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Pang X, Zhou B, Wu J, Mo Q, Yang L, Liu T, Jin G, Zhang L, Liu X, Xu X, Wang B, Cao H. Lacticaseibacillus rhamnosus GG alleviates sleep deprivation-induced intestinal barrier dysfunction and neuroinflammation in mice. Food Funct 2024; 15:8740-8758. [PMID: 39101469 DOI: 10.1039/d4fo00244j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
Consuming probiotic products is a solution that people are willing to choose to augment health. As a global health hazard, sleep deprivation (SD) can cause both physical and mental diseases. The present study investigated the protective effects of Lacticaseibacillus rhamnosus GG (LGG), a widely used probiotic, on a SD mouse model. Here, it has been shown that SD induced intestinal damage in mice, while LGG supplementation attenuated disruption of the intestinal barrier and enhanced the antioxidant capacity. Microbiome analysis revealed that SD caused dysbiosis in the gut microbiota, characterized by increased levels of Clostridium XlVa, Alistipes, and Desulfovibrio, as well as decreased levels of Ruminococcus, which were partially ameliorated by LGG. Moreover, SD resulted in elevated pro-inflammatory cytokine concentrations in both the intestine and the brain, while LGG provided protection in both organs. LGG supplementation significantly improved locomotor activity in SD mice. Although heat-killed LGG showed some protective effects in SD mice, its overall efficacy was inferior to that of live LGG. In terms of mechanism, it was found that AG1478, an inhibitor of the epidermal growth factor receptor (EGFR) tyrosine kinase, could diminish the protective effects of LGG. In conclusion, LGG demonstrated the ability to alleviate SD-induced intestinal barrier dysfunction through EGFR activation and alleviate neuroinflammation.
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Affiliation(s)
- Xiaoqi Pang
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, National Key Clinical Specialty, Tianjin Institute of Digestive Diseases, Tianjin Key Laboratory of Digestive Diseases, Anshan Road No. 154, Heping District, Tianjin, 300052, China.
| | - Bingqian Zhou
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, National Key Clinical Specialty, Tianjin Institute of Digestive Diseases, Tianjin Key Laboratory of Digestive Diseases, Anshan Road No. 154, Heping District, Tianjin, 300052, China.
| | - Jingyi Wu
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, National Key Clinical Specialty, Tianjin Institute of Digestive Diseases, Tianjin Key Laboratory of Digestive Diseases, Anshan Road No. 154, Heping District, Tianjin, 300052, China.
| | - Qi Mo
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, National Key Clinical Specialty, Tianjin Institute of Digestive Diseases, Tianjin Key Laboratory of Digestive Diseases, Anshan Road No. 154, Heping District, Tianjin, 300052, China.
| | - Lijiao Yang
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, National Key Clinical Specialty, Tianjin Institute of Digestive Diseases, Tianjin Key Laboratory of Digestive Diseases, Anshan Road No. 154, Heping District, Tianjin, 300052, China.
| | - Tiaotiao Liu
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin, 300070, China
| | - Ge Jin
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, National Key Clinical Specialty, Tianjin Institute of Digestive Diseases, Tianjin Key Laboratory of Digestive Diseases, Anshan Road No. 154, Heping District, Tianjin, 300052, China.
| | - Lan Zhang
- Department of Geriatrics, General Hospital, Tianjin Medical University, Tianjin, 300052, China
| | - Xiang Liu
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, National Key Clinical Specialty, Tianjin Institute of Digestive Diseases, Tianjin Key Laboratory of Digestive Diseases, Anshan Road No. 154, Heping District, Tianjin, 300052, China.
| | - Xin Xu
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, National Key Clinical Specialty, Tianjin Institute of Digestive Diseases, Tianjin Key Laboratory of Digestive Diseases, Anshan Road No. 154, Heping District, Tianjin, 300052, China.
| | - Bangmao Wang
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, National Key Clinical Specialty, Tianjin Institute of Digestive Diseases, Tianjin Key Laboratory of Digestive Diseases, Anshan Road No. 154, Heping District, Tianjin, 300052, China.
| | - Hailong Cao
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, National Key Clinical Specialty, Tianjin Institute of Digestive Diseases, Tianjin Key Laboratory of Digestive Diseases, Anshan Road No. 154, Heping District, Tianjin, 300052, China.
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Li X, Hu X, You C. Interactive effects of Composite Dietary Antioxidant Index with Body Mass Index for the risk of stroke among U.S. adults: insight from NHANES 2001-2018. Front Nutr 2024; 11:1378479. [PMID: 38912299 PMCID: PMC11190190 DOI: 10.3389/fnut.2024.1378479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/28/2024] [Indexed: 06/25/2024] Open
Abstract
Background This cross-sectional study aims to explore the interactive effects of the Composite Dietary Antioxidant Index (CDAI) and Body Mass Index (BMI) on stroke risk among U.S. adults, utilizing data from the National Health and Nutrition Examination Survey (NHANES) conducted between 2001 and 2018. Methods The analysis involved 42,042 participants from a representative sample of non-institutionalized U.S. civilians, selected through a stratified, multistage probability sampling method. Dietary intake data were collected over two 24-h periods using the Automated Multiple-Pass Method. The study calculated a modified CDAI to assess dietary antioxidant intake, excluding supplements and water sources. Statistical methods included multivariable logistic regression and Generalized Additive Models (GAM) to evaluate the interaction between CDAI scores and BMI in relation to stroke risk, adjusting for a wide range of demographic, lifestyle, and health covariates. Results The research identified a significant interaction between CDAI scores and BMI categories in stroke risk assessment. While a negative correlation was observed between CDAI scores and stroke risk across the total population (OR 0.97, 95% CI 0.96-0.99), this relationship varied notably across different BMI groups. In participants with a BMI ≥25, a statistically significant negative association persisted, displaying a non-linear pattern. The study also revealed an inflection point in the CDAI score, indicating a shift in the relationship between dietary antioxidants and stroke risk. Conclusion This study underscores the complex interaction between dietary antioxidant intake and BMI in determining stroke risk among U.S. adults. The findings suggest that individuals with higher BMI may experience more pronounced benefits from dietary antioxidants in stroke prevention. These insights could inform targeted dietary recommendations and public health strategies aimed at reducing stroke risk, particularly in populations with higher BMI. Further research is needed to fully understand these interactions and their implications for stroke prevention guidelines.
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Affiliation(s)
- Xi Li
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
- Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xin Hu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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DiCaro MV, Lei K, Yee B, Tak T. The Effects of Obstructive Sleep Apnea on the Cardiovascular System: A Comprehensive Review. J Clin Med 2024; 13:3223. [PMID: 38892933 PMCID: PMC11172971 DOI: 10.3390/jcm13113223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 05/23/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Obstructive sleep apnea (OSA) is an increasingly relevant cause of cardiovascular morbidity worldwide. Although the association between OSA and the cardiovascular system is well-known, the extent of its effects is still a topic of interest, including pathophysiologic mechanisms, cardiovascular sequelae, and OSA therapies and their effects. Commonly described mechanisms of cardiovascular etiologies revolve around sympathetic activation, inflammation, and intermittent hypoxia resulting from OSA. Ultimately, these effects lead to manifestations in the cardiovascular system, such as arrhythmias, hypertension, and heart failure, among others. The resulting sequelae of OSA may also have differential effects based on gender and age; several studies suggest female gender to have more susceptibility to cardiovascular mortality, as well as an increase in age. Furthermore, several therapies for OSA, both established and emerging, show a reduction in cardiovascular morbidity and may even reduce cardiovascular burden. Namely, the establishment of CPAP has led to improvement in hypertension and cardiac function in patients with heart failure and even reduced the progression of early stages of atherosclerosis. Effective management of OSA decreases abnormal neural sympathetic activity, which results in better rhythm control and blood pressure control, both in waking and sleep cycles. With newer therapies for OSA, its effects on the cardiovascular system may be significantly reduced or even reversed after long-term management. The vast extent of OSA on the cardiovascular system, as well as current and future therapeutic strategies, will be described in detail in this review.
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Affiliation(s)
| | | | | | - Tahir Tak
- Department of Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV 89102, USA; (M.V.D.); (K.L.); (B.Y.)
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Bao J, Zhao Z, Qin S, Cheng M, Wang Y, Li M, Jia P, Li J, Yu H. Elucidating the association of obstructive sleep apnea with brain structure and cognitive performance. BMC Psychiatry 2024; 24:338. [PMID: 38711061 DOI: 10.1186/s12888-024-05789-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 04/25/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a pervasive, chronic sleep-related respiratory condition that causes brain structural alterations and cognitive impairments. However, the causal association of OSA with brain morphology and cognitive performance has not been determined. METHODS We conducted a two-sample bidirectional Mendelian randomization (MR) analysis to investigate the causal relationship between OSA and a range of neurocognitive characteristics, including brain cortical structure, brain subcortical structure, brain structural change across the lifespan, and cognitive performance. Summary-level GWAS data for OSA from the FinnGen consortium was used to identify genetically predicted OSA. Data regarding neurocognitive characteristics were obtained from published meta-analysis studies. Linkage disequilibrium score regression analysis was employed to reveal genetic correlations between OSA and related traits. RESULTS Our MR study provided evidence that OSA was found to significantly increase the volume of the hippocampus (IVW β (95% CI) = 158.997 (76.768 to 241.227), P = 1.51e-04), with no heterogeneity and pleiotropy detected. Nominally causal effects of OSA on brain structures, such as the thickness of the temporal pole with or without global weighted, amygdala structure change, and cerebellum white matter change covering lifespan, were observed. Bidirectional causal links were also detected between brain cortical structure, brain subcortical, cognitive performance, and OSA risk. LDSC regression analysis showed no significant correlation between OSA and hippocampus volume. CONCLUSIONS Overall, we observed a positive association between genetically predicted OSA and hippocampus volume. These findings may provide new insights into the bidirectional links between OSA and neurocognitive features, including brain morphology and cognitive performance.
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Affiliation(s)
- Jiahao Bao
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, No. 639 Zhizaoju Road, Shanghai, China
| | - Zhiyang Zhao
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, No. 639 Zhizaoju Road, Shanghai, China
| | - Shanmei Qin
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Mengjia Cheng
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, No. 639 Zhizaoju Road, Shanghai, China
| | - Yiming Wang
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, No. 639 Zhizaoju Road, Shanghai, China
| | - Meng Li
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, No. 639 Zhizaoju Road, Shanghai, China
| | - Pingping Jia
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jinhui Li
- Department of Urology, Stanford University Medical Center, Stanford, CA, USA.
| | - Hongbo Yu
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, No. 639 Zhizaoju Road, Shanghai, China.
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Ju X, Hedges J, Sethi S, Jamieson LM. Poor Self-Rated Sleep Quality and Quantity Associated with Poor Oral Health-Related Quality of Life among Indigenous Australian Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:453. [PMID: 38673364 PMCID: PMC11050505 DOI: 10.3390/ijerph21040453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 03/31/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Indigenous Australians score worse on both sleep and oral health. This study aimed to evaluate sleep quality and quantity associated with oral health-related quality of life (OHRQoL) among Indigenous Australian adults. METHODS A cross-sectional study involving 728 Indigenous Australian adults aged 18+ years was conducted. Exposure variables were sleep quality and quantity. The primary outcome variable was Oral Health Impact Profile-14 (OHIP14), which has been used to assess OHRQoL. Multivariable log-Poisson regression models were applied to estimate the mean ratios (MRs) for mean OHIP14 scores. RESULTS The average OHIP14 score was 14.9, and the average amount of sleep was 6.8 h/night. After adjusting for all covariates, self-rated very bad sleep quality was associated with 2.2 times (MR = 2.17, 95% CI: 1.97-2.37) higher OHIP14 scores than those who rated their sleep quality as very good. Participants who self-reported sleeping 7-8 h/night had 0.9 times (MR = 0.89, 95%CI: 0.83-0.95) lower OHIP14 scores than those sleeping more than 8 h. CONCLUSIONS The average number of sleep hours for Indigenous participants were lower than recommended (7-8 h/night). Our findings indicate that poor sleep quality and quantity, and oral health-related behaviours associated with sleep deprivation were positively associated with poor oral health related quality of life among Indigenous Australian adults.
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Affiliation(s)
- Xiangqun Ju
- Australian Research Centre of Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide 5000, Australia; (J.H.); (S.S.); (L.M.J.)
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Pikula A, Gulati M, Bonnet JP, Ibrahim S, Chamoun S, Freeman AM, Reddy K. Promise of Lifestyle Medicine for Heart Disease, Diabetes Mellitus, and Cerebrovascular Diseases. Mayo Clin Proc Innov Qual Outcomes 2024; 8:151-165. [PMID: 38434935 PMCID: PMC10907160 DOI: 10.1016/j.mayocpiqo.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
The burden of noncommunicable chronic diseases has relevant and negative consequences to persons, health care systems, and economies worldwide. Chronic diseases are the leading cause of disability and mortality and are responsible for 90% of health care expenditure. The most common chronic diseases are diabetes mellitus (DM), cardiovascular disease, and cerebrovascular disease (stroke and vascular cognitive impairment). Modifiable risk factors (MRFs) for these conditions include hypertension, hyperlipidemia, smoking, poor diet, and low-physical activity; with hypertension being the most prevalent MRF. Most MRFs can be successfully targeted through lifestyle medicine (LSM), which is a medical specialty that addresses the root causes of chronic diseases through its primary, secondary, and tertiary preventative approaches. Lifestyle medicine comprises 6 pillars (nutrition, physical activity, sleep health, stress reduction, social connections, and substance use) which through various behavioral approaches, focus on regular physical activity, healthy eating, good quality and quantity sleep, and meaningful social connections coupled with the reduction of stress and substance use. This paper will briefly review the evidence and promise of individual LSM pillars in addressing the underlying MRFs of DM, cardiovascular and cerebrovascular disease (specifically stroke and vascular cognitive impairment). Lifestyle medicine holds a great promise for comprehensive and much improved population health. However, the adoption of LSM at the societal scale requires a multifaceted approach and widespread integration would galvanize a paradigm shift to prevent, treat or reverse chronic diseases from the root causes and achieve health equity.
