Chronotype, Unhealthy Lifestyle, and Diabetes Risk in Middle-Aged U.S. Women : A Prospective Cohort Study

The metabolic and circadian signatures of gestational diabetes in the postpartum period characterised using multiple wearable devices

AIMS/HYPOTHESIS

Gestational diabetes mellitus (GDM) affects 14% of all pregnancies worldwide and is associated with cardiometabolic risk. We aimed to exploit high-resolution wearable device time-series data to create a fine-grained physiological characterisation of the postpartum GDM state in free-living conditions, including clinical variables, daily glucose dynamics, food and drink consumption, physical activity, sleep patterns and heart rate.

METHODS

In a prospective observational study, we employed continuous glucose monitors (CGMs), a smartphone food diary, triaxial accelerometers and heart rate and heart rate variability monitors over a 2 week period to compare women who had GDM in the previous pregnancy (GDM group) and women who had a pregnancy with normal glucose metabolism (non-GDM group) at 1-2 months after delivery (baseline) and 6 months later (follow-up). We integrated CGM data with ingestion events recorded with the smartphone app MyFoodRepo to quantify the rapidity of returning to preprandial glucose levels after meal consumption. We inferred the properties of the underlying 24 h rhythm in the baseline glucose. Aggregating the baseline and follow-up data in a linear mixed model, we quantified the relationships between glycaemic variables and wearable device-derived markers of circadian timing.

RESULTS

Compared with the non-GDM group (n=15), the GDM group (n=22, including five with prediabetes defined based on fasting plasma glucose [5.6-6.9 mmol/l (100-125 mg/dl)] and/or HbA1c [39-47 mmol/mol (5.7-6.4%)]) had a higher BMI, HbA1c and mean amplitude of glycaemic excursion at baseline (all p≤0.05). Integrating CGM data and ingestion events showed that the GDM group had a slower postprandial glucose decrease (p=0.01) despite having a lower proportion of carbohydrate intake, similar mean glucose levels and a reduced amplitude of the underlying glucose 24 h rhythm (p=0.005). Differences in CGM-derived variables persisted when the five women with prediabetes were removed from the comparison. Longitudinal analysis from baseline to follow-up showed a significant increase in fasting plasma glucose across both groups. The CGM-derived metrics showed no differences from baseline to follow-up. Late circadian timing (i.e. sleep midpoint, eating midpoint and peak time of heart rate) was correlated with higher fasting plasma glucose and reduced amplitudes of the underlying glucose 24 h rhythm (all p≤0.05).

CONCLUSIONS/INTERPRETATION

We reveal GDM-related postpartum differences in glucose variability and 24 h rhythms, even among women clinically considered to be normoglycaemic. Our results provide a rationale for future interventions aimed at improving glucose variability and encouraging earlier daily behavioural patterns to mitigate the long-term cardiometabolic risk of GDM.

TRIAL REGISTRATION

ClinicalTrials.gov no. NCT04642534.

Do patients with severe acne vulgaris prefer the evening chronotype more? A case-control study

This study aimed to investigate sleep quality, chronotype preferences, anxiety, and depression levels in patients diagnosed with acne vulgaris and compare them with healthy controls. This cross-sectional case-control study included 92 patients with acne vulgaris and 59 age- and sex-matched healthy controls. Acne severity was assessed using the Global Acne Grading System (GAGS); sleep quality using the Pittsburgh Sleep Quality Index (PSQI); chronotype preferences using the Morningness-Eveningness Questionnaire (MEQ); and anxiety and depression levels using the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI). There were no significant differences in the MEQ, BDI, or BAI scores between the two groups. The PSQI score was significantly higher in the patient group than that in the control group. Acne severity was negatively correlated with the MEQ scores and positively correlated with the PSQI scores. When the patient group was divided into three subgroups according to acne severity (mild, moderate, and severe), significant differences in MEQ and BAI scores were observed between the groups. According to the post-hoc analysis, the severe acne group had higher BAI scores, while the mild acne group had higher MEQ scores. It would be more appropriate to be aware of the potential psychiatric comorbidities of acne vulgaris and adopt a multidisciplinary approach to the treatment and management process.

