Factors Affecting Abdominal Obesity: Analyzing National Data

The purpose of this study is to understand the factors affecting abdominal obesity. A secondary data analysis was conducted to analyze 5262 individuals' data from the 2020 Korea National Health and Nutrition Examination Survey. The prevalence of obesity was slightly higher in men than women, while abdominal obesity was more prevalent in women. A higher correlation with obesity was observed in young and middle-aged individuals, unmarried individuals, urban residents, those with good subjective health, low-stress perception, moderate alcohol consumption, nonsmokers, regular aerobic exercisers, and those getting more than seven hours of sleep. In contrast, middle-aged and elderly individuals, married individuals, rural residents, those with an elementary school or lower education level, those with low-to-moderate income, those with fair or poor subjective health, high stress perception, nondrinkers, smokers, nonregular aerobic exercisers, and those getting less than seven hours of sleep had a higher correlation with abdominal obesity. Health education suggests that everyone should maintain healthy lifestyle habits, such as getting sufficient sleep, exercise, smoking cessation, and moderate drinking. Specifically, diverse health management support focusing on population groups with demographic factors related to the risk of obesity and abdominal obesity is necessary.

[Analysis of inducement of benign paroxysmal positional vertigo]

Objective:To analyze the related factors that may affect the onset of benign paroxysmal positional vertigo（BPPV）. Methods:Fifty BPPV patients treated in Department of Otolaryngology Head and Neck Surgery, Shanxi Provincial People's Hospital from May to September 2023 were selected as the case group, and 50 healthy adults were selected as the control group. Relevant information was collected by means of questionnaire survey and medical history inquiry. The two groups were compared in terms of sleep time, night sleep duration, wake times, underlying diseases（hypertension, diabetes, coronary heart disease, etc.） and negative emotional impact. Results:The proportion of male and female in the case group was 16% and 84%, and that in the control group was 20% and 80%. The mean age of the case group was（54.66±13.39） years old, and the mean age of the control group was（54.42±12.55） years old, ranging from 27 to 80 years old. The sleeping time of the case group was significantly later than that of the healthy group, and the difference was statistically significant（P<0.05）. The night sleep duration of the case group was shorter than that of the healthy group, the difference was statistically significant（P<0.05）. There was no significant difference in awakening times between the case group and the healthy group（P>0.05）. There were more patients in the case group with underlying diseases（54%） and affected by negative emotions（70%） than in the healthy group, and the difference was statistically significant（P<0.05）. Conclusion:Late sleep time, short sleep duration at night, accompanied by underlying diseases and negative emotions can affect the onset of BPPV.

Short sleep time may be the main reason for irregular breakfast to cause overweight-a cross-sectional study

Introduction

In recent years, the relationship between circadian rhythm and overweight and obesity has attracted the attention of many scholars.

Methods

To evaluate association between the duration of sleep and the regularity of breakfast and overweight. A total of 1,178 students from Qingdao University were selected by stratified cluster sampling. There were 601 males (24.69 ± 0.80 years old) and 569 females (24.54 ± 0.70 years old). We used body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) to define overweight levels. Chi-square test, Pearson correlation test, and logistic regression were applied to test association among overweight, sleep duration, sleep onset time, and breakfast regularity. Pittsburgh sleep quality index was used to assess the overall sleep quality of the study subjects. Mediation effect and Sobel test were used to analyze the effect of sleep duration on breakfast regularity and overweight.

Results

Only 34.1% of the population ate breakfast every day, and eating breakfast 1-3 times per week was associated with a higher risk of overweight (BMI: OR = 2.183, 95%CI: 1.369,3,481; WC: OR = 2.101, 95%CI: 1.232,3,583; WHR: OR = 2.108, 95%CI: 1.331,3,337). The effects of all types of Usual Breakfast Consumption Frequency on overweight were fully mediated by sleep duration (p < 0.05). In particular, the subjects exercised outdoors more than five times per week slept longer (p < 0.05).

Conclusion

Short sleep duration may be the main reason for irregular breakfast leading to overweight. Adequate outdoor exercise is essential for weight maintenance.

Examining the sleeping habits of preschool and elementary school children in Southern Slovakia

OBJECTIVES

Our research aimed to examine children's sleeping habits from preschool to the end of elementary school age. Developing proper sleeping habits in childhood is essential, as it is decisive for the rest of our lives.

METHODS

A total of 339 children (160 males and 179 females) took part in the research, of which 145 were preschool-age children (3-7 years old), 72 lower-grade elementary school children (6-11 years old), and 122 upper-grade elementary school children (12-16 years old). The questionnaire was completed in a paper form (elementary school students) and online (kindergarten children).

RESULTS

The research results show that most of the children spend enough time sleeping following the recommendations. In case of the kindergarten children, the younger ones also sleep in the afternoon on weekends (average of 3.66 years, 28.3%), and the older ones do not sleep in the afternoon either in kindergarten during the week or at home at the weekend (average of 5.22 years, 46.2%). The use of blue light typically increases with age; 39% of the preschoolers, 61% of the 6-11-year-olds, and 67% of the 12-16-year-olds use it before falling asleep. Sleep aids and rituals are used by 87.6% of the preschoolers, 67.4% of the 6-11-year-olds, and 34.4% of the 12-16-year-olds, because significantly more preschoolers find it more difficult to fall asleep than older children. At night, 40% of the preschoolers wake up at least once (due to biological needs - 46.3%), 32% of the 6-11-year-olds wake up at night (due to nightmares - 42.3%), and 41% of the 12-16-year-olds also wake up all night (due to biological needs - 31.9%, and due to noise - 29.8%).

CONCLUSION

Although the children get enough sleep, significantly more upper-grade school children feel tired in the morning. It is essential to help sleep and eliminate factors that prevent falling asleep to create a healthy circadian rhythm in the life of children.

Exploring Variations in Sleep Perception: Comparative Study of Chatbot Sleep Logs and Fitbit Sleep Data

BACKGROUND

Patient-generated health data are important in the management of several diseases. Although there are limitations, information can be obtained using a wearable device and time-related information such as exercise time or sleep time can also be obtained. Fitbits can be used to acquire sleep onset, sleep offset, total sleep time (TST), and wakefulness after sleep onset (WASO) data, although there are limitations regarding the depth of sleep and satisfaction; therefore, the patient's subjective response is still important information that cannot be replaced by wearable devices.

OBJECTIVE

To effectively use patient-generated health data related to time such as sleep, it is first necessary to understand the characteristics of the time response recorded by the user. Therefore, the aim of this study was to analyze the characteristics of individuals' time perception in comparison with wearable data.

METHODS

Sleep data were acquired for 2 weeks using a Fitbit. Participants' sleep records were collected daily through chatbot conversations while wearing the Fitbit, and the two sets of data were statistically compared.

