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1.
Sleep Med ; 64: 56-61, 2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31670162

RESUMO

OBJECTIVE: The aim of this study was to assess the trends and determinants of sleeping pill consumption in the general population. METHODS: This was a prospective study that included 4329 participants (2379 women, 51.9 ± 10.4 years) living in the city of Lausanne, Switzerland, followed up for an average of 10.9 years. Benzodiazepines and benzodiazepine receptor agonists were considered as sleeping pills. RESULTS: The prevalence (95% confidence interval [CI]) of sleeping pills use was 8.0% (7.2-8.9) at baseline and 8.4 (7.6-9.3) after 10.9 years. Overall, sleeping pills use was higher among women, elderly individuals, and individuals reporting a history of anxiety and depression. During the 10.9-year follow-up, 85.8% of participants never used sleeping pills, 2.7% used the sleeping pills at all assessments, and 11.5% shifted from using to quitting (and vice versa). On multivariate analysis, the factors associated with "always" sleeping pills use were as follows: female gender (relative risk ratio and [95% CI] = 1.80 [1.14-2.85]); older age (7.05 [3.56-14.0] for 65 + vs < 45 years); lower educational level (2.06 [1.06-3.99] for mandatory vs university); anxiety (5.61 [3.61-8.71] for yes/no); and depression (3.75 [2.47-5.69] for yes/no). The same factors were also associated with occasional sleeping pills use (ie, shifters): relative risk ratios and 95% CI = 1.56 (1.26-1.94), 2.37 (1.72-3.26), 1.35 (0.98-1.87), 3.40 (2.59-4.45), and 2.50 (1.99-3.15) for female gender, older age, lower educational level, and anxiety and depression, respectively. CONCLUSION: During a 10.9-year follow-up, one out of seven participants (14.2%) used sleeping pills at least once during the study period. Sleeping pills use is more frequent among individuals with anxiety or depression, elderly individuals, and women.

2.
Rev Med Suisse ; 15(665): 1760-1764, 2019 Oct 02.
Artigo em Francês | MEDLINE | ID: mdl-31580020

RESUMO

Neurostimulation of the hypoglossal nerve is a new alternative treatment to CPAP (Continuous Positive Airway Pressure) for patients with moderate-to-severe OSAS (Obstructive Sleep Apnea Syndrome) with anteroposterior pharyngeal obstruction visualized during a Drug Induced Sleep Endoscopy (DISE). Implantation and follow-up are performed at the CHUV with the collaboration between the SAOS-ronchopathie unit, the maxillofacial and dental surgery division and the center for investigation and research on sleep (CIRS). In this article, we present the technique, its indication and the outcomes through a recent review of the literature. This new device has been used for five years, mainly in the United States and Europe.


Assuntos
Terapia por Estimulação Elétrica , Nervo Hipoglosso/fisiologia , Apneia Obstrutiva do Sono/terapia , Humanos
3.
Heart ; 2019 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-31501230

RESUMO

OBJECTIVE: There is controversy regarding the effect of napping on cardiovascular disease (CVD), with most studies failing to consider napping frequency. We aimed to assess the relationship of napping frequency and average nap duration with fatal and non-fatal CVD events. METHODS: 3462 subjects of a Swiss population based cohort with no previous history of CVD reported their nap frequency and daily nap duration over a week, and were followed over 5.3 years. Fatal and non-fatal CVD events were adjudicated. Cox regressions were performed to obtain HRs adjusted for major cardiovascular risk factors and excessive daytime sleepiness or obstructive sleep apnoea. RESULTS: 155 fatal and non-fatal events occurred. We observed a significantly lower risk for subjects napping 1-2 times weekly for developing a CVD event (HR 0.52, 95% CI 0.28 to 0.95) compared with non-napping subjects, in unadjusted as well as adjusted models. The increased HR (1.67, 95% CI 1.10 to 2.55) for subjects napping 6-7 times weekly disappeared in adjusted models (HR 0.89, 95% CI 0.58 to 1.38). Neither obstructive sleep apnoea nor excessive daytime sleepiness modified this lower risk. No association was found between nap duration and CVD events. CONCLUSION: Subjects who nap once or twice per week have a lower risk of incident CVD events, while no association was found for more frequent napping or napping duration. Nap frequency may help explain the discrepant findings regarding the association between napping and CVD events.

