A potential association of endogenous circadian rhythm disruption with risk of cancer development has been suggested, however, epidemiological evidence for the association of sleep traits with colorectal cancer (CRC) is limited and often contradictory. Here we investigated whether genetically predicted chronotype, insomnia and sleep duration are associated with CRC risk in males, females and overall and according to CRC anatomical subsites using Mendelian randomization (MR). The two-sample inverse variance weighted (IVW) method was applied using summary-level data in up to 58,221 CRC cases and 67,694 controls and genome-wide association data of genetic variants for self-reported sleep traits. Secondary analyses using alternative instruments and sensitivity analyses assessing potential violations of MR assumptions were conducted. Genetically predicted morning preference was associated with 13% lower risk of CRC in men (ORIVW = 0.87, 95% CI = 0.78, 0.97, P = 0.01), but not in women or in both sexes combined. Τhis association remained consistent in some, but not all, sensitivity analyses and was very similar for colon and rectal cancer. There was no evidence of an association for any other sleep trait. Overall, this study provides little to no evidence of an association between genetically predicted sleep traits and CRC risk.
- MeSH
- celogenomová asociační studie MeSH
- cirkadiánní rytmus genetika MeSH
- genetická predispozice k nemoci MeSH
- jednonukleotidový polymorfismus MeSH
- kolorektální nádory * genetika epidemiologie MeSH
- lidé MeSH
- mendelovská randomizace * MeSH
- poruchy iniciace a udržování spánku genetika MeSH
- rizikové faktory MeSH
- spánek * genetika MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Insomnia is a prevalent and disabling condition whose treatment is not always effective. This pilot study explores the feasibility and effects of closed-loop auditory stimulation (CLAS) as a potential non-invasive intervention to improve sleep, its subjective quality, and memory consolidation in patients with insomnia. A total of 27 patients with chronic insomnia underwent a crossover, sham-controlled study with 2 nights of either CLAS or sham stimulation. Polysomnography was used to record sleep parameters, while questionnaires and a word-pair memory task were administered to assess subjective sleep quality and memory consolidation. The initial analyses included 17 patients who completed the study, met the inclusion criteria, and received CLAS. From those, 10 (58%) received only a small number of stimuli. In the remaining seven (41%) patients with sufficient CLAS, we evaluated the acute and whole-night effect on sleep. CLAS led to a significant immediate increase in slow oscillation (0.5-1 Hz) amplitude and activity, and reduced delta (1-4 Hz) and sigma/sleep spindle (12-15 Hz) activity during slow-wave sleep across the whole night. All these fundamental sleep rhythms are implicated in sleep-dependent memory consolidation. Yet, CLAS did not change sleep-dependent memory consolidation or sleep macrostructure characteristics, number of arousals, or subjective perception of sleep quality. Results showed CLAS to be feasible in patients with insomnia. However, a high variance in the efficacy of our automated stimulation approach suggests that further research is needed to optimise stimulation protocols to better unlock potential CLAS benefits for sleep structure and subjective sleep quality in such clinical settings.