RESULTS

In total, 736 people aged 30-59 years were recruited for this study, and the sleep data of 543 people who wore a Fitbit and responded to the chatbot for more than 7 days on the same day were analyzed. Research participants tended to respond to sleep-related times on the hour or in 30-minute increments, and each participant responded within the range of 60-90 minutes from the value measured by the Fitbit. On average for all participants, the chat responses and the Fitbit data were similar within a difference of approximately 15 minutes. Regarding sleep onset, the participant response was 8 minutes and 39 seconds (SD 58 minutes) later than that of the Fitbit data, whereas with respect to sleep offset, the response was 5 minutes and 38 seconds (SD 57 minutes) earlier. The participants' actual sleep time (AST) indicated in the chat was similar to that obtained by subtracting the WASO from the TST measured by the Fitbit. The AST was 13 minutes and 39 seconds (SD 87 minutes) longer than the time WASO was subtracted from the Fitbit TST. On days when the participants reported good sleep, they responded 19 (SD 90) minutes longer on the AST than the Fitbit data. However, for each sleep event, the probability that the participant's AST was within ±30 and ±60 minutes of the Fitbit TST-WASO was 50.7% and 74.3%, respectively.

CONCLUSIONS

The chatbot sleep response and Fitbit measured time were similar on average and the study participants had a slight tendency to perceive a relatively long sleep time if the quality of sleep was self-reported as good. However, on a participant-by-participant basis, it was difficult to predict participants' sleep duration responses with Fitbit data. Individual variations in sleep time perception significantly affect patient responses related to sleep, revealing the limitations of objective measures obtained through wearable devices.

Using a Decision Tree Algorithm Predictive Model for Sperm Count Assessment and Risk Factors in Health Screening Population

Purpose

Approximately 20% of couples face infertility challenges and struggle to conceive naturally. Despite advances in artificial reproduction, its success hinges on sperm quality. Our previous study used five machine learning (ML) algorithms, random forest, stochastic gradient boosting, least absolute shrinkage and selection operator regression, ridge regression, and extreme gradient boosting, to model health data from 1375 Taiwanese males and identified ten risk factors affecting sperm count.

Methods

We employed the CART algorithm to generate decision trees using identified risk factors to predict healthy sperm counts. Four error metrics, SMAPE, RAE, RRSE, and RMSE, were used to evaluate the decision trees. We identified the top five decision trees based on their low errors and discussed in detail the tree with the least error.

Results

The decision tree featuring the least error, comprising BMI, UA, ST, T-Cho/HDL-C ratio, and BUN, corroborated the negative impacts of metabolic syndrome, particularly high BMI, on sperm count, while emphasizing the link between good sleep and male fertility. Our study also sheds light on the potentially significant influence of high BUN on spermatogenesis. Two novel risk factors, T-Cho/HDL-C and UA, warrant further investigation.

Conclusion

The ML algorithm established a predictive model for healthcare personnel to assess low sperm counts. Refinement of the model using additional data is crucial for improved precision. The risk factors identified offer avenues for future investigations.

Children with asthma gained more weight during the Coronavirus Disease-2019 pandemic than in previous years: a case-control study

Objective:The objective of our study to evaluate weight changes and factors influencing weight gain in children with asthma during the coronavirus disease-2019 (COVID-19) pandemic.Methods:The study included 100 children with asthma, aged 5-17, from two regions in Turkey. Face-to-face written questionnaires were used, and siblings closest in age sharing the same household were taken as controls. Only 65 of these children had healthy sibling(s), aged between 2 and 25 years. One hundred children with asthma were compared in terms of weight gain and lifestyle factors before (March 2019 to March 2020) and after the pandemic (March 2020 to March 2021). To determine whether the weight gain differed from the control group, the 65 children with asthma were compared to their siblings.Results:Survey responses indicate that children with asthma performed less physical activity, were exposed to screens more, and slept later during the pandemic period than pre-pandemic (p = 0.003, p < 0.001, and p ≤ 0.001, respectively). Children with asthma and their siblings gained more weight during the pandemic than before the pandemic (both p < 0.001). However, children with asthma gained significantly more weight than their non-asthmatic siblings during the pandemic (p = 0.011). There was no statistical relationship between weight gain and physical activity, screen time, or sleep status.Conclusions:Children with asthma gained more weight during the COVID-19 pandemic than before the pandemic. They also gained more weight than their non-asthmatic siblings during the COVID-19 pandemic.

Impact of the COVID-19 Pandemic on the Lifestyle and Psychosocial Behavior of Patients with Inflammatory Bowel Diseases: A Narrative Review

The coronavirus disease (COVID-19) pandemic has had a considerable impact on the global healthcare system and potentially the clinical course of patients with inflammatory bowel disease (IBD). Although IBD is a chronic disease, its therapy (except steroid therapy) does not increase the risk of contracting or aggravating COVID-19. However, the clinical course of patients is significantly influenced by environmental factors. Social restrictions due to the pandemic or the fear of contracting the virus have influenced lifestyle and psychosocial behaviors that may worsen the clinical course of patients with IBD. This narrative literature review summarizes the current evidence on the impact of the COVID-19 pandemic on the lifestyle and psychosocial behaviors of patients with IBD. The COVID-19 pandemic negatively affected the lifestyle and psychosocial behaviors of patients with IBD. Furthermore, patients with IBD failed to maintain medication adherence, thus affecting the clinical course of their condition.

The associations between sleep timing and night sleep duration with dyslipidemia in a rural population: The Henan Rural Cohort Study

Evidence linking sleep timing and night sleep duration to dyslipidemia was limited and inconclusive, especially among low- and middle-income adults. The aims were to evaluate the associations between sleep timing, night sleep duration and dyslipidemia in a rural population. Based on the Henan Rural Cohort Study, a total of 37 164 participants were included. The Pittsburgh Sleep Quality Index was used to collect sleep information. Logistic regression and restrictive cubic splines were conducted to explore the associations. Of the 37 164 enrolled participants, 13881 suffered from dyslipidemia. Compared to the reference groups, people who went to sleep after 23:00 or woke up after 7:30 had higher prevalence of dyslipidemia, the adjusted odds ratios (ORs) and 95% confidence intervals (CIs)were 1.30 (1.20-1.41) and 1.34 (1.19-1.50). The adjusted OR (95%CI) of participants in the Late-sleep/Late-rise category compared to the Early-sleep/Early-rise category was 1.55 (1.08-1.23). Compared to the reference (7~≤8 h), the adjusted OR (95%CI) was 1.11 (1.03-1.20) for longer (>9 h) night sleep duration. Moreover, the combined effects of sleep duration (>9 h) with sleep time (22:00~) (OR = 1.46, 95%CI: 1.16-1.84), sleep duration (>9 h) with wake-up time (≥7:30) (OR = 1.28, 95%CI: 1.08-1.51), and sleep duration (>9 h) with the Late-sleep/Late-rise category (OR = 1.41, 95%CI: 1.14-1.75) increased the prevalence of dyslipidemia. Accordingly, our results indicate that delayed sleep timing and longer night sleep duration had independent and joint effects on higher risks of dyslipidemia in rural population.

