delayed sleep and midpoint of intake and had more frequent social jet lag (P < 0.05). More evening-types had higher light intensity at 2 h before sleep and lower melatonin values (01:00 h). Eveningness associated with higher BMI and metabolic risk (higher values of insulin, glucose, triglycerides and cholesterol). Evening-types presented better grades in art. In conclusion, more evening-types, as objectively assessed, presented sleep alterations, social jet lag, obesity and higher metabolic risk.