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Kim SJ, Lee JH, Jang JW, Jung HS, Suh IB. Abnormalities of Rest-Activity and Light Exposure Rhythms Associated with Cognitive Function in Patients with Mild Cognitive Impairment (MCI). J Circadian Rhythms 2023; 21:4. [PMID: 38162255 PMCID: PMC10756154 DOI: 10.5334/jcr.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 10/05/2023] [Indexed: 01/03/2024] Open
Abstract
We aimed to examine the difference in rest-activity rhythm (RAR) and light exposure rhythm (LER) between patients with mild cognitive impairment (MCI) and normal controls (NC), and to verify their relationships with cognitive functions. The neuropsychological battery was administered to participants above 50 years old. The MCI diagnosis was made according to Petersen's criteria. Ten patients with MCI (77.90 ± 6.95 years) and eight NC (74.75 ± 5.06 years) were studied. Actigraphy (Actiwatch 2; Philips Respironics) was recorded at home for 5 days. RAR and LER variables, including interdaily stability (IS), intradaily variability (IV) and relative amplitude, were calculated using nonparametric analyses. The associations between cognitive performance and RAR and LER variables were explored using generalized linear models. There were no significant differences in RAR or LER variables between MCI and NC. There was a significant main effect of RAR-IS on the Stroop Color and Word Test (SCWT), indicating a positive relationship between RAR stability and SCWT performance. There was a significant group by RAR-IS interaction on Trail Making Test-A, indicating a negative relationship in MCI compared to NC. There was a significant group by LER-IV interaction on the Boston Naming Test, indicating a positive relationship in MCI compared to NC. There was no disruption in RAR and LER in patients with MCI. Our study showed that circadian rhythm abnormality was associated with a decline in executive function. However, circadian rhythm abnormality was not associated with declines in processing speed and language function in patients with MCI, implying an altered pathophysiology compared to NC.
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Affiliation(s)
- Seong Jae Kim
- Department of Psychiatry, Chosun University College of Medicine, Gwangju, South Korea
- Department of Psychiatry, Chosun University Hospital, Gwangju, South Korea
| | - Jung Hie Lee
- Department of Psychiatry, Kangwon National University School of Medicine, Chuncheon, South Korea
- Department of Psychiatry, Gwanggyo Good Sleep Clinic, Suwon, South Korea
| | - Jae-Won Jang
- Department of Neurology, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Hee Seo Jung
- Department of Psychiatry, Kangwon National University Hospital, Chuncheon, South Korea
| | - In Bum Suh
- Department of Laboratory Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea
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Haniffa S, Narain P, Hughes MA, Petković A, Šušić M, Mlambo V, Chaudhury D. Chronic social stress blunts core body temperature and molecular rhythms of Rbm3 and Cirbp in mouse lateral habenula. Open Biol 2023; 13:220380. [PMID: 37463657 PMCID: PMC10353891 DOI: 10.1098/rsob.220380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 06/29/2023] [Indexed: 07/19/2023] Open
Abstract
Chronic social stress in mice causes behavioural and physiological changes that result in perturbed rhythms of body temperature, activity and sleep-wake cycle. To further understand the link between mood disorders and temperature rhythmicity in mice that are resilient or susceptible to stress, we measured core body temperature (Tcore) before and after exposure to chronic social defeat stress (CSDS). We found that Tcore amplitudes of stress-resilient and susceptible mice are dampened during exposure to CSDS. However, following CSDS, resilient mice recovered temperature amplitude faster than susceptible mice. Furthermore, the interdaily stability (IS) of temperature rhythms was fragmented in stress-exposed mice during CSDS, which recovered to control levels following stress. There were minimal changes in locomotor activity after stress exposure which correlates with regular rhythmic expression of Prok2 - an output signal of the suprachiasmatic nucleus. We also determined that expression of thermosensitive genes Rbm3 and Cirbp in the lateral habenula (LHb) were blunted 1 day after CSDS. Rhythmic expression of these genes recovered 10 days later. Overall, we show that CSDS blunts Tcore and thermosensitive gene rhythms. Tcore rhythm recovery is faster in stress-resilient mice, but Rbm3 and Cirbp recovery is uniform across the phenotypes.