4.
Rev Med Suisse ; 15(662): 1620-1624, 2019 Sep 11.
Artigo em Francês | MEDLINE | ID: mdl-31508913

RESUMO

Obstructive sleep apnea syndrome (OSAS) and arterial hypertension (HT) are two frequent, often concomitant diseases, who are both associated with an increased cardiovascular risk. In the last years, an association between these two entities has been established. The purpose of this article is to review the current knowledge about the link between HT and OSAS, the pathophysiological mechanisms involved in the common genesis of the two conditions and the characteristics suggesting an underlying OSAS in a hypertensive subject. We will also update readers about the current screening of OSAS in which primary care physicians are directly involved, and review the pros and cons of different treatment options for HT in OSAS.


Assuntos
Hipertensão/complicações , Hipertensão/terapia , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/diagnóstico , Humanos , Hipertensão/fisiopatologia , Apneia Obstrutiva do Sono/fisiopatologia
5.
Lancet Respir Med ; 7(8): 687-698, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31300334

RESUMO

BACKGROUND: There is a scarcity of published data on the global prevalence of obstructive sleep apnoea, a disorder associated with major neurocognitive and cardiovascular sequelae. We used publicly available data and contacted key opinion leaders to estimate the global prevalence of obstructive sleep apnoea. METHODS: We searched PubMed and Embase to identify published studies reporting the prevalence of obstructive sleep apnoea based on objective testing methods. A conversion algorithm was created for studies that did not use the American Academy of Sleep Medicine (AASM) 2012 scoring criteria to identify obstructive sleep apnoea, allowing determination of an equivalent apnoea-hypopnoea index (AHI) for publications that used different criteria. The presence of symptoms was not specifically analysed because of scarce information about symptoms in the reference studies and population data. Prevalence estimates for obstructive sleep apnoea across studies using different diagnostic criteria were standardised with a newly developed algorithm. Countries without obstructive sleep apnoea prevalence data were matched to a similar country with available prevalence data; population similarity was based on the population body-mass index, race, and geographical proximity. The primary outcome was prevalence of obstructive sleep apnoea based on AASM 2012 diagnostic criteria in individuals aged 30-69 years (as this age group generally had available data in the published studies and related to information from the UN for all countries). FINDINGS: Reliable prevalence data for obstructive sleep apnoea were available for 16 countries, from 17 studies. Using AASM 2012 diagnostic criteria and AHI threshold values of five or more events per h and 15 or more events per h, we estimated that 936 million (95% CI 903-970) adults aged 30-69 years (men and women) have mild to severe obstructive sleep apnoea and 425 million (399-450) adults aged 30-69 years have moderate to severe obstructive sleep apnoea globally. The number of affected individuals was highest in China, followed by the USA, Brazil, and India. INTERPRETATION: To our knowledge, this is the first study to report global prevalence of obstructive sleep apnoea; with almost 1 billion people affected, and with prevalence exceeding 50% in some countries, effective diagnostic and treatment strategies are needed to minimise the negative health impacts and to maximise cost-effectiveness. FUNDING: ResMed.

6.
Sleep Med ; 61: 31-36, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31300205

RESUMO

STUDY OBJECTIVES: The temporal relationship between nocturnal sleep and daytime napping has only been assessed in small non-representative samples, and suggests that nocturnal sleep and napping are interdependent, although mixed results exist. In this study, we investigated the temporal relationship between nocturnal sleep and napping (and vice versa). METHODS: A population-based sample of middle-aged adults (N = 683, mean age 60.7 [SD 9.5]) completed seven days of ecological momentary assessment reporting sleep and nap characteristics. Multilevel random-effects models were used to assess the temporal relationship between sleep duration and quality, and nap occurrence and duration (and vice versa). RESULTS: In sum, 64% of the study population took at least one nap over the course of seven days. Poor subjective sleep quality and shorter sleep duration increased the likelihood and duration of next-day napping. No effect of nap occurrence or duration was found on same-day nocturnal sleep duration and quality. However, when considering the timing of nap, afternoon naps, but not morning or evening naps, decreased same-day nocturnal sleep duration. CONCLUSION: Naps seem to compensate for poor subjective sleep quality, and to some extent for short sleep duration. As only afternoon naps reduced same-day nocturnal sleep duration, timing of the daytime nap seems to matter with respect to same-day nocturnal sleep duration.