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Affiliation(s)
- Aleksandra Pikula
- Department of Medicine, Division of Neurology, University of Toronto, Ontario, Canada
- Jay and Sari Sonshine Centre for Stroke Prevention and Cerebrovascular Brain Health, Univeristy Health Network, Toronto Western Hospital, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
| | - Mahima Gulati
- Department of Medical Sciences, Frank H. Netter School of Medicine, Quinnipiac University, North Haven, Connecticut
| | - Jonathan P. Bonnet
- Palo Alto Veteran’s Affairs, Palo Alto, California
- Stanford University School of Medicine, Palo Alto, California
| | - Sarah Ibrahim
- University of Toronto, Lawrence S. Bloomberg Faculty of Nursing, Ontario, Canada
- SickKids Research Institute, Toronto, Ontario, Canada
- Centre for Advancing Collaborative Healthcare & Education (CACHE), University of Toronto, Ontario, Canada
| | | | - Andrew M. Freeman
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, Colorado
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Liu J, Ito S, Ngo TM, Lawate A, Ong QC, Fox TE, Chang SY, Phung D, Nair E, Palaiyan M, Joty S, Abisheganaden J, Lee CP, Lwin MO, Theng YL, Ho MHR, Chia M, Bojic I, Car J. A pilot randomised controlled trial exploring the feasibility and efficacy of a human-AI sleep coaching model for improving sleep among university students. Digit Health 2024; 10:20552076241241244. [PMID: 38638406 PMCID: PMC11025445 DOI: 10.1177/20552076241241244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 04/20/2024] Open
Abstract
Objective Sleep quality is a crucial concern, particularly among youth. The integration of health coaching with question-answering (QA) systems presents the potential to foster behavioural changes and enhance health outcomes. This study proposes a novel human-AI sleep coaching model, combining health coaching by peers and a QA system, and assesses its feasibility and efficacy in improving university students' sleep quality. Methods In a four-week unblinded pilot randomised controlled trial, 59 university students (mean age: 21.9; 64% males) were randomly assigned to the intervention (health coaching and QA system; n = 30) or the control conditions (QA system; n = 29). Outcomes included efficacy of the intervention on sleep quality (Pittsburgh Sleep Quality Index; PSQI), objective and self-reported sleep measures (obtained from Fitbit and sleep diaries) and feasibility of the study procedures and the intervention. Results Analysis revealed no significant differences in sleep quality (PSQI) between intervention and control groups (adjusted mean difference = -0.51, 95% CI: [-1.55-0.77], p = 0.40). The intervention group demonstrated significant improvements in Fitbit measures of total sleep time (adjusted mean difference = 32.5, 95% CI: [5.9-59.1], p = 0.02) and time in bed (adjusted mean difference = 32.3, 95% CI: [2.7-61.9], p = 0.03) compared to the control group, although other sleep measures were insignificant. Adherence was high, with the majority of the intervention group attending all health coaching sessions. Most participants completed baseline and post-intervention self-report measures, all diary entries, and consistently wore Fitbits during sleep. Conclusions The proposed model showed improvements in specific sleep measures for university students and the feasibility of the study procedures and intervention. Future research may extend the intervention period to see substantive sleep quality improvements.
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Affiliation(s)
- Jintana Liu
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Sakura Ito
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Tra My Ngo
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Ashwini Lawate
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Qi Chwen Ong
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Tatiana Erlikh Fox
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Si Yuan Chang
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Duy Phung
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | | | - Malar Palaiyan
- University Counselling Centre, Nanyang Technological University, Singapore, Singapore
| | - Shafiq Joty
- Salesforce AI Research, San Francisco, CA, USA
- School of Computer Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - John Abisheganaden
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Chuen Peng Lee
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - May Oo Lwin
- Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore, Singapore
| | - Yin Leng Theng
- Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore, Singapore
| | - Moon-Ho Ringo Ho
- School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Michael Chia
- Physical Education and Sports Science, National Institute of Education, Nanyang Technological University, Singapore, Singapore
| | - Iva Bojic
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Josip Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- School of Life Course & Population Sciences, King's College London, London, UK
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Kiaer E, Ravn A, Jennum P, Prætorius C, Welinder R, Ørntoft S, von Buchwald C, Backer V. Fractional exhaled nitric oxide-a possible biomarker for risk of obstructive sleep apnea in snorers. J Clin Sleep Med 2024; 20:85-92. [PMID: 37707290 PMCID: PMC10758563 DOI: 10.5664/jcsm.10802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 09/04/2023] [Accepted: 09/06/2023] [Indexed: 09/15/2023]
Abstract
STUDY OBJECTIVES Airway inflammation in patients with obstructive sleep apnea (OSA) has been described and can be assessed by measuring the biomarker fractional exhaled nitric oxide (FeNO). In this pilot study, we investigated FeNO measurements in identification of OSA among persons with snoring. METHODS In this study we aimed to investigate (1) if FeNO could be used in screening for OSA, (2) if daytime sleepiness correlated to FeNO levels, and (3) whether asthma affected FeNO levels. Persons with snoring were prospectively included in three primary care ear, nose, and throat clinics. Patients underwent spirometry, FeNO tests, and partial polygraphy. They filled out questionnaires on sinonasal and asthma symptoms, daytime sleepiness, and quality of life. Current smokers, patients with upper airway inflammatory conditions, and patients treated with steroids were excluded. RESULTS Forty-nine individuals were included. Median apnea-hypopnea index was 11.4, mean age was 50.9 years, and 29% were females. OSA was diagnosed in 73% of the patients of whom 53% had moderate-severe disease. Patients with moderate-severe OSA had significantly higher FeNO counts than patients with no or mild OSA (P = .024). Patients younger than 50 years with a FeNO below 15 had the lowest prevalence of moderate-severe OSA. No correlation was found between FeNO measurements and daytime sleepiness, and asthma did not affect FeNO levels. CONCLUSIONS We found a low prevalence of moderate-severe OSA in persons with snoring when FeNO and age were low. This might be considered in a future screening model, though further studies testing the FeNO cutoff level and the diagnostic accuracy are warranted. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: NO Measurements in Screening for Asthma and OSA, in Patients With Severe Snoring; URL: https://clinicaltrials.gov/study/NCT03964324; Identifier: NCT03964324. CITATION Kiaer E, Ravn A, Jennum P, et al. Fractional exhaled nitric oxide-a possible biomarker for risk of obstructive sleep apnea in snorers. J Clin Sleep Med. 2024;20(1):85-92.
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Affiliation(s)
- Eva Kiaer
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Andreas Ravn
- Frederiksberg Øre-næse-halsklinik (Frederiksberg Ear, Nose, and Throat Clinic), Frederiksberg, Denmark
| | - Poul Jennum
- Department of Clinical Neurophysiology, Copenhagen University Hospital (Rigshospitalet), Glostrup, Denmark
| | - Christian Prætorius
- Øre-næse-halsklinikken i Hørsholm (Hoersholm Ear, Nose, and Throat Clinic), Hoersholm, Denmark
| | - Roland Welinder
- Øre-næse-halsklinikken i Hørsholm (Hoersholm Ear, Nose, and Throat Clinic), Hoersholm, Denmark
| | - Steffen Ørntoft
- Øre næse hals klinikken ved Steffen Ørntoft (Ear, Nose, and Throat Clinic by Steffen Oerntoft), Hvidovre, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Vibeke Backer
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
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Ding Y, Chen S, Sun Q, Han F, Chen R, Li J. Correlation of Circadian Rhythms and Improvement of Depressive Symptoms in Acute Ischemic Stroke Patients. Curr Neurovasc Res 2024; 21:15 - 24. [PMID: 38279764 DOI: 10.2174/0115672026288134231228091756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/01/1970] [Accepted: 12/13/2023] [Indexed: 01/28/2024]
Abstract
OBJECTIVES To investigate the correlation between evening melatonin timing secretion, dim light melatonin onset (DLMO), and post-stroke depression (PSD) in acute ischemic stroke patients and their influence on the improvement of depressive symptoms. MATERIALS AND METHODS 120 patients with a recent magnetic resonance imaging confirmed stroke were included. Salivary melatonin samples were collected at 5 time points within 1 week after hospitalization (7 p.m.-11 p.m., 1 sample per hour). The circadian phase was defined by calculating DLMO secretion. Post-stroke depressive symptoms were evaluated by the 17-item Hamilton Rating Scale for Depression (HRSD) both on day 7 of hospitalization and 3 months after stroke. Patients were divided into PSD and non-PSD groups based on whether the acute phase HRSD score was ≥8. Similarly, patients were divided into the improved depressive symptoms (IDS) and no improvement in depressive symptoms (non-IDS) groups based on whether the HRSD score at 3 months was lower than at baseline. Neurological recovery at 3 months was assessed using the modified Rankin Scale (mRS). RESULTS The difference in DLMO between PSD and non-PSD patients was not statistically significant (p =0.173). In the non-IDS group, there was a significant decrease in melatonin secretion at 10 p.m. (p =0.012), and DLMO was significantly later than in the IDS group (p =0.017). Logistic regression analysis showed that DLMO (OR 1.91, 95%CI:1.13-3.23, p = 0.016) was an independent risk factor for persistent no improvement in depressive symptoms, which was associated with a markedly worse prognosis (p <.001). CONCLUSION Our findings suggest possible interventions for the very early identification of non-IDS patients.
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Affiliation(s)
- Yue Ding
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Shengnan Chen
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Qian Sun
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Fei Han
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Rui Chen
- Department of Respiratory Medicine, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Jie Li
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
- Clinical Research Center for Neurological Diseases, Soochow University, Suzhou 215004, China
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Maroufi N, Sohrabi M, Mehrabadi S, Zamani F, Ajdarkosh H, Hatamian S, Bahavar A, Hassanzadeh P, Safarnezhad Tameshkel F, Gholami A. Poor Sleep Quality and Its Influencing Factors Among Iranian Patients with Esophageal and Gastric Cancer. Middle East J Dig Dis 2024; 16:39-46. [PMID: 39050101 PMCID: PMC11264832 DOI: 10.34172/mejdd.2024.367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 12/07/2023] [Indexed: 07/27/2024] Open
Abstract
Background Sleep quality is a notable factor of well-being. It also may play a role in the development and progression of chronic diseases and cancers. Therefore, this study was performed to investigate poor sleep quality and its influencing factors among Iranian patients with esophageal and gastric cancer. Methods In this cross-sectional study, a total of 312 Iranian adult patients who suffered from esophageal and gastric cancers were employed from a gastrointestinal cancer-based cohort study conducted in a referral hospital in Tehran between 2015 and 2018. Persian version of the Pittsburg Sleep Quality Index (PSQI) was used to measure poor sleep quality. Univariate and multiple logistic regression models were applied to determine the related factors to poor sleep quality. Results Of the participants, 203 (65.06%) were men, and 75.96% had gastric cancer. The mean age was 63.13±12.10 years. The results demonstrated that more than 62% of the patients had poor sleep quality. 148 (62.44%) patients out of 237 patients with gastric cancer had poor-quality sleep. Also, 46 (64.38%) patients out of 237 patients with esophageal cancer had poor-quality sleep. Based on the results of multiple logistic regression models, marital status has a negative association with poor sleep quality (odds ratio [OR]=0.32, P=0.015). In addition, having chronic disease (OR=2.16; P=0.028) and wealth index (OR=3.11, P=0.013; OR=3.81, P=0.003; OR=3.29, P=0.009; OR=3.85, P=0.003 for rich, moderate, poor, and poorest subgroups, respectively) had a positive association with poor sleep quality. Conclusion The findings showed that about two-thirds of the patients studied were poor sleepers. Also, it was observed that marital status, chronic disease, and wealth index were important factors associated with poor sleep quality.
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Affiliation(s)
- Negin Maroufi
- Epidemiology & Biostatistics Department, School of Public Health, Neyshabur University of Medical, Sciences, Neyshabur, Iran
| | - Masoudreza Sohrabi
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Shima Mehrabadi
- Student Research Committee, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Farhad Zamani
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Ajdarkosh
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sare Hatamian
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Atefeh Bahavar
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Parvin Hassanzadeh
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Ali Gholami
- Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran
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11
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Li TC, Li CI, Liu CS, Lin CH, Yang SY, Lin CC. Association of time-varying sleep duration and cognitive function with mortality in the elderly: a 12-year community-based cohort study. BMC Psychiatry 2023; 23:954. [PMID: 38124053 PMCID: PMC10731683 DOI: 10.1186/s12888-023-05434-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 12/02/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Sleeping problems and cognitive impairment are common in elders. Baseline sleep duration and cognitive status are predictors of mortality. But few studies have explored whether longitudinal changes in sleep duration and cognitive function are related to mortality in older adults. The present study investigated the time-varying relationships of sleep duration and cognitive function with subsequent mortality among community-dwelling elders by using 12 years of repeated-measure data. METHODS Taichung Community Health Study for Elders (TCHS-E) is a retrospective, population-based cohort that started in 2009 (wave 1) with a total of 912 elders aged 65 years or above. Follow up was conducted in 2010 (wave 2), 2018 (wave 3), and 2020 (wave 4). Sleep duration and Mini-Mental State Examination (MMSE) forms were executed at baseline and three visits during follow-up. Time-varying Cox proportional hazards regression estimated adjusted hazard ratios (HRs) of mortality with 95% confidence intervals (CIs). RESULTS During about 12 years (9,396 person-years) follow-up, 329 deaths from all causes were documented, including 102 deaths due to expanded cardiovascular disease (CVD). In the multivariable-adjusted, time-varying Cox proportional hazard model, the adjusted HR values of all-cause mortality were 1.47 (1.02-2.12) for sleep duration > 9 h/day (vs. 7 h/day) and 1.81 (1.26-2.59) for MMSE < 27 (vs. 30). The adjusted HR values of the expanded CVD mortality were 2.91 (1.24-6.83) for MMSE of 29; 2.69 (1.20-6.05) for MMSE of 27-28; and 4.32 (95% CI: 1.92-9.74) for MMSE < 27. The dose-dependent relationship was significant (p < 0.001). The combinations of sleep duration longer than 9 h/day and MMSE < 27 were linked with the highest risks for expanded CVD and all-cause mortality. CONCLUSIONS Long sleep duration and low cognitive function were jointly and independently linked with higher risk of mortality in elders residing in community.
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Affiliation(s)
- Tsai-Chung Li
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Chia-Ing Li
- School of Medicine, College of Medicine, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist., Taichung City, 406040, Taiwan ROC
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Chiu-Shong Liu
- School of Medicine, College of Medicine, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist., Taichung City, 406040, Taiwan ROC
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Hsueh Lin
- School of Medicine, College of Medicine, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist., Taichung City, 406040, Taiwan ROC
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Shing-Yu Yang
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Cheng-Chieh Lin
- School of Medicine, College of Medicine, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist., Taichung City, 406040, Taiwan ROC.
