Association of circadian rest-activity rhythms with cardiovascular disease and mortality in type 2 diabetes.

AIMS: To examine the associations of disrupted circadian rest-activity rhythm (CRAR) with cardiovascular diseases and mortality among people with type 2 diabetes. METHODS: A total of 3147 participants with baseline type 2 diabetes (mean age 65.21 years, 39.78% female; mean HbA1c 50.02 mmol/mol) from UK Biobank were included. The following CRAR parameters were derived from acceleration data: interdaily stability (IS), intradaily variability (IV), relative amplitude (RA), most active 10 h period onset (M10 onset), and least active 5 h period onset (L5 onset). We used Cox proportional hazards models to estimate the associations of CRAR with cardiovascular diseases and mortality, adjusting for sociodemographic, lifestyle, and health characteristics. RESULTS: Participants in the lowest quartile of IS and RA exhibited the greatest risk of developing cardiovascular disease (IS, hazard ratio [HR]Q1 vs. Q4 1.40 [95% confidence interval (CI) 1.04, 1.88]; RA, HRQ1 vs. Q4 2.45 [95% CI 1.73, 3.49]). However, the association between delayed L5 onset and cardiovascular disease risk did not reach statistical significance. Additionally, we found that high IV and low RA were associated with all-cause and cardiovascular mortality. CONCLUSION: Objectively determined CRAR disturbances may increase the risk of cardiovascular diseases and mortality among people with type 2 diabetes.

Status cataplecticus leading to the obstetric complication of prolonged labor.

A 32-year-old married Chinese woman with cataplectic narcolepsy developed status cataplecticus during childbirth. It resulted in prolonged labor and required an emergency cesarean section. The patient had a history of severe and prolonged cataplectic attacks during sexual excitement but relatively mild attacks in other situations. We postulated that her susceptibility to genital stimulation might predispose her to cataplectic attacks during childbirth. Awareness of this potential obstetric complication, especially in those with a history of prominent sex-related cataplexy, together with careful planning and monitoring during the labor process may help to minimize the obstetric risk of patients with narcolepsy.