The relationship between depression and insulin resistance in the population without diabetes: Results from the 2005-2016 NHANES

BACKGROUND

Insulin resistance (IR), a precursor of type 2 diabetes and other metabolic disorders, is becoming more common owing to rising obesity rates. Depression, which affects 4.4 % of the global population, has been linked to IR; however, the findings are inconsistent. The roles of moderating factors in the depression-IR relationship remain underexplored, creating a gap in the current understanding.

METHODS

Data from six cycles of the National Health and Nutrition Examination Survey (NHANES, 2005-2016), including 6636 participants without diabetes, were analyzed. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9), with scores of 5-9 and 10-27 defined as mild and moderate-to-severe depression, respectively. IR was measured using the HOMA2-IR model, with IR defined as a value of ≥ 2.3. Weighted generalized linear models (GLMs) were used to investigate the relationship between depression and IR. Stratified analyses were used to evaluate the potential moderators.

RESULTS

After adjusting for demographic factors and metabolic indicators, the results of GLMs analysis showed that moderate-to-severe depression significantly increased the odds of IR (OR = 1.65, 95 % CI: 1.04-2.61, p = 0.035), especially in non-Hispanic White individuals (OR = 2.64, 95 % CI: 1.39-5.00, p = 0.004). Antidepressant use also reduced this association.

CONCLUSION

Moderate-to-severe depression was significantly associated with IR, and race/ethnicity and antidepressant use were important moderators. These findings underscore the need for targeted interventions to address both mental and metabolic health risks in high-risk populations.

Healthy Lifestyle Behaviors Attenuate the Effect of Poor Sleep Patterns on Chronic Kidney Disease Risk: A Prospective Study from the UK Biobank

OBJECTIVES

This study aimed to assess the impact of modifiable lifestyle behaviors on the association between sleep patterns and chronic kidney disease (CKD) risk.

METHODS

This study included 294,215 UK Biobank participants initially without CKD, followed until 13 October 2023. Sleep patterns were derived from five sleep factors, including sleep duration, chronotype, insomnia, snoring, and daytime dozing. The healthy lifestyle score (HLS) was newly calculated based on smoking status, physical activity, diet, body mass index, and mental health. Cox's proportional hazards models were used to assess the associations between sleep patterns, HLS, and CKD risk.

RESULTS

A total of 17,357 incident CKD cases were identified during a median follow-up of 14.5 (interquartile range: 13.7-15.3) years. Both sleep patterns and HLS were independently associated with increased CKD risk (p-trend < 0.001). Importantly, the HLS was found to modify the association between sleep patterns and CKD risk (p-interaction = 0.026). Among participants with a low HLS, medium (HR = 1.12; 95% CI 1.05-1.19) and poor sleep patterns (HR = 1.23; 95% CI 1.17-1.30) increased CKD risk to varying degrees, whereas no significant association was observed for a high HLS. Moreover, the combination of a low HLS and poor sleep pattern significantly increased the risk of incident CKD (HR = 2.19; 95% CI 2.00-2.40).

CONCLUSIONS

A high HLS may significantly reduce CKD risk associated with poor sleep, whereas a low HLS may exacerbate this risk. These findings underscore the critical importance of lifestyle interventions as a primary prevention strategy for CKD.

Misalignment Between Circadian Preference and Accelerometer-Derived Sleep-Wake Cycle With Increased Risk of Cardiometabolic Diseases

Background

The relationship of circadian misalignment, sleep-wake cycle, and cardiometabolic diseases (CMDs) remains unclear.

Objectives

This prospective study investigated the associations between circadian misalignment and CMDs, including type 2 diabetes (T2D), coronary heart disease (CHD), and stroke, and explored potential mechanisms.

Methods

Data from 60,965 participants without pre-existing CMDs from the UK Biobank study and followed for an average of 7.9 years were analyzed. Circadian misalignment was determined by comparing self-reported chronotype and accelerometer-derived sleep timing. Incident CMDs were documented via multiple medical registries and self-reported information. Cox proportional hazards models were applied to estimate HRs and 95% CIs for these associations.

