Poor Sleep Quality in Aging: The Association with Mental Health

Plasma IL-1β Concentration Associates with Sleep Quality and Cognitive Functions in Men with Prostate Cancer

OBJECTIVES

The purpose of this study was to ascertain whether sleep quality is altered in patients with prostate cancer (PCa) during androgen deprivation therapy (ADT) and whether sleep impairment associates with depressive symptoms, cognitive function or frailty syndrome, and if this varies between patients with localized or metastatic disease. The pro-inflammatory cytokine, IL-1β is involved in sleep regulation, we assessed whether sleep quality, depressive symptoms, cognitive function or frailty syndrome are associated with IL-1β concentration.

METHODS

Sleep quality was assessed using the Athens Insomnia Scale (AIS), depressive symptoms using the Yesavage Scale (GDS), and cognitive functions using the MiniMental State Exam (MMSE) and the level of frailty was measured based on the Fried criteria. Plasma IL-1β was measured by enzyme-linked immunoassay. Linear regression lanalyses were performed to determine which variables predict plasma IL-1β is involved in poor sleep quality and higher IL-1β concentration.

RESULTS

A cross-sectional study was carried out between 2021 and 2023. Sixty-seven men with PCa (N=36 (53.7%) with localized disease and N=31 (46.3%) with metastatic disease) were enrolled in the study. Plasma IL-1β concentration correlated with poorer sleep quality in all sample and, men with metastatic PCa had poorer sleep quality compared to men with localized disease. Analysis of self-reported sleep quality revealed that half of them had insomnia symptoms and 19.4% reported clinically relevant insomnia disorder (mean value of AIS 3.39±0.44). Poor sleep quality significantly predicted the concentration of IL-1β in plasma. In contrast, a better cognitive function significantly (P = .037) predicted IL-1β concentration. Detailed analysis of AIS items showed that score in the item "Sleep induction" and "Sleepiness during the da) significantly predicted IL-1β concentrations (P = .001 and P0=.044, respectively).

CONCLUSIONS

Plasma IL-1β levels may be useful to address the presence of insomnia in patients with PCa who are receiving ADT and to monitor the effect of interventions to improve sleep problems in these patients.

IMPLICATIONS FOR NURSING PRACTICE

Nurses will play a critical role in educating patients about their risk for specific symptoms based on an evaluation of specific biomarkers such as IL-1β and sleep quality. Nurses will be involved in using biomarker data to titrate medications and to evaluate the effect of nonpharmacological interventions to improve sleep quality in patients with PCa.

Moderating effect of instrumental activities of daily living on the relationship between loneliness and depression in people with cognitive frailty

BACKGROUND

The identification of depression and loneliness among people with cognitive frailty (CF) could prevent negative psychological and physical health outcomes. Few studies have focused on physical and mental health together, and little is known about the role of daily activity in the association between depression and loneliness among elderly individuals with CF.

OBJECTIVES

To determine the positive effect of loneliness on depression among community-dwelling older adults with CF as well as the moderating effect of instrumental activities of daily living (IADL) on this association.

DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS

This cross-sectional study included 529 adults aged 65 years and older from a community-dwelling population who were screened for CF and was conducted from July 2023 to December 2023. The participants were assessed via validation instruments for the following main variables: Short-form Geriatric Depression Scale, Loneliness Questionnaire, Athens Insomnia Scale, Instrumental Activities of Daily Living (IADL), Social Support Scale, and sociodemographic characteristics. The participants were classified as having reversable CF (RCF) or potentially reversable CF (PRCF).

RESULTS

The IADL, depression, insomnia, and loneliness scores were lower among individuals with RCF than among individuals PRCF. The moderating effect of IADL scores shows that the relationship between loneliness and depression has a steeper and positive slope when lower levels of IADL exist, compared with a straight line when there are higher levels of IADL, for this case, the line is less steep and showed negative association.

CONCLUSIONS

The integrity of physical and social connections has a protective effect on the mental health of elderly people with CF. It is necessary to pay attention to disability and loneliness among elderly individuals. Targeted interventions for improving physical activity and social participation seem to be practical and feasible solutions to alleviate depressive symptoms.

Individualized symptom experience and predictors in cancer patients after oesophagectomy: A latent profile analysis

PURPOSE

In the care for oesophageal cancer, symptom assessment was mainly carried out from the perspective of the total score using scales, which ignored individual differences in symptom experience among patients. To provide personalized symptom management, individual differences among patients with oesophageal cancer warranted further investigation. The objective was to identify the different symptom profiles of patients after oesophagectomy and examine the risk factors affecting the symptom profiles.