7.
J Clin Sleep Med ; 15(6): 839-847, 2019 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-31138378

RESUMO

STUDY OBJECTIVES: To evaluate continuous positive airway pressure (CPAP) treatment in patients with moderate to severe sleep-disordered breathing (SDB) after an ischemic stroke. METHODS: We identified patients included in the Acute Stroke Registry and Analysis of Lausanne (ASTRAL) who underwent polysomnography after an ischemic stroke. We compared patients without significant SDB (apnea-hypopnea index [AHI] < 15 events/h: SDB-), with AHI ≥ 15 events/h who refused CPAP or with poor CPAP adherence (SDB+ CPAP-), and patients with SDB effectively treated by CPAP (SDB+ CPAP+). RESULTS: We analyzed data from 101 patients (age 68.5 ± 11.1 years, 84.1% men). In multivariate analysis the SDB+ CPAP+ group was associated with a significant reduction of stroke recurrence and mortality (odds ratio 0.13, 95% confidence interval 0.00-0.86, P = .031), whereas atrial fibrillation was independently associated with a higher risk (odds ratio 4.32, 95% confidence interval 1.51-12.33, P = .006). Event-free survival analysis (stroke recurrence and death) after 2-year follow-up showed that those in the SDB+ CPAP+ group had significantly higher cardiovascular survival, and Cox proportion hazard model identified CPAP treatment as significantly associated with survival time (P = .025). The AHI and the National Institutes of Health Stroke Scale subacute score were independently associated with CPAP adherence among patients with SDB. CONCLUSIONS: This observational study shows that CPAP treatment in stroke patients with moderate to severe SDB is associated with lower rates of stroke recurrence and death.

8.
JAMA Otolaryngol Head Neck Surg ; 145(6): 509-515, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-30973594

RESUMO

Importance: The association of positive airway pressure (PAP) with reduced mortality in patients with obstructive sleep apnea (OSA) remains uncertain. Objective: To investigate the association between PAP prescription and mortality. Design, Setting, and Participants: This multicenter, population-based cohort study evaluated data from the Sleep Heart Health Study (SHHS), a long-term observational cohort study that included participants between 1995 and 1998, with a mean follow-up of 11.1 years. Analyses were performed in September 2018. Within the SHHS, we compared patients with obesity and severe OSA with (n = 81) and without (n = 311) prescription of PAP therapy, after matching patients from each group by age, sex, and apnea-hypopnea index. Exposures: Self-reported use of PAP. Main Outcomes and Measures: All-cause mortality. Results: Of 392 study participants, 316 (80.6%) were men, and mean (SD) age was 63.1 (11.0) years. Ninety-six deaths occurred; 12 among the prescribed-PAP group and 84 among the nonprescribed-PAP group, yielding crude incidence rates of 12.8 vs 24.7 deaths per 1000 person-years. In Cox multivariate analysis, the hazard ratio (HR) of all-cause mortality for prescribed PAP therapy was 0.38 (95% CI, 0.18-0.81). After propensity matching, the HR of all-cause mortality for prescribed PAP therapy was 0.58 (95% CI, 0.35-0.96). According to survival curves, the difference in mortality appears 6 to 7 years after initiation of PAP therapy. Conclusions and Relevance: Positive airway pressure prescription is associated with reduced all-cause mortality, and this association appears several years after PAP initiation. If replicated, these findings may have strong clinical implications.

