Melatonin and inflammatory bowel disease: From basic mechanisms to clinical application.

Inflammatory bowel disease is a chronic inflammatory disease and has periods of recurrence and remission. Improper immune responses to gut flora bacteria, along with genetic susceptibility, appear to be involved in causing this complex disease. It seems dysbiosis and oxidative stress may also be involved in IBD pathogenesis. A significant number of clinical studies have shown an interesting association between sleep disturbances and IBD. Studies in animal models have also shown that sleep deprivation has a significant effect on the pathogenesis of IBD and can aggravate inflammation. These interesting findings have drawn attention to melatonin, a sleep-related hormone. Melatonin is mainly produced by the pineal gland, but many tissues in the body, including the intestines, can produce it. Melatonin can have an interesting effect on the pathogenesis of IBD. Melatonin can enhance the intestinal mucosal barrier, alter the composition of intestinal bacteria in favor of bacteria with anti-inflammatory properties, regulate the immune response, alleviate inflammation and attenuate oxidative stress. It seems that, melatonin supplementation is effective in relieving inflammation and healing intestinal ulcers in IBD animal models. Some clinical studies have also shown that melatonin supplementation as an adjuvant therapy may be helpful in reducing disease activity in IBD patients. In this review article, in addition to reviewing the effects of sleep disturbances and melatonin on key mechanisms involved in the pathogenesis of IBD, we will review the findings of clinical studies regarding the effects of melatonin supplementation on IBD treatment.

Dual orexin receptor antagonists for treatment of insomnia: A systematic review and meta-analysis on randomized, double-blind, placebo-controlled trials of suvorexant and lemborexant.

Study objectives: Recent treatment guidelines for chronic insomnia recommend pharmacological and non-pharmacological therapies. One of the contemporary drug options for insomnia includes dual orexin receptor antagonist (DORA), such as suvorexant and lemborexant. We conducted a systematic review and meta-analysis for the treatment of insomnia with suvorexant and lemborexant based on randomized, double-blind, placebo-controlled Trials. Methods: We conducted a comprehensive search on three databases (PubMed/Medline, Web of Science, and Cochrane Library) till August 14, 2021, without any restrictions to retrieve the relevant articles. The effect sizes were computed presenting the pooled mean difference or risk ratio along with 95% confidence interval of each outcome. Results: Our search showed eight articles (five for suvorexant and three for lemborexant). Results of diary measures, rating scales, polysomnography results, treatment discontinuation, and adverse events were measured. All efficacy outcome measures favorably and significantly differed in the suvorexant compared to placebo. Safety profile did not differ significantly except for somnolence, excessive daytime sleepiness/sedation, fatigue, back pain, dry mouth, and abnormal dreams. Important adverse events including hallucinations, suicidal ideation/behavior and motor vehicle accidents did not differ between suvorexant and placebo. All the efficacy outcomes significantly differed between lemborexant 5 and lemborexant 10 compared to placebo. Somnolence rate for lemborexant 5 and lemborexant 10 and nightmare for lemborexant 10 were significantly higher than placebo. Conclusion: The present meta-analysis reported that suvorexant and lemborexant are efficacious and safe agents for the patients with insomnia. Further data in patients with insomnia and various comorbid conditions are needed.

Telemedicine and insomnia: a comprehensive systematic review and meta-analysis.

BACKGROUND: Telemedicine has been introduced as a new and effective method in dealing with public health challenges, improving access to health care, and reducing healthcare costs in today's world. Insomnia is the most common sleep disorder that can be managed with cognitive behavioural therapy, however, access to skilled therapists is an issue. Telemedicine improves access to care and thus, it may facilitate management of insomnia. The aim of this study was to assess whether telemedicine can be as effective as traditional in person sleep medicine service for the diagnosis, follow-up, and treatment of insomnia. METHODS: In this systematic review and meta-analysis, studies related to telemedicine and insomnia were identified and selected, using the keywords of telemedicine, insomnia, sleep disorder, treatment, non-pharmacological treatment. The international databases of Embase, ProQuest, ScienceDirect, Scopus, PubMed and Web of Science (WoS), and Google Scholar were searched without a lower time limit, and until July 12, 2021. Data were analysed within the Comprehensive Meta-Analysis (version 2) software, and the significance level of the test was considered P Ë‚ 0.05. RESULTS: A systematic review of 16 selected studies showed that telemedicine interventions have a positive effect on improving insomnia in different groups. The meta-analysis was performed on 2 studies. Based on the results, CBTI interventions based on telemedicine have a greater effect on improving chronic insomnia than face to face CBTI with an average difference of 2.05 ± 0.66 based on the random effects model. Moreover, the difference between the mean in the telemedicine intervention group and the non-intervention group was 0.65 ± 0.19, which shows the positive effect of the telemedicine intervention. CONCLUSION: The use of telemedicine in treatment of insomnia not only accelerates access to sleep services, but can also improve the efficiency of health services in terms of time and cost, as well as therapeutic effects.