- Klíčová slova
- closed‐loop auditory stimulation, insomnia, memory consolidation, polysomnography, slow oscillation,
- MeSH
- akustická stimulace * metody MeSH
- dospělí MeSH
- elektroencefalografie MeSH
- klinické křížové studie * MeSH
- konsolidace paměti fyziologie MeSH
- kvalita spánku MeSH
- lidé středního věku MeSH
- lidé MeSH
- pilotní projekty MeSH
- polysomnografie * MeSH
- poruchy iniciace a udržování spánku * terapie patofyziologie MeSH
- průzkumy a dotazníky MeSH
- spánek pomalých vln * fyziologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVE: To identify distinct sleep health phenotypes in adults, examine transitions in sleep health phenotypes over time, and subsequently relate these to the risk of chronic conditions. METHODS: A national sample of adults from the Midlife in the United States study ( N = 3683) provided longitudinal data with two time points (T1: 2004-2006, T2: 2013-2017). Participants self-reported on sleep health (regularity, satisfaction, alertness, efficiency, duration) and the number and type of chronic conditions. Covariates included age, sex, race, education, education, partnered status, number of children, work status, smoking, alcohol, and physical activity. RESULTS: Latent transition analysis identified four sleep health phenotypes across both time points: good sleepers, insomnia sleepers, weekend catch-up sleepers, and nappers. Between T1 and T2, the majority (77%) maintained their phenotype, with the nappers and insomnia sleepers being the most stable. In fully adjusted models with good sleepers at both time points as the reference, being an insomnia sleeper at either time point was related to having an increased number of total chronic conditions by 28%-81% at T2, adjusting for T1 conditions. Insomnia sleepers at both time points were at 72%-188% higher risk for cardiovascular disease, diabetes, depression, and frailty. Being a napper at any time point related to increased risks for diabetes, cancer, and frailty. Being a weekend catch-up sleeper was not associated with chronic conditions. Those with lower education and unemployed were more likely to be insomnia sleepers; older adults and retirees were more likely to be nappers. CONCLUSION: Findings indicate a heightened risk of chronic conditions involved in suboptimal sleep health phenotypes, mainly insomnia sleepers.
- MeSH
- chronická nemoc MeSH
- dospělí MeSH
- fenotyp * MeSH
- lidé středního věku MeSH
- lidé MeSH
- longitudinální studie MeSH
- poruchy iniciace a udržování spánku * epidemiologie MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Research Support, N.I.H., Extramural MeSH
- Geografické názvy
- Spojené státy americké epidemiologie MeSH
BACKGROUND AND OBJECTIVES: Sleep disorders often predict or co-occur with cognitive decline. Yet, little is known about how the relationship unfolds among older adults at risk for cognitive decline. To examine the associations of sleep disorders with cognitive decline in older adults with unimpaired cognition or impaired cognition (mild cognitive impairment and dementia). RESEARCH DESIGN AND METHODS: A total of 5,822 participants (Mage = 70) of the National Alzheimer's Coordinating Center database with unimpaired or impaired cognition were followed for 3 subsequent waves. Four types of clinician-diagnosed sleep disorders were reported: sleep apnea, hyposomnia/insomnia, REM sleep behavior disorder, or "other." Cognition over time was measured by the Montreal Cognitive Assessment (MoCA) or an estimate of general cognitive ability (GCA) derived from scores based on 12 neuropsychological tests. Growth curve models were estimated adjusting for covariates. RESULTS: In participants with impaired cognition, baseline sleep apnea was related to better baseline MoCA performance (b = 0.65, 95% confidence interval [95% CI] = [0.07, 1.23]) and less decline in GCA over time (b = 0.06, 95% CI = [0.001, 0.12]). Baseline insomnia was related to better baseline MoCA (b = 1.54, 95% CI = [0.88, 2.21]) and less decline in MoCA over time (b = 0.56, 95% CI = [0.20, 0.92]). Furthermore, having more sleep disorders (across the 4 types) at baseline predicted better baseline MoCA and GCA, and less decline in MoCA and GCA over time. These results were only found in those with impaired cognition and generally consistent when using self-reported symptoms of sleep apnea or insomnia. DISCUSSION AND IMPLICATIONS: Participants with sleep disorder diagnoses may have better access to healthcare, which may help maintain cognition through improved sleep.