9.
Heart ; 105(19): 1500-1506, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30962189

RESUMO

OBJECTIVE: We aimed to investigate the association between cardiovascular health (CVH), as defined by the American Heart Association, and several sleep disturbances. METHODS: Two community-based cohorts, the Paris Prospective Study 3 (PPS3, France, n=6441) and the CoLaus study (Switzerland, n=2989) were analysed. CVH includes 7 metrics which all can be classified as poor, intermediate and ideal. Global CVH score was categorised into poor (0-2 ideal metrics), intermediate (3-4 ideal metrics) and ideal (≥5 ideal metrics). Associations between global CVH and self-reported sleep disturbances (proxy of sleep-disordered breathing [SDB], excessive daytime sleepiness, insomnia symptoms and short/long sleep duration) and SDB severity measured by polysomnography (PSG) were investigated. Adjusted OR/relative risk ratio (RRR) and 95% CIs were estimated. Subjects with previous cardiovascular disease were excluded. RESULTS: Compared with poor CVH, subjects with intermediate and ideal global CVH had lower odds of self-reported SDB in both cohorts (ORs 0.55; 95% CI 0.44 to 0.68 and 0.35; 95% CI 0.22 to 0.53, respectively) and had lower SDB severity measured by PSG (RRR 0.07; 95% CI 0.02 to 0.20) in CoLaus. Subjects with intermediate and ideal global CVH had lower odds of excessive daytime sleepiness in PPS3 (ORs 0.82; 0.72 to 0.95 and 0.80; 0.82 to 1.02, respectively). No consistent associations were found between CVH and sleep duration or insomnia symptoms. CONCLUSIONS: Higher levels of CVH are associated with lower odds of SDB and excessive daytime sleepiness. However, causal interpretation cannot be made and associations might be bidirectional.

10.
J Neurophysiol ; 121(6): 2140-2152, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-30943100

RESUMO

Previous studies have shown that regional slow-wave activity (SWA) during non-rapid eye movement (NREM) sleep is modulated by prior experience and learning. Although this effect has been convincingly demonstrated for the sensorimotor domain, attempts to extend these findings to the visual system have provided mixed results. In this study we asked whether depriving subjects of external visual stimuli during daytime would lead to regional changes in slow waves during sleep and whether the degree of "internal visual stimulation" (spontaneous imagery) would influence such changes. In two 8-h sessions spaced 1 wk apart, 12 healthy volunteers either were blindfolded while listening to audiobooks or watched movies (control condition), after which their sleep was recorded with high-density EEG. We found that during NREM sleep, the number of small, local slow waves in the occipital cortex decreased after listening with blindfolding relative to movie watching in a way that depended on the degree of visual imagery subjects reported during blindfolding: subjects with low visual imagery showed a significant reduction of occipital sleep slow waves, whereas those who reported a high degree of visual imagery did not. We also found a positive relationship between the reliance on visual imagery during blindfolding and audiobook listening and the degree of correlation in sleep SWA between visual areas and language-related areas. These preliminary results demonstrate that short-term alterations in visual experience may trigger slow-wave changes in cortical visual areas. Furthermore, they suggest that plasticity-related EEG changes during sleep may reflect externally induced ("bottom up") visual experiences, as well as internally generated ("top down") processes. NEW & NOTEWORTHY Previous work has shown that slow-wave activity, a marker of sleep depth, is linked to neural plasticity in the sensorimotor cortex. We show that after short-term visual deprivation, subjects who reported little visual imagery had a reduced incidence of occipital slow waves. This effect was absent in subjects who reported strong spontaneous visual imagery. These findings suggest that visual imagery may "substitute" for visual perception and induce similar changes in non-rapid eye movement slow waves.