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.
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12
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Song Z, Ying chen, Li J, Chen Z, Lu X, Wang Z. Comparative effectiveness of different treatments for post-stroke insomnia: A network meta-analysis. Heliyon 2023; 9:e21801. [PMID: 38027586 PMCID: PMC10658229 DOI: 10.1016/j.heliyon.2023.e21801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 08/25/2023] [Accepted: 10/28/2023] [Indexed: 12/01/2023] Open
Abstract
Background :Post-stroke insomnia(PSI)is one of the common complications after stroke and it is a chronic problem and hampers the patient's recovery. Some treatments have been shown to be effective in treating post-stroke insomnia. However, it is not clear which treatment is more effective. Methods In this study, we searched CNKI, PubMed, and Cochrane Library for appropriate keywords with a deadline of October 2022 to select 23 randomized controlled trials(RCTs). The mean difference between different treatments was assessed and summarized as mean and 95 % confidence interval (CI), resulting in a Bayesian network meta-analysis. Results By meta-analysis of Bayesian networks, we found acupuncture(MD, -2.49; 95 % CI, [-3.63, -1.31]) and herbal (MD, -2.79; 95 % CI, [-4.9, -0.69]) were significantly better than estazolam in terms of PSQI score change, and the difference was statistically significant. Dexzopiclone, electrics stimulation, rTMS and zopiclone were not statistically significant with other treatments. Conclusion Herbal, zopiclone, and acupuncture were more effective in improving PSQI scores in patients with post-stroke insomnia, followed by rTMS and dexzopiclone. However, the effectiveness between herbal, zopiclone and acupuncture was not statistically significant. Acupuncture and herbal are promising for the treatment of PSI, and more research remains to be invested.
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Affiliation(s)
- Zhaoming Song
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, 215006, China
| | - Ying chen
- Department of Neurosurgery, The First People's Hospital of Taicang, Taicang Affiliated Hospital of Soochow University, Soochow Medical College of Soochow University, Suzhou, Jiangsu Province, 215400, China
| | - Jian Li
- Department of Neurosurgery, The First People's Hospital of Zhangjiagang, Jiangsu Province, 215600, China
| | - Zhouqin Chen
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, 215006, China
| | - Xiaojun Lu
- Department of Neurosurgery, The First People's Hospital of Taicang, Taicang Affiliated Hospital of Soochow University, Soochow Medical College of Soochow University, Suzhou, Jiangsu Province, 215400, China
| | - Zhong Wang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, 215006, China
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13
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de Bergeyck R, Geoffroy PA. Insomnia in neurological disorders: Prevalence, mechanisms, impact and treatment approaches. Rev Neurol (Paris) 2023; 179:767-781. [PMID: 37620177 DOI: 10.1016/j.neurol.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023]
Abstract
Insomnia is more prevalent in neurological disorders compared to the general population, with rates ranging from 11 to 74.2% in neurodegenerative disorders, 20 to 37% in vascular diseases, 13.3 to 50% in inflammatory diseases, 28.9 to 74.4% in epilepsy, and nearly 70% in migraines. Insomnia in neurological disorders stems from a variety of factors, encompassing physical and neuropsychiatric factors, behavioral patterns, and disruptions in the biological clock and circadian rhythm. There are bidirectional connections between neurological disorders and insomnia. Insomnia in neurological disorders worsens symptoms, resulting in heightened depressive symptoms, elevated mortality rates, reduced quality of life, and intensified acute symptoms. Managing comorbid sleep disorders, especially in the presence of psychiatric comorbidities, is crucial. Cognitive behavioral therapy for insomnia (CBT-I) is the first-line recommendation for insomnia management in neurological disorders. Other treatments are second-line strategies. Melatonin may demonstrate effectiveness in addressing insomnia, with soporific and chronobiotic effects. Furthermore, it has the potential to alleviate "sundowning" and behavioral disturbances, while generally being well-tolerated. Other treatment options that may be of interest include morning bright light therapy, sedative antidepressants, new orexin dual antagonists and levodopa specifically indicated for Parkinson's disease. Benzodiazepines and z-drugs can be used primarily during acute phases to prevent pharmacotolerance and minimize side effects. However, they should be avoided in patients with neurological disorders and not used in patients over 75 years old due to the risk of falls and confusion. In neurological disorders, insomnia has a profound impact on daytime functioning, making its management crucial. Effective treatment can result in improved outcomes, and additional research is necessary to investigate alternative therapeutic options and enhance patient care.
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Affiliation(s)
- R de Bergeyck
- Centre ChronoS, GHU Paris - Psychiatry Neurosciences, 1, rue Cabanis, 75014 Paris, France.
| | - P A Geoffroy
- Centre ChronoS, GHU Paris - Psychiatry Neurosciences, 1, rue Cabanis, 75014 Paris, France; Département de psychiatrie et d'addictologie, DMU Neurosciences, GHU Paris Nord, hôpital Bichat-Claude-Bernard, AP-HP, 75018 Paris, France; Université Paris Cité, NeuroDiderot, Inserm U1141, 75019 Paris, France; CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, 5, rue Blaise-Pascal, 67000 Strasbourg, France
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14
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Lee-Iannotti JK. Sleep Disorders in Patients with Neurologic Disease. Continuum (Minneap Minn) 2023; 29:1188-1204. [PMID: 37590829 DOI: 10.1212/con.0000000000001270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
OBJECTIVE This article provides an overview of the growing body of evidence showing bidirectional relationships between sleep and various neurologic disorders. LATEST DEVELOPMENTS Mounting evidence demonstrates that disrupted sleep can negatively impact various neurologic disease processes, including stroke, multiple sclerosis, epilepsy, neuromuscular disorders including amyotrophic lateral sclerosis, and headache syndromes. Abnormal sleep can also be a precursor to Alzheimer disease and neurodegenerative disease states such as Parkinson disease and dementia with Lewy bodies. Interventions to improve sleep and treat obstructive sleep apnea may play a vital role in preventing neurologic disease development and progression. ESSENTIAL POINTS Sleep disorders are common among patients with neurologic disorders. To provide comprehensive care to patients with neurologic conditions, neurologists must ask patients about sleep issues that may warrant further diagnostic testing, treatment, and sleep medicine referral when indicated.
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15
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Chen C, Wang J, Yang C, Yu H, Zhang B, Yang X, Xiong B, Xie Y, Li S, Zhang Z, Zhu F, Liu J, Liu G, Yang X. Multiomics analysis of human peripheral blood reveals marked molecular profiling changes caused by one night of sleep deprivation. MedComm (Beijing) 2023; 4:e252. [PMID: 37139463 PMCID: PMC10149526 DOI: 10.1002/mco2.252] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/04/2023] [Accepted: 03/12/2023] [Indexed: 05/05/2023] Open
Abstract
Sleep insufficiency is associated with various disorders; the molecular basis is unknown until now. Here, 14 males and 18 females were subjected to short-term (24 h) sleep deprivation, and donated fasting blood samples prior to (day 1) and following (days 2 and 3) short-term sleep deprivation. We used multiple omics techniques to examine changes in volunteers' blood samples that were subjected to integrated, biochemical, transcriptomic, proteomic, and metabolomic analyses. Sleep deprivation caused marked molecular changes (46.4% transcript genes, 59.3% proteins, and 55.6% metabolites) that incompletely reversed by day 3. The immune system in particular neutrophil-mediated processes associated with plasma superoxidase dismutase-1 and S100A8 gene expression was markedly affected. Sleep deprivation decreased melatonin levels and increased immune cells, inflammatory factors and c-reactive protein. By disease enrichment analysis, sleep deprivation induced signaling pathways for schizophrenia and neurodegenerative diseases enriched. In sum, this is the first multiomics approach to show that sleep deprivation causes prominent immune changes in humans, and clearly identified potential immune biomarkers associated with sleep deprivation. This study indicated that the blood profile following sleep disruption, such as may occur among shift workers, may induce immune and central nervous system dysfunction.
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Affiliation(s)
- Chongyang Chen
- Shenzhen Key Laboratory of Modern Toxicology, Shenzhen Medical Key Discipline of Health Toxicology (2020‐2024)Shenzhen Center for Disease Control and PreventionShenzhenChina
- Key Laboratory of Nuclear Medicine, Ministry of Health, Jiangsu Key Laboratory of Molecular Nuclear MedicineJiangsu Institute of Nuclear MedicineWuxiChina
| | - Jing Wang
- Shenzhen Key Laboratory of Modern Toxicology, Shenzhen Medical Key Discipline of Health Toxicology (2020‐2024)Shenzhen Center for Disease Control and PreventionShenzhenChina
| | - Chao Yang
- Cognitive Impairment Ward of Neurology DepartmentThe 3rd Affiliated Hospital of Shenzhen UniversityShenzhenChina
| | - Haitao Yu
- Department of Pathophysiology, School of Basic Medicine and the Collaborative Innovation Center for Brain Science, Key Laboratory of Ministry of Education of China and Hubei Province for Neurological Disorders, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Bingge Zhang
- Department of Pathophysiology, School of Basic Medicine and the Collaborative Innovation Center for Brain Science, Key Laboratory of Ministry of Education of China and Hubei Province for Neurological Disorders, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Xiao Yang
- Shenzhen Key Laboratory of Modern Toxicology, Shenzhen Medical Key Discipline of Health Toxicology (2020‐2024)Shenzhen Center for Disease Control and PreventionShenzhenChina
| | - Bocheng Xiong
- Shenzhen Key Laboratory of Modern Toxicology, Shenzhen Medical Key Discipline of Health Toxicology (2020‐2024)Shenzhen Center for Disease Control and PreventionShenzhenChina
| | - Yongmei Xie
- State Key Laboratory of Biotherapy and Cancer Center, West China HospitalSichuan University and Collaborative Innovation Center of BiotherapyChengduChina
| | - Shupeng Li
- School of Chemical Biology and BiotechnologyPeking University Shenzhen Graduate SchoolShenzhenChina
| | - Zaijun Zhang
- Institute of New Drug Research and Guangzhou, Key Laboratory of Innovative Chemical Drug Research in Cardio‐cerebrovascular DiseasesJinan University College of PharmacyGuangzhouChina
| | - Feiqi Zhu
- Cognitive Impairment Ward of Neurology DepartmentThe 3rd Affiliated Hospital of Shenzhen UniversityShenzhenChina
| | - Jianjun Liu
- Shenzhen Key Laboratory of Modern Toxicology, Shenzhen Medical Key Discipline of Health Toxicology (2020‐2024)Shenzhen Center for Disease Control and PreventionShenzhenChina
| | - Gong‐Ping Liu
- Cognitive Impairment Ward of Neurology DepartmentThe 3rd Affiliated Hospital of Shenzhen UniversityShenzhenChina
- Co‐innovation Center of NeurodegenerationNantong UniversityNantongChina
| | - Xifei Yang
- Shenzhen Key Laboratory of Modern Toxicology, Shenzhen Medical Key Discipline of Health Toxicology (2020‐2024)Shenzhen Center for Disease Control and PreventionShenzhenChina
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Kwon HS, Kim C, Kim YS, Koh SH, Kim HY, Lee SH, Jung KH, Kim JM, Kim YD, Kwon HM, Koo DL, Kim BJ, Kim BJ, Heo SH, Chang DI, Bushnell CD. Long Sleep Duration and Dissatisfaction with Sleep Quality Are Associated with Ischemic Stroke in Young Patients. Cerebrovasc Dis 2023; 52:671-678. [PMID: 36944320 DOI: 10.1159/000530003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 03/01/2023] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION Suboptimal sleep duration and poor sleep quality have been proposed to increase stroke risk. However, their significance in young ischemic stroke is unclear. We aimed to investigate the importance of sleep duration and quality on young ischemic stroke patients. METHODS A multicenter matched case-control study was performed to evaluate under-recognized risk factors in young (<45 years) ischemic stroke patients in 8 tertiary hospitals in Korea. A total of 225 patients and 225 age- and sex-matched controls were enrolled in the same period. Detailed information about patients' demographics, socioeconomic state, and traditional and nontraditional risk factors including sleep-related factors were obtained using structured questionnaires. Risk of ischemic stroke was estimated using conditional logistic regression analysis. RESULTS Although average sleep duration was similar in patients and controls, patients were more likely to have long (≥9 h) or extremely short (<5 h) sleep durations. In addition, the proportion of subjects with dissatisfaction with sleep quality was higher in patients than controls (66.2 vs. 49.3%, p < 0.001). In multivariable conditional logistic regression analysis, long sleep duration (OR: 11.076, 95% CI: 1.819-67.446, p = 0.009) and dissatisfaction with sleep quality (OR: 2.116, 95% CI: 1.168-3.833, p = 0.013) were independently associated with risk of ischemic stroke. CONCLUSIONS Long sleep duration and dissatisfaction with sleep quality may be associated with increased risk of ischemic stroke in young adults. Improving sleep habit or quality could be important for reducing the risk of ischemic stroke.