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Affiliation(s)
- Salma Haniffa
- Department of Biology, Science Division, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Priyam Narain
- Centre for Genomics and Systems Biology (CGSB), New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Michelle Ann Hughes
- Department of Biology, Science Division, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Aleksa Petković
- Department of Biology, Science Division, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Marko Šušić
- Department of Biology, Science Division, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Vongai Mlambo
- Department of Biology, Science Division, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Dipesh Chaudhury
- Department of Biology, Science Division, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
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Paewponsong J, Gerber BS, Anothaisintawee T, Chirakalwasan N, Saetung S, Reutrakul S. The association between rest-activity parameters and hemoglobin A1c in patients with prediabetes. Chronobiol Int 2023; 40:834-839. [PMID: 37222284 PMCID: PMC10524640 DOI: 10.1080/07420528.2023.2215337] [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: 03/02/2023] [Revised: 04/11/2023] [Accepted: 05/12/2023] [Indexed: 05/25/2023]
Abstract
Circadian abnormalities can adversely affect glucose metabolism. This study determined whether behavioral circadian parameters, as assessed by rest-activity rhythm, were predictors of glycemic control in patients with prediabetes. Seventy-nine patients with prediabetes participated. Nonparametric rest-activity rhythm parameters, sleep duration and efficiency were obtained from 7-d actigraphy recordings. Sleep-disordered breathing severity was assessed using a home sleep apnea test. Hemoglobin A1c (HbA1c) was obtained to evaluate glycemic control. The results revealed that shorter sleep duration, lower relative amplitude and higher L5 (average activity of the least active 5-h period) were associated with higher HbA1c, while other sleep variables were not related to HbA1c. Multiple stepwise regression analysis adjusting for age, sex, body mass index and sleep duration revealed that lower relative amplitude, but not L5, was independently associated with higher HbA1c (B = -0.027, p = 0.031). In summary, among patients with prediabetes, an abnormal circadian rhythm was associated with higher HbA1c, implying a greater risk of developing diabetes. These results support the role of circadian rhythmicity in glucose control among those with prediabetes.
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Affiliation(s)
- Jirayupa Paewponsong
- Division of Endocrinology and Metabolism, Faculty of Medicine Ramathibodi Hospital, 270 Rama VI Rd, Bangkok 10400, Thailand
| | - Ben S. Gerber
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, 368 Plantation Street, Worcester, MA 01605
| | - Thunyarat Anothaisintawee
- Department of Family Medicine, Faculty of Medicine Ramathibodi Hospital, 270 Rama VI Rd, Bangkok 10400, Thailand
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, 270 Rama VI Rd, Bangkok 10400, Thailand
| | - Naricha Chirakalwasan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Bangkok, 10330, Thailand
- Excellence Center for Sleep Disorders, Thai Red Cross Society, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Sunee Saetung
- Division of Endocrinology and Metabolism, Faculty of Medicine Ramathibodi Hospital, 270 Rama VI Rd, Bangkok 10400, Thailand
| | - Sirimon Reutrakul
- Division of Endocrinology and Metabolism, Faculty of Medicine Ramathibodi Hospital, 270 Rama VI Rd, Bangkok 10400, Thailand
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Yang L, Feng H, Chen J, Kwok Wing Y, Benedict C, Tan X, Zhang J. Association of circadian rest-activity rhythms with cardiovascular disease and mortality in type 2 diabetes. Diabetes Res Clin Pract 2023; 197:110262. [PMID: 36690211 DOI: 10.1016/j.diabres.2023.110262] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/30/2022] [Accepted: 01/17/2023] [Indexed: 01/21/2023]
Abstract
AIMS To examine the associations of disrupted circadian rest-activity rhythm (CRAR) with cardiovascular diseases and mortality among people with type 2 diabetes. METHODS A total of 3147 participants with baseline type 2 diabetes (mean age 65.21 years, 39.78% female; mean HbA1c 50.02 mmol/mol) from UK Biobank were included. The following CRAR parameters were derived from acceleration data: interdaily stability (IS), intradaily variability (IV), relative amplitude (RA), most active 10 h period onset (M10 onset), and least active 5 h period onset (L5 onset). We used Cox proportional hazards models to estimate the associations of CRAR with cardiovascular diseases and mortality, adjusting for sociodemographic, lifestyle, and health characteristics. RESULTS Participants in the lowest quartile of IS and RA exhibited the greatest risk of developing cardiovascular disease (IS, hazard ratio [HR]Q1 vs. Q4 1.40 [95% confidence interval (CI) 1.04, 1.88]; RA, HRQ1 vs. Q4 2.45 [95% CI 1.73, 3.49]). However, the association between delayed L5 onset and cardiovascular disease risk did not reach statistical significance. Additionally, we found that high IV and low RA were associated with all-cause and cardiovascular mortality. CONCLUSION Objectively determined CRAR disturbances may increase the risk of cardiovascular diseases and mortality among people with type 2 diabetes.