- Klíčová slova
- Alzheimer’s disease, Insomnia, Sleep apnea, Social determinants of health,
- MeSH
- kognice MeSH
- kognitivní dysfunkce * psychologie MeSH
- kognitivní stárnutí * MeSH
- lidé MeSH
- neuropsychologické testy MeSH
- poruchy iniciace a udržování spánku * epidemiologie MeSH
- senioři MeSH
- syndromy spánkové apnoe * MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Research Support, N.I.H., Extramural MeSH
- Research Support, U.S. Gov't, Non-P.H.S. MeSH
PURPOSE: Social media use has increased rapidly during the past decade, raising concerns about adolescents who display problematic social media use (PSMU), as indicated by addiction-like symptoms (e.g., preoccupation, tolerance). We aimed to assess the extent to which an individual resource (health literacy), and social resources (friend support and family support), moderated the association between a range of individual characteristics (gender, age, family affluence, and depressive feelings) and PSMU; also the association between PSMU and health outcomes (self-rated health, life satisfaction, and sleep difficulties), both cross-nationally and nationally. METHODS: Our sample included 22,226 adolescents from six European countries. We used data from the Health Behaviour in School-aged Children cross-sectional survey (2017/2018). Random-effects models and moderator analyses were applied. RESULTS: Six moderations were found, with the resources moderating the association between individual characteristics and PSMU. One moderation emerged cross-nationally, namely that a higher level of family support was associated with a lower likelihood of PSMU, especially among adolescents who did not have frequent depressive feelings. In addition, five national moderations were identified. For example, a higher level of health literacy was associated with a lower likelihood of PSMU among Finnish girls. The resources were also found to moderate the association between PSMU and health outcomes, with two moderations emerging cross-nationally. For instance, a higher level of family support was related to higher self-rated health, especially among problematic users. In addition, nine national moderations were identified; these included a higher level of health literacy being associated with having less sleep difficulties, especially among problematic users in Germany. DISCUSSION: In adolescence, health literacy, family support, and friend support have the potential to moderate the association between individual characteristics and PSMU, and between PSMU and health outcomes, cross-nationally and nationally. We recommend the use of universal and targeted interventions to promote individual and social resources to counteract PSMU.
- Klíčová slova
- Adolescent, Family support, Friend support, Health, Health literacy, Problematic social media use, Social media,
- MeSH
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- návykové chování * MeSH
- poruchy iniciace a udržování spánku * MeSH
- průřezové studie MeSH
- sociální média * MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Evropa MeSH
Progress in the field of insomnia since 2017 necessitated this update of the European Insomnia Guideline. Recommendations for the diagnostic procedure for insomnia and its comorbidities are: clinical interview (encompassing sleep and medical history); the use of sleep questionnaires and diaries (and physical examination and additional measures where indicated) (A). Actigraphy is not recommended for the routine evaluation of insomnia (C), but may be useful for differential-diagnostic purposes (A). Polysomnography should be used to evaluate other sleep disorders if suspected (i.e. periodic limb movement disorder, sleep-related breathing disorders, etc.), treatment-resistant insomnia (A) and for other indications (B). Cognitive-behavioural therapy for insomnia is recommended as the first-line treatment for chronic insomnia in adults of any age (including patients with comorbidities), either applied in-person or digitally (A). When cognitive-behavioural therapy for insomnia is not sufficiently effective, a pharmacological intervention can be offered (A). Benzodiazepines (A), benzodiazepine receptor agonists (A), daridorexant (A) and low-dose sedating antidepressants (B) can be used for the short-term treatment of insomnia (≤ 4 weeks). Longer-term treatment with these substances may be initiated in some cases, considering advantages and disadvantages (B). Orexin receptor antagonists can be used for periods of up to 3 months or longer in some cases (A). Prolonged-release melatonin can be used for up to 3 months in patients ≥ 55 years (B). Antihistaminergic drugs, antipsychotics, fast-release melatonin, ramelteon and phytotherapeutics are not recommended for insomnia treatment (A). Light therapy and exercise interventions may be useful as adjunct therapies to cognitive-behavioural therapy for insomnia (B).