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Affiliation(s)
- Hyuk Sung Kwon
- Department of Neurology, Hanyang University College of Medicine, Seoul, Republic of Korea,
| | - Chulho Kim
- Department of Neurology, Hallym University Sacred Heart Hospital, Chuncheon, Republic of Korea
| | - Young Seo Kim
- Department of Neurology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Seong-Ho Koh
- Department of Neurology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Hyun Young Kim
- Department of Neurology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Seung-Hoon Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Keun-Hwa Jung
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeong-Min Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyung-Min Kwon
- Department of Neurology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dae Lim Koo
- Department of Neurology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Beom Joon Kim
- Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Dae-Il Chang
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Cheryl D Bushnell
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Wang B, Hao W, Fan J, Yan Y, Gong W, Zheng W, Que B, Ai H, Wang X, Nie S. Clinical significance of obstructive sleep apnea in patients with acute coronary syndrome with or without prior stroke: a prospective cohort study. Eur J Med Res 2023; 28:107. [PMID: 36859391 PMCID: PMC9976418 DOI: 10.1186/s40001-023-01071-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 02/16/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Whether obstructive sleep apnea (OSA) is associated with worse prognosis in patients with acute coronary syndrome (ACS) with or without prior stroke remains unclear. We investigated the association of OSA with cardiovascular events in ACS patients with or without prior stroke. METHODS Between June 2015 and January 2020, we prospectively recruited eligible ACS patients who underwent cardiorespiratory polygraphy during hospitalization. We defined OSA as an apnea hypopnea index (AHI) ≥ 15 events/hour. The primary composite end point was major adverse cardiovascular and cerebrovascular events (MACCEs), including cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularization, or hospitalization for unstable angina or heart failure. RESULTS Among 1927 patients enrolled, 207 patients had prior stroke (10.7%) and 1014 had OSA (52.6%). After a mean follow-up of 2.9 years, patients with stroke had significantly higher risk of MACCEs than those without stroke (hazard ratio [HR]:1.49; 95% confidence interval [CI]: 1.12-1.98, P = 0.007). The multivariate analysis showed that patients with OSA had 2.0 times the risk of MACCEs in prior stroke group (41 events [33.9%] vs 18 events [20.9%]; HR:2.04, 95% CI:1.13-3.69, P = 0.018), but not in non-prior stroke group (186 events [20.8%] vs 144 events [17.4]; HR:1.21, 95% CI 0.96-1.52, P = 0.10). No significant interaction was noted between prior stroke and OSA for MACCE (interaction P = 0.17). CONCLUSIONS Among ACS patients, the presence of OSA was associated with an increased risk of cardiovascular events in patients with prior stroke. Further trials exploring the efficacy of OSA treatment in high-risk patients with ACS and prior stroke are warranted. Trial registration Clinicaltrials.gov identifier NCT03362385.
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Affiliation(s)
- Bin Wang
- grid.411606.40000 0004 1761 5917Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029 China ,grid.415105.40000 0004 9430 5605National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029 China
| | - Wen Hao
- grid.411606.40000 0004 1761 5917Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029 China ,grid.415105.40000 0004 9430 5605National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029 China
| | - Jingyao Fan
- grid.411606.40000 0004 1761 5917Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029 China ,grid.415105.40000 0004 9430 5605National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029 China
| | - Yan Yan
- grid.411606.40000 0004 1761 5917Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029 China ,grid.415105.40000 0004 9430 5605National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029 China
| | - Wei Gong
- grid.411606.40000 0004 1761 5917Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029 China ,grid.415105.40000 0004 9430 5605National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029 China
| | - Wen Zheng
- grid.411606.40000 0004 1761 5917Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029 China ,grid.415105.40000 0004 9430 5605National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029 China
| | - Bin Que
- grid.411606.40000 0004 1761 5917Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029 China ,grid.415105.40000 0004 9430 5605National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029 China
| | - Hui Ai
- grid.411606.40000 0004 1761 5917Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029 China ,grid.415105.40000 0004 9430 5605National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029 China
| | - Xiao Wang
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China. .,National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
| | - Shaoping Nie
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China. .,National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
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Kamat PK, Khan MB, Smith C, Siddiqui S, Baban B, Dhandapani K, Hess DC. The time dimension to stroke: Circadian effects on stroke outcomes and mechanisms. Neurochem Int 2023; 162:105457. [PMID: 36442686 PMCID: PMC9839555 DOI: 10.1016/j.neuint.2022.105457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/14/2022] [Accepted: 11/19/2022] [Indexed: 11/26/2022]
Abstract
The circadian system is widely involved in the various pathological outcomes affected by time dimension changes. In the brain, the master circadian clock, also known as the "pacemaker," is present in the hypothalamus's suprachiasmatic nucleus (SCN). The SCN consists of molecular circadian clocks that operate in each neuron and other brain cells. These circadian mechanisms are controlled by the transcription and translation of specific genes such as the clock circadian regulator (Clock) and brain and muscle ARNT-Like 1 (Bmal1). Period (Per1-3) and cryptochrome (Cry1 and 2) negatively feedback and regulate the clock genes. Variations in the circadian cycle and these clock genes can affect stroke outcomes. Studies suggest that the peak stroke occurs in the morning after patients awaken from sleep, while stroke severity and poor outcomes worsen at midnight. The main risk factor associated with stroke is high blood pressure (hypertension). Blood pressure usually dips by 15-20% during sleep, but many hypertensives do not display this normal dipping pattern and are non-dippers. A sleep blood pressure is the primary determinant of stroke risk. This article discusses the possible mechanism associated with circadian rhythm and stroke outcomes.
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Affiliation(s)
- Pradip K Kamat
- Departments of Neurology, Medical College of Georgia, Augusta University, USA.
| | | | - Cameron Smith
- Departments of Neurology, Medical College of Georgia, Augusta University, USA
| | - Shahneela Siddiqui
- Departments of Neurology, Medical College of Georgia, Augusta University, USA
| | - Babak Baban
- Departments of Oral Biology, Dental College of Georgia, Augusta University, USA
| | - Krishnan Dhandapani
- Department of Neurosurgery, Medical College of Georgia, Augusta University, USA
| | - David C Hess
- Departments of Neurology, Medical College of Georgia, Augusta University, USA
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Zhang XH, Zhang X, Feng HY, Cao CC, Lv HL, Wang YL, Ren LJ. An investigation on the changes of serum CCK-8, substance P, and 5-HT in patients with post-stroke insomnia. Technol Health Care 2023; 31:2355-2361. [PMID: 37483040 DOI: 10.3233/thc-230506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
BACKGROUND At present, the pathogenesis of post-stroke insomnia (PSI) is still inconclusive. OBJECTIVE To explore the changes and significance of serum cholecystokinin-8 (CCK-8), substance P (SP), and 5-hydroxytryptamine (5-HT) in patients with PSI. METHODS Ninety-one patients with stroke were selected as the research subjects, and according to the score of the Athens Insomnia Scale (AIS), they were divided into the insomnia group and the non-insomnia group. The serum levels of CCK-8, SP, and 5-HT in the two groups were compared to explore their relationships with PSI. RESULTS Among the 91 patients, 56 were in the insomnia group and 35 were in the non-insomnia group, and the incidence of insomnia was 61.5%. There was no significant difference in the serum levels of CCK-8, SP, and 5-HT between the two groups (P= 0.696, 0.980, and 0.809, respectively). One-way analysis of variance showed that there was no significant correlation between the serum levels of CCK-8, SP, 5-HT, and the AIS score (P= 0.7393, 0.9581, and 0.5952, respectively). CONCLUSION The incidence of PSI was relatively high, but it could not be proved that CCK-8, SP, and 5-HT were involved in the pathogenesis of PSI. There might exist other neurotransmitters involved in the pathophysiological process of PSI, which should be further explored.
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Affiliation(s)
- Xiao-Hua Zhang
- Department of Rehabilitation, Shenzhen Dapeng New District Nanao People's Hospital, Shenzhen, Guangdong, China
| | - Xin Zhang
- Department of Rehabilitation, Shenzhen Dapeng New District Nanao People's Hospital, Shenzhen, Guangdong, China
| | - Hong-Ye Feng
- Department of Rehabilitation, The First Affiliated Hospital, Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Chang-Chun Cao
- Department of Rehabilitation, Shenzhen Dapeng New District Nanao People's Hospital, Shenzhen, Guangdong, China
| | - Hui-Lan Lv
- Department of Rehabilitation, Shenzhen Dapeng New District Nanao People's Hospital, Shenzhen, Guangdong, China
| | - Yu-Long Wang
- Department of Rehabilitation, The First Affiliated Hospital, Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Li-Jie Ren
- Department of Rehabilitation, The First Affiliated Hospital, Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
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20
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Maalouf E, Hallit S, Salameh P, Hosseini H. Depression, anxiety, insomnia, stress, and the way of coping emotions as risk factors for ischemic stroke and their influence on stroke severity: A case-control study in Lebanon. Front Psychiatry 2023; 14:1097873. [PMID: 36896347 PMCID: PMC9988919 DOI: 10.3389/fpsyt.2023.1097873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/06/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Stroke is a leading cause of disability and death worldwide. There are numerous debates regarding the relationship between depression, anxiety, insomnia, perceived stress, and ischemic stroke. Moreover, no research on the efficacy of emotion regulation, which is critical for various components of healthy affective and social adaptability, is being conducted. To the best of our knowledge, this is the first study in the MENA region to shed light on the relationship between these conditions and stroke risk, aiming to determine whether depression, anxiety, insomnia, stress, and the way of coping with emotions may be risk factors for ischemic stroke occurrence and to further investigate the ability of two specific types of emotion regulation (cognitive reappraisal and expressive suppression) as possible moderators of the relationship between these psychological diseases and ischemic stroke risk. As a secondary objective, we sought to determine how these pre-existing conditions affect stroke severity levels. METHODS This is a case-control survey study involving 113 Lebanese inpatients with a clinical diagnosis of ischemic stroke admitted in hospitals and rehabilitation centers in Beirut and Mount Lebanon, and 451 gender-matched volunteers without clinical signs of stroke as controls recruited from the same hospitals as the cases or attending outpatient clinics for illnesses or treatments unconnected to stroke or transient ischemic attack, as well as visitors or relatives of inpatients (April 2020-April 2021). Data was collected by filling out an anonymous paper-based questionnaire. RESULTS According to the outcomes of the regression model, depression (aOR: 1.232, 95%CI: 1.008-1.506), perceived stress (aOR: 1.690, 95%CI: 1.413-2.022), a lower educational level (aOR: 0.335, 95%CI: 0.011-10.579), and being married (aOR: 3.862, 95%CI: 1.509-9.888) were associated with an increased risk of ischemic stroke. The moderation analysis revealed that expressive suppression had a significant moderating effect on the relationship between depression, anxiety, perceived stress, insomnia, and ischemic stroke risk, resulting in an increased risk of stroke incidence. In contrast, cognitive reappraisal significantly reduced the risk of ischemic stroke by moderating the association between ischemic stroke risk and the following independent variables: perceived stress and insomnia. On the other hand, our multinomial regression model revealed that the odds of moderate to severe/severe stroke were significantly higher in people with pre-stroke depression (aOR: 1.088, 95% CI: 0.747-1.586) and perceived stress (aOR: 2.564, 95% CI: 1.604-4.100) compared to people who had never had a stroke. CONCLUSION Despite several limitations, the findings of our study suggest that people who are depressed or stressed are more likely to have an ischemic stroke. Consequently, additional research into the causes and effects of depression and perceived stress may provide new directions for preventive strategies that can help reduce the risk of stroke. Since pre-stroke depression and perceived stress were also found to be strongly correlated with stroke severity, future studies should evaluate the association between pre-stroke depression, perceived stress, and stroke severity to gain a deeper understanding of the complex interaction between these variables. Lastly, the study shed new light on the role of emotion regulation in the relationship between depression, anxiety, perceived stress, insomnia, and ischemic stroke.
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Affiliation(s)
- Elise Maalouf
- Life and Health Sciences Department, Paris-Est University, Paris, France
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon.,Applied Science Research Center, Applied Science Private University, Amman, Jordan.,Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Pascale Salameh
- School of Medicine, Lebanese American University, Byblos, Lebanon.,INSPECT-LB: Institut National de Santé Publique, Épidémiologie Clinique et Toxicolo-gie-Liban, Beirut, Lebanon.,Medical School, University of Nicosia, Nicosia, Cyprus.,Faculty of Pharmacy, Lebanese University, Hadat, Lebanon
| | - Hassan Hosseini
- Faculté de Santé, UPE-C, Université Paris-Est Créteil, Créteil, France.,Hopital Henri Mondor, APHP, Créteil, France
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21
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Hong Y, Mo H, Cho SJ, Im HJ. Wake-up ischemic stroke associated with short sleep duration and sleep behavior: A stratified analysis according to risk of obstructive sleep apnea. Sleep Med 2023; 101:497-504. [PMID: 36527941 DOI: 10.1016/j.sleep.2022.11.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/30/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Wake-up stroke (WUS) is an ischemic stroke occurring during nocturnal sleep with neurological deficits observed upon awakening. Our study aimed to investigate the association between WUS, sleep curtailment, and sleep behavior according to the obstructive sleep apnea (OSA) risk in patients with acute ischemic stroke. METHODS This single-centered, retrospective study included hospitalized subjects with acute ischemic stroke occurring within 30 days. A total of 250 participants were classified as WUS or not and enquired about their sleep habits concerning sleep time on weekdays and weekends, demographic factors, and assessed comorbid medical conditions. Weekend catch-up sleep (CUS) was defined as the extension of sleep duration during weekends. The average weekly sleep duration and chronotype were assessed. The association between WUS and sleep factors was analyzed. RESULTS WUS was observed in 70 patients (28.0%) with acute ischemic stroke. There were no significant differences in the demographic and stroke-related variables between the WUS and non-WUS (NWUS) groups. Upon stratified analysis based on risk of OSA, average weekly sleep duration (odds ratio, [OR] = 0.60, 95% confidence interval, [CI] = 0.41-0.89; p = 0.011), the presence of weekend CUS (OR = 0.07, 95% CI = 0.01-0.97; p = 0.047), and chronotype (OR = 0.62, 95% CI = 0.39-0.98; p = 0.041) were independently associated with WUS in low-risk group with OSA, but not in the high-risk group. CONCLUSIONS Short sleep duration and lack of compensation are significantly associated with WUS in low-risk OSA group. Insufficient sleep and sleep behaviors could play a different role in causing ischemic stroke during sleep when patients are stratified by their risk of sleep apnea.
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Affiliation(s)
- Yooha Hong
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea
| | - Heejung Mo
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea
| | - Soo-Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea
| | - Hee-Jin Im
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea.
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22
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Li Y, Nazari N, Sadeghi M. Internet delivered, non-inferiority, two-arm, assessor-blinded intervention comparing mindfulness-based stress reduction and cognitive-behavioral treatment for insomnia: a protocol study for a randomized controlled trial for nursing staff with insomnia. Trials 2022; 23:1020. [PMID: 36527137 PMCID: PMC9756716 DOI: 10.1186/s13063-022-06986-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 12/06/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Insomnia and poor sleep quality are highly prevalent conditions related to coronavirus disease 2019 (COVID-19) complications among clinical nurses. Although cognitive behavioral therapy for insomnia (CBT-I) is a first-line treatment, CBT-I suffers from several major drawbacks. This study investigates whether the application of the internet-delivered mindfulness-based stress reduction (iMBSR) intervention will produce effects that are non-inferior to the internet-delivered CBT-I (iCBT-I) intervention in reducing the severity of insomnia in clinical nurses with insomnia at the end of the study. METHODS This study protocol presents an internet-delivered, parallel-groups, assessor-blinded, two-arm, non-inferiority randomized controlled trial. The primary outcome is sleep quality, assessed by the Insomnia Severity Index. Secondary outcomes include depression, dysfunctional beliefs, five facets of mindfulness, and client satisfaction. CONCLUSION It is expected that this study may address several gaps in the literature. The non-inferiority study design is a novel approach to evaluating whether a standardized, complementary treatment (i.e., MBSR) is as practical as a gold standard treatment rather than its potential benefits. This approach may lead to expanded evidence-based practice and improve patient access to effective treatments. TRIAL REGISTRATION Trial registration number: ISRCTN36198096 . Registered on 24th May 2022.