Results

A U-shaped relationship between circadian misalignment and both T2D and CHD was observed. Compared to individuals with aligned midsleep and circadian preferences (the third quintile, Q3), those with advanced and delayed circadian misalignment had higher risks of T2D (HR: 1.22 [95% CI: 1.03-1.45] for Q1 and 1.39 [95% CI: 1.18-1.62] for Q5). Delayed circadian misalignment also associated with higher CHD risk (HR: 1.15 [95% CI: 1.01-1.31] for Q4 and 1.16 [95% CI: 1.02-1.33] for Q5). The association between delayed circadian misalignment and CMDs was greater in women (T2D, P interaction  = 0.03) and younger adults (CHD, P interaction  = 0.02). Early (HR: 1.19 [95% CI: 1.06-1.34]), rather than late, chronotype was associated with an increased T2D risk.

Conclusions

Both advanced and delayed circadian misalignment were associated with an increased CMD risk, highlighting the potential health benefits of aligning sleep-wake cycles with individual circadian preferences.

Association between Accelerometer-Measured Irregular Sleep Duration and Longitudinal Changes in Body Mass Index in Older Adults

Irregular sleep duration may disrupt circadian rhythms and contribute to metabolic, behavioral, and mood changes, potentially increasing the risk for obesity. However, quantitative data on the relationship between sleep duration irregularity and weight change are lacking. In this prospective study, we analyzed data from 10,572 participants (mean age: 63 years) in the UK Biobank who wore accelerometers for a week between 2013-2015 and had two body mass index (BMI; kg/m 2 ) measurements on average 2.5 years apart. Irregular sleep duration was assessed by the within-person standard deviation (SD) of 7-night accelerometer-measured sleep duration. Participants with sleep duration SD >60 minutes versus ≤30 minutes had 0.24 kg/m 2 (95% CI: 0.08, 0.40) higher BMI change (kg/m 2 ), standardized to three-year intervals, and 80% (95% CI: 1.28, 2.52) higher risk for incident obesity, after adjusting for sociodemographic factors, shift work, and baseline BMI or follow-up period (p-trend<0.02 for both). These associations remained consistent after adjusting for lifestyle, comorbidities, and other sleep factors, including sleep duration. Age, sex, baseline BMI, and genetic predisposition to higher BMI (measured with a polygenic risk score) did not appear to modify the association. Since irregular sleep duration is common, trials of interventions targeting sleep irregularity might lead to new public health strategies that tackle obesity.

Chronotypes in middle-aged women with polycystic ovary syndrome: A population-based study

INTRODUCTION

Circadian rhythm disruption has been associated with the risk of polycystic ovary syndrome (PCOS), as the evening chronotype (EC) shares several traits with PCOS, including metabolic disorders, cardiovascular diseases, and psychiatric disorders. It has been suggested that the biological clock could be targeted with new, preventive, and therapeutic strategies for PCOS in women with biorhythm disorders. We evaluated inner circadian rhythmicity in middle-aged women with PCOS in a population-based setting, focusing on whether women with PCOS and an EC have a specific subtype in relation to their clinical characteristics.

MATERIAL AND METHODS

The data derived from the Northern Finland Birth Cohort, a population-based longitudinal birth cohort of 12 058 individuals born in 1966. We compared the circadian phenotype between 314 women with PCOS (according to the Rotterdam criteria) and 1248 women without PCOS at age 46 years using the validated Finnish shortened 6-item Morningness-Eveningness Questionnaire (sMEQ) and the single-item self-assessed morningness-eveningness question.

RESULTS

PCOS was not associated with the EC by the sMEQ (p = 0.495) or self-assessment (p = 0.303). The self-assessed morningness-eveningness values differed from the sMEQ chronotype distribution (p < 0.001), nevertheless, the most frequent chronotype was the intermediate chronotype (IC) determined by both chronotyping methods (sMEQ PCOS 47.7% vs. 45.2% non-PCOS; self-assessment PCOS 66.5% vs. 68.4% non-PCOS). The hyperandrogenic PCOS phenotypes A-C did not differ from the non-hyperandrogenic phenotype D as for the chronotype (p = 0.271). The EC was associated in both groups with depressive and anxiety symptoms (PCOS p = 0.012, non-PCOS p < 0.001) and the use of sleep medication (PCOS p = 0.017, non-PCOS p < 0.001).