11.
Sleep Med ; 2019 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-30979645

RESUMO

BACKGROUND: Although a few studies suggest an adverse effect of sleep duration variability on cardiovascular risk factor, others did not and this association remains controversial. Moreover, most studies were non-representative of the general population, used different sleep duration variability measures, and relied on self-reported sleep duration. We aimed to assess the association between different, actigraphy-based sleep duration variability measures and cardiovascular risk factors in a population-based sample. METHODS: In a middle-aged population-based cohort, 2598 subjects had data on sleep duration variability measured by actigraph over 14 days. Multivariable logistic regressions were performed to assess the relationship between different sleep duration variability measures [ie, night-to-night variability (NNV), range between shortest and longest sleep duration (RSL), range between average weekday and weekend sleep duration (RWW)] and cardiovascular risk factors including obesity, diabetes and hypertension. RESULTS: Subjects with highest sleep duration variability - measured as NNV, RSL and RWW, were more likely to be obese. These associations robust in most but not all sensitivity analyses, and no associations between sleep duration variability measures and diabetes or hypertension were found. CONCLUSION: There is a possible association between high sleep duration variability and obesity, although results were not robust in all sensitivity analyses. Further, no associations between sleep duration variability and other cardiovascular risk factor such as diabetes or hypertension were found.

12.
Sleep ; 42(6)2019 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-30895315

RESUMO

STUDY OBJECTIVES: Although several studies have linked short and long sleep duration to weight gain, mixed results exist. Contrarily, few studies associated objectively measured sleep characteristics with weight gain. We investigated the association between several sleep characteristics measured by questionnaire and polysomnography with prospective weight gain in a population-based, middle-aged cohort. METHODS: Three samples were analyzed: sample 1 (n = 2551, 47.3% men, 56.9 ± 10.3 years) had data for subjective sleep characteristics, sample 2 (n = 1422, 49.4% men, 57.6 ± 10.4 years) had objective sleep assessment (polysomnography), and sample 3 consisting of 1259 subjects included in both samples. Multivariable logistic regressions were performed to assess the relationship between sleep characteristics and ≥5 kg weight gain during a median follow-up of 5.3 years. RESULTS: In both study samples, 12% of the subjects gained ≥5 kg during follow-up. Multivariable analyses showed poor subjective sleep quality (as assessed by Pittsburgh Sleep Quality Index: odds ratio [95% confidence interval] = 1.54 [1.19 to 1.99]), percentage of sleep spent in stage 2 (1.32 [1.10 to 1.58]), and less than 90% oxygen saturation (SpO2 < 90) (1.23 [1.07 to 1.41]); moderate/severe Oxygen Desaturation Index (1.70 [1.01 to 2.85]) and autonomic arousal duration (1.22 [1.02 to 1.45]) were related to ≥5 kg weight gain. Only poor subjective sleep quality was robustly associated with weight gain in all sensitivity analyses, except in female subsamples. CONCLUSIONS: Poor subjective sleep quality, and to some extent moderate to severe oxygen desaturation, but no other sleep characteristics, were robustly associated with weight gain. Future studies should confirm the relationship between sleep quality and weight gain, assess sex differences, and investigate underlying mechanisms.

13.
J Am Heart Assoc ; 8(7): e011372, 2019 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-30898062

RESUMO

Background Although sleep characteristics have been linked to cardiovascular disease and cardiovascular risk factors, the association between sleep characteristics measured by polysomnography and cardiovascular health ( CVH ) remains unknown. Methods and Results In a population-based sample (n=1826), sleep characteristics were assessed by both sleep questionnaires and polysomnography. Global, behavioral, and biological CVH were defined according to the American Heart Association. Multinomial logistic regressions were performed to estimate relative risk ratios and 95% CI . Strong dose-response associations were found between all oxygen saturation-related variables (oxygen desaturation index, mean oxygen saturation, and percentage of total sleep time spent under 90% oxygen saturation) and obstructive sleep apnea (severity categories and apnea/hypopnea index) and global, behavioral, and biological CVH . Mean oxygen saturation had the strongest positive association (relative risk ratios 1.31 [ CI 1.22-1.41]; 1.78 [ CI 1.55-2.04] for intermediate relative to ideal CVH ), and oxygen desaturation index had the strongest negative association (relative risk ratios 0.71 [ CI 0.65-0.78]; 0.45 [ CI 0.34-0.58] for intermediate relative to ideal CVH ) with global CVH , and these associations were also the most robust in sensitivity analyses. The impacts of sleep architecture and sleep fragmentation were less consistent. Conclusions Mean oxygen saturation, oxygen desaturation index, and apnea/hypopnea index were associated with CVH . Conversely, most variables related to sleep architecture and sleep fragmentation were not consistently related to CVH . Sleep-disordered breathing and the associated oxygen (de)saturation were associated with CVH more strongly than with sleep fragmentation.