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Affiliation(s)
- Yaling Li
- grid.499351.30000 0004 6353 6136Mental Health Education and Counseling Center, Shenzhen Technology University, Shenzhen, 518118 Guangdong China
| | - Nabi Nazari
- grid.411406.60000 0004 1757 0173Department of Psychology, Faculty of Human Sciences, Lorestan University, Khorramabad, Iran
| | - Masoud Sadeghi
- grid.411406.60000 0004 1757 0173Department of Psychology, Faculty of Human Sciences, Lorestan University, Khorramabad, Iran
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23
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Koo DL, Park Y, Nam H, Chai YJ. Sleep quality of patients with papillary thyroid carcinoma: a prospective longitudinal study with 5-year follow-up. Sci Rep 2022; 12:18823. [PMID: 36335214 PMCID: PMC9637156 DOI: 10.1038/s41598-022-23549-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 11/02/2022] [Indexed: 11/08/2022] Open
Abstract
We evaluated the pre- and postoperative sleep quality of patients with newly diagnosed papillary thyroid carcinoma (PTC) who underwent thyroid surgery, and investigated the factors associated with persistent poor sleep quality. The Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale, and Stanford sleepiness scale were used to estimate sleep quality and daytime sleepiness. Face-to-face surveys were conducted preoperatively, and 1, 4, and 10 months after thyroid surgery. The PSQI was administered during a telephone interview about after 5 years after surgery. Forty-six patients (mean age 47.3 ± 10.1 years) with PTC (11 males, 35 females) were included in this study. Twenty-one participants underwent lobectomy and 25 underwent total thyroidectomy. Preoperatively, 35 (76.1%) patients showed poor sleep quality. PSQI scores at postoperative 1, 4, and 10 months were significantly lower than preoperative scores (p < 0.001). Postoperative 5-year PSQI scores decreased significantly compared to the preoperative scores (p < 0.001). Patients newly diagnosed with PTC suffered from sleep disturbance before and after surgery for at least 10 months, recovering to a comparable rate of sleep disturbance with the general population by 5 years after surgery. Higher preoperative PSQI score was at risk for prolonged poor sleep quality in patients with PTC.
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Affiliation(s)
- Dae Lim Koo
- grid.31501.360000 0004 0470 5905Department of Neurology, Seoul Metropolitan Government Seoul National University Boramae Medical Center and Seoul National University College of Medicine, Seoul, South Korea
| | - Yangmi Park
- grid.31501.360000 0004 0470 5905Department of Neurology, Seoul Metropolitan Government Seoul National University Boramae Medical Center and Seoul National University College of Medicine, Seoul, South Korea
| | - Hyunwoo Nam
- grid.31501.360000 0004 0470 5905Department of Neurology, Seoul Metropolitan Government Seoul National University Boramae Medical Center and Seoul National University College of Medicine, Seoul, South Korea
| | - Young Jun Chai
- grid.412479.dDepartment of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 39 Boramae-Gil, Dongjak-Gu, Seoul, 156-707 South Korea ,grid.412484.f0000 0001 0302 820XTransdisciplinary Department of Medicine & Advanced Technology, Seoul National University Hospital, Seoul, South Korea
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24
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Zhang Y, Xia X, Zhang T, Zhang C, Liu R, Yang Y, Liu S, Li X, Yue W. Relationship between sleep disorders and the prognosis of neurological function after stroke. Front Neurol 2022; 13:1036980. [DOI: 10.3389/fneur.2022.1036980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/27/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThis study aims to investigate the effects of sleep disorders on the prognosis of neurological function after stroke and other factors affecting the prognosis after stroke.MethodWe designed a cohort study. A total of 1,542 patients with their first stroke were hospitalized in the department of neurology of Tianjin Huanhu Hospital from 2015.6.1 to 2016.12.31. We recorded the personal histories of patients. The MMSE (mini-mental state examination), MoCA (Montreal Cognitive Assessment), HAMD (Hamilton Depression Scale), National Institutes of Health Stroke Scale (NIHSS) score, mRS (Modified Rankin Scale), BI (Barthel Index), PSQI (Pittsburgh Sleep Quality Index), ESS (Epworth Sleepiness Scale), Berlin questionnaire, and nocturnal TST (Total sleep time) were assessed before discharge, 3 months, 6 months, and 4 years (2019–2020) after stroke.ResultLow sleep quality (OR 2.019, 95%CI 1.199–3.398, p = 0.008), nocturnal TST (<7 h) (OR 4.060, 95%CI 1.494–11.034, p = 0.006), nocturnal TST (>8 h) (OR 5.928, 95% CI 2.134–16.464, p = 0.001) were risk factors for poor neurological function recovery at 3 months after stroke. Nocturnal TST (<7 h) (OR 13.042, 95%-CI 2.576–66.027, p = 0.002) and nocturnal TST (>8 h) (OR 11.559, 95%-CI 2.108–63.390, p = 0.005) were risk factors for poor neurological function at 6 months after stroke. Nocturnal TST (<7 h) (OR 2.668, 95% CI 1.250–5.698, p = 0.011) and nocturnal TST (>8 h) (OR 2.516, 95% CI 1.080–5.861, p = 0.033) were risk factors for poor neurological function at 4 years after stroke. High risk of OSA (HR 1.582, 95%CI 1.244–2.012, p < 0.001) was a risk factor for all-cause death in patients followed up for 4 years after stroke.ConclusionLow sleep quality is associated with short-term poor neurological function after stroke. Unusual nocturnal TST (long or short) is associated with short-term or long-term poor neurological function after stroke. A high risk of OSA is associated with a higher risk of all-cause death after stroke.
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Khambadkone SG, Benjamin SE. Sleep Disturbances in Neurological Disease: A Target for Intervention. Semin Neurol 2022; 42:639-657. [PMID: 36216356 DOI: 10.1055/a-1958-0710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Sleep is a biological function required for neurological and general health, but a significant and under-recognized proportion of the population has disturbed sleep. Here, we briefly overview the biology of sleep, sleep requirements over the lifespan, and common sleep disorders. We then turn our attention to five neurological diseases that significantly contribute to global disease burden and neurology practice makeup: epilepsy, headache, ischemic stroke, Parkinson's disease, and Alzheimer's disease. For each disease, we review evidence that sleep disturbances contribute to disease risk and severity and discuss existing data that addressing sleep disturbances may have disease-modifying effects. We provide recommendations derived from the literature and existing clinical guidelines to facilitate the evaluation and management of sleep disturbances within the context of each neurological disease. Finally, we synthesize identified needs and commonalities into future directions for the field and practical sleep-related recommendations for physicians caring for patients at risk for or currently suffering from neurological disease.
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Affiliation(s)
- Seva G Khambadkone
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon
| | - Sara E Benjamin
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Johns Hopkins Center for Sleep, Columbia, Maryland
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26
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Zorgor G, Kabeloglu V, Soysal A. Restless legs syndrome after acute ıschemic stroke and ıts relation to lesion location. Sleep Biol Rhythms 2022; 20:551-560. [PMID: 38468622 PMCID: PMC10899909 DOI: 10.1007/s41105-022-00401-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/15/2022] [Indexed: 11/28/2022]
Abstract
Purpose We aimed to investigate the prevalence, clinical profiles and lesion location of Restless Legs Syndrome (RLS) developed after ischemic stroke. Methods This study prospectively included 244 patients with acute cerebral infarction. All patients were evaluated for RLS, and those who met all of the essential diagnostic criteria of the International RLS Study Group were diagnosed with RLS. The evaluation of lesion location was performed by magnetic resonance imaging. International Restless Legs Syndrome Rating Scale was performed 1 week, 1 month, and 3 months after the index stroke to determine the symptom severity of the patients and to observe the exacerbation or regression in follow-up. Results A total of 14 patients (5.7%) had post-stroke RLS (psRLS). The psRLS group consisted mostly of males (9 males, 5 females). Among the patients with psRLS, 12 had a subcortical stroke (9.2%, 130 patients) whereas only 2 had a cortical stroke (1.8%, 114 patients) (p = 0.01). The subcortical lesion locations in the psRLS group were the pons, basal ganglia and/or corona radiata, thalamus, and cerebellum in order of decreasing frequency. Five patients had symptoms in both legs, and 9 patients had symptoms in unilateral legs (7 contralateral, 2 ipsilateral to the lesion). At follow-up, the symptoms of 6 patients resolved completely without medication, 5 patients responded well to pramipexole and 1 patient responded poorly. Only 2 patients who refused to take medication had worsened symptoms. Conclusion The subcortical ischemic lesions are associated with psRLS. Pons, basal ganglia and corona radiata are the structures more likely to cause RLS.
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Affiliation(s)
- Gulsah Zorgor
- Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
- Basaksehir Cam & Sakura City Hospital, Istanbul, Turkey
| | - Vasfiye Kabeloglu
- Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
| | - Aysun Soysal
- Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
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Choi JW, Kim DH, Koo DL, Park Y, Nam H, Lee JH, Kim HJ, Hong SN, Jang G, Lim S, Kim B. Automated Detection of Sleep Apnea-Hypopnea Events Based on 60 GHz Frequency-Modulated Continuous-Wave Radar Using Convolutional Recurrent Neural Networks: A Preliminary Report of a Prospective Cohort Study. SENSORS (BASEL, SWITZERLAND) 2022; 22:7177. [PMID: 36236274 PMCID: PMC9570824 DOI: 10.3390/s22197177] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/12/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
Radar is a promising non-contact sensor for overnight polysomnography (PSG), the gold standard for diagnosing obstructive sleep apnea (OSA). This preliminary study aimed to demonstrate the feasibility of the automated detection of apnea-hypopnea events for OSA diagnosis based on 60 GHz frequency-modulated continuous-wave radar using convolutional recurrent neural networks. The dataset comprised 44 participants from an ongoing OSA cohort, recruited from July 2021 to April 2022, who underwent overnight PSG with a radar sensor. All PSG recordings, including sleep and wakefulness, were included in the dataset. Model development and evaluation were based on a five-fold cross-validation. The area under the receiver operating characteristic curve for the classification of 1-min segments ranged from 0.796 to 0.859. Depending on OSA severity, the sensitivities for apnea-hypopnea events were 49.0-67.6%, and the number of false-positive detections per participant was 23.4-52.8. The estimated apnea-hypopnea index showed strong correlations (Pearson correlation coefficient = 0.805-0.949) and good to excellent agreement (intraclass correlation coefficient = 0.776-0.929) with the ground truth. There was substantial agreement between the estimated and ground truth OSA severity (kappa statistics = 0.648-0.736). The results demonstrate the potential of radar as a standalone screening tool for OSA.
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Affiliation(s)
- Jae Won Choi
- Department of Radiology, Armed Forces Yangju Hospital, Yangju 11429, Korea
| | - Dong Hyun Kim
- Department of Radiology, Seoul Metropolitan Government—Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Korea
| | - Dae Lim Koo
- Department of Neurology, Seoul Metropolitan Government—Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Korea
| | - Yangmi Park
- Department of Neurology, Seoul Metropolitan Government—Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Korea
| | - Hyunwoo Nam
- Department of Neurology, Seoul Metropolitan Government—Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Korea
| | - Ji Hyun Lee
- Department of Radiology, Seoul Metropolitan Government—Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Korea
| | - Hyo Jin Kim
- Department of Radiology, Seoul Metropolitan Government—Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Korea
| | - Seung-No Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul Metropolitan Government—Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Korea
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Joseph N, Suresh S, Prasad S, Malwee SM, Brittas A, Gupta V. Study on restless leg syndrome and its relationship with quality of sleep among the general population of Mangalore, India. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022; 58:109. [PMID: 36124287 PMCID: PMC9476396 DOI: 10.1186/s41983-022-00544-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 09/02/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Restless leg syndrome (RLS) is a common neurological morbidity. It is, however, a frequently underdiagnosed medical condition. This study was hence done to assess the occurrence and severity of RLS among participants and to study its determinants and its association with quality of sleep. This was a cross-sectional study conducted among the general population of Mangalore in July 2021. Data were collected using a Google Form. The International Restless Legs Syndrome Study Group Rating Scale was used to diagnose RLS and its severity. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality.
Results
The prevalence of RLS among the 202 participants was 24(11.9%). Among them, 5 were already diagnosed with RLS. Their mean age at onset was 40.4 ± 25.3 years. Among the rest 197 participants, 19(9.6%) were newly diagnosed with RLS. The severity of RLS was mild, moderate and severe among 7(36.8%), 9(47.4%) and 3(15.8%) participants, respectively. Five (26.3%) of the 19 newly diagnosed participants were identified as RLS sufferers. In multivariable analysis, the presence of diabetes mellitus and family history of RLS were associated with the presence of RLS among the participants. The mean Global PSQI value was 5.0 ± 3.1. Sleep latency was prolonged (p = 0.001), and sleep disturbances (p = 0.01) were higher among participants newly diagnosed with RLS (n = 19) compared to those without RLS (n = 178). Subjective sleep quality was poor (p = 0.038), and sleep disturbances (p = 0.016) were more among participants with severe degree RLS.
Conclusions
The prevalence of RLS in the present study was higher than that reported in previous Indian studies. Unpleasant sensations in RLS affected sleep initiation and maintenance among the affected. A multi-disciplinary approach is required to control its determinants and address other sleep-related problems among the RLS affected population.