When Non-Suicidal Self-Injury Predicts Non-Suicidal Self-Injury and Poor Sleep-Results from a Larger Cross-Sectional and Quasi-Longitudinal Study.

Poor sleep is associated with a higher risk of non-suicidal self-injury (NSSI) as a proxy of unfavorable emotion regulation. In the present study, we tested the hypothesis that past non-suicidal self-injury was associated with current non-suicidal self-injury and with current subjective sleep patterns. To this end, a larger sample of young adults were assessed. A total of 2374 adults (mean age: 27.58 years; 39.6% females) completed a series of self-rating questionnaires covering sociodemographic information, past and current NSSIs, suicide attempts, and current sleep patterns, including experiencing nightmares. Past NSSIs predicted current NSSIs. Current sleep patterns had a modest impact on the association between past and current NSSIs. Compared to male participants, female participants did not report more sleep complaints or more current NSSIs, but more past NSSIs. Past NSSIs predicted the occurrences of nightmares and suicide attempts. The best predictor of current NSSI was the remembered past NSSI, while current poor sleep was only modestly associated with current NSSI. Further indicators of current NSSI and poor sleep were suicide attempts and nightmares within the last six months. Overall, it appears that poor emotion regulation should be considered as underlying factor to trigger and maintain non-suicidal self-injury-related behavior and poor sleep. Further, unlike previous studies, which focused on the possible influence of sleep patterns on NSSIs, the aim of the present study paradigm was to investigate NSSIs on sleep patterns.

Cluster analysis of risky behaviors among the youth in Western Iran: Determining correlates and comparing clusters based on severity of disability and attitude toward mental health help-seeking.

BACKGROUND AND AIMS: The objectives of the study were (i) cluster analysis of risky behaviors; (ii) determining correlates; and (iii) comparing clusters with regard to the attitude toward mental health help seeking. METHODS: The current cross-sectional study is a part of the first phase of the Persian Youth Cohort. From October 2014 to January 2017, 2990 individuals from Ravansar City in western Iran completed structured interviews and national and international standard questionnaires. The obtained data were analyzed using two-stage cluster analysis, multinomial logistic regression analysis, and Chi-square test. RESULTS: This model provided three distinct clusters: (i) low-risk group with mild distress, (ii) high-risk group with high distress, and (iii) violent group with medium distress. Some sociodemographic and lifetime psychiatric disorders were the correlates of unhealthy clusters (P < 0.05). Compared to the reference cluster, a higher number of members in unhealthy clusters were suffering from medium to severe disability. Nevertheless, the participants in these clusters were less inclined to mental health help seeking. CONCLUSIONS: More than half of the youth were suffering from suicidal and violent behaviors. Since high-risk participants are less inclined to mental health help seeking, the health policymakers can successfully utilize the results in planning general health programs.

The role of daytime napping in declarative memory performance: a systematic review.

Sleep plays an important role in stabilizing and reinforcing memory of newly acquired information. Like nocturnal sleep, a daytime nap is shown to effectively contribute to memory processing. However, studies are often focused on nocturnal sleep. This review has aimed at systematically compiling the results of studies which have examined the effects of napping on declarative memory performance in healthy adults. Such studies have focused on different aspects of memory reinforcement following a diurnal nap including the involved mechanisms in memory reconsolidation, type of declarative tasks, cross-gender differences, the role of age, duration of nap and its delayed onset. One of the reviewed studies reported that even as short as 6 min of napping exerts a positive effect on memory function. Evidence from these studies indicates hippocampal-dependent enhancement of the learned information. Diurnal naps predominantly include non-rapid eye movement sleep with slow waves yielding potential effects on declarative memory. Evidence has shown that the empowered learning and retrieval depends upon spindle density during the nap. Moreover, the role of coordinated autonomic and central events in enhancing declarative memory has also been reported. Slow waves and sleep spindles are known to fuel declarative memory function during the NREM-2 (N2) stage of sleep.

A systematic review and meta-analysis of the association between shift work and metabolic syndrome: The roles of sleep, gender, and type of shift work.