14.
J Clin Sleep Med ; 15(2): 183-194, 2019 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-30736872

RESUMO

STUDY OBJECTIVES: Apnea-hypopnea index (AHI) is the main polysomnographic measure to diagnose obstructive sleep apnea (OSA). We aimed to evaluate the effect of three standard hypopnea definitions on the prevalence of OSA and its association with cardiometabolic outcomes in the general population. METHODS: We analyzed data from the HypnoLaus study (Lausanne, Switzerland), in which 2,162 participants (51% women, 57 ± 19 years) underwent in-home full polysomnography. AHI was calculated using three hypopnea definitions: AASM1999 (≥ 50% decrease in airflow or lower airflow reduction associated with oxygen desaturation ≥ 3% or an arousal), AASM2007 (≥ 30% airflow reduction associated with ≥ 4% oxygen desaturation), and AASM2012 (≥ 30% airflow reduction associated with ≥ 3% oxygen desaturation or an arousal). Participants underwent clinical assessment for hypertension, diabetes, and metabolic syndrome. RESULTS: Median AHI of AASM1999, AASM2007 and AASM2012 criteria were 10.9, 4.4, and 10.1 events/h, respectively. OSA prevalence defined as AHI ≥ 5, ≥ 15, and ≥ 30 events/h was 74.5%, 39.3%, and 16.3% using AASM1999; 46.9%, 18.8%, and 6.8% using AASM2007; and 72.2%, 36.6%, and 14.9% using AASM2012. Different AHI thresholds derived from AASM1999, AASM2007, and AASM2012 criteria, respectively, were associated with hypertension (11.5, 4.8, 10.7 events/h), diabetes (15.7, 7.1, 14.4 events/h), and metabolic syndrome (12.8, 5.5, 11.8 events/h). CONCLUSIONS: Hypopnea definition has a major effect on AHI and on OSA prevalence in the general population and, hence, important implications for public health policies. There is a twofold difference in the threshold above which an association with diabetes, hypertension, and metabolic syndrome is observed using AASM2007 compared to AASM1999 or AASM2012 criteria.

15.
Psychol Health ; 34(6): 754-770, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30755031

RESUMO

OBJECTIVE: Subjective health complaints (SHC) are frequent in musicians. These complaints may be particularly distressing in this population because they are performance relevant. This paper aims at testing a model positing that (a) perseverative cognition (PC) predicts sleep duration/quality, (b) sleep duration/quality predicts SHC and (c) mood is a mediator of these associations. DESIGN: Participants were 72 music students (mean age (SD): 22.7 (3.0) years), and the assessment period consisted of seven consecutive days, with a solo performance on the fifth day. MAIN OUTCOME MEASURES: Self-reported total sleep time (TST) and sleep quality were assessed 30 min after wake-up, and objective TST/sleep quality were assessed with an actigraphy watch. PC and mood were measured five times a day. Daily SHC were assessed at 9 p.m. RESULTS: PC did not significantly predict sleep duration/quality. Self-reported and objective TST and sleep quality were all significantly associated with SHC. Mood played a mediating role in each of these relationships with the exception of objective sleep quality. CONCLUSION: The tested model on the association among PC, sleep and SHC and the mediating role of mood received partial support, highlighting the importance of sleep and mood in the emergence of SHC among university music students.