- Klíčová slova
- diagnosis, evidence-based medicine, guideline, insomnia, treatment,
- MeSH
- antidepresiva terapeutické užití MeSH
- benzodiazepiny terapeutické užití MeSH
- dospělí MeSH
- lidé MeSH
- melatonin * terapeutické užití farmakologie MeSH
- poruchy iniciace a udržování spánku * terapie farmakoterapie MeSH
- spánek MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
- Názvy látek
- antidepresiva MeSH
- benzodiazepiny MeSH
- melatonin * MeSH
OBJECTIVES: Thus far, the diagnosis of insomnia is based on purely clinical criteria. Although a broad range of altered physiological parameters has been identified in insomniacs, the evidence to establish their diagnostic usefulness is very limited. Purpose of this WFSBP Task Force consensus paper is to systematically evaluate a series of biomarkers as potential diagnostic tools for insomnia. METHODS: A newly created grading system was used for assessing the validity of various measurements in establishing the diagnosis of insomnia; these measurements originated from relevant studies selected and reviewed by experts. RESULTS: The measurements with the highest diagnostic performance were those derived from psychometric instruments. Biological measurements which emerged as potentially useful diagnostic instruments were polysomnography-derived cyclic alternating pattern, actigraphy, and BDNF levels, followed by heart rate around sleep onset, deficient melatonin rhythm, and certain neuroimaging patterns (mainly for the activity of frontal and pre-frontal cortex, hippocampus and basal ganglia); yet, these findings need replication, as well as establishment of commonly accepted methodology and diagnostic cut-off points. Routine polysomnography, EEG spectral analysis, heart rate variability, skin conductance, thermoregulation, oxygen consumption, HPA axis, and inflammation indices were not shown to be of satisfactory diagnostic value. CONCLUSIONS: Apart from psychometric instruments which are confirmed to be the gold standard in diagnosing insomnia, six biomarkers emerge as being potentially useful for this purpose.
- Klíčová slova
- Insomnia, biomarkers, diagnostic accuracy, grading system, psychometrics,
- MeSH
- biologické markery MeSH
- lidé MeSH
- poruchy iniciace a udržování spánku * diagnóza MeSH
- spánek fyziologie MeSH
- systém hypofýza - nadledviny MeSH
- systém hypotalamus-hypofýza MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Názvy látek
- biologické markery MeSH
PURPOSE: Because of the common and increasing use of antipsychotics in older adults, we aim to summarize the current knowledge on the causes of antipsychotic-related risk of falls in older adults. We also aim to provide information on the use of antipsychotics in dementia, delirium and insomnia, their adverse effects and an overview of the pharmacokinetic and pharmacodynamic mechanisms associated with antipsychotic use and falls. Finally, we aim to provide information to clinicians for weighing the benefits and harms of (de)prescribing. METHODS: A literature search was executed in CINAHL, PubMed and Scopus in March 2022 to identify studies focusing on fall-related adverse effects of the antipsychotic use in older adults. We focused on the antipsychotic use for neuropsychiatric symptoms of dementia, insomnia, and delirium. RESULTS: Antipsychotics increase the risk of falls through anticholinergic, orthostatic and extrapyramidal effects, sedation, and adverse effects on cardio- and cerebrovascular system. Practical resources and algorithms are available that guide and assist clinicians in deprescribing antipsychotics without current indication. CONCLUSIONS: Deprescribing of antipsychotics should be considered and encouraged in older people at risk of falling, especially when prescribed for neuropsychiatric symptoms of dementia, delirium or insomnia. If antipsychotics are still needed, we recommend that the benefits and harms of antipsychotic use should be reassessed within two to four weeks of prescription. If the use of antipsychotic causes more harm than benefit, the deprescribing process should be started.