Sleep Time and Depression Symptoms as Predictors of Cognitive Development Among Adolescents: A Cross-Lagged Study From China

Sleep time and depression symptoms are important factors affecting cognitive development in adolescents. Based on the China Education Panel Survey (CEPS) database, this study used a two-wave cross-lagged model to examine the bidirectional relationship between sleep time, depression symptoms, and cognitive development. Descriptive statistics showed that Chinese adolescents' cognitive development increased significantly from 7th to 8th grade in junior high school, but unfortunately, their depression level and average sleep time per night demonstrated a slightly deteriorating trend. Correlation analysis showed that there was a relatively stable negative correlation between cognitive development, sleep time, and depression symptoms. Moreover, the cross-lagged model revealed that there was a bidirectional relationship between cognitive development and sleep time, a bidirectional relationship between depression symptoms and sleep time, and a unidirectional relationship between depression symptoms and cognitive development. Male adolescents in the subgroup were consistent with the total sample. Among female adolescents, only cognitive development and sleep time have a bidirectional relationship, while depression symptoms and cognitive development, and depression symptoms and sleep time have a unidirectional relationship. Therefore, it is of significance to take targeted action to promote cognitive development and healthy growth in adolescents worldwide.

Machine Learning Predictive Models for Evaluating Risk Factors Affecting Sperm Count: Predictions Based on Health Screening Indicators

In many countries, especially developed nations, the fertility rate and birth rate have continually declined. Taiwan's fertility rate has paralleled this trend and reached its nadir in 2022. Therefore, the government uses many strategies to encourage more married couples to have children. However, couples marrying at an older age may have declining physical status, as well as hypertension and other metabolic syndrome symptoms, in addition to possibly being overweight, which have been the focus of the studies for their influences on male and female gamete quality. Many previous studies based on infertile people are not truly representative of the general population. This study proposed a framework using five machine learning (ML) predictive algorithms-random forest, stochastic gradient boosting, least absolute shrinkage and selection operator regression, ridge regression, and extreme gradient boosting-to identify the major risk factors affecting male sperm count based on a major health screening database in Taiwan. Unlike traditional multiple linear regression, ML algorithms do not need statistical assumptions and can capture non-linear relationships or complex interactions between dependent and independent variables to generate promising performance. We analyzed annual health screening data of 1375 males from 2010 to 2017, including data on health screening indicators, sourced from the MJ Group, a major health screening center in Taiwan. The symmetric mean absolute percentage error, relative absolute error, root relative squared error, and root mean squared error were used as performance evaluation metrics. Our results show that sleep time (ST), alpha-fetoprotein (AFP), body fat (BF), systolic blood pressure (SBP), and blood urea nitrogen (BUN) are the top five risk factors associated with sperm count. ST is a known risk factor influencing reproductive hormone balance, which can affect spermatogenesis and final sperm count. BF and SBP are risk factors associated with metabolic syndrome, another known risk factor of altered male reproductive hormone systems. However, AFP has not been the focus of previous studies on male fertility or semen quality. BUN, the index for kidney function, is also identified as a risk factor by our established ML model. Our results support previous findings that metabolic syndrome has negative impacts on sperm count and semen quality. Sleep duration also has an impact on sperm generation in the testes. AFP and BUN are two novel risk factors linked to sperm counts. These findings could help healthcare personnel and law makers create strategies for creating environments to increase the country's fertility rate. This study should also be of value to follow-up research.

Moderate-Vigorous Physical Activity, Screen Time and Sleep Time Profiles: A Cluster Analysis in Spanish Adolescents

The study had two aims: (1) To classify the adolescents according to their levels of moderate-vigorous physical activity, screen time and sleep time, and (2) to analyze, in a descriptive and correlational manner, the profiles of moderate-vigorous physical activity, screen time and sleep time of each cluster according to the sex and grade of the adolescents. The study design was cross-sectional, with descriptive and correlational analysis. The sample consisted of 663 adolescents in Compulsory Secondary Education from Soria (Spain). The Four by One-Day Physical Activity Questionnaire was used to measure levels of physical activity, screen time and sleep time. The results showed that the young people had an average of 67.99 ± min/day of moderate-vigorous physical activity, 112.56 min/day of screen time and 548.63 min/day of sleep time. Adolescents were classified into three clusters according to their levels of physical activity, screen time and sleep time (F_MANOVA (6,1318) = 314.439; p ≤ 0.001; β = 1; f = 1.177). In conclusion, only 28.21% of the young people accomplished the recommendations for physical activity practice, screen time and sleep time. Moreover, these results vary according to the sex and grade of the adolescents.

The Relationships between Physical Activity, Screen Time and Sleep Time According to the Adolescents' Sex and the Day of the Week

This study had two aims: (1) to identify the levels of physical activity, screen time and sleep time of adolescents according to the sex of the participant and the day of the week; (2) to find out the relationships between physical activity, screen time and sleep time according to the sex of the participant and the day of the week. The study design was non-experimental, descriptive-correlational and cross-sectional. The sample consisted of 694 adolescents in Compulsory Secondary Education from Soria (Spain). Four by One-Day Physical Activity Questionnaires were used to measure levels of physical activity, screen time and sleep time. Levene’s test and Student’s t-test were used to calculate the difference between the means of the variables. Pearson’s test was used to calculate bivariate correlations between variables. Results showed higher levels of screen time in males (136.93 min/day ± 81.548). Screen time, sleep time and moderate−vigorous physical activity are higher during the weekend. Positive relationships were found between screen time and light physical activity (rmales = 0.274; p ≤ 0.01; rfemales = 0.065; p > 0.05). The correlations between moderate−vigorous physical activity and screen time were negative (rmales = −0.282; p ≤ 0.01; rfemales = −0.187; p ≤ 0.05). The relationship between screen time and sleep time was negative in males (r = −0.135; p ≤ 0.05). In conclusion, the levels of physical activity, screen time and sleep time vary according to the sex of the participants and the day of the week.

24 h movement behavior and metabolic syndrome study protocol: A prospective cohort study on lifestyle and risk of developing metabolic syndrome in undergraduate students from low-income regions during a pandemic

Introduction

Obesity and its comorbidities are increasingly prevalent in Latin America, with a more rapid growth in individuals with lower income. The composition of movement behaviors within a 24 h period may have important implications for obesity, metabolic and mental health in cross-sectional data. However, a longitudinal study is needed to confirm the findings from the primarily cross-sectional evidence. The COVID-19 pandemic has been associated with cardiometabolic outcomes and has impeded healthy behavior.

Objectives

The first objective is to evaluate the time elapsed since the diagnosis of not meeting 24 h movement guidelines and the potential subsequent onset of metabolic syndrome in undergraduate students from low-income regions within 4 years of follow up. The second objective is to test the association between 24 h movement, mental wellbeing, eating behaviors, and abdominal obesity in the period of this pandemic.