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Affiliation(s)
- Lulu Yang
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Hongliang Feng
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China; Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Jie Chen
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Yun Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Christian Benedict
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Xiao Tan
- Department of Big Data in Health Science, Zhejiang University School of Public, Health and Department of Psychiatry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China; Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
| | - Jihui Zhang
- Center for Sleep and Circadian Medicine, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China; Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China; Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China.
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Xu Y, Wang X, Belsky DW, McCall WV, Liu Y, Su S. Blunted Rest-Activity Circadian Rhythm Is Associated With Increased Rate of Biological Aging: An Analysis of NHANES 2011-2014. J Gerontol A Biol Sci Med Sci 2023; 78:407-413. [PMID: 36124764 PMCID: PMC9977247 DOI: 10.1093/gerona/glac199] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Indexed: 11/14/2022] Open
Abstract
Impaired rest-activity circadian rhythm has been associated with increased risk for morbidity and mortality. Animals with mutations in clock genes display accelerated aging and shortened life span. Whether impaired rest-activity circadian rhythm is also associated with processes of aging in humans has not been explored. We analyzed accelerometry and physiological data from 7 539 adults participating in the 2011-2014 waves of the U.S. National Health and Nutrition Examination Surveys. We used accelerometry data to compute rest-activity rhythm measurements. We used physiological data to compute measurements of biological aging according to 3 published algorithms: Klemera-Doubal method (KDM) Biological Age, PhenoAge, and homeostatic dysregulation (HD). In the models adjusting multiple covariates, participants with higher relative amplitude (RA) and interdaily stability (IS) and lower intradaily variability (IV) exhibited less advanced biological aging indexed by KDM and PhenoAge (effect sizes for 1-quantile increase in these rest-activity measurements ranged from 0.54 to 0.57 "years" for RA, 0.24 to 0.28 "years" for IS, and 0.24 to 0.35 "years" for IV, ps < .001). Similar finding was observed for biological aging indexed by HD, but the significance was limited to RA with 1-quantile increase in RA associated with 0.09 log units decrease in HD (p < .001). The results indicate that blunted rest-activity circadian rhythm is associated with accelerated aging in the general population, suggesting that interventions aiming at enhancing circadian rhythm may be a novel approach for the extension of a healthy life span.