METHODS

It was a descriptive study with cross-sectional design. A total of 258 participants were recruited. Latent profile analysis was used to identify different profile of symptoms, and multiple logistic regression was used to identify risk factors.

RESULTS

Three distinct profiles were identified: the "complex symptoms group" (32.6%), the "throat symptoms group" (25.2%), and the "single fatigue group" (42.2%). Patients with higher prognostic nutritional index (OR = 0.797), higher resilience scale score (OR = 0.907), living in city or town (OR = 0.396), and stage II cancer (OR = 0.413) were more likely to be classified as "single fatigue group". Patients with higher prognostic nutritional index (OR = 1.233) and cervical anastomosis (OR = 4.586) tended to be classified as the "throat symptoms group". Unemployed patients (OR = 0.204) tended to belong to the "complex symptoms group," whereas patients with higher prognostic nutritional index were less likely to be in the "complex symptoms group."

CONCLUSION

Individual differences existed in the symptom experience of patients undergoing surgery for oesophageal cancer. Precise symptom management programs should be designed and implemented according to the individualized characteristics of the patient's symptom experience to promote patients' recovery.

Prolactin in sleep and EEG regulation: New mechanisms and sleep-related brain targets complement classical data

The role of prolactin in sleep regulation has been the subject of extensive research over the past 50 years, resulting in the identification of multiple, disparate functions for the hormone. Prolactin demonstrated a characteristic circadian release pattern with elevation during dark and diminution during light. High prolactin levels were linked to non-rapid eye movement sleep and electroencephalogram delta activity in humans. Conversely, hyperprolactinemia showed strong correlation with REM sleep in rodent studies. Prolactin may be implicated in the alterations in female sleep patterns observed during the reproductive cycle, it may play a role in the REM sleep enhancement following stress and in sleep-related immunological processes. In conclusion, prolactin appears to have a sleep-promoting role, particularly during the dark phase. However, it does not appear to play a central and coherent role in sleep regulation, as observed in some neuropeptides such as orexin. Conversely, its principal function may be to facilitate situational, yet adaptive, changes in sleep patterns in response to challenging physiological phases, such as those associated with stress, immunological challenges, or the reproductive cycle. Neuronal substrates for prolactin-mediated sleep effects remain unknown; however, recent rodent sleep studies may provide insights into the potential sites of these effects.

Examining the Relationship Between Chronic Pain and Mortality in U.S. Adults

Chronic pain (CP) significantly impacts quality of life and increases noncommunicable disease risk, with recent U.S. data showing a 6.3% incidence rate, surpassing diabetes, depression, and hypertension. International studies suggest higher mortality in CP populations, yet prior U.S. data are inconclusive. To investigate CP's mortality risk, we analyzed National Health Interview Survey and National Death Index data. We hypothesized that individuals with CP and high-impact CP (HICP [≥1 activity limitation]) would exhibit higher mortality rates. National Health Interview Survey provided demographics, pain reporting, lifestyle, and psychosocial data matched with National Death Index mortality records. Chi-square analyses explored the relationships between CP/HICP and demographics, lifestyle factors, psychosocial variables, and mortality. Cox proportional hazards models assessed mortality risk between groups. The weighted sample was 245,899,776; 20% reported CP and 8% HICP, both groups exhibiting higher mortality rates than pain-free individuals (CP: 5.55%, HICP: 8.79%, total: 2.82%). Hazard ratios indicated nearly double the mortality risk for CP and 2.5 times higher risk for HICP compared to those without these conditions. Adjusting for lifestyle and psychosocial factors reduced mortality risk but remained elevated compared with non-CP individuals. Heart disease, malignant neoplasms, and chronic lower respiratory diseases accounted for a higher percentage of deaths in CP cases. CP individuals showed higher rates of smoking, alcohol consumption, obesity, inactivity, depression, anxiety, emotional problems, and sleep disturbances. CP and HICP significantly influence mortality outcomes, leading to excess deaths compared with pain-free individuals. Given the relationship between pain, lifestyle, psychosocial variables, and mortality, further investigations are needed into CP causation and prevention strategies. PERSPECTIVE: This article presents evidence regarding the relationship between CP, HICP, and mortality. Additional findings are discussed regarding the impact of demographics, lifestyle, and psychosocial variables on mortality in those with versus without CP and HICP. These findings are crucial for informing future research, prevention, and healthcare management strategies.