Methods

The 24 h movement behavior and metabolic syndrome (24 h-MESYN) study is a multicentre cohort study that will include participants from two Brazilian cities within the 2022-2025 period to asses the first objective, and also a nested case-control study at the baseline will be carried out to evaluate the second objective. Previously, we conducted a feasibility study in the academic year of 2021 to assessing the psychometric properties of subjective tools, refine our study protocol, and adjust the epidemiological conditions of the cohort's subsequent phases (like as prevalence of exposure of interest, sampling process, and study adherence). Statistical tests as Cohen's kappa agreement; factorial analysis; logistic, Poisson and linear regression; and Kaplan-Meier analysis will be performed, in accordance with the objectives.

[Is Icelanders' sleep duration getting shorter? Review on sleep duration and sleeping habits]

Sleep health promotion is an ever-increasing subject of public discourse in Iceland. Prominent claims made include that the duration of sleep among Icelanders is shortening, and that changing sleeping habits constitute a significant public health risk. Like many aspects of healthcare, commercial interests and sales hype can skew perception. This review article will seek to shed light on the scientific background of these statements. International meta-analysis suggests there has been little change in sleep duration in adults over the past century. The duration of childrens sleep has shortened, but the consequences of this are not yet well established. Significant shortening of the sleep of adult Icelanders has not been demonstrated. No difference in sleep duration is found between Icelandic adults and adolescents and comparable groups in neighboring countries. The measurement methods that are used when comparing sleep studies are variable and can lead to different results. Associations have been established between sleep duration and adverse health outcomes, both physical and mental, but causality has not yet been established, and potential important mediators of the relationships are discussed. The circadian sleep phase of Icelanders is generally delayed relative to neighbors, likely related to Iceland's diurnal length variation at sub-Arctic latitudes and longitudinal discrepancies between natural light and local time.

Association with Temperature Variability and Physical Activity, Sedentary Behavior, and Sleep in a Free-Living Population

The present study examines the temperature variability in physical activity (PA), sedentary behavior (SB), and sleep in a free-living population. A representative sample of 1235 adults (ages 21–70) from Iowa, U.S.A., wore a SenseWear Mini Armband (SWA) for a randomly assigned day. Koppen’s weather climate classification was used to precisely classify the temperature: cold (−13 to 32 °F), cool (32 to 50 °F), mild (50 to 64 °F), warm (64 to 73 °F), and hot (73 to 95 °F). The main effect of three-way ANOVA (age × gender × temperature) had differences for SB and sleep, with older adults having higher levels than younger adults (p < 0.05). However, moderate to vigorous PA (MVPA) did not vary systematically by age or gender, and contrary to expectations, the main effect of the weather was not significant for MVPA (p > 0.05). Participants spent more time participating in PA at cold than at hot temperatures. The results clarify the impact of temperature on shaping PA and SB patterns in adults. The variable impacts and differential patterns by age suggest that weather should be considered when interpreting differences in PA patterns in research or surveillance applications.

Brain-Derived Neurotrophic Factor and Psychophysiological Response in Youth Badminton Athletes During the Season

PURPOSE

To analyze peripheral brain-derived neurotrophic factor (BDNF) levels and psychophysiological parameters in youth badminton athletes during the season and to determine the relationship between variables.

METHODS

Fourteen young badminton athletes were assessed over the season (preseason, middle season, and final season). Serum BDNF (sBDNF) was determined during the preseason and final season. Sleep time, total physical activity, and time in vigorous activity were measured using an accelerometer. The fat-free mass, skeletal muscle mass, fat mass, handgrip strength, cardiorespiratory fitness (VO2max), and dietary intake were evaluated during the season. The Stroop Color and Word Test was employed to assess cognitive tasks. To evaluate the mood, the Brunel Mood Scale was used.

RESULTS

There  were lower sBDNF levels (-16.3% [46.8%]; P = .007) and sleep time (final season = 5.7 [1.1] vs preseason = 6.6 [1.1] h·night-1, P = .043) during the end of the season. The total calories and carbohydrate intake decreased across the season (P < .05). Conversely, better cognitive function was found in the final season with respect to the preseason (P < .05). There were significant correlations between BDNF and VO2max only in the preseason (r = .61, P = .027), but no significant relationship was found among sBDNF and cognitive performance, sleep time, and percentage of won games.

CONCLUSIONS

Youth badminton athletes decreased their sBDNF levels, sleep time, carbohydrate, and calorie intake across the season. The athletes improved in cognitive function; however, only the females improved in body composition, and the males improved their VO2max in the middle season. The sBDNF levels were positively correlated with the VO2max in the preseason, and no correlations were observed among the sBDNF and psychological parameters, sleep time, and sport performance during the season.

What Happened Pre- and during COVID-19 in South Korea? Comparing Physical Activity, Sleep Time, and Body Weight Status

The purpose of the current study is to investigate the changes in physical activity (PA), sleep time (ST), and body weight (BW) Pre- and during COVID-19 in South Korea, and specifically, PA data were obtained during COVID-19 at three-time points based on the multilevel social distancing policies. All data were surveyed by questionnaires online and offline, and participants were required to fill in the monthly average of daily step counts were recorded an application on participants’ smartphone devices from Pre-COVID-19 (2019 year) and during COVID-19 (2020 year). Participants were 834 adults (males: 54.4%, female: 45.6%) and all statistical analyses were summarized by SPSS 25.0 program. The monthly average of daily step counts was 6747.09 during Pre-COVID-19, but the PA during COVID-19 was 5812.11 daily step counts per month. Also, there were significant pairwise differences between average PA Pre-COVID-19 and each level of social distancing (p < 0.001). After COVID-19, the participants who slept less than 7 h decreased by 3.6%, while those who slept more than 9 h increased by that much. As a result of BW, 269 participants responded their BW changed during COVID-19, and 199 of them reported they gained BW during COVID-19 (74.0%). Although self-reported questionnaires may have led to an under-or over-estimation of ST and BW, the present study found that the environment in which the COVID-19 is prevalent had adverse relationships on PA, ST, and BW. Therefore, it is important to identify strategies to motivate individuals for remaining physically active and getting adequate sleep while maintaining social distancing due to the presence of the COVID-19 global pandemic.

The influence of antidepressants and actigraphy-derived sleep characteristics on pediatric multiple sleep latency testing

STUDY OBJECTIVES

Research evaluating the influence of rapid eye movement suppressing antidepressants (REMS-AD) on multiple sleep latency test (MSLT) results and the value of performing actigraphy prior to this test in children and adolescents is lacking. We examined the impact of REMS-AD and actigraphy parameters on mean sleep latency (MSL) and sleep-onset REM episodes (SOREMs) on MSLT in a pediatric clinical sample.

METHODS

This was a retrospective chart review at a quarternary referral center. We identified 164 MSLTs conducted in patients aged less than 18 years between 2014-2017. Correlations between REMS-AD, self-reported sleep duration, actigraphy parameters and each of the outcomes (MSL and SOREMs) were examined. Regression analyses accounting for clinical characteristics were performed.