CONCLUSIONS

The EC was not over-represented in middle-aged women with PCOS or in the hyperandrogenic PCOS phenotypes A-C in our study. This does not support the need for chronotyping in the comprehensive assessment of women with PCOS. However, as chronotypes tend to change with aging, cross-sectional studies in different age groups are warranted to draw conclusions on the role of chronotypes in PCOS and the associated metabolic risks.

Association between insulin resistance indices and kidney stones: results from the 2015-2018 National Health and Nutrition Examination Survey

Objective

To explore the association between representative insulin resistance (IR) indices and the risk of kidney stone disease in an American adult population. The representative IR indices referred to metabolic score for IR (METS-IR), triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio, triglyceride glucose-body mass index (TyG-BMI), visceral adiposity index (VAI), and homeostatic model assessment of IR (HOMA-IR).

Methods

We investigated adult participants who joined the 2015-2018 National Health and Nutrition Examination Survey (NHANES) and reported kidney stone histories. Weighted proportions, multivariable regression analysis, and restricted cubic splines were used to evaluate the associations between IR indices and kidney stones after their adjustment for gender, age, race, education, smoking status, alcohol drinking frequency, hypertension and diabetes status, physical activity level, water intake, and levels of calcium, cholesterol, and uric acid.

Results

A total of 19,225 participants were included. The weighted prevalence of kidney stone was 11.1%. A multivariable logistic regression model showed a dose-response relationship between the METS-IR and kidney stone [odds ratio (OR) = 1.02, 95% confidence interval (CI) (1.01, 1.04), p < 0.01]. A similar relationship was observed between the TyG-BMI and kidney stone after full adjustment [OR = 1.0, 95% CI (1.0, 1.01), p < 0.001]. Sex-stratified analyses revealed that the association between METS-IR and nephrolithiasis [OR = 1.03, 95% CI (1.01, 1.05), p < 0.01], and the association between TyG-BMI and nephrolithiasis [OR = 1.01, 95% CI (1.0, 1.01), p <0.001] was significant among the male participants in the fully adjusted model. Moreover, a significant association was found between the METS-IR levels and nephrolithiasis [OR = 1.03, 95% CI (1.01, 1.06), p < 0.01], and between the TyG-BMI levels and nephrolithiasis [OR = 1.01, 95% CI (1.0, 1.01), p < 0.05] among the diabetic participants after full adjustment. Furthermore, a potential nonlinear association was found between other IR indices (i.e., TG/HDL-C, VAI, and HOMA-IR) and the risk of kidney stone disease.

Conclusion

Higher METS-IR and TyG-BMI levels were associated with a higher risk of nephrolithiasis. Future investigations are required to identify the role of IR in the progress of kidney stone formation and to propose prevention measures and health guidelines.

Association Between Accelerometer-Measured Irregular Sleep Duration and Type 2 Diabetes Risk: A Prospective Cohort Study in the UK Biobank

OBJECTIVE

To evaluate the association between irregular sleep duration and incident diabetes in a U.K. population over 7 years of follow-up.

RESEARCH DESIGN AND METHODS

Among 84,421 UK Biobank participants (mean age 62 years) who were free of diabetes at the time of providing accelerometer data in 2013-2015 and prospectively followed until May 2022, sleep duration variability was quantified by the within-person SD of 7-night accelerometer-measured sleep duration. We used Cox proportional hazard models to estimate hazard ratios (HRs) for incident diabetes (identified from medical records, death register, and/or self-reported diagnosis) according to categories of sleep duration SD.