This study was conducted to investigate the association between shift work and metabolic syndrome (MetS) and quantify the roles of sleep, gender, and type of shift work. We searched online databases, including PubMed, Scopus, and Web of Science on November 17, 2019. Of the 821 articles identified, 38 observational studies (27 cross-sectional, 10 cohorts, and one nested case-control), conducted on 128,416 participants, met our eligibility criteria. The pooled Odds ratio (OR) and 95% Confidence interval (CI) of MetS in shift-versus day-workers were estimated as 1.14 (1.07, 1.21) and 1.11 (1.06, 1.17) for the unadjusted and adjusted models. This association remained significant only for the studies with a cross-sectional design. There was a significantly higher odds of MetS in the studies conducted only on females (1.13 [1.06, 1.20]) or males (1.12 [1.02, 1.21]). The pooled adjusted OR (95% CI) for the studies without and with sleep adjustment was calculated as 1.14 (1.08, 1.21) and 1.29 (1.06, 1.52). We observed that rotating shift workers had stronger odds of MetS than the other shift workers. In conclusion, our findings revealed the significant odds of an association between shift work and MetS and different effects for sleep, gender, and type of shift work.

A weight-independent association between atypical antipsychotic medications and obstructive sleep apnea.

BACKGROUND: With increasing use of atypical antipsychotic (AAP) agents, the concern has been raised about the association between AAP agents and medical complications. Obstructive sleep apnea (OSA) is a common breathing disorder that adversely affects health and quality of life. Because the major risk factors for OSA are weight gain and obesity by altering the upper airway anatomy, an association between AAP and development of OSA is predictable. However, we hypothesized that AAP may promote OSA not only by weight gain but also because of its potential effects on upper airway muscle function. In the present study, we evaluated the possible association between AAP use and the severity of OSA. METHODS: A sample of patients using AAP for treatment of paradoxical insomnia was evaluated before and at least 8 weeks after AAP use. Patients were divided based on type of AAP use to olanzapine, risperidone, and quetiapine groups. Patients used olanzapine (5-10 mg), risperidone (2-4 mg), or quetiapine (100-200 mg) 2 h before bedtime. Before and after treatment, respiratory variables were recorded using polysomnography. BMI, neck circumference (NC), and waist circumference (WC) were measured before and after treatment period. RESULTS: There was no significant difference between pre- and post-treatment apnea index (0.2 ± 0.6 vs. 2.6 ± 4.3; p = 0.094) in olanzapine group. However, significant differences in hypopnea index (5.1 ± 5 vs. 30 ± 10.8; p < 0.0001) and AHI (5.3 ± 4.9 vs. 32.6 ± 9.6; p < 0.0001) were observed. Similar results were found in quetiapine and risperidone groups, except that in quetiapine group, apnea index was significantly increased after treatment period (0.7 ± 1.2 in pre-treatment vs. 3.1 ± 2.4 in post-treatment; p = 0.007). There were no significant changes in BMI, NC, and WC during treatment period in all three groups. CONCLUSION: While AAP medications are known cause of weight gain as a main risk factor of OSA, our finding demonstrated a weight-independent association between AAP medications and worsening respiration during sleep.

Validation of the Farsi version of the revised Adolescent Sleep Hygiene Scale (ASHSr): a cross-sectional study.

BACKGROUND: Restoring sleep is associated with a broad variety of favorable cognitive, emotional, social and behavioral benefits during the day. This holds particularly true for adolescents, as maturational, social, cognitive, emotional and behavioral changes might unfavorably impact on adolescents' sleep. Among adolescents, poor sleep hygiene practices are a potentially modifiable risk factor that can be addressed via appropriate interventions. Accordingly, having reliable and valid self-report measures to assess sleep hygiene practices is essential to gauge individual responses to behavioral interventions and evaluate sleep hygiene recommendations. The aim of the present study therefore was to translate and to test the psychometric properties (internal consistency, test-retest reliability, factorial and concurrent validity) of the Farsi/Persian version of the revised version of the Adolescent Sleep Hygiene Scale (ASHSr). METHOD: A total of 1013 adolescents (mean age: M = 15.4 years; SD = 1.2; range: 12-19 years; 42.9% females) completed the ASHSr and the Pittsburgh Sleep Quality Index (PSQI) in their classroom during an official school lesson. Further, 20% completed the ASHSr 6 weeks later to evaluate the test-retest reliability. Cronbach's alpha coefficients were calculated to examine internal consistency, confirmatory factor analysis (CFA) was used to test factorial validity, whereas concurrent validity and test-retest reliability were examined via correlation analyses. RESULTS: A first-order confirmatory factor analysis (CFA) corroborated the six-factor structure of the ASHSr, including a physiological, behavioral arousal, cognitive/emotional, daytime sleep, sleep environment, and sleep stability factor. A second-order CFA showed that a higher-order sleep hygiene construct explained sufficient variance in each factor. Cronbach's alpha values ranged between .71 and .75, correlations for test-retest reliability between .82 and .87. Significant correlations were found between most ASHSr scales and the PSQI indices. However, the magnitude of these correlations was weak. CONCLUSIONS: The Farsi/Persian version of the Adolescent Sleep Hygiene Scale can be used as a reliable and valid tool for evaluation of sleep hygiene practices among Farsi/Persian-speaking adolescents.