RESULTS

Mean age of the sample was 11.9±4.19 years, 62% were female, 28 (17%) were on REMS-AD (48% of whom were able to discontinue these medications prior to MSLT) and mean pediatric daytime sleepiness score was 21.7±6.1. MSL was 11.27±5.77 min and mean number of SOREMs 0.55±1.04. Patients on a REMS-AD at initial assessment had fewer SOREMs compared to those not taking these medications (0.17±0.19 versus 0.62±0.09; p=0.04); no difference was noted in MSL (10.36±1.10 versus 11.47±0.50; p=0.36). Increased time in bed on actigraphy (TIBa) correlated with a longer MSL and fewer SOREMs (r=0.23; p=0.04 and r=0.316; p=0.004 respectively). Following regression analyses, use of REMS-AD continued to remain associated with fewer SOREMs; greater TIBa, but not self-reported sleep duration, was associated with a longer MSL (all p<0.05).

CONCLUSIONS

Clinicians should account for the use of REMS-AD and utilize actigraphy to determine time in bed while interpreting the results of a pediatric MSLT.

Sleep time and homework hours/daily are associated with reduced visual acuity among school students aged 9-18 in Shenyang in 2016

PURPOSE

The purpose of this survey was to explore the prevalence of reduced visual acuity and its associated factors among school students in Shenyang in 2016.

METHODS

This was a cross-sectional study using data from the Ministry of Education' Student Physical Fitness (MESPF) monitoring in 2016. A total of 13,642 students aged 9-18 years were surveyed in Shenyang. The unaided distance visual acuity was measured, and questionnaire on lifestyle behaviors that may affect visual acuity was investigated among students. The prevalence of reduced visual acuity and its associated factors were analyzed.

RESULTS

The average prevalence of reduced visual acuity among students aged 9-18 years was 65.8%, and severe reduced visual acuity was main (42.9%), and there were statistical effect of age, gender, and region on the prevalence of reduced visual acuity. Binary and multi variable logistic regression results revealed that students sleeping <8 h, homework hours ⩾1 h, and parental myopia had an increased risk of reduced visual acuity.

CONCLUSIONS

Sleep time <8 h and homework time ⩾1 h may be associated with reduced visual acuity among students in Shenyang. Therefore, it is benefit for student to get enough sleep and decreasing studying time in order to prevent and reduce poor vision.

Consequences of Low Sleep Duration in Anthropometric and Body Composition Parameters of Chilean Preschoolers

Reduced sleep duration in schoolchildren has been associated with poor health outcomes at the scholar level; however, there is little information on the effects of sleep loss on Chilean preschoolers. The aim of this study was to describe and compare cardiometabolic outcomes according with the sleep duration in Chilean preschoolers. A second aim was to identify potential risk outcomes (i.e., in odds ratios) for suffering anthropometric and body composition alterations related with participants’ sleep duration. A total of 99 (n = 54 boys; n = 45 girls) preschoolers (mean age (95% CI) 3.1 (2.7, 3.4 years), mean weight 16.1 (15.5, 16.6 kg)) were included in this study. Sleep duration was assessed using standardized questionnaires with the parents. Socio-demographic parents’ information, as well as anthropometric, nutritional, and handgrip strength outcomes in preschoolers were distributed by tertiles (T1; < 10 h, T2; 10 to < 11 h, and T3; ≥ 11 h) of sleep time. Children in the lowest tertile of sleep duration had significantly higher body mass indices (p = 0.036), weight-for-height Z-scores (p < 0.0001), waist–hip ratios (p = 0.041), and body fat in percent (p = 0.035) and kg (p = 0.044) compared to those in the top tertile. Low sleep duration was associated with significantly greater risks of overweight/obesity (OR 1.3 (0.9, 1.8)), low height (OR 1.2 (0.8, 1.6)), and increased BMI (OR 1.5 (0.4, 1.4)), but not with reductions in grip strength. Chilean preschoolers with low sleep duration showed higher cardiometabolic markers (anthropometric/body composition) and were more likely to be classified as obese than youth with longer sleep duration.

The Effects of Anodal Transcranial Direct Current Stimulation on Sleep Time and Efficiency

A single session of anodal transcranial direct current stimulation (tDCS) has been shown to increase arousal in healthy participants for up to 24 h post-stimulation. However, little is known about the effects of tDCS on subsequent sleep in this population. Based on previous clinical studies, we hypothesized that anodal stimulation to the left dorsolateral prefrontal cortex (lDLPFC) would produce higher arousal with decreased sleep time and stimulation to the primary motor cortex (M1) would have the converse effect. Thirty-six active duty military were randomized into one of three groups (n = 12/group); active anodal tDCS over the lDLPFC, active anodal tDCS over left M1, or sham tDCS. Participants answered questionnaires 3 times a day and wore a wrist activity monitor (WAM) to measure sleep time and efficiency for 3 weeks. On weeks 2 and 3 (order counterbalance), participants received stimulation at 1800 h before 26 h of sustained wakefulness testing (sleep deprived) and at 1800 h without sleep deprivation (non-sleep deprived). There were no significant effects for the non-sleep deprived portion of testing. For the sleep deprived portion of testing, there were main effects of group and night on sleep time. The DLPFC group slept less than the other groups on the second and third night following stimulation. There is no negative effect on mood or sleep quality from a single dose of tDCS when participants have normal sleep patterns (i.e., non-sleep deprived portion of testing). The results suggest that stimulation may result in faster recovery from fatigue caused by acute periods of sleep deprivation, as their recovery sleep periods were less.

Feasibility, acceptability and affective consequences of at-home sleep extension in young women with depressive symptoms: A pilot study

Insufficient sleep is common in young adults and has meaningful consequences for daytime functioning, including increased sleepiness, affective disruption and depressive symptoms. This study provides a preliminary evaluation of the feasibility, acceptability and affective consequences of extended sleep opportunity in young women with insufficient sleep and depressive symptoms. Participants were 32 women, 18-22 years of age, who regularly obtained less than 8-hr sleep/night and had daytime sleepiness and depressive symptoms at or above population averages. Participants were asked to maintain a sleep schedule of their typical duration for 7 days and were then randomly assigned to either extend sleep opportunity (ESO) by 90 min per night or maintain typical sleep opportunity (TSO), for the next 7 days. Sleep characteristics and daytime sleepiness were measured using continuous actigraphy and daily sleep diary, and affect, stress and depressive symptoms were assessed with daily and weekly questionnaires. Extended sleep opportunity increased sleep duration by over 1 hr, improved morning sleepiness and positive affect, and diminished anhedonia and depressive symptoms in study completers (n = 11 ESO, 11 TSO). However, 31.3% of participants (n = 10) were withdrawn from the study due to difficulty maintaining the sleep schedule. These results provide initial evidence that sleep extension is beneficial for young women who usually have inadequate sleep and mood disruption and can maintain a consistent sleep schedule. If extending sleep opportunity improves sleep, daytime sleepiness and affect in young adults who typically have insufficient sleep, it could broaden the range of interventions for sleep and mental wellness.