RESULTS

There were 2,058 incident diabetes cases over 622,080 person-years of follow-up. Compared with sleep duration SD ≤ 30 min, the HR (95% CI) was 1.15 (0.99, 1.33) for 31-45 min, 1.28 (1.10, 1.48) for 46-60 min, 1.54 (1.32, 1.80) for 61-90 min, and 1.59 (1.33, 1.90) for ≥91 min, after adjusting for age, sex, and race. We found a nonlinear relationship (P nonlinearity 0.0002), with individuals with a sleep duration SD of >60 vs. ≤60 min having 34% higher diabetes risk (95% CI 1.22, 1.47). Further adjustment for lifestyle, comorbidities, environmental factors, and adiposity attenuated the association (HR comparing sleep duration SD of >60 vs. ≤60 min: 1.11; 95% CI 1.01, 1.22). The association was stronger among individuals with lower diabetes polygenic risk score (PRS; P interaction ≤ 0.0264) and longer sleep duration (P interaction ≤ 0.0009).

CONCLUSIONS

Irregular sleep duration was associated with higher diabetes risk, particularly in individuals with a lower diabetes PRS and longer sleep duration.

Assessment of Chronotype Distribution Among University Students and Its Association With Lifestyle Characteristics and Academic Performance

BACKGROUND

 Chronotype is associated with the timing of peak physical and mental performance and activity levels. University students may experience changes in their chronotype, influencing their daytime activity and academic performance. This study aims to assess the distribution of chronotypes among a sample of university students from southern Saudi Arabia, examining its association with demographic, academic, and lifestyle factors.

METHODS

 A cross-sectional study was conducted at Jazan University, located in the southwestern region of Saudi Arabia, between February and March 2023. Data collection was carried out using a structured questionnaire comprising three main components: demographic and academic data of participants, lifestyle characteristics, and an assessment of chronotype using the reduced version of the Horne and Östberg morningness-eveningness questionnaire. Associations between chronotype and demographic/lifestyle characteristics were analyzed using Pearson's chi-squared test or Fisher's exact test.

RESULTS

 The study included 507 students. The mean age of the participants was 22 years (standard deviation: 2.07), with over half being male 277 (54.6%). The chronotype assessment indicated that 139 (27.4%) of students were morning types, 112 (22.1%) evening types, and 256 (50.5%) were neither type. Statistically significant variations in chronotypes were found in relation to the year of study, perceived influence of sleep habits on academic performance, meal frequency, consumption of fast food and certain caffeinated beverages, and smoking or Khat chewing habits (P < 0.05).

CONCLUSION

 The findings suggest that an unhealthy lifestyle and the use of certain stimulants can influence chronotypes. Students with an evening chronotype should be a focus for university health services, allowing early identification and counseling to mitigate the negative impact of a disturbed chronotype on academic performance and reduce the risk of study-related stress.

Sleep traits and breast cancer risk: a two-sample Mendelian randomization study

Globally, breast cancer continues to be the leading cause of cancer-related incidence and mortality among females. Research has shown that sleep patterns significantly influence tumor onset and progression. In this research, the association was examined through the application of a two-sample Mendelian randomization (MR) approach. For the analysis of seven sleep patterns, genetic tools were sourced from both the UK Biobank and 23andMe, including morning/evening person (chronotype) n = 177,604, morning person (chronotype) n = 248,094, daytime dozing/sleepiness n = 193,472, getting up in the morning n = 193,717, and sleeplessness n = 193,987; sleep duration n = 192,810; and nap during the day n = 166,853. The Breast Cancer Association Consortium (BCAC) supplied genome-wide association studies (GWAS) data, including 133,384 breast cancer cases and 113,789 controls, alongside subtype-specific data with 106,278 cases and 91,477 controls. We discovered that chronotype encompasses both morning and evening types contributes to the risk of overall breast cancer. While daytime dozing and morning person (chronotype) are linked to a lower risk of breast cancer in general, In subtype-specific analyses, morning person (chronotype) was negatively associated with luminal B, HER2-negative-like, and daytime dozing was negatively correlated with luminal A-like, luminal B-like, and HER2-enriched-like. The study corroborates that chronotype is a danger element for breast cancer, aligning with previous observational findings. The association between being a morning person (chronotype) or having daytime dozing and a decreased risk of breast cancer underscores the significance of sleep patterns in formulating strategies for cancer prevention.