Mechanisms, consequences and role of interventions for sleep deprivation: Focus on mild cognitive impairment and Alzheimer's disease in elderly

Sleep is established as an essential physiological need that impacts physical, emotional, and cognitive functions profoundly. Physiologically, inadequate sleep weakens immune function, heightening susceptibility to infections and chronic illnesses such as obesity, diabetes, and cardiovascular diseases. Hormonal disruptions due to sleep loss further exacerbate metabolic dysregulation, contributing to weight gain and other health complications. Emotionally, sleep deprivation leads to mood disturbances, including increased irritability, heightened stress responses, and a greater likelihood of mood disorders like depression and anxiety. These effects are compounded by cognitive impairments such as reduced alertness, impaired memory consolidation, and compromised decision-making abilities, akin to the impairments caused by alcohol consumption. Motor skills and coordination also suffer, elevating the risk of accidents, particularly in high-stress environments. For older adults, sleep quality is closely linked to cognitive function and overall longevity. Optimal sleep patterns are associated with slower brain aging and improved health outcomes. However, sleep disorders exacerbate existing conditions such as epilepsy and asthma, necessitating interventions like cognitive behavioral therapy (CBT) and medications such as melatonin to mitigate their impact. Education emerges as a crucial tool in promoting healthier sleep habits across all age groups. Addressing misconceptions about sleep and integrating sleep health into public health policies are essential steps toward improving overall well-being. Additionally, lifestyle factors such as diet and physical activity play significant roles in regulating sleep patterns, further emphasizing the interconnectedness of sleep with broader health outcomes. In summary, the articles underscore the intricate mechanisms through which sleep influences physiological functions and advocate for comprehensive approaches to enhance sleep hygiene and mitigate the adverse effects of sleep deprivation on human health.

Prevalence and risk factors of sleep disturbances among patients with lung cancer: systematic review and meta-analysis

PURPOSE

Patients with lung cancer endure the most sleep problems. Understanding the prevalence and risk factors of sleep disturbances in lung cancer populations is critical in reducing symptom burden and improving their quality of life. This systematic review aimed to determine the prevalence and risk factors of sleep disturbances in patients with lung cancer.

METHODS

Seven electronic databases were systematically screened for studies on the prevalence or risk factors of sleep disturbances in patients with lung cancer. Subgroup analyses were conducted to investigate significant heterogeneity (I2 > 50%) across studies.

RESULTS

Thirty-seven studies were found eligible. The pooled prevalence was 0.61 (95% CI = [0.54-0.67], I2 = 96%, p < 0.00001). Seven risk factors were subject to meta-analyses. Significant differences were found for old age (OR = 1.23; 95% CI = [1.09-1.39], p = 0.0006,I2 = 39%), a low education level (OR = 1.17; 95%CI = [1.20-2.66], p = 0.004, I 2 = 42%), fatigue (OR = 1.98; 95%CI = [1.23-3.18], p = 0.005, I 2 = 31%), pain (OR = 2.63; 95% CI = [1.35-5.14], p = 0.005, I 2 = 91%), tumor stage of III or IV (OR = 2.05; 95%CI = [1.54-2.72], p < 0.00001, I 2 = 42%), anxiety (OR = 1.62; 95%CI = [1.22-2.14], p = 0.0008, I2 = 78%), and depression (OR = 4.02; 95% CI = [1.39-11.61], p = 0.01, I2 = 87%). After the included studies were withdrawn one after the other, pain (OR = 3.13; 95% CI = [2.06-4.75], p < 0.00001, I 2 = 34%) and depression (OR = 5.47; 95% CI = [2.65-11.30], p < 0.00001) showed a substantial decrease of heterogeneity. Meanwhile, the heterogeneity of anxiety symptoms remained unchanged.

CONCLUSION

Results showed that sleep disturbances were experienced in more than 60% of patients with lung cancer. The comparatively high prevalence of sleep disturbances in this population emphasizes the need to adopt measures to reduce them. Significant associations were found between sleep disturbances and various factors, including age, education level, fatigue, pain, cancer stage, anxiety, and depression. Among these factors, depression emerged as the most significant. Future research should concentrate on identifying high-risk individuals and tailored interdisciplinary interventions based on these risk factors.

Nonlinear relationships between sleep duration, mental health, and quality of life: The dangers of less sleep versus more sleep

BACKGROUND

Recent research has found a non-linear relationship between sleep duration and mental health/quality of life. However, it is currently unclear which age group is more affected by sleep duration and what the optimal sleep duration is for each age group. Additionally, the underlying mechanisms of the non-linear relationship between sleep duration and quality of life are not well understood.

METHODS

Therefore, this study utilized questionnaire data from 20,962 participants in the Chinese PBICR-2022 database(Cross-sectional study) and constructed models to analyze the relationship between sleep duration and quality of life.