[Workers' Lifestyles and Urinary 8-hydroxydeoxyguanosine as an Oxidative Stress Marker]

Oxidative stress in biological components has become recognized as one of the causative factors of various diseases. In this study, we investigated the effects of worker lifestyle and fatigue on the levels of urinary 8-hydroxydeoxyguanosine (8-OHdG), a marker of oxidative stress. Our results revealed that urinary 8-OHdG level was increased by alcohol intake and decreased by snack intake and adequate sleep time on the day before the survey. A decrease in urinary 8-OHdG level was also observed in parallel with a decrease in workload. Urinary 8-OHdG monitoring is expected to be useful for disease prevention in the future.

[Sleep conditions of adult residents in Shandong Province from 2010 to 2012]

OBJECTIVE

To understand the sleep conditions of adults in Shandong Province.

METHODS

From 2010 to 2012, 10 201 residents aged ≥6 years old were selected from 7 counties and cities in Shandong Province by multi-stage stratified cluster sampling method in proportion to the population. A face-to-face interview was conducted with a questionnaire uniformly formulated by "China National Nutrition and Health Surveillance"to investigate and analyze the sleep status of residents aged 18 years and above.

RESULTS

A total of 6626 people over the age of 18 were investigated. The average daily sleep was(7. 84±1. 29) h. There was no significant difference between male((7. 80 ± 1. 07) h) and female((7. 86 ± 1. 18) h). However, there was significant difference between males((7. 87±1. 17) h) and females((8. 01±1. 27) h) in rural areas(t = 3. 08, P < 0. 01). There was significant difference in different regions(big cities(7. 62± 1. 17) h, small and medium-sized cities(7. 85 ± 0. 89) h, rural areas(7. 95 ±1. 23) h, F = 39. 733, P<0. 001) and in different age groups(18-44 years old(7. 97±0. 98) h, 45-49 years old(7. 80±1. 07) h, 60 years old and above(7. 74±1. 33) h, F =21. 642, P<0. 001), the average daily sleep time was decreased with increasing age. The insufficient sleep rate was 9. 8%, there was no significant different between male(9. 5%)and female(10. 1%). There was significant difference in different regions(big cities15. 3%, small and medium-sized cities 5. 2%, rural areas 9. 7%, χ~2= 105. 870, P <0. 001) and in different age groups(18-44 years old 5. 1%, 45-59 years old 9. 7%, 60 years old and above 15. 3%, χ~2= 114. 308, P < 0. 001). Big cities had the higher insufficient sleep rate than medium-sized cities and rural areas, The insufficient sleep rate showed an upward trend with the increase of age. The proportion of excessive sleep was9. 3%. The difference between male(8. 4%) and female(10. 0%) was statistically significant(t = 2. 11, P < 0. 05). There were statistically significant differences in different regions(7. 0% in large cities, 6. 0% in medium and small cities, 12. 8% in rural areas, χ~2= 77. 156, P< 0. 01) and different, age groups(6. 7% in 18-44 years old, 6. 1% in 45-59 years old, 16. 8% in 60 years old and above, χ~2= 175. 556, P <0. 01). The rate of excessive sleep in rural areas was higher than that in cities, and the rate of excessive sleep in the 45-59 age group was the highest.

CONCLUSION

Insufficient sleep is common in adult residents in Shandong Province. The insufficient sleep is more significant among elderly population and residents of big cities. The problem of excessive sleep also exists.

Gender Difference in the Effect of Short Sleep Time on Suicide among Korean Adolescents

A close association between the duration of sleep and suicide has been reported in previous studies. This study was designed to investigate whether there is a difference in the effects of sleep duration on suicide by gender. This study was conducted based on the results of a volunteer online survey for adolescents in middle and high school in the Republic of Korea. The results showed that the effect of a depressive mood on short sleep time and on suicide was not different between male and female adolescents. It has been reported that the direct effect of short sleep time on increasing suicidal ideation is 2.50 times higher in female than in male adolescents. Differences in the metabolism of sex hormones and sleep-associated neurotransmitters might have affected this result, but further studies are needed to clarify more obvious mechanisms. In addition, this result should be considered when establishing sleep education for adolescents.

Lifestyle patterns and endocrine, metabolic, and immunological biomarkers in European adolescents: The HELENA study

OBJECTIVE

To evaluate the association of lifestyle patterns related to physical activity (PA), sedentariness, and sleep with endocrine, metabolic, and immunological health biomarkers in European adolescents.

METHODS

The present cross-sectional study comprised 3528 adolescents (1845 girls) (12.5-17.5 years) enrolled in the Healthy Lifestyle in Europe by Nutrition in Adolescence Study. Cluster analysis was performed by including body composition, PA by accelerometry, self-reported sedentary behaviors, and sleep duration. We also measured endocrine, metabolic, and immunological biomarkers.

RESULTS

Three-cluster solutions were identified: (a) light-PA time, moderate-vigorous-PA time and sedentary time, (b) light-PA time, moderate-vigorous-PA time, sedentary time and sleep time, (c) light-PA time, moderate-vigorous-PA time, sedentary time and body composition. In addition, each cluster solution was defined as: "healthy," "medium healthy," and "unhealthy" according to the presented rating. Analysis of variance showed that overall the healthiest groups from the three clusters analyzed presented a better metabolic profile. A decision tree analysis showed that leptin had a strong association with cluster 3 in both boys and girls, high-density lipoprotein cholesterol had the strongest association with clusters 1 and 3 in boys. Cortisol had the strongest association with cluster 1. HOMA index (homeostatic model assessment) and C3 showed a strong association with cluster 3 in girls.

CONCLUSIONS

Our results support the existence of different interactions between metabolic health and lifestyle patterns related to PA, sedentariness, and sleep, with some gender-specific findings. These results highlight the importance to consider multiple lifestyle-related health factors in the assessment of adolescents' health to plan favorable strategies.

Metabolic disorders and sleep

Epidemiologic studies show that both atypical sleep time and obstructive sleep apnea (OSA) are independently associated with higher risk of metabolic disease development, particularly obesity and type 2 diabetes mellitus (T2DM). OSA is an independent risk factor for cardiovascular mortality, which is amongst the most common causes of death in T2DM. It is advisable to screen patients for OSA due to the high prevalence of the disease in T2DM patients. For screening are recommended questionnaires and home sleep monitoring. OSA diagnosis is then verified by home sleep apnea testing (using polygraphy) or by polysomnography. Positive airway pressure (PAP) is a gold standard in the treatment of moderate and severe OSA. PAP prevents hypoxia and sleep fragmentation, eliminating excessive daytime sleepiness and decreasing the risk of cardiovascular diseases. Studies have not yet shown an effect of PAP treatment on T2DM compensation and glucose metabolism. Despite this a positive effect of PAP on insulin resistance and glucose tolerance has been proven in patients with prediabetes. PAP therapy is advised in obese patients of the central type with OSA, bariatric surgery has been proven to decrease the severity of OSA.