16.
Am J Clin Nutr ; 109(1): 17-28, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30615104

RESUMO

Background: Overconsumption of energy-dense foods and sleep restriction are both associated with the development of metabolic and cardiovascular diseases, but their combined effects remain poorly evaluated. Objective: The aim of this study was to assess whether sleep restriction potentiates the effects of a short-term overfeeding on intrahepatocellular lipid (IHCL) concentrations and on glucose homeostasis. Design: Ten healthy subjects were exposed to a 6-d overfeeding period (130% daily energy needs, with 15% extra energy as sucrose and 15% as fat), with normal sleep (8 h sleep opportunity time) or sleep restriction (4 h sleep opportunity time), according to a randomized, crossover design. At baseline and after intervention, IHCL concentrations were measured by proton magnetic resonance spectroscopy, and a dual intravenous [6,6-2H2]-, oral 13C-labeled glucose tolerance test and a polysomnographic recording were performed. Results: Overfeeding significantly increased IHCL concentrations (Poverfeeding < 0.001; overfeeding + normal sleep: +53% ± 16%). During the oral glucose tolerance test, overfeeding significantly increased endogenous glucose production (Poverfeeding = 0.034) and the oxidation of 13C-labeled glucose load (Poverfeeding = 0.038). Sleep restriction significantly decreased total sleep time, and the duration of stages 1 and 2 and rapid eye movement sleep (all P < 0.001), whereas slow-wave sleep duration was preserved (Poverfeeding × sleep = 0.809). Compared with overfeeding, overfeeding + sleep restriction did not change IHCL concentrations (Poverfeeding × sleep = 0.541; +83% ± 33%), endogenous glucose production (Poverfeeding × sleep = 0.567), or exogenous glucose oxidation (Poverfeeding × sleep = 0.118). Sleep restriction did not significantly alter blood pressure, heart rate, or plasma cortisol concentrations (all Poverfeeding × sleep = NS). Conclusions: Six days of a high-sucrose, high-fat overfeeding diet significantly increased IHCL concentrations and increased endogenous glucose production, suggesting hepatic insulin resistance. These effects of overfeeding were not altered by sleep restriction. This trial was registered at clinicaltrials.gov as NCT02075723. Other study ID numbers: SleepDep 02/14.


Assuntos
Hipernutrição/metabolismo , Privação do Sono/metabolismo , Adulto , Glicemia/metabolismo , Estudos Cross-Over , Dieta Hiperlipídica/efeitos adversos , Sacarose na Dieta/administração & dosagem , Sacarose na Dieta/efeitos adversos , Ingestão de Energia , Feminino , Teste de Tolerância a Glucose , Homeostase , Humanos , Resistência à Insulina , Metabolismo dos Lipídeos/efeitos dos fármacos , Lipídeos/análise , Fígado/química , Fígado/metabolismo , Masculino , Hipernutrição/complicações , Espectroscopia de Prótons por Ressonância Magnética , Ganho de Peso , Adulto Jovem
17.
J Sleep Res ; : e12799, 2018 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-30474290

RESUMO

Sleep-disordered breathing is a common condition, related to a higher cardiometabolic and neurocognitive risk. The main risk factors for sleep-disordered breathing include obesity, craniofacial characteristics, male sex and age. However, some studies have suggested that adverse socioeconomic circumstances and lifestyle-related behaviours such as smoking and alcohol use, may also be risk factors for sleep-disordered breathing. Here, we investigate the associations between socioeconomic status and sleep-disordered breathing, as measured by sleep apnea-hypopnea and oxygen desaturation indexes. Furthermore, we assess whether these associations are explained by lifestyle-related factors (smoking, sedentary behaviour, alcohol use and body mass index [BMI]). We used data from the CoLaus|HypnoLaus study, a population-based study including 2162 participants from Lausanne (Switzerland). Socioeconomic status was measured through occupation and education. Sleep-disordered breathing was assessed through polysomnography and measured using the apnea-hypopnea index (AHI: number of apnea/hypopnea events/hr: ≥15/≥30 events), and the ≥3% oxygen desaturation index (ODI: number of oxygen desaturation events/hr: ≥15/≥30 events). Lower occupation and education were associated with higher AHI and ODI (occupation: AHI30, odds ratio (OR) = 1.88, 95% confidence interval (CI) [1.07; 3.31]; ODI30, OR = 2.29, 95% CI [1.19; 4.39]; education: AHI30, OR = 1.21, 95% CI [0.85; 1.72]; ODI30, OR = 1.26, 95% CI [0.83; 1.91]). BMI was associated with socioeconomic status and AHI/ODI, and contributed to the socioeconomic gradient in SDB, with mediation estimates ranging between 43% and 78%. In this Swiss population-based study, we found that low socioeconomic status is a risk factor for sleep-disordered breathing, and that these associations are partly explained by BMI. These findings provide a better understanding of the mechanisms underlying social differences in sleep-disordered breathing and may help implement policies for identifying high-risk profiles for this disorder.