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Lee MH, Lee SK, Kim S, Kim REY, Nam HR, Siddiquee AT, Thomas RJ, Hwang I, Yoon JE, Yun CH, Shin C. Association of Obstructive Sleep Apnea With White Matter Integrity and Cognitive Performance Over a 4-Year Period in Middle to Late Adulthood. JAMA Netw Open 2022; 5:e2222999. [PMID: 35857321 PMCID: PMC9301517 DOI: 10.1001/jamanetworkopen.2022.22999] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Obstructive sleep apnea (OSA) is associated with cognitive impairment and brain structural alterations, but longitudinal outcomes are understudied. OBJECTIVE To examine the associations of OSA with cognition and white matter (WM) integrity over a 4-year period. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study was conducted in a community-based adult population among participants who had both baseline (2011-2014) and 4-year follow-up (2015-2018) polysomnography, diffusion tensor imaging, and cognitive assessment data. Participants with neurological disorders, anomalous findings on brain magnetic resonance imaging, or inadequate quality of the evaluations were excluded. Data were analyzed from March to November 2021. EXPOSURES Participants were categorized depending on the presence vs absence of OSA at baseline and follow-up polysomnographic analysis. MAIN OUTCOMES AND MEASURES The main outcomes were proportional changes over a 4-year period in neuropsychological performance and WM integrity. The neuropsychological assessment battery included verbal and visual memory, verbal fluency, Digit Symbol-coding, Trail Making Test-A, and Stroop Test. WM integrity was assessed by fractional anisotropy, axial, and radial diffusivity. To examine interactions with age and sex, participants were subgrouped by age older than 60 years vs 60 years or younger and men vs women. RESULTS A total of 1998 individuals were assessed for eligibility, and 888 were excluded based on exclusion criteria, leaving 1110 participants (mean [SD] age, 58.0 [6.0] years; 517 [46.6%] men) for analysis, including 458 participants grouped as OSA-free, 72 participants with resolved OSA, 163 participants with incident OSA, and 417 participants with persistent OSA. Incident OSA was associated with altered WM integrity and with concomitant changes in sustained attention compared with participants without OSA (eg, change in Digit Symbol-coding test score, -3.2% [95% CI, -5.2% to -1.2%]). Participants with resolved OSA showed better visual recall at the follow-up (change in Visual Reproduction-immediate recall test, 17.5% [95% CI, 8.9% to 26.1%]; change in Visual Reproduction-delayed recall test, 33.1% [95% CI, 11.3% to 54.9%]), with concordant changes in diffusion parameters at the relevant anatomic areas. In the older group only (age >60 years), persistent OSA was associated with altered WM integrity and cognition (eg, Visual Reproduction-recognition test: β = -24.2 [95% CI, -40.7 to -7.7]). Sex also was associated with modifying the association of OSA with WM integrity of the left posterior internal capsule, the left genu of corpus callosum, and the right middle cerebellar peduncle only in men and with cognition only in women (eg, Visual Reproduction-immediate recall test: β = 33.4 [95% CI, 19.1 to 47.7]). CONCLUSIONS AND RELEVANCE These findings suggest that dynamic changes in OSA status were significantly associated with WM integrity and cognition, which varied by age and sex. It is possible that adequate interventions for OSA could better preserve brain health in middle to late adulthood.
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Affiliation(s)
- Min-Hee Lee
- Institute of Human Genomic Study, College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Seung Ku Lee
- Institute of Human Genomic Study, College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Soriul Kim
- Institute of Human Genomic Study, College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Regina E. Y. Kim
- Institute of Human Genomic Study, College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Hye Ryeong Nam
- Institute of Human Genomic Study, College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Ali T. Siddiquee
- Institute of Human Genomic Study, College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Robert J. Thomas
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Division of Pulmonary, Critical Care & Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Inha Hwang
- Department of Neurology, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Jee-Eun Yoon
- Department of Neurology, Uijeongbu Eulji Medical Center, Uijeongbu, Republic of Korea
| | - Chang-Ho Yun
- Department of Neurology, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Chol Shin
- Institute of Human Genomic Study, College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
- Department of Pulmonary Sleep and Critical Care Medicine Disorder Center, College of Medicine, Korea University, Ansan, Republic of Korea
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Spanish version of Jenkins Sleep Scale in physicians and nurses: psychometric properties from a Peruvian nationally representative sample. J Psychosom Res 2022; 157:110759. [PMID: 35358746 DOI: 10.1016/j.jpsychores.2022.110759] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 02/02/2022] [Accepted: 02/05/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the psychometric properties of the Spanish version of Jenkins Sleep Scale with 4 items (JSS-4) of the Peruvian health system's (PHS) nurses and physicians. METHODS We carried out a psychometric study based on secondary analysis in a sample from a nationally representative survey that used acomplex sampling design. The participants were physicians and nurses aged 18-65 years, working in PHS private and public facilities, who have fulfilled all JSS-4 items. We performed a confirmatory factor analysis. Reliability was evaluated via two estimates - classic alpha (α) and categorical omega (ω) coefficients. Also, we tested the invariance across groups of variables. The convergent validity was evaluated based on the relation between JSS-4 and PHQ-2 using Pearson's correlation coefficient and effect size (Cohen's d). Also, we designed normative values based on percentiles. RESULTS We included 2100 physicians and 2826 nurses in the analysis. We observed that the unidimensional model has adequate goodness-of-fit indices and values of α and ω coefficients. No measurement invariance was found between the groups of professionals and age groups; however, invariance was achieved between sex, monthly income, work-related illness, and chronic illness groups. Regarding the relation with other variables, the JSS-4 has a small correlation with PHQ-2. Also, profession and age-specific normative values were proposed. CONCLUSION JSS-4 Spanish version has adequate psychometric properties in PHS nurses and physicians.
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Ulsa MC, Xi Z, Li P, Gaba A, Wong PM, Saxena R, Scheer FAJL, Rutter M, Akeju O, Hu K, Gao L. Association of Poor Sleep Burden in Middle Age and Older Adults With Risk for Delirium During Hospitalization. J Gerontol A Biol Sci Med Sci 2022; 77:507-516. [PMID: 34558609 PMCID: PMC8893188 DOI: 10.1093/gerona/glab272] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Delirium is a distressing neurocognitive disorder recently linked to sleep disturbances. However, the longitudinal relationship between sleep and delirium remains unclear. This study assessed the associations of poor sleep burden, and its trajectory, with delirium risk during hospitalization. METHODS About 321 818 participants from the UK Biobank (mean age 58 ± 8 years [SD]; range 37-74 years) reported (2006-2010) sleep traits (sleep duration, excessive daytime sleepiness, insomnia-type complaints, napping, and chronotype-a closely related circadian measure for sleep timing), aggregated into a sleep burden score (0-9). New-onset delirium (n = 4 775) was obtained from hospitalization records during a 12-year median follow-up. About 42 291 (mean age 64 ± 8 years; range 44-83 years) had repeat sleep assessment on average 8 years after their first. RESULTS In the baseline cohort, Cox proportional hazards models showed that moderate (aggregate scores = 4-5) and severe (scores = 6-9) poor sleep burden groups were 18% (hazard ratio = 1.18 [95% confidence interval: 1.08-1.28], p < .001) and 57% (1.57 [1.38-1.80], p < .001), more likely to develop delirium, respectively. The latter risk magnitude is equivalent to 2 additional cardiovascular risks. These findings appeared robust when restricted to postoperative delirium and after exclusion of underlying dementia. Higher sleep burden was also associated with delirium in the follow-up cohort. Worsening sleep burden (score increase ≥2 vs no change) further increased the risk for delirium (1.79 [1.23-2.62], p = .002) independent of their baseline sleep score and time lag. The risk was highest in those younger than 65 years at baseline (p for interaction <.001). CONCLUSION Poor sleep burden and worsening trajectory were associated with increased risk for delirium; promotion of sleep health may be important for those at higher risk.
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Affiliation(s)
- Ma Cherrysse Ulsa
- Medical Biodynamics Program, Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Zheng Xi
- Medical Biodynamics Program, Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Peng Li
- Medical Biodynamics Program, Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Arlen Gaba
- Medical Biodynamics Program, Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Patricia M Wong
- Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Richa Saxena
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Frank A J L Scheer
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Martin Rutter
- Division of Diabetes, Endocrinology & Gastroenterology, The University of Manchester, UK
| | - Oluwaseun Akeju
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Kun Hu
- Medical Biodynamics Program, Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Lei Gao
- Medical Biodynamics Program, Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
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Carpi M, Cianfarani C, Vestri A. Sleep Quality and Its Associations with Physical and Mental Health-Related Quality of Life among University Students: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052874. [PMID: 35270566 PMCID: PMC8910365 DOI: 10.3390/ijerph19052874] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/26/2022] [Accepted: 02/28/2022] [Indexed: 02/04/2023]
Abstract
The association between sleep problems and quality of life has been well documented and the COVID-19 pandemic seemingly had an impact on both sleep quality and health-related quality of life (HRQoL). However, recent evidence about this relationship among university students is limited. The aims of this study are to investigate the prevalence of poor sleep quality and insomnia and to explore the associations between these outcomes, perceived stress, and HRQoL among Italian university students. An anonymous questionnaire comprising the Pittsburgh Sleep Quality Index, the Insomnia Severity Index, the Short Form-12 health survey, and the Perceived Stress Scale was administered to a convenience sample of 1279 students (1119 females and 160 males, mean age: 23.4 ± 2.5 years) attending one of the largest Italian universities. A total of 65% of the participants showed poor sleep quality, whereas 55% reported insomnia symptoms. Students reporting poor sleep quality and insomnia obtained higher perceived stress scores and lower physical and mental HRQoL scores. Controlling for health-related variables and perceived stress, hierarchical regression analyses showed that sleep quality components added a significant contribution to the prediction of both physical (ΔR2 = 0.1) and mental (ΔR2 = 0.02) HRQoL. As a whole, these findings confirm the relevance of sleep for university students’ well-being and might inform the development of health promotion interventions for this population.
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Affiliation(s)
- Matteo Carpi
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy
- Correspondence:
| | - Claudia Cianfarani
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (C.C.); (A.V.)
| | - Annarita Vestri
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (C.C.); (A.V.)
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Rahill GJ, Joshi M, Blanc J, Littlewood K, Salinas-Miranda A, Rice C. Self-reported sleep disturbance patterns in urban haitians: A latent class analysis. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2022. [DOI: 10.1080/00207411.2022.2041266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Guitele J. Rahill
- College of Behavioral & Community Sciences (CBCS), University of South Florida (USF), Tampa Florida, FL, USA
| | - Manisha Joshi
- College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA
| | - Judite Blanc
- Center for Healthful Behavior, New York University Langone Health, New York, New York
| | - Kerry Littlewood
- College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA
| | | | - Christopher Rice
- School of Social Work, Florida International University, Miami, FL, USA
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Chen JT, Zhang P, Kong XY, Ge YJ, Li XY, Yang S, He S, Chen GH. Changed Serum Levels of CD62E+, Angiotensin II and Copeptin in Patients with Chronic Insomnia Disorder: A Link Between Insomnia and Stroke? Sleep Med 2022; 91:96-104. [DOI: 10.1016/j.sleep.2022.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/15/2022] [Accepted: 02/19/2022] [Indexed: 12/16/2022]
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VAGO EL, FRANGE C, DA PAZ OLIVEIRA G, JULIANO ML, MACHADO MA, COELHO FMS. The association between sleep disturbances and tooth loss among post-stroke patients. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:173-179. [DOI: 10.1590/0004-282x-anp-2020-0368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/17/2021] [Accepted: 06/15/2021] [Indexed: 11/21/2022]
Abstract
ABSTRACT Background: Loss of teeth has been associated with neurological and sleep disorders. It is considered to be a predictor of stroke and leads to modifications of airway patency and predisposition to obstructive sleep apnea. Objective: To investigate sleep quality, risk of obstructive sleep apnea and excessive sleepiness among post-stroke patients with tooth loss attending the Neurovascular Clinic of the Federal University of São Paulo. Methods: The prevalence rates of different types of stroke were assessed among 130 patients with different degrees of tooth loss, along with the presence of sleep disturbances, risk of obstructive sleep apnea and excessive daytime sleepiness. Results: The prevalence of ischemic stroke was 94.6%, with either no significant disability or slight disability. Our sample had poor sleep quality, and a high risk of obstructive sleep apnea, but without excessive daytime sleepiness. Half of our sample had lost between 9 and 31 teeth, and more than 25% had edentulism. The majority used full removable dental prostheses, and more than half of these individuals slept without removing the prosthesis. Conclusions: We found high prevalence of poor sleep quality and high risk of obstructive sleep apnea among post-stroke patients with tooth loss. This indicates the need for further studies on treating and preventing sleep disturbances in stroke patients with tooth loss.
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Yao CW, Pelletier A, Fereshtehnejad SM, Cross N, Dang-Vu T, Postuma RB. Insomnia symptom subtypes and manifestations of prodromal neurodegeneration: a population-based study in the Canadian Longitudinal Study on Aging. J Clin Sleep Med 2022; 18:345-359. [PMID: 34314348 PMCID: PMC8804990 DOI: 10.5664/jcsm.9562] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVES To identify the association between insomnia symptoms and signs of prodromal neurodegeneration, including an analysis of potential differences between sleep-onset and sleep-maintenance insomnia. METHODS We included those aged 45-85 years, living in 1 of 10 Canadian provinces between 2012 and 2015 (at the baseline), recruited via 3 population-based sampling methods. Insomnia symptoms were assessed using questions adapted/modified from the Pittsburgh Sleep Quality Index. A panel of potential prodromal neurodegenerative markers including self-reported symptoms and objective gait motor, cognitive, and autonomic variables were assessed cross sectionally. We compared those who endorsed insomnia symptoms ≥ 3 times per week to controls, adjusting for age, sex, and education via logistic regression. RESULTS Overall, 2,051/30,097 people screened positive for sleep-onset insomnia alone and 4,333 for sleep-maintenance insomnia alone, while 2,371 endorsed both subtypes. On objective gait tests, participants with sleep-onset insomnia, but not sleep-maintenance insomnia, had worse balance (odds ratio [OR] = 1.33, 95% confidence interval = [1.16, 1.52]) and slower gait speed (OR = 1.52 [1.34, 1.73]). Although participants with any insomnia subtype endorsed more motor symptoms, these were more severe in those with sleep-onset insomnia (OR onset vs maintenance = 1.13 [1.07, 1.18]). On objective cognitive tests, those with sleep-maintenance insomnia scored normally. However, participants with sleep-onset insomnia performed worse on tests of verbal fluency (OR = 1.24 [1.06, 1.43]), immediate memory (OR = 1.23 [1.08, 1.41]), and prospective memory task (OR = 1.29 [1.11, 1.50]). The sleep-onset insomnia group also had lower heart rate variability (OR = 1.23 [1.07, 1.43]). Secondary analyses found generally similar results in young vs older age of insomnia development. CONCLUSIONS Compared to maintenance insomnia, those with sleep-onset insomnia have more motor, cognitive, and autonomic signs/symptoms. When evaluating neurodegenerative risk, differentiating insomnia subtypes may increase precision. CITATION Yao CW, Pelletier A, Fereshtehnejad S-M, Cross N, Dang-Vu T, Postuma RB. Insomnia symptom subtypes and manifestations of prodromal neurodegeneration: a population-based study in the Canadian Longitudinal Study on Aging. J Clin Sleep Med. 2022;18(2):345-359.