[Sleep conditions of children and adolescents aged 6-17 years old in Shandong Province in 2010-2012]

OBJECTIVE

To understand the sleep conditions of children and adolescents aged 6-17 years old in Shandong Province.

METHODS

The data of physical activity from " 2010-2012 China National Nutrition and Health Surveillance " in Shandong Province were used. A total of 1808 children aged 6 to 17 years old in urban and rural schools were investigated to analyze their sleep conditions by multi-stage stratified cluster random samplingand a unified questionnaire.

RESULTS

the average sleeping time of children aged 6 to 17 years old in Shandong Province was 8. 62 h, and there was no significant difference between children of different genders( male 8. 66 h, n = 900, female 8. 59 h, n = 908) and children of different regions( urban 8. 64 h, n =982, rural 8. 61 h, n = 826). The lack of sleep rate among children aged 6-17 years old was 60. 1%( n = 1808), that of boys( 58. 3%) was lower than that of girls( 61. 8%), and that of urban( 59. 9%) and rural( 60. 3%) was close, with no statistically significant difference. However, there were statistically significant differences between urban and rural lack of sleep rates between the ages 6 to 11 years old( t = 3. 57, P <0. 01) and between the ages 15 to 17 years old( t = 8. 60, P < 0. 001). With the increase of age, the average sleep time decreased, the lack of sleep rate showed a downward trend.

CONCLUSION

The average sleeping time of average daily sleep time, lack of sleep rate, children and adolescents children aged 6 to 17 years old is insufficient and the rate of sleep deficiency is high in shandong province.

The effects of home oxygen therapy on energy metabolism in patients with COPD

Background

COPD is preventable and treatable and is characterized by completely nonreversible airflow obstruction. In this study, we aimed to investigate the effect of long-term oxygen therapy on patients with stage 4 COPD who were followed up and treated at the polyclinic or clinic service. We evaluated the effects of oxygen therapy on energy metabolism and physical activity in patients with COPD.

Methods

Nineteen patients with COPD (16 male/3 female), treated with oxygen therapy for the first time, were included in this study. Analysis of arterial blood gases and pulmonary function test was performed. Metabolic Holter device (SenseWear^® Armband) was placed pre- and post-oxygen therapy on the patients’ arm for at least 3 days. This device captures Holter data in a digitized electronic system, and the daily average value was calculated from the data.

Results

Post-oxygen treatment showed a significant increase in energy expenditure by patients with COPD (pretreatment, 1,497±596 joule; posttreatment, 2,977±5,985 joule; P=0.044). Moreover, number of steps during walking (pretreatment, 2,056±256; posttreatment, 2,120±195; P=0.03), resting (pretreatment, 6.36±3.31 hours; posttreatment, 3.47±2.19 hours; P<0.03), and sleeping (pretreatment, 4.23±2.13 hours; posttreatment, 2.33±1.42 hours; P<0.00) showed significant differences. Increased daily energy expenditure in patients with respiratory failure was detected with long-term oxygen therapy. In addition, the immobility of patients decreased and duration of physical activity increased in patients with COPD.

Conclusion

In this study, positive effects of long-term oxygen therapy have been demonstrated with respect to energy metabolism and physical activity of patients with COPD. Thus, we recommend that medication adherence and long-term oxygen therapy should begin early in patients with COPD.

Sleep time and pattern of adult individuals in primary care in an Asian urbanized community: A cross-sectional study

Sleep norms vary between individuals, being affected by personal, communal, and socioeconomic factors. Individuals with sleep time which deviate from the population norm are at risks of adverse mental, cardiovascular, and metabolic health. Sleep-related issues are common agenda for consultation in primary care. This study aimed to determine the sleep time, pattern, and behavior of multiethnic Asian individuals who attended public primary care clinics in an urban metropolitan city-state.Standardized questionnaires were assistant-administered to adult Asian individuals who visited 2 local public primary care clinics in north-eastern and southern regions of Singapore. The questionnaire included questions on demographic characteristics, self-reported sleep time, patterns, and behavior and those originated from the American National Sleep Foundation Sleep Diary. The data were collated, audited, rectified, and anonymized before being analyzed by the biostatistician. Individuals with 7 h sleep time or longer were deemed getting adequate sleep. Chi-squared or Fisher exact test was used to test the association between the demographic and behavioral variables and sleep time. Next, regression analysis was performed to identify key factors associated with their sleep time.A total of 350 individuals were recruited, with higher proportion of those of Chinese ethnicity reporting adequate sleep. Almost half (48.1%) of those who slept <7 h on weekdays tended to sleep ≥7 h on weekends. More individuals who reported no difficulty falling asleep, had regular sleep hours and awakening time, tended to sleep adequately. Those who slept with children, studied, read leisurely, used computer or laptops in their bedrooms, drank caffeinated beverages or smoked had inadequate sleep. Those who perceived sufficient sleep and considered 8 h as adequate sleep time had weekday and weekend sleep adequacy.Sleep time varied according to ethnicity, employment status, personal behavior, and perception of sleep sufficiency. Awareness of sleep time and pattern allows the local physicians to contextualize the discussion of sleep adequacy with their patients during consultation, which is a prerequisite to resolve their sleep-related issues.

Abnormal Sleep Duration Is Associated with a Higher Risk of Accidental Injury

OBJECTIVE

Develop normative data for adult sleep duration and determine if nonstandard sleep time relates to the likelihood of accidental injury.

STUDY DESIGN

Cross-sectional analysis.

SETTING

National health information database.

METHODS

The National Health Interview Survey, 2004-2013, was examined for adult sleep time and accidental injury within the past 3 months. The mean hours slept per night was determined. The relationship between sleep time and incidence of accidental injury was determined for any injury, injury while driving, and injury while working, adjusting for demographic variables.

RESULTS

Among 221.4 million adults (raw sample, N = 282,692), the mean sleep time was 7.17 hours (95% confidence interval [95% CI], 7.16-7.18 hours). Men and women slept very similar times (7.14 vs 7.17 hours, respectively), and sleep time decreased until the fifth decade (minimum, 6.99 hours), increasing each decade thereafter; 2.81% of adults reported being accidentally injured in the preceding 3 months. Too little sleep and excessive sleep times were both associated with higher rates of accidental injury (odds ratio per hour of deviation from mean, 1.16 [95% CI, 1.12-1.19]), adjusting for age, sex, marital status, and education level. Similar increased odds ratios were noted for injury while driving (1.11 [95% CI, 1.01-1.22]) and injury while at work (1.12 [95% CI, 1.04-1.20]) with sleep time deviation.