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Affiliation(s)
- Yanyan Xu
- Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Xiaoling Wang
- Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Daniel W Belsky
- Department of Epidemiology and Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, New York, USA
| | - William V McCall
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Yutao Liu
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
- Department of Cellular Biology & Anatomy, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Shaoyong Su
- Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
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Haniffa S, Narain P, Hughes MA, Petković A, Šušić M, Mlambo V, Chaudhury D. Chronic social stress blunts core body temperature and molecular rhythms of Rbm3and Cirbpin mouse lateral habenula.. [DOI: 10.1101/2023.01.02.522528] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2023]
Abstract
AbstractChronic social stress in mice causes behavioral and physiological changes that result in perturbed rhythms of body temperature, activity and sleep-wake cycle. To further understand the link between mood disorders and temperature rhythmicity in mice that are resilient or susceptible to stress, we measured core body temperature (Tcore) before and after exposure to chronic social defeat stress (CSDS). We found that Tcore amplitudes of stress-resilient and susceptible mice are dampened during exposure to CSDS. However, following CSDS, resilient mice recovered temperature amplitude faster than susceptible mice. Furthermore, the interdaily stability (IS) of temperature rhythms was fragmented in stress-exposed mice during CSDS, which recovered to control levels following stress. There were minimal changes in locomotor activity after stress exposure which correlates with regular rhythmic expression ofProk2- an output signal of the suprachiasmatic nucleus. We also determined that expression of thermosensitive genesRbm3andCirbpin the lateral habenula (LHb) were blunted 1-day after CSDS. Rhythmic expression of these genes recovered 10 days later. Overall, we show that CSDS blunts Tcore and thermosensitive gene rhythms. Tcore rhythm recovery is faster in stress-resilient mice, butRbm3andCirbprecovery is uniform across the phenotypes.
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Sun X, Yu W, Wang M, Hu J, Li Y. Association between rest-activity rhythm and cognitive function in the elderly: The U.S. National Health and Nutrition Examination Survey, 2011-2014. Front Endocrinol (Lausanne) 2023; 14:1135085. [PMID: 36967786 PMCID: PMC10034093 DOI: 10.3389/fendo.2023.1135085] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 01/30/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Circadian rhythm plays an essential role in various physiological and pathological processes related to cognitive function. The rest-activity rhythm (RAR) is one of the most prominent outputs of the circadian system. However, little is known about the relationships between RAR and different domains of cognitive function in older adults. The purpose of this study was to examine the relationships between RAR and various fields of cognitive function in older Americans. METHODS This study included a total of 2090 older adults ≥ 60 years old from the National Health and Nutrition Examination Survey (NHANES) in 2011-2014. RAR parameters were derived from accelerometer recordings. Cognitive function was assessed using the word learning subtest developed by the Consortium to Establish a Registry for Alzheimer's disease (CERAD W-L), the Animal Fluency Test (AFT) and the Digital Symbol Substitution Test (DSST). Linear regression was used to determine the relationships between RAR parameters (IS, IV, RA, L5, M10) and cognitive function scores (CERAD W-L, AFT, DSST). RESULTS After adjusting for potential confounders, lower IS and M10 were associated with lower CERAD W-L scores (P=0.033 and P=0.002, respectively). Weaker RA and higher L5 were associated with lower AFT scores (P<0.001 and P=0.001, respectively). And lower IS, RA, and higher L5 were associated with lower DSST scores (P=0.019, P<0.001 and P<0.001, respectively). In addition, the results of sensitivity analysis were similar to those of our main analyses. The main correlation results between the RAR indicators and cognitive function were robust. CONCLUSIONS This study suggested that the weakened and/or disrupted RAR was associated with cognitive decline in different domains in Americans over the age of 60.