- Klíčová slova
- Antipsychotics, Delirium, Dementia, Falls, Insomnia, Older adults,
- MeSH
- antipsychotika * škodlivé účinky MeSH
- delirium * chemicky indukované farmakoterapie MeSH
- demence * farmakoterapie chemicky indukované MeSH
- lidé MeSH
- poruchy iniciace a udržování spánku * chemicky indukované farmakoterapie MeSH
- senioři MeSH
- úrazy pádem prevence a kontrola MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
- Názvy látek
- antipsychotika * MeSH
BACKGROUND: Physicians who suffer from poor sleep quality are at an increased risk of mistakes and poor decision-making. We deemed it noteworthy to assess sleep quality in practicing physiatrists, previously reported to be at higher risk of physician burnout, which was documented associated with sleep deprivation. OBJECTIVE: The aim was to estimate the prevalence of sleep disturbance among practicing physiatrists and evaluate the association of sleep quality with their sleep hygiene habits and depression. METHODS: Of the 101 study participants (77 females) who met the inclusion criteria, the majority was between the age of 25 and 40 years (70.3%); 62 (61.4%) were specialists and 39 (38.6%) were in training. In this cross-sectional study, practicing physiatrists were invited to complete an anonymous and voluntary web-based survey. The survey consisted of questions covering demographic information, nicotine and caffeine consumption, exercise habits, and three questionnaires: the Pittsburgh Sleep Quality Index (PSQI), the Beck Depression Inventory-II (BDI-II), and the Sleep Hygiene Index (SHI). RESULTS: Sixty-five (64.4%) respondents showed poor sleep quality (PSQI > 5), and 23 (22.8%) showed at least mild symptoms of depression (BDI-II>13). The mean PSQI, SHI, BDI-II scores were 6.85±3.09, 18.18±5.35, and 8.36±7.52, respectively. Poor sleep quality was significantly positively correlated with symptoms of depression and sleep hygiene misbehavior. CONCLUSION: We found that 64.4% of practicing physiatrists suffered from poor sleep quality, and 22.8% showed at least mild symptoms of depression. Considerable efforts should be directed toward sleep hygiene behavior and mental health improvement.
- Klíčová slova
- Rehabilitation, burnout, depression, sleep, sleep hygiene,
- MeSH
- deprese psychologie MeSH
- dospělí MeSH
- internet MeSH
- lidé MeSH
- poruchy iniciace a udržování spánku * epidemiologie MeSH
- poruchy spánku a bdění * etiologie MeSH
- prevalence MeSH
- průřezové studie MeSH
- průzkumy a dotazníky MeSH
- rehabilitační lékaři * MeSH
- spánek MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika epidemiologie MeSH
BACKGROUND: Borderline personality disorder (BPD) patients commonly suffer from nightmares. Still, the prevalence of this issue does not match the little clinical attention it usually receives. Nightmares impact sleep and daily functioning and may play a role in BPD symptomatology, including suicidality. Since BPD has been linked with high rates of suicide, the potential connection with suicidality is crucial to address. AIMS: To create an up-to-date review of current knowledge on nightmares in BPD and to explore the links between nightmares, insomnia, and suicidality or self-harm in BPD patients. METHOD: This narrative review was conducted using the PubMed, Web of Science, and Google Scholar databases to search for articles published between January 1990 and October 2022, using the following key terms: 'borderline personality disorder' and 'nightmares' or 'insomnia' and 'suicidality' or 'self-harm' or 'self-injuring'. The final list consisted of 99 publications. RESULTS: Sleep disturbances often occur in BPD patients. The prevalence of nightmares in BPD is higher than in general or clinical populations. Nightmares influence borderline personality traits and vice versa through emotional dysregulation, poorer sleep quality, nightmare anxiety, higher arousal, and worsened self-control. A link between nightmares and suicidal behaviour was established in some psychiatric conditions (depression, insomnia); studies on BPD are lacking in this area. Studies comparing nightmares in BPD to other disorders are also missing. There are some suggestions for pharmaceuticals or psychotherapy in treating nightmares, but their application to BPD needs more research. CONCLUSION: Sleep disturbance and nightmares are common among individuals with BPD yet underrepresented in research. Nightmares have been linked with suicidality in other conditions (depression, PTSD) but only indirectly in BPD. More clinical studies are needed to explore the phenomenon further.