CONCLUSION

Most adults sleep between 7 and 8 hours nightly. Adults with sleep time outside this range, with either less or more sleep, have increased rates of accidental injury. These data highlight the need for sufficient quantity and quality of sleep in preventing accidental injury.

The Association between Short or Long Sleep Times and Quality of Life (QOL): Results of the Korea National Health and Nutrition Examination Survey (KNHANES IV-V)

STUDY OBJECTIVES

Sleep can affect quality of life (QOL). We examined the association between self-reported sleep time and QOL independent of perceived health status and depressive disorder using the EuroQol-5 Dimension (EQ-5D) and a visual analog scale (VAS).

METHODS

We used the nationwide cross-sectional survey data of 28,178 subjects from the Korea National Health and Nutrition Examination Survey (KNHANES) IV-V. Self-reported sleep time was assessed by average hours of sleep per day. QOL was measured using the EQ-5D and VAS. A generalized additive model and multiple linear regression analysis were used to estimate the effect of sleep time on the QOL while adjusting for potential confounding variables.

RESULTS

We found a significant inverted U-shaped relationship between sleep time and QOL using both the EQ-5D and VAS indices. Compared with subjects who slept 7 h/day, Korean men whose sleep time was very short (≤ 4 h/ day) or very long (≥ 10 h/day) had substantially worse QOL (-3.125 in EQ-5D, p < 0.001 and -4.387 on the VAS, p = 0.000 for ≤ 4 h/day; -1.763 in EQ-5D, p = 0.001 and -1.944 on the VAS for ≥ 10 h/day, all p = 0.038). A similar inverted U-shape was observed between sleep time and QOL in Korean women.

CONCLUSIONS

Inappropriate sleep time (either short or long) in both men and women was significantly associated with lower QOL. In particular, such an association was more apparent among persons whose perceived health status was poor.

Sociodemographic characteristics and waking activities and their role in the timing and duration of sleep

STUDY OBJECTIVES

Chronic sleep restriction is prevalent in the U.S. population and associated with increased morbidity and mortality. The primary reasons for reduced sleep are unknown. Using population data on time use, we sought to identify individual characteristics and behaviors associated with short sleep that could be targeted for intervention programs.

DESIGN

Analysis of the American Time Use Survey (ATUS).

SETTING

Cross-sectional annual survey conducted by the U.S. Bureau of Labor Statistics.

PARTICIPANTS

Representative cohort (N = 124,517) of Americans 15 years and older surveyed between 2003 and 2011.

INTERVENTIONS

None.

MEASUREMENTS AND RESULTS

Telephone survey of activities over 24 hours. Relative to all other waking activities, paid work time was the primary waking activity exchanged for sleep. Time spent traveling, which included commuting to/ from work, and immediate pre- and post-sleep activities (socializing, grooming, watching TV) were also reciprocally related to sleep duration. With every hour that work or educational training started later in the morning, sleep time increased by approximately 20 minutes. Working multiple jobs was associated with the highest odds for sleeping ≤6 hours on weekdays (adjusted OR 1.61, 95% CI 1.44; 1.81). Self-employed respondents were less likely to be short sleepers compared to private sector employees (OR 0.83, 95% CI 0.72; 0.95). Sociodemographic characteristics associated with paid work (age 25-64, male sex, high income, and employment per se) were consistently associated with short sleep.

CONCLUSIONS

U.S. population time use survey findings suggest that interventions to increase sleep time should concentrate on delaying the morning start time of work and educational activities (or making them more flexible), increasing sleep opportunities, and shortening morning and evening commute times. Reducing the need for multiple jobs may increase sleep time, but economic disincentives from working fewer hours will need to be offset. Raising awareness of the importance of sufficient sleep for health and safety may be necessary to positively influence discretionary behaviors that reduce sleep time, including television viewing and morning grooming.

Ambient temperature and obstructive sleep apnea: effects on sleep, sleep apnea, and morning alertness

STUDY OBJECTIVES

The aim of the study was to investigate the effect of ambient temperature on sleep, sleep apnea, and morning alertness in patients with obstructive sleep apnea.

DESIGN

Randomized controlled trial.

SETTING

In-hospital investigations.

PARTICIPANTS

Forty patients with obstructive sleep apnea naïve to treatment, with an apnea-hypopnea index of 10-30.

INTERVENTIONS

Three different nights in room temperatures of 16°C, 20°C, and 24°C.

MEASUREMENTS

Overnight polysomnography and Karolinska Sleepiness Scale.

RESULTS

The obstructive apnea-hypopnea index was 30 ± 17 at 16°C room temperature, 28 ± 17 at 20°C, and 24 ± 18 at 24°C. The obstructive apnea-hypopnea index was higher at 16°C room temperature versus 24°C (P = 0.001) and at 20°C room temperature versus 24°C (P = 0.033). Total sleep time was a mean of 30 min longer (P = 0.009), mean sleep efficiency was higher (77 ± 11% versus 71 ± 13% respectively, P = 0.012), and the patients were significantly more alert according to the Karolinska Sleepiness Scale (P < 0.028) in the morning at 16°C room temperature versus 24°C. The amount of sleep in different sleep stages was not affected by room temperature.

CONCLUSIONS

Untreated patients with obstructive sleep apnea sleep longer, have better sleep efficiency, and are more alert in the morning after a night's sleep at 16°C room temperature compared with 24°C, but obstructive sleep apnea is more severe at 16°C and 20°C compared with 24°C.

CLINICAL TRIAL INFORMATION

This study is registered in ClinicalTrials.gov number NCT00544752.

Short sleep times predict obesity in internal medicine clinic patients

STUDY OBJECTIVES

Epidemiological studies have demonstrated an association between short sleep times and obesity as defined by body mass index (BMI). We wanted to determine whether this association occurs in patients with chronic medical diagnoses since the number of confounding factors is likely higher in patients than the general population.

METHODS

Two hundred patients attending internal medicine clinics completed a survey regarding sleep habits, lifestyle characteristics, and medical diagnoses. An independent surveyor collected the information on the questionnaires and reviewed the medical records. Height and weight were measured by clinic personnel. Data were analyzed with multivariate logistic regression.

RESULTS

Subjects with short sleep times (< 7 hours) had an increased likelihood of obesity as defined by a BMI > or = 30 kg/m2 when compared to the reference group of (8, 9] hours (odds ratio 2.93; 95% confidence interval, 1.06-8.09). There was a U-shaped relationship between obesity and sleep time in women but not in men. Young age (18 to 49 years), not smoking, drinking alcohol, hypertension, diabetes, and sleep apnea were also associated with obesity in the overall model.

CONCLUSIONS

This study demonstrates an association between short sleep times and obesity in undifferentiated patients attending an internal medicine clinic using models adjusting for age, lifestyle characteristics, and some medical diagnoses. The U-shaped relationship in women suggests that sleep patterns may have gender specific associations. These observations provide the background for therapeutic trials in weight loss in patients with established medical problems.