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Affiliation(s)
- Chun W Yao
- Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Amélie Pelletier
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Research Center of the Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | | | - Nathan Cross
- Institut Universitaire de Gériatrie de Montréal and CRIUGM, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
- PERFORM Centre, Center for Studies in Behavioral Neurobiology, Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Quebec, Canada
| | - Thanh Dang-Vu
- Institut Universitaire de Gériatrie de Montréal and CRIUGM, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
- PERFORM Centre, Center for Studies in Behavioral Neurobiology, Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Quebec, Canada
| | - Ronald B Postuma
- Research Center of the Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
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Prevalence of Sleep Disorders and Associated Factors in People Living With HIV in the Ceará, Brazil: A Cross-sectional Study. J Assoc Nurses AIDS Care 2022; 33:436-447. [PMID: 35120074 DOI: 10.1097/jnc.0000000000000326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The aim of this study was to determine the prevalence of sleep disorders and associated factors in people living with HIV (PLWH). This was a cross-sectional study with a sample of 385 participants followed-up on an outpatient basis in Fortaleza, Ceará, Brazil. Interviews were conducted using the Sociodemographic, Epidemiological and Clinical Form for PLWH and the Pittsburgh Sleep Quality Index. Descriptive statistics and univariate and multivariate logistic regression analysis were performed, and the odds ratio (OR) and 95% confidence interval (95% CI) were calculated, considering p < .05 as statistically significant. The prevalence of sleep disorders was 43.38%. Having children (p = .0054; OR = 1.91; 95% CI = 1.21-3.01), less than 8 years of education (p = .0013; OR = 2.11; 95% CI = 1.34-3.34), and not engaging in regular physical exercise (p = .0001; OR = 2.61; 95% CI = 1.61-4.23) were factors associated with the occurrence of sleep disorders. It was concluded that almost half of the sample had sleep disorders, especially those with children, low level education, and sedentary habits. These data point to the need for increased guidance on sleep hygiene, in addition to the practice of regular physical exercise for this population.
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Truksinas E, Frange C, da Paz G, Vago EL, Andersen ML, Tufik S, Santos Coelho FM. Circadian preference and stroke characteristics: A descriptive study. Chronobiol Int 2022; 39:644-652. [PMID: 34983278 DOI: 10.1080/07420528.2021.2021228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
There is evidence that circadian misalignment is linked with an increased risk of stroke and that circadian preference is linked with rehabilitation outcomes after stroke. Circadian preferences refer to preferences based on individuals' characteristics in respect of the timing of physiological functions that are typically assessed by self-report questionnaires. This study set out to explore this relationship by examining whether there was an association between circadian preference and stroke characteristics in a sample of stroke outpatients, considering the time of stroke onset, the topography of the stroke and the resulting disability. We also examined whether sleep complaints (snoring, insomnia, sleep apnea) were associated with circadian preferences (i.e., morning-, evening-, and intermediate-types). We also compared circadian preferences and comorbidities in this sample, matched by age and sex, with those of healthy controls who took part in an epidemiological study (EPISONO) comprising a representative sample of the population of the city of São Paulo, Brazil. Most of our sample in both groups were morning-type, and in the stroke group, ischemic stroke was the most common type. There was an increased risk for sleep apnea among evening-types, and a higher prevalence of diabetes in the evening- and intermediate-types. We found no association between circadian preference and the time of stroke onset, or with wake-up stroke. We found a low prevalence of evening-type participants in our sample of controls (2.9%) and in the stroke group (1.7%). This investigation showed a similar circadian preference (morning-types) in stroke outpatients and the general population.
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Affiliation(s)
- Eveli Truksinas
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Cristina Frange
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Giuliano da Paz
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Eliana Lottenberg Vago
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Monica Levy Andersen
- Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Sergio Tufik
- Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Fernando Morgadinho Santos Coelho
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.,Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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Kim WH, Joa KL, Kim CB, Lee HS, Kang SG, Jung HY, Bae JN. The Effect of Bright Light Therapy on Sleep and Quality of Life in Patients With Poststroke Insomnia. Psychosom Med 2022; 84:123-130. [PMID: 34581703 DOI: 10.1097/psy.0000000000001014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Poststroke insomnia is common and negatively affects stroke recovery. The objective of this study was to determine the effectiveness of bright light therapy for mild-to-moderate stroke patients with insomnia. METHODS This study was randomized, double blind, and placebo controlled. A 2-week trial was conducted on patients with mild-to-moderate stroke who had poststroke insomnia. Only patients who had experienced a first episode of stroke were enrolled in this study. Sleep parameters were measured using the Actiwatch Spectrum Pro for 7 days before and after light therapy. The instrument specifically collected data concerning sleep, mood state, fatigue, and subjective quality of life. Participants with poststroke insomnia received bright light therapy (10,000 lux) or placebo therapy for 30 minutes in the early morning. A total of 112 eligible participants entered the study, but only 56 patients were randomized to treatment (27 to bright light therapy and 29 to placebo therapy). RESULTS Results from analysis of variance showed that the mean change of sleep latency (F(1,55) =4.793, p = .033) and sleep efficiency (F(1,55) = 5.625, p = .022) were significantly superior in bright light therapy over placebo. Bright light therapy resulted in significant improvements in daytime sleepiness, fatigue, mood, and quality of life in study participants (p < .05). CONCLUSIONS Bright light therapy is a nonpharmacological treatment of early, poststroke insomnia in patients who had a mild to moderate stroke. In addition, bright light therapy is effective for the treatment of daytime sleepiness, fatigue, and depression and for improving quality of life in patients with poststroke insomnia. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04721574.
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Affiliation(s)
- Won-Hyoung Kim
- From the Departments of Psychiatry (W.-H. Kim, Kang, Bae) and Physical Medicine and Rehabilitation (Joa, C.-B. Kim, Lee, Jung), Inha University Hospital, Incheon, South Korea
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Yang Y, Zheng J, Du Z, Li Y, Cai Y. Accurate Prediction of Stroke for Hypertensive Patients Based on Medical Big Data and Machine Learning Algorithms: Retrospective Study. JMIR Med Inform 2021; 9:e30277. [PMID: 34757322 PMCID: PMC8663532 DOI: 10.2196/30277] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 08/31/2021] [Accepted: 09/17/2021] [Indexed: 12/23/2022] Open
Abstract
Background Stroke risk assessment is an important means of primary prevention, but the applicability of existing stroke risk assessment scales in the Chinese population has always been controversial. A prospective study is a common method of medical research, but it is time-consuming and labor-intensive. Medical big data has been demonstrated to promote disease risk factor discovery and prognosis, attracting broad research interest. Objective We aimed to establish a high-precision stroke risk prediction model for hypertensive patients based on historical electronic medical record data and machine learning algorithms. Methods Based on the Shenzhen Health Information Big Data Platform, a total of 57,671 patients were screened from 250,788 registered patients with hypertension, of whom 9421 had stroke onset during the 3-year follow-up. In addition to baseline characteristics and historical symptoms, we constructed some trend characteristics from multitemporal medical records. Stratified sampling according to gender ratio and age stratification was implemented to balance the positive and negative cases, and the final 19,953 samples were randomly divided into a training set and test set according to a ratio of 7:3. We used 4 machine learning algorithms for modeling, and the risk prediction performance was compared with the traditional risk scales. We also analyzed the nonlinear effect of continuous characteristics on stroke onset. Results The tree-based integration algorithm extreme gradient boosting achieved the optimal performance with an area under the receiver operating characteristic curve of 0.9220, surpassing the other 3 traditional machine learning algorithms. Compared with 2 traditional risk scales, the Framingham stroke risk profiles and the Chinese Multiprovincial Cohort Study, our proposed model achieved better performance on the independent validation set, and the area under the receiver operating characteristic value increased by 0.17. Further nonlinear effect analysis revealed the importance of multitemporal trend characteristics in stroke risk prediction, which will benefit the standardized management of hypertensive patients. Conclusions A high-precision 3-year stroke risk prediction model for hypertensive patients was established, and the model's performance was verified by comparing it with the traditional risk scales. Multitemporal trend characteristics played an important role in stroke onset, and thus the model could be deployed to electronic health record systems to assist in more pervasive, preemptive stroke risk screening, enabling higher efficiency of early disease prevention and intervention.
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Affiliation(s)
- Yujie Yang
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Jing Zheng
- Shenzhen Health Information Center, Shenzhen, China
| | - Zhenzhen Du
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Ye Li
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.,Joint Engineering Research Center for Health Big Data Intelligent Analysis Technology, Shenzhen, China
| | - Yunpeng Cai
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
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Dang B, Dicarlo J, Lukashov S, Hinds N, Reinen J, Wen B, Hao T, Bilal E, Rogers J. Development of a Smart Sleep Mask with Multiple Sensors. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:7058-7062. [PMID: 34892728 DOI: 10.1109/embc46164.2021.9630086] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In this work, we demonstrated a Smart Sleep Mask with several integrated physiological sensors such as 3-axis accelerometers, respiratory acoustic sensor, and an eye movement sensor. In particular, using infrared optical sensors, eye movement frequency, direction, and amplitude can be directly monitored and recorded during sleep sessions. We also developed a mobile app for data storage, signal processing and data analytics. Aggregation of these signals from a single wearable device may offer ease of use and more insights for sleep monitoring and REM sleep assessment. The user-friendly mask design can enable at-home use applications in the studies of digital biomarkers for sleep disorder related neurodegenerative diseases. Examples include REM Sleep Behavior Disorder, epilepsy event detection and stroke induced facial and eye movement disorder.Clinical Relevance-Many diseases such as stroke, epilepsy, and Parkinson's disease can cause significant abnormal events during sleep or are associated with sleep disorder. A smart sleep mask may serve as a simple platform to provide various physiological signals and generate clinical meaningful insights by revealing the neurological activities during various sleep stages.
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Mekky J, El-Kholy O, Hamdy E, Fawzy A. Rapid eye movement (REM) sleep microarchitecture is altered in patients with wake-up ischemic stroke: A polysomnographic study. Neurobiol Sleep Circadian Rhythms 2021; 11:100069. [PMID: 34258472 PMCID: PMC8255241 DOI: 10.1016/j.nbscr.2021.100069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/06/2021] [Accepted: 06/11/2021] [Indexed: 12/05/2022] Open
Abstract
It is well established that certain alteration of sleep disorders occur in patients with wake-up stroke (WUS) such as sleep disordered breathing, periodic limb movements and sleep duration. However, the data are lacking about the microarchitecture of different sleep stages among those patients. Aim of work To compare the polysomnographic microarchitecture of rapid eye movement (REM) sleep between WUS and daytime stroke (DTS). Methods A cross-sectional polysomnographic study was conducted on 20 patients with WUS and 20 patients with DTS, with analysis of REM sleep microarchitecture in specific. Results Patients with WUS had significantly shorter REM stage (11.76 ± 5.48% in WUS versus 16.59 ± 5.33% in DTS, P = 0.008), longer early morning REM was (25.70 ± 13.13 min in WUS versus 4.15 ± 4.69 min in DTS, P=<0.001), higher apnea-hypopnea index (AHI) during REM (6.29 ± 10.18 in WUS versus 1.10 ± 4.57 in DTS, P = 0.009), and lower mean Oxygen saturation during REM (92.70 ± 3.63 WUS versus 95.45 ± 1.35 DTS, P = 0.012). The OR of early morning REM duration was 1.8 (CI 1.099–3.130, p = 0.021) for WUS. Conclusion The microarchitecture of REM sleep is disrupted in patients with wake-up stroke. The polysomnographic parameters are significantly different between patients with daytime stroke (DTS) and wake-up stroke (WUS). Patients with WUS have longer stage 2 and shorter REM stage. The REM microarchitecture is disrupted among patients with WUS e.g. early morning REM duration in comparison to patients with daytime stroke (DTS). The distruption was in the form of shorter REM percentage to total sleep time, higher sleep apnea hypopnea index (AHI) during REM sleep, lower oxygen saturation during REM sleep and longer early morning REM duration. Periodic limb movement (PLM) index, and PLM-related arousals are higher among DTS.
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Affiliation(s)
- Jaidaa Mekky
- Department of Neuropsychiatry, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Osama El-Kholy
- Department of Neuropsychiatry, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Eman Hamdy
- Department of Neuropsychiatry, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Akram Fawzy
- Department of Neuropsychiatry, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Wang T, Yang J, Song Y, Pang F, Guo X, Luo Y. Interactions of central and autonomic nervous systems in patients with sleep apnea-hypopnea syndrome during sleep. Sleep Breath 2021; 26:621-631. [PMID: 34231085 DOI: 10.1007/s11325-021-02429-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Sleep apnea-hypopnea syndrome (SAHS) is an independent risk factor for various cardiovascular and cerebrovascular diseases, but the underlying relationship of its physiological subsystems remains unclear. Thus, we aimed to investigate the effect of SAHS on central and autonomic nervous system (CNS-ANS) interactions during sleep. METHODS Thirty-five patients with SAHS and 19 healthy age-matched controls underwent overnight polysomnography. The absolute spectral powers of five frequency bands from six EEG channels and ECG morphological features (HR, PR interval, QT interval) were calculated. Multivariable transfer entropy was applied to analyze the differences of the CNS-ANS network interactions between patients with SAHS of different severities and healthy controls during deep, light, and rapid eye movement sleep. RESULTS The CNS-ANS network interacted bidirectionally in all researched groups, with the cardiac information modulating the brain activity. The information strength from QT to most EEG components and PR to some EEG components was significantly affected by SAHS severity during light sleep, which indicates the coupling features of QT-brain nodes are important indicators. The driver effects from the β-band significantly increased in patients with SAHS. CONCLUSIONS Respiratory events may be the main reason for the CNS-ANS interaction changes in SAHS. These findings help explain the physiological regulation process of SAHS and provide valuable information for analysis of the development of SAHS-related cardiovascular and chronic diseases.
