Sleep quality and risk of diabetes and coronary artery disease among young men.

AIMS: To assess the time-dependent effect of sleep quality on diabetes and coronary artery disease (CAD) incidence among young adults. METHODS: Incident rates of diabetes and CAD during a mean follow-up of 6.4 ± 4.1 years were assessed among 26,023 men (mean age 30.9 ± 5.6 years) of the Metabolic Lifestyle and Nutrition Assessment in Young Adults stratified by sleep quality at baseline, as assessed by the Mini-Sleep Questionnaire (MSQ). Incident diabetes and CAD were analyzed using a Cox proportional hazard model. RESULTS: There were 445 cases of diabetes and 92 cases of CAD during 151,312 person-years. An abnormal MSQ score was associated with a 53 % higher incidence of diabetes (95 % CI 1.22-1.94, p < 0.001) compared to those with a normal score, after adjustment for clinical and biochemical diabetes risk factors. The increased risk associated with abnormal sleep quality remained when MSQ was modeled as a continuous time-dependent variable in a multivariable model (HR = 1.036, 95 % CI 1.024-1.049, p < 0.001). The increased risk was higher among overweight or obese participants (BMI and MSQ interaction p = 0.046). Sustained abnormality in MSQ score resulted in higher HR for diabetes (2.35; 95 % CI 1.564-3.519, p < 0.001). In addition, abnormal sleep quality was associated with a 2.38 higher incidence of CAD (95 % CI 1.38-4.11, p = 0.002), after adjustment for traditional clinical and biochemical risk factors. CONCLUSIONS: Sleep quality contributes to the development of diabetes and CAD in apparently healthy young adults in a time-dependent manner. The use of a simple questionnaire to assess sleep quality may be a useful tool for risk stratification in this population.

The effect of nocturnal CPAP therapy on the intraocular pressure of patients with sleep apnea syndrome.

PURPOSE: Few studies have documented that nocturnal continuous positive airway pressure (CPAP) therapy is associated with an increase in intraocular pressure (IOP) in patients with severe obstructive sleep apnea syndrome (OSAS). We re-examined the effect of CPAP therapy on the IOP of OSAS patients. METHODS: The IOP of two different groups of newly diagnosed OSAS patients was compared at their first sleep lab exam without CPAP treatment (non-CPAP treated group; n = 20) and at the second sleep lab exam with CPAP treatment (CPAP treated group; n = 31). The sleep lab exam (sleep period: from 11:00 p.m. until 6:00 a.m.) included IOP measurements, a complete ophthalmologic exam, and nocturnal hemodynamic recordings. The IOP was measured serially using rebound tonometer (IOP; ICARE® PRO) performed while in sitting and supine positions before, during, and after the sleep period. We compared the difference in IOP of CPAP and non-CPAP groups. RESULTS: The mean IOP of the CPAP and non-CPAP groups measured in sitting position before the sleep period was 13.33 ± 2.04 mmHg and 14.02 ± 2.44 mmHg, respectively (p = 0.9). Assuming a supine position for 1 minute significantly increased the IOP by 1.93 mmHg and 2.13 mmHg for both the non-CPAP and CPAP groups (paired t-test; p = 0.02, p = 0.001 respectively), but this IOP rise showed no difference between the two groups. The IOP increased significantly further after 7 hours of sleep in the supine position, and the mean IOP of the CPAP and non-CPAP groups was 19.2 ± 5.68 mmHg and 19.69 ± 5.61 mmHg respectively (independent t-test; p = 0.74). The rise in IOP for both groups was not correlated with any hemodynamic parameters. Three OSAS patients with glaucoma treated with CPAP had mean IOP of 23.75 mmHg after 7 hours of sleep. CONCLUSIONS: OSAS patients have a significant rise in IOP during the sleep period when comparing measurements before and after the sleep period; however, CPAP therapy did not affect the measured IOP. The presented findings suggest that in terms of IOP, CPAP is safe for non-glaucomatous patients, but this may not hold true for glaucomatous patients.

Characterization of sleep disorders in patients with E200K familial Creutzfeldt-Jakob disease.

The largest cluster of E200K familial Creutzfeldt-Jakob disease (fCJD) which occurs is in Jews of Libyan origin in Israel. Insomnia is a very common early complaint in those patients and may even be the presenting symptom. The aim of this study was to assess and characterize sleep pathology in E200K fCJD patients. To do so, sleep studies of 10 consecutive fCJD patients were compared with those of 39 age and gender-matched controls. All patients presented pathological sleep characterized by fragmentation of sleep, loss of sleep spindles and reduced REM sleep amount. Respiration was characterized by irregular rhythm, periodic breathing, apneas and hypopneas, either central or obstructive. EMG recordings revealed repeated movements in sleep, with loss of REM atonia. Comparing to controls, a significant decrease of total sleep time, sleep efficacy and slow-wave sleep as well as a significant increase in the number of awakenings, apnea-hypopnea index and mixed and central apneas were evident in CJD patients. Comparison of two sequential sleep studies in one patient revealed a 40 % reduction of the total sleep time, a 40 % reduction in sleep efficacy and a 40-fold increase of the number of arousals in the second study. A significant correlation was found between the disease severity, as reflected by the CJD Neurological Scale and Periodic leg movement index. These definite and characteristic sleep pathologies in patients with fCJD associated with the E200K mutation may serve as a new diagnostic tool in the disease.