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Affiliation(s)
- Xinyi Sun
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China
- National Key Discipline, Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, China
| | - Weiwei Yu
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Mingsi Wang
- Department of Health Economics, College of Health Management of Harbin Medical University, Harbin, China
- *Correspondence: Yunong Li, ; Jun Hu, ; Mingsi Wang,
| | - Jun Hu
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China
- *Correspondence: Yunong Li, ; Jun Hu, ; Mingsi Wang,
| | - Yunong Li
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China
- *Correspondence: Yunong Li, ; Jun Hu, ; Mingsi Wang,
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Xu Y, Su S, McCall WV, Isales C, Snieder H, Wang X. Rest-activity circadian rhythm and impaired glucose tolerance in adults: an analysis of NHANES 2011-2014. BMJ Open Diabetes Res Care 2022; 10:10/2/e002632. [PMID: 35241430 PMCID: PMC8895931 DOI: 10.1136/bmjdrc-2021-002632] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/09/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Circadian rhythm disturbance occurs in type 2 diabetes, yet it is unknown whether it also exists in the prediagnostic phase of the disease. Thus, we examined the association of rest-activity circadian rhythm with 2-hour glucose levels and the risk of impaired glucose tolerance (IGT) in a nationally representative sample of adults without diabetes using a cross-sectional design. RESEARCH DESIGN AND METHODS We analyzed data from 2760 adults without diabetes (age ≥20) with at least 4 days of validated accelerometer recordings and a valid oral glucose tolerance test from the National Health and Nutrition Examination Survey 2011-2014. Non-parametric rest-activity circadian rhythm parameters were derived from the accelerometer recordings. RESULTS In the models adjusting for multiple covariates, a one-quantile increase in relative amplitude (ie, increased circadian rhythmicity) was associated with 2.66 mg/dL decrease in 2-hour glucose level (95% CI -3.94 to -1.38, p<0.001) and a decreased odds of IGT (OR 0.75, 95% CI 0.63 to 0.89, p=0.002). A one-quantile increase in intradaily variability (ie, increased rhythm fragmentation) was associated with 3.01 mg/dL increase in 2-hour glucose level (95% CI 1.52 to 4.49, p=0.001) and an increased odds of IGT (OR 1.37, 95% CI 1.19 to 1.58, p<0.001). CONCLUSIONS Circadian disruption is significantly associated with impaired glucose homeostasis in a general population of adults without diabetes. The association of circadian rhythm abnormalities with indicators of the pre-diabetic state suggests that circadian dysfunction may contribute to early disease pathogenesis.
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Affiliation(s)
- Yanyan Xu
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Shaoyong Su
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - William V McCall
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Carlos Isales
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Harold Snieder
- Department of Epidemiology, University of Groningen, Groningen, The Netherlands
| | - Xiaoling Wang
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
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Griggs S, Strohl KP, Grey M, Barbato E, Margevicius S, Hickman RL. Circadian characteristics of the rest-activity rhythm, executive function, and glucose fluctuations in young adults with type 1 diabetes. Chronobiol Int 2021; 38:1477-1487. [PMID: 34128443 DOI: 10.1080/07420528.2021.1932987] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Circadian alignment is an important element in individual health, and one behavioral marker, rest-activity rhythm, could influence self-management in young adults with type 1 diabetes (T1D). Little is known about the rest-activity rhythms, executive function, and glycemia among young adults with type 1 diabetes (T1D). The purpose of this study was to evaluate parametric and nonparametric circadian characteristics of the rest-activity rhythm and the associations between these variables, sleep-wake behavior, executive function, and glycemia among young adults with T1D. Young adults with T1D, recruited from diabetes clinics, wore wrist actigraphs and a continuous glucose monitor (CGM) concurrently for 6-14 days. Participants completed a 3-minute Trail Making Test on paper and electronic questionnaires - 8-item PROMIS v1.0 Emotional Distress Scale, 17-item Diabetes Distress Scale, including twice-daily Pittsburgh sleep diaries. Cosinor and nonparametric analyses were used to compute the rest-activity rhythm parameters, and linear regression modeling procedures were performed to determine the associations among the study variables. The sample included 46 young adults (mean age 22.3 ± 3.2; 32.6% male; 84.8% non-Hispanic White, HbA1c mean 7.2 ± 1.1%, BMI mean 27.0 ± 4.4 kg/m2). A number of parametric associations were observed between a stronger rhythm, better objective sleep-wake characteristics, and less daytime sleepiness. Nonparametric circadian parameters were significantly associated with several outcomes: a stronger rhythm adherence (higher inter-daily stability) with better objective sleep-wake characteristics, better executive function, lower diabetes distress, less hyperglycemia risk, and more time spent in hypoglycemia/hypoglycemia risk; and a more robust rhythm (higher relative amplitude) with better objective sleep-wake characteristics and more time spent in hypoglycemia/higher hypoglycemia risk. Future work should be directed at designs that test causality, such as interventions directed at the strength and stability of rest-activity rhythms, for the potential to improve glucoregulation and other diabetes outcomes.