The multimorbidity association of metabolic syndrome and depression on type 2 diabetes: a general population cohort study in Southwest China

Background

Metabolic syndrome(MetS) and depression are independently associated with type 2 diabetes (T2DM) risk. However, little is known about the combined effect of MetS and depression on the risk of T2DM. The present study aims to prospectively explore the impact of MetS and depression on T2DM susceptibility among the Chinese general population.

Methods

6489 general population without T2DM adults in Southwest China were recruited from 2010 to 2012. Depression and MetS were prospectively assessed using a 9-item Patient Health Questionnaire(PHQ-9) and Guideline for the prevention and treatment of type 2 diabetes mellitus in China (2020 edition) (CDS2020) during 2016-2020, respectively. Modified Poisson regression models were conducted to estimate relative risk(RR) and 95% confidence intervals (95%CI) for independent and combined associations of MetS and depression with an incidence of T2DM.

Results

During a median follow-up of 6.6 years, 678 cases of T2DM were documented. Individuals with MetS were 1.33 times more likely to develop T2DM than those without MetS. The corresponding RR(95%CI) for depression with no depression was 1.45(1.22-1.72). Notably, compared with no MetS or depression, the multivariate-adjusted RR for a combined effect of MetS and depression on the risk of T2DM was 2.11(1.39-3.22). Moreover, an increased risk of T2DM was more apparent in those ≥ 60 years, males, and overweight.

Conclusions

Individuals with multimorbidity of MetS and depression are at a higher risk of T2DM compared with those with no MetS or depression.

Eating Patterns, Chronotypes, and Their Relationship with Metabolic Health in the Early Postpartum Period in Women after Gestational Diabetes Mellitus

Observational studies have shown a relationship between eating patterns and chronotypes with metabolic health in the general population and in healthy pregnancies. Data are lacking in the postpartum period, which is characterized by an externally driven misalignment of sleep and food intake. We investigated the associations between eating patterns, chronotypes, and metabolic health in the early postpartum period in women who had gestational diabetes mellitus (GDM). We prospectively included 313 women who completed their 6-8 weeks postpartum visit between January 2021 and March 2023 at the Lausanne University Hospital. Women filled questionnaires on the timing of food intake, sleep (a shortened Pittsburgh Sleep Quality Questionnaire), and the chronotype (the Morningness-Eveningness Questionnaire) and underwent HbA1c and fasting plasma glucose measurements. After adjustments for weight, sleep quality, or breastfeeding, the later timing of the first and last food intake were associated with higher fasting plasma glucose and HbA1c levels 6-8 weeks postpartum (all p ≤ 0.046). A higher number of breakfasts per week and longer eating durations were associated with lower fasting plasma glucose levels (all p ≤ 0.028). The chronotype was not associated with metabolic health outcomes. Eating patterns, but not the chronotype, were associated with worsened metabolic health in the early postpartum period in women with previous GDM.

Waking Up to the Importance of Sleep in Type 2 Diabetes Management: A Narrative Review

For the first time, the latest American Diabetes Association/European Association for the Study of Diabetes (ADA/EASD) consensus guidelines have incorporated a growing body of evidence linking health outcomes associated with type 2 diabetes to the movement behavior composition over the whole 24-h day. Of particular note, the importance of sleep as a key lifestyle component in the management of type 2 diabetes is promulgated and presented using three key constructs: quantity, quality, and timing (i.e., chronotype). In this narrative review we highlight some of the key evidence justifying the inclusion of sleep in the latest consensus guidelines by examining the associations of quantity, quality, and timing of sleep with measures of glycemia, cardiovascular disease risk, and mortality. We also consider potential mechanisms implicated in the association between sleep and type 2 diabetes and provide practical advice for health care professionals about initiating conversations pertaining to sleep in clinical care. In particular, we emphasize the importance of measuring sleep in a free-living environment and provide a summary of the different methodologies and targets. In summary, although the latest ADA/EASD consensus report highlights sleep as a central component in the management of type 2 diabetes, placing it, for the first time, on a level playing field with other lifestyle behaviors (e.g., physical activity and diet), the evidence base for improving sleep (beyond sleep disorders) in those living with type 2 diabetes is limited. This review should act as a timely reminder to incorporate sleep into clinical consultations, ongoing diabetes education, and future interventions.