RESULTS

The results showed that the optimal sleep duration varied among different age groups: approximately 9 h for adolescents, 8 h for early/middle-aged adults, and 7 h for older adults. Compared to other age groups, less or more sleep duration had a greater impact on mental health and quality of life in adolescents. Furthermore, mental health was found to play a significant mediating role between sleep duration and quality of life in both the less sleep group and the more sleep group, but this mediating effect was not significant among the older adults in the less sleep group, whereas the mediating effect of mental health was not significant among the middle-aged adults in the more sleep group.

CONCLUSIONS

This suggests that different age groups have different optimal sleep duration, and age may be an important factor influencing the relationship between sleep duration and mental health/quality of life, with mental health playing a mediating role in the relationship between sleep duration and quality of life.

Association of Sociodemographic Factors with Physical Activity and Sleep Quality in Arab and Non-Arab Individuals of Both Sexes during the COVID-19 Pandemic

We explored the association of sociodemographic and anthropometric factors with self-reported physical activity (PA) and sleep quality in Arab and non-Arab individuals of both sexes during the COVID-19 pandemic. In this cross-sectional study, 638 participants (those recovered from COVID-19 = 149, and non-infected = 489) of both sexes aged 18-55 years were recruited. Their sociodemographic and anthropometric information, PA (self-reported using the International Physical Activity Questionnaire Short-form [IPAQ-SF)]) and sleep quality (self-reported using the Pittsburgh Sleep Quality Index [PSQI]) were documented. The association between participants' characteristics, PA levels, and sleep quality were determined using the chi-squared test. Variables significantly associated with IPAQ and PSQI in bivariate analyses were included in a multivariate binary logistic regression model. Men were more active than women (odds ratio [OR] = 1.66, p = 0.010), and non-Arab participants were more active than Arab ones (OR = 1.49, p = 0.037). Participants ≥40 years, men, non-Arab participants, and those who were working were more likely to have a good sleep quality than those ≤40 years (OR 1.70, p = 0.048), women (OR 1.10, p = 0.725), Arab individuals (OR 1.95, p = 0.002), and unemployed people (OR 2.76, p = 0.007). Male and non-Arab participants seemed to have a better self-reported PA and sleep quality compared to female and Arab participants, during the pandemic.

To Binge Watch TV Series: How a Leisure Activity May Affect Sleep, Mood and Quality of Life

Objective

New TV-watching patterns increased the practice of binge-watching (BW). Considering the adaptive-maladaptive continuum of BW, the relationship between BW and health outcomes is still unclear. This study aimed to analyze some features of BW related to quality of life, focusing on sleep quality.

Methods

Four-hundred eighty-two young adults were classified into four groups according to their BW approach. Then, sleep quality, mood, and quality of life were assessed.

Results

All the investigated variables were associated with problematic and moderate BW. No differences emerged between BW as a leisure activity and not watching TV series. Moreover, quality of life is directly affected by BW.

Conclusion

Accordingly, BW should be considered a continuum of behavioral patterns from a leisure activity characterized by positive outcomes to a maladaptive behavior characterized by negative outcomes for sleep, mood, and quality of life.

Episodic and Semantic Autobiographical Memory in Mild Cognitive Impairment (MCI): A Systematic Review

INTRODUCTION

Mild cognitive impairment (MCI) is a syndrome defined as a decline in cognitive performance greater than expected for an individual according to age and education level, not interfering notably with daily life activities. Many studies have focused on the memory domain in the analysis of MCI and more severe cases of dementia. One specific memory system is represented by autobiographical memory (AM), which has been largely studied in Alzheimer's disease and its effect on AM; however, the impairment of AM in moderate forms of decline, such as MCI, is still controversial.

OBJECTIVE

The main aim of this systematic review is to analyze the functioning of autobiographical memory in patients with MCI, considering both the semantic and the episodic components.

MATERIALS

The review process was conducted according to the PRISMA statement. The search was conducted until 20 February 2023 in the following bibliographical databases: PubMed, Web of Science, Scopus, and PsycInfo, and twenty-one articles were included.

RESULTS

The results highlight controversial findings concerning the semantic component of AM since only seven studies have found a worse semantic AM performance in patients with MCI compared to the HC group. The results of impaired episodic AM in individuals with MCI are more consistent than those concerning semantic AM.

CONCLUSIONS

Starting from the evidence of this systematic review, further studies should detect and investigate the cognitive and emotional mechanisms that undermine AM performance, allowing the development of specific interventions targeting these mechanisms.