18.
Eur Respir J ; 52(5)2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30287472

RESUMO

Cross-sectional studies have demonstrated that obstructive sleep apnoea (OSA) and metabolic syndrome (MetS) are often associated, but whether a temporal relationship exists is unknown. We aimed to investigate the effect of OSA on the risk of developing MetS in the general population.A prospective study was conducted combining two population-based samples: Episono (Brazil) and HypnoLaus (Switzerland). MetS was assessed according to unified criteria. Polysomnography (PSG) was performed at baseline and follow-up in Episono, and at baseline in HypnoLaus. OSA was defined according to the apnoea-hypopnoea index as mild (≥5- <15 events h-1) and moderate-to-severe (≥15 events·h-1). We included 1853 participants (mean±sd age 52±13 years, 56% female) without MetS at baseline.After mean±sd 6±1 years, 318 (17.2%) participants developed MetS. Moderate-to-severe OSA was independently associated with incident MetS (OR 2.58, 95% CI 1.61-4.11) and increased the number of MetS components from baseline to follow-up through mediation of the percentage of time with arterial oxygen saturation <90%. Subset analysis in Episono confirmed that the increase in this parameter between baseline and follow-up PSGs represented a risk factor for incident MetS (OR 1.42, 95% CI 1.04-1.95, for each 10% increase).OSA is independently associated with an increased risk of developing MetS through mediation of nocturnal hypoxaemia in the general population.

19.
Rev Med Suisse ; 14(621): 1751-1754, 2018 Oct 03.
Artigo em Francês | MEDLINE | ID: mdl-30303327

RESUMO

Obstructive sleep apnea (OSA) is a sleep disorder that affects 49 % of men and 23% of women over 40 years old. CPAP is currently the treatment of choice for severe OSAS, but there are mild to moderate cases of OSAS with poor compliance or intolerance to CPAP, for which alternative treatments should be considered. In this article, we present a tool for evaluation of the upper airways, the DISE (Drug-induced sleep endoscopy), the OAM (mandibular advancement device), the bimaxillary advancement osteotomy, the hypoglossal nerve stimulation and the positional treatment.

20.
Sleep Med ; 51: 29-36, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30081384

RESUMO

OBJECTIVE: Sleep-disordered breathing (SDB) is currently considered as a unique condition, but it has been suggested that the prevalence, clinical presentation, and associated conditions may differ by sex or by menopausal status in women. We aimed to assess the prevalence of SDB and associated comorbidities in pre- and postmenopausal women compared with men. METHODS: Participants of the population-based HypnoLaus Sleep Cohort study underwent polysomnography in their home environment and had extensive phenotyping for diabetes, hypertension, metabolic syndrome, and depression. RESULTS: A total of 2121 subjects (age 40-85 [59 ± 11] years, body mass index 25.6 ± 4.1 kg/m2, 1024 men and 1097 women [769 postmenopausal]) were included. SDB prevalence based on an apnea-hypopnea index of >5/h, >15/h, >20/h, and ≥30/h, respectively, was 83.8%, 49.7%, 37.5%, and 22.0% in men; 35.1%, 8.6%, 3.3%, and 1.3% in premenopausal women; and 71.6%, 29.4%, 20.7%, and 10.1% in postmenopausal women. In multivariable models, SDB severity was significantly associated with hypertension in women (p = 0.007) (mainly in postmenopausal women) but not in men (p = 0.065), with diabetes in men (p = 0.021) but not in women overall (p = 0.853) or in postmenopausal women (p = 0.725), with metabolic syndrome in men (p = 0.002) and women (p < 0.001), and with depression in women (p = 0.007) but not in men (p = 0.853). CONCLUSION: SDB prevalence in this middle-aged to-older population was high, particularly in men and postmenopausal women. SDB was associated with hypertension and depression exclusively in women, whereas an association with diabetes was present only in men. These findings suggest that the SDB definition and management recommendations may need to be adapted to these groups' specificities.

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