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Affiliation(s)
- Tingting Wang
- School of Biomedical Engineering, Sun Yat-Sen University, Guangzhou, China
| | - Juan Yang
- School of Biomedical Engineering, Sun Yat-Sen University, Guangzhou, China
| | - Yingjie Song
- School of Biomedical Engineering, Sun Yat-Sen University, Guangzhou, China
| | - Feng Pang
- Sleep-Disordered Breathing Center, the Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xinwen Guo
- Psychology Department, Guangdong 999 Brain Hospital, Guangzhou, China
| | - Yuxi Luo
- School of Biomedical Engineering, Sun Yat-Sen University, Guangzhou, China.
- Key Laboratory of Sensing Technology and Biomedical Instrument of Guangdong Province, Sun Yat-Sen University, Guangzhou, China.
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Implications of Circadian Rhythm in Stroke Occurrence: Certainties and Possibilities. Brain Sci 2021; 11:brainsci11070865. [PMID: 34209758 PMCID: PMC8301898 DOI: 10.3390/brainsci11070865] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/17/2021] [Accepted: 06/25/2021] [Indexed: 11/17/2022] Open
Abstract
Stroke occurrence is not randomly distributed over time but has circadian rhythmicity with the highest frequency of onset in the morning hours. This specific temporal pattern is valid for all subtypes of cerebral infarction and intracerebral hemorrhage. It also correlates with the circadian variation of some exogenous factors such as orthostatic changes, physical activity, sleep-awake cycle, as well as with endogenous factors including dipping patterns of blood pressure, or morning prothrombotic and hypofibrinolytic states with underlying cyclic changes in the autonomous system and humoral activity. Since the internal clock is responsible for these circadian biological changes, its disruption may increase the risk of stroke occurrence and influence neuronal susceptibility to injury and neurorehabilitation. This review aims to summarize the literature data on the circadian variation of cerebrovascular events according to physiological, cellular, and molecular circadian changes, to survey the available information on the chronotherapy and chronoprophylaxis of stroke and its risk factors, as well as to discuss the less reviewed impact of the circadian rhythm in stroke onset on patient outcome and functional status after stroke.
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Benjamin SE. Sleep in Patients With Neurologic Disease. ACTA ACUST UNITED AC 2021; 26:1016-1033. [PMID: 32756234 DOI: 10.1212/con.0000000000000887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW This article provides a discussion of the current evidence and contemporary views on the relationship between sleep disorders and neurologic disease. RECENT FINDINGS Disrupted or disordered sleep can be associated with increased morbidity and mortality, the risk of cardiovascular events, increased seizure frequency, and altered immune responses. Studies have implicated disrupted sleep and circadian rhythm dysfunction with both amyloid-β (Aβ) deposition and tau deposition. A bidirectional relationship exists between disrupted sleep and the progression of Alzheimer disease pathology. Insomnia has been reported as a prodromal symptom in autoimmune encephalitis. Primary sleep disorders have now been increasingly recognized as a common comorbid condition in multiple sclerosis, making it imperative that neurologists feel comfortable differentiating multiple sclerosis fatigue from excessive daytime sleepiness caused by primary sleep disorders to optimally treat their patients. SUMMARY Sleep disorders are common across the population. By recognizing sleep disorders in patients with neurologic conditions, neurologists can provide comprehensive care and, in some cases, reduce neurologic disease burden.
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Koo DL, Kim HR, Kim H, Seong JK, Joo EY. White matter tract-specific alterations in male patients with untreated obstructive sleep apnea are associated with worse cognitive function. Sleep 2021; 43:5680176. [PMID: 31848608 DOI: 10.1093/sleep/zsz247] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/21/2019] [Indexed: 01/13/2023] Open
Abstract
STUDY OBJECTIVES Neurocognitive impairment is one of the daytime symptoms of obstructive sleep apnea (OSA). We proposed to use tract-specific statistical analysis (TSSA) to investigate whether there are fiber tract abnormalities in OSA, which may be undiscovered using voxel-based approaches, and whether such tract-specific disruptions in brain connectivity are associated with neuropsychological deficits in patients with untreated OSA. METHODS We enrolled 38 patients with OSA diagnosed by overnight polysomnography, and 41 healthy sleepers. Fractional anisotropy (FA) and mean diffusivity (MD) maps were obtained from whole-brain diffusion tensor imaging, and TSSA were used to assess regional deficits of white matter tracts. All participants underwent a battery of neuropsychological tests. To evaluate the association between FA values and clinical, polysomnographic, and neuropsychological parameters in the OSA group, permutation-based tests for correlation were performed preceding cluster-based statistics. RESULTS Compared to healthy controls, patients with OSA showed decreased values of FA in the left and right anterior thalamic radiations, and right uncinate fasciculus (UNC) (p < 0.001, p = 0.005, and p = 0.008, respectively). A lower score of digit span backward was associated with lower FA values of right UNC in the OSA group (p = 0.023). The Rey Complex Figure Test copy score revealed a positive correlation with FA values in the right UNC (p = 0.010). CONCLUSIONS The TSSA method indeed identified previously unrevealed tract-specific disruptions in OSA. Furthermore, reduced FA values in the frontal lobe portion of the right UNC which has been known to be involved in working memory function were significantly associated with lower cognitive performance in patients with untreated OSA.
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Affiliation(s)
- Dae Lim Koo
- Department of Neurology, Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Hye Ryun Kim
- Global Health Technology Research Center, College of Health Science, Korea University, Seoul, South Korea
| | - Hosung Kim
- Department of Neurology, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Joon-Kyung Seong
- Global Health Technology Research Center, College of Health Science, Korea University, Seoul, South Korea.,School of Biomedical Engineering, Korea University, Seoul, South Korea
| | - Eun Yeon Joo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Samsung Biomedical Research Institute, Seoul, South Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea
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Cai H, Wang XP, Yang GY. Sleep Disorders in Stroke: An Update on Management. Aging Dis 2021; 12:570-585. [PMID: 33815883 PMCID: PMC7990374 DOI: 10.14336/ad.2020.0707] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 07/07/2020] [Indexed: 12/18/2022] Open
Abstract
Stroke is a leading cause of disability and mortality all over the world. Due to an aging population, the incidence of stroke is rising significantly, which has led to devastating consequences for patients. In addition to traditional risk factors such as age, hypertension, hyperlipidemia, diabetes and atrial fibrillation, sleep disorders, as independent modifiable risk factors for stroke, have been highlighted increasingly. In this review, we provide an overview of common types of current sleep disturbances in cerebrovascular diseases, including insomnia, hypersomnia, breathing-related sleep disorders, and parasomnias. Moreover, evidence-based clinical therapeutic strategies and pitfalls of specific sleep disorders after stroke are discussed. We also review the neurobiological mechanisms of these treatments as well as their effects on stroke. Since depression after stroke is so prevalent and closely related to sleep disorders, treatments of post-stroke depression are also briefly mentioned in this review article.
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Affiliation(s)
- Hongxia Cai
- Department of Neurology, Tong-Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Xiao-Ping Wang
- Department of Neurology, Tong-Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Guo-Yuan Yang
- Med-X Research Institute and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
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Brief Psychosocial Intervention to Address Poststroke Depression May Also Benefit Fatigue and Sleep-Wake Disturbance. Rehabil Nurs 2021; 46:222-231. [PMID: 33443981 DOI: 10.1097/rnj.0000000000000304] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aimed to determine if brief psychosocial/behavioral therapy directed to reduce poststroke depression would decrease fatigue and improve sleep-wake disturbance. DESIGN A preplanned secondary data analysis from a completed clinical trial was conducted. METHODS One hundred participants received usual care, in-person intervention, or telephone intervention. Depression, fatigue, and sleep-wake disturbance were measured at entry, 8 weeks, 21 weeks, and 12 months following the intervention. FINDINGS Fatigue (within: p = .042, between: p = .394), sleep disturbance (within: p = .024, between: p = .102), and wake disturbance (within: p = .004, between: p = .508) decreased over the 12 months in the intervention groups, but not in the control group. This difference was clinically meaningful for wake disturbance and approached the clinically important difference for fatigue. CONCLUSIONS/CLINICAL RELEVANCE Reduction in wake disturbance was consistent with clinically meaningful difference standards for patient-reported outcomes, warranting further research in larger samples.
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Hasan F, Gordon C, Wu D, Huang HC, Yuliana LT, Susatia B, Marta OFD, Chiu HY. Dynamic Prevalence of Sleep Disorders Following Stroke or Transient Ischemic Attack: Systematic Review and Meta-Analysis. Stroke 2021; 52:655-663. [PMID: 33406871 DOI: 10.1161/strokeaha.120.029847] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The exact prevalence of sleep disorders following stroke or transient ischemic attack (TIA) remains unclear. We aimed to determine the prevalence of sleep-disordered breathing, insomnia, periodic leg movement during sleep, and restless leg syndrome following stroke or TIA in acute, subacute, and chronic phases and examine the moderating effects of patient characteristics (eg, age) and methodological features (eg, study quality) on the prevalence. METHODS We performed a systematic review and meta-analysis. Embase and PubMed were searched from inception to December 18, 2019. We included 64 047 adults in 169 studies (prospective, retrospective, case-control, and cross-sectional study designs) reporting the prevalence of sleep disorders following stroke or TIA. RESULTS In the acute phase, the overall prevalence of mild, moderate, and severe sleep-disordered breathing was 66.8%, 50.3%, and 31.6% (95% CIs, 63.8-69.7, 41.9-58.7, and 24.9-39.1). In the subacute phase, the prevalence of mild, moderate, and severe sleep-disordered breathing was 65.5%, 44.3%, and 36.1% (95% CIs, 58.9-71.5, 36.1-52.8, and 22.2-52.8). In the chronic phase, the summary prevalence of mild, moderate, and severe sleep-disordered breathing was 66.2%, 33.1%, and 25.1% (95% CIs, 58.6-73.1, 24.8-42.6, and 10.9-47.6). The prevalence rates of insomnia in the acute, subacute, and chronic phases were 40.7%, 42.6%, and 35.9% (95% CIs, 31.8-50.3, 31.7-54.1, and 28.6-44.0). The pooled prevalence of periodic leg movement during sleep in the acute, subacute, and chronic phases was 32.0%, 27.3%, and 48.2% (95% CIs, 7.4-73.5, 11.6-51.7, and 33.1-63.5). The summary prevalence of restless leg syndrome in the acute and chronic phases was 10.4% and 13.7% (95 CIs, 6.4-16.4 and 2.3-51.8). Age, sex, comorbidities, smoking history, and study region had significant moderating effects on the prevalence of sleep disorders. CONCLUSIONS Sleep disorders following stroke or TIA are highly prevalent over time. Our findings indicate the importance of early screening and treating sleep disorders following stroke or TIA.
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Affiliation(s)
- Faizul Hasan
- School of Nursing, College of Nursing (F.H., H.-C.H., O.F.D.M., H.-Y.C.), Taipei Medical University, Taiwan.,School of Nursing (F.H., B.S.), Politeknik Kesehatan Kemenkes Malang, Indonesia
| | - Christopher Gordon
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Australia (C.G.)
| | - Dean Wu
- Department of Neurology, School of Medicine, College of Medicine (D.W.), Taipei Medical University, Taiwan.,Department of Neurology, Shuang-Ho Hospital (D.W.), Taipei Medical University, Taiwan.,Research Center of Sleep Medicine, College of Medicine (D.W., H.-Y.C.), Taipei Medical University, Taiwan
| | - Hui-Chuan Huang
- School of Nursing, College of Nursing (F.H., H.-C.H., O.F.D.M., H.-Y.C.), Taipei Medical University, Taiwan
| | | | - Budi Susatia
- School of Nursing (F.H., B.S.), Politeknik Kesehatan Kemenkes Malang, Indonesia
| | - Ollyvia Freeska Dwi Marta
- School of Nursing, College of Nursing (F.H., H.-C.H., O.F.D.M., H.-Y.C.), Taipei Medical University, Taiwan.,Nursing Department, Faculty of Health Science, University of Muhammadiyah Malang, Indonesia (O.F.D.M.)
| | - Hsiao-Yean Chiu
- School of Nursing, College of Nursing (F.H., H.-C.H., O.F.D.M., H.-Y.C.), Taipei Medical University, Taiwan.,Research Center of Sleep Medicine, College of Medicine (D.W., H.-Y.C.), Taipei Medical University, Taiwan
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Obesity and sleep disorders: A nationwide study of 1.3 million Israeli adolescents. Obes Res Clin Pract 2020; 14:542-547. [PMID: 33189604 DOI: 10.1016/j.orcp.2020.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/01/2020] [Accepted: 10/31/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To assess the association between sleep disorders prevalence and obesity in Israeli adolescents. METHODS A nationwide, population-based, cross-sectional study of 1,348,817 Israeli adolescents (57% males) who were medically examined prior to military service between 1997 and 2015; height and weight were measured along with assessment of medical status at age 17.3⬰±⬰0.4 years. The diagnosis of a sleep disorder was made based on objective diagnostic criteria. The prevalence and odds ratio (OR) for a sleep disorder were computed across BMI subgroups and were adjusted for socio-demographic confounders. RESULTS Overall sleep disorders prevalence was 1.8:1000 (males) and 0.45:1000 (females), with a total of 1601 cases. There was a gradual increase in the odds ratio for sleep disorders with increasing BMI. Multivariable-adjusted ORs for sleep disorders were 1.29 (95% CI 1.10⬜1.52), 1.44 (1.18⬜1.75), 3.03 (2.32⬜3.96) and 3.38 (1.98⬜5.75) for overweight, obese class I, II and III, respectively (5th⬜49th BMI percentile was the reference). Results persisted in extensive sensitivity analyses including limiting the study sample to participants with unimpaired health. CONCLUSIONS We found a higher prevalence of sleep disorders in males and a dose-dependent association between sleep disorders and adolescent BMI in both sexes. Our findings warrant clinical awareness among healthcare providers, given the rise in obesity in teenagers, and particularly in light of the obesity epidemic that we are experiencing in this era. Sleep related complaints should be actively screened in adolescents who suffer obesity.
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