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Affiliation(s)
- Stephanie Griggs
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Kingman P Strohl
- Department of Physiology and Biophysics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Margaret Grey
- School of Nursing and School of Medicine, Yale University, West Haven, Connecticut, USA
| | - Eric Barbato
- Department of Genetics and Genome Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Seunghee Margevicius
- Department of Population and Quantitative Health Sciences, School of Medicine, Cleveland, Ohio, USA
| | - Ronald L Hickman
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
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Cochran JM, Heidary Z, Knights J. Characterization of activity behavior using a digital medicine system and comparison to medication ingestion in patients with serious mental illness. NPJ Digit Med 2021; 4:63. [PMID: 33824406 PMCID: PMC8024287 DOI: 10.1038/s41746-021-00436-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 03/03/2021] [Indexed: 11/04/2022] Open
Abstract
Activity patterns can be important indicators in patients with serious mental illness. Here, we utilized an accelerometer and electrocardiogram incorporated within a digital medicine system, which also provides objective medication ingestion records, to explore markers of patient activity and investigate whether these markers of behavioral change are related to medication adherence. We developed an activity rhythm score to measure the consistency of step count patterns across the treatment regimen and explored the intensity of activity during active intervals. We then compared these activity features to ingestion behavior, both on a daily basis, using daily features and single-day ingestion behavior, and at the patient-level, using aggregate features and overall ingestion rates. Higher values of the single-day features for both the activity rhythm and activity intensity scores were associated with higher rates of ingestion on the following day. Patients with a mean activity rhythm score greater than the patient-level median were also shown to have higher overall ingestion rates than patients with lower activity rhythm scores (p = 0.004). These initial insights demonstrate the ability of digital medicine to enable the development of digital behavioral markers that can be compared to previously unavailable objective ingestion information to improve medication adherence.
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Affiliation(s)
- Jeffrey M Cochran
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA.
| | - Zahra Heidary
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
| | - Jonathan Knights
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
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Hoopes EK, Witman MA, D'Agata MN, Berube FR, Brewer B, Malone SK, Grandner MA, Patterson F. Rest-activity rhythms in emerging adults: implications for cardiometabolic health. Chronobiol Int 2021; 38:543-556. [PMID: 33435741 DOI: 10.1080/07420528.2020.1868490] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Emerging adulthood (18-25 years) represents a window of opportunity to modify the trajectory of cardiometabolic disease risk into older adulthood. Not known is the extent to which rest-activity rhythms (RAR) may be related to biomarkers of cardiometabolic health in this population. In this cross-sectional, observational study, 52 healthy emerging adults wore wrist accelerometers (14 consecutive days; 24 h/day) for assessment of nonparametric RAR metrics, including interdaily stability (IS; day-to-day RAR consistency), intradaily variability (IV; within-day RAR fragmentation), and relative amplitude (RA; robustness of RAR), as well as autocorrelation (correlation of rest/activity levels at 24-h lag-times). Cardiometabolic biomarkers, including body mass index (BMI), body fat percentage, blood pressure (BP), fasting lipids, glucose, and C-reactive protein (CRP) were assessed. Additional measures including physical activity, sleep duration, and habitual caffeine and alcohol consumption were also evaluated. A series of multivariable regression models of cardiometabolic biomarkers were used to quantify associations with RAR metrics. On average, participants were 20 ± 1 years of age (21 males, 31 females), non-obese, and non-hypertensive. All were nonsmokers and free of major diseases or conditions. In separate models, which adjusted for sex, BMI, moderate-vigorous physical activity, sleep duration, caffeine, and alcohol consumption, IS was inversely associated with total cholesterol (p ≤ 0.01) and non-HDL cholesterol (p < .05), IV was positively associated with CRP (p < .05), and autocorrelation was inversely associated with total cholesterol (p < .05) and CRP (p < .05). Conversely, associations between RA and cardiometabolic biomarkers were nonsignificant after adjustment for BMI, alcohol, and caffeine consumption. In conclusion, RAR metrics, namely, a higher IS, lower IV, and higher autocorrelation, emerged as novel biomarkers associated with more favorable indices of cardiometabolic health in this sample of apparently healthy emerging adults.