Association of sleep duration, chronotype, social jetlag, and sleep disturbance with phenotypic age acceleration: A cross-sectional analysis

OBJECTIVE

Sleep is a critical health-related behavior; research evidence has shown that sleep duration, poor sleep quality and insomnia are associated with aging and relevant age-related diseases. However, the associations between sleep duration, chronotype, sleep disturbance, and biological age have not been comprehensively assessed. This study aimed to examine sleep characteristics with biological age.

METHODS

The study included 6534 participants aged 20 years and older from the National Health and Nutrition Examination Survey between 2017 and March 2020. Sleep questionnaires were used to collect information on sleep duration and wake behavior on workdays and workfree days and sleep disturbance. Phenotypic age acceleration (PhenoAgeAccel) was estimated as a biological age measure using 9 blood chemistry biomarkers.

RESULTS

Long sleep (>9 hours) and extremely short sleep (≤4 hours) on workdays were positively associated with PhenoAgeAccel, compared with optimal sleep duration (7-8 hours). Similar positive associations with PhenoAgeAccel were observed for sleep duration on workfree days and across the whole week. Both slightly evening and evening chronotypes were associated with faster PhenoAgeAccel compared to morning chronotype. Social jetlag and sleep disturbance were not associated with PhenoAgeAccel, while long corrected social jetlag was associated with faster PhenoAgeAccel. The associations of sleep duration, chronotype, and corrected social jetlag with PhenoAgeAccel appeared stronger among females than among males.

CONCLUSIONS

Findings suggest a U-shape relationship between sleep duration and biological aging; slightly evening and evening chronotypes may be risk factors for aging. Further studies are needed to confirm these findings.

Investigating Chronotype and Sleep Quality in Psoriatic Patients: Results from an Observational, Web-Based Survey

BACKGROUND

Psoriasis is an inflammatory disease for which the implications and repercussions go far beyond the skin. Psoriasis patients suffer not only due to its skin manifestations and related symptoms but also because of comorbidities and a huge emotional impact.

OBJECTIVE

The objective of this study was to investigate chronotype and sleep quality in a group of Italian psoriatic patients.

MATERIALS AND METHODS

An observational, cross-sectional, web-based study was set up by the Dermatology and Clinical Medicine Sections of the Department of Medical Sciences, University of Ferrara, Italy. The web questionnaire was sent to an email list of an Italian association of psoriatic patients with the aim of recording their main demographic, social, historical, and clinical data. The survey included two questionnaires: the Morningness-Eveningness Questionnaire (MEQ) and the Pittsburg Sleep Quality Index (PSQI).

RESULTS

Two hundred and forty-three psoriatic patients (mean age 52.9 ± 12.8 yrs., 32.5% males and 67.5% females) filled out the questionnaire. A good 63.8% of them were affected with psoriasis for more than 10 years, 25.9% reported having a diffuse psoriasis, and 66.7% were on treatment at the time they completed the questionnaire. With reference to chronotype, the mean MEQ score was 55.2 ± 10.7; furthermore, 44% of the patients were "morning-oriented types", M-types, or "larks", 44.5% were "intermediate-types" or I-types, and 11.5% were "evening-oriented types", E-types, or "owls". No correlations were found between chronotype and psoriasis extension. Based on the PSQI results, 72.8% of the study population was judged to have a low sleep quality. Sleep disturbance was significantly related to female sex, living alone, and the presence of comorbidities.

CONCLUSIONS

Sleep disturbance is very common in psoriatic patients, especially in those with comorbidities, in females, and in patients who live alone. The chronotype in psoriatic patients does not appear different when compared to the general population, nor does it seem to have any link with psoriasis severity.