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Affiliation(s)
- Elissa K Hoopes
- College of Health Sciences, University of Delaware, Newark, DE, USA
| | - Melissa A Witman
- College of Health Sciences, University of Delaware, Newark, DE, USA
| | | | - Felicia R Berube
- College of Health Sciences, University of Delaware, Newark, DE, USA
| | - Benjamin Brewer
- College of Health Sciences, University of Delaware, Newark, DE, USA
| | - Susan K Malone
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | | | - Freda Patterson
- College of Health Sciences, University of Delaware, Newark, DE, USA
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12
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Circadian Patterns of Patients with Type 2 Diabetes and Obstructive Sleep Apnea. J Clin Med 2021; 10:jcm10020244. [PMID: 33440893 PMCID: PMC7826782 DOI: 10.3390/jcm10020244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/24/2020] [Accepted: 01/05/2021] [Indexed: 01/19/2023] Open
Abstract
Sleep apnea, a condition that modifies sleep and circadian rhythms, is highly prevalent in patients with diabetes. However, it is not known if there is an association between sleep apnea, circadian alterations and glycemic regulation in this type of patient. Here, a polysomnographic study was carried out on 21 women and 25 men (mean age = 64.3 ± 1.46 years) with diagnoses of type 2 diabetes to detect the presence of sleep apnea. Moreover, patients wore an actigraph and a temperature sensor on the wrist for one week, to study the manifestation of the circadian rhythms. The correlations of circadian and polysomnographic variables with the severity of apnea, measured by the apnea-hypopnea index, and with glycemic dysregulation, measured by the percentage of glycated hemoglobin, were analyzed. The mean apnea-hypoapnea index of all the participants was 39.6 ± 4.3. Apnea-hypoapnea index correlated with % N1, negatively with % N3, and also the stability of the active circadian rhythm. However, no significant correlation was found between the apnea-hypopnea index and wrist temperature rhythm and glycated hemoglobin. Glycated hemoglobin levels were negatively associated with the percentage of variance explained by the wrist temperature circadian rhythm (calculated via 24 and 12 h rhythms). This association was independent of body mass index and was strongest in patients with severe apnea. In conclusion, patients with diabetes showed altered circadian rhythms associated with a poor glycemic control and this association could partially be related to the coexistence of sleep apnea.
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13
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Conley S, Jeon S, Lehner V, Proctor DD, Redeker NS. Sleep Characteristics and Rest-Activity Rhythms Are Associated with Gastrointestinal Symptoms Among Adults with Inflammatory Bowel Disease. Dig Dis Sci 2021; 66:181-189. [PMID: 32193859 PMCID: PMC8162988 DOI: 10.1007/s10620-020-06213-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 03/14/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Sleep disturbance is common in inflammatory bowel disease (IBD) and is associated with poorer quality of life and increased disease activity; however, sleep is a multidimensional process, and little is known about specific sleep characteristics and rest-activity rhythms (RARs) in this population. AIMS The purposes were to (1) describe sleep characteristics and RARs; (2) compare sleep characteristics and RARs and GI symptoms by disease activity; and (3) describe associations between sleep characteristics, RARs, and GI symptoms among adults with IBD. METHODS We conducted a cross-sectional study of adults with IBD. We measured sleep characteristics and RARs (continuous wrist actigraphy); GI symptoms (PROMIS-GI); and disease activity (physicians' global assessment). We conducted cosinor and nonparametric analyses to compute RAR variables and bivariate analyses to address the aims. RESULTS The sample included 37 participants [age M = 38 years (SD = 13.8) and 21 (56.8%) female], of whom 23 (60.6%) were in remission. Sleep efficiency [M = 82.91% (SD 5.35)] and wake after sleep onset (WASO) [M = 42.26 min (SD 18.57)] were not associated with disease activity. Inter-daily stability of the RAR was associated with heartburn/reflux (r = - .491, p = .005) and gas/bloating (r = - .469, p = .008). Intra-daily variability of the RAR was associated with heartburn/reflux (r = .421, p = .018). CONCLUSIONS People with IBD may have disrupted RARs, which are associated with GI symptoms. Research is needed to improve understanding of these associations and to develop interventions to improve these characteristics in adults with IBD.
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Affiliation(s)
| | | | - Vanessa Lehner
- Yale School of Nursing, 400 West Campus Dr., Orange, CT, 06477, USA
| | | | - Nancy S Redeker
- Yale School of Nursing, 400 West Campus Dr., Orange, CT, 06477, USA
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14
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Zuraikat FM, Makarem N, Redline S, Aggarwal B, Jelic S, St-Onge MP. Sleep Regularity and Cardiometabolic Heath: Is Variability in Sleep Patterns a Risk Factor for Excess Adiposity and Glycemic Dysregulation? Curr Diab Rep 2020; 20:38. [PMID: 32700156 PMCID: PMC7584347 DOI: 10.1007/s11892-020-01324-w] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW Night-to-night variability in sleep patterns leads to circadian disruption and, consequently, could increase cardiometabolic risk. The purpose of this review is to summarize findings from studies published between 2015 and 2020 examining various measures of night-to-night variability in sleep in relation to metabolic syndrome (MetS), type 2 diabetes (T2D), and their risk factors. We illustrate a potential causal pathway between irregular sleep patterns and T2D, highlighting knowledge gaps along the way. RECENT FINDINGS Across different measures of sleep variability, irregular sleep patterns were associated with poorer cardiometabolic outcomes. Higher standard deviations (SD) across nights of sleep duration and onset or midpoint of sleep were associated with increased odds of having MetS and clusters of metabolic abnormalities as well as greater adiposity and poorer glycemic control. Conversely, greater regularity of rest-activity patterns related to lower risk for T2D. Social jetlag was associated with glycemic dysregulation, adiposity, T2D, and MetS. These associations are often observed in both metabolically healthy and unhealthy individuals; both higher SD of sleep duration and social jetlag relate to poorer glucose regulation in individuals with diabetes. There is consistent evidence of associations of sleep variability with increased risk for adiposity, glucose dysregulation, T2D, and MetS. Although experimental evidence is needed to determine causation, there is support to recommend stabilizing sleep patterns for cardiometabolic risk prevention.
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Affiliation(s)
- Faris M Zuraikat
- Department of Medicine, Sleep Center of Excellence, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Nour Makarem
- Department of Medicine, Sleep Center of Excellence, Columbia University Irving Medical Center, New York, NY, 10032, USA
- Department of Medicine, Columbia University Irving Medical Center, 51 Audubon Avenue, 5th floor, New York, NY, USA
| | - Susan Redline
- Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Brooke Aggarwal
- Department of Medicine, Sleep Center of Excellence, Columbia University Irving Medical Center, New York, NY, 10032, USA
- Department of Medicine, Columbia University Irving Medical Center, 51 Audubon Avenue, 5th floor, New York, NY, USA
| | - Sanja Jelic
- Department of Medicine, Sleep Center of Excellence, Columbia University Irving Medical Center, New York, NY, 10032, USA
- Department of Medicine, Columbia University Irving Medical Center, 630 West 168th Street, P&S8-512, New York, NY, USA
| | - Marie-Pierre St-Onge
- Department of Medicine, Sleep Center of Excellence, Columbia University Irving Medical Center, New York, NY, 10032, USA.
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15
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Abstract
Circadian rhythms are observed in most physiologic functions across a variety of species and are controlled by a master pacemaker in the brain called the suprachiasmatic nucleus. The complex nature of the circadian system and the impact of circadian disruption on sleep, health, and well-being support the need to assess internal circadian timing in the clinical setting. The ability to assess circadian rhythms and the degree of circadian disruption can help in categorizing subtypes or even new circadian rhythm disorders and aid in the clinical management of the these disorders.
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Affiliation(s)
- Kathryn J Reid
- Department of Neurology, Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, 710 North Lakeshore Drive, Abbott Hall Room 522, Chicago, IL 60611, USA.
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