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1.
PLoS One ; 16(9): e0255323, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34495955

RESUMO

Sleep disorders are increasingly being characterized in modern society as contributing to a host of serious medical problems, including obesity and metabolic syndrome. Changes to the microbial community in the human gut have been reportedly associated with many of these cardiometabolic outcomes. In this study, we investigated the impact of sleep length on the gut microbiota in a large cohort of 655 participants of African descent, aged 25-45, from Ghana, South Africa (SA), Jamaica, and the United States (US). The sleep duration was self-reported via a questionnaire. Participants were classified into 3 sleep groups: short (<7hrs), normal (7-<9hrs), and long (≥9hrs). Forty-seven percent of US participants were classified as short sleepers and 88% of SA participants as long sleepers. Gut microbial composition analysis (16S rRNA gene sequencing) revealed that bacterial alpha diversity negatively correlated with sleep length (p<0.05). Furthermore, sleep length significantly contributed to the inter-individual beta diversity dissimilarity in gut microbial composition (p<0.01). Participants with both short and long-sleep durations exhibited significantly higher abundances of several taxonomic features, compared to normal sleep duration participants. The predicted relative proportion of two genes involved in the butyrate synthesis via lysine pathway were enriched in short sleep duration participants. Finally, co-occurrence relationships revealed by network analysis showed unique interactions among the short, normal and long duration sleepers. These results suggest that sleep length in humans may alter gut microbiota by driving population shifts of the whole microbiota and also specific changes in Exact Sequence Variants abundance, which may have implications for chronic inflammation associated diseases. The current findings suggest a possible relationship between disrupted sleep patterns and the composition of the gut microbiota. Prospective investigations in larger and more prolonged sleep researches and causally experimental studies are needed to confirm these findings, investigate the underlying mechanism and determine whether improving microbial homeostasis may buffer against sleep-related health decline in humans.

2.
Sleep Med Rev ; 60: 101532, 2021 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-34507028

RESUMO

The goal of this study was to examine the effects of behavioral sleep extension interventions on sleep duration outcomes in children and adults ≥ age 12. We conducted a systematic literature review, article extraction and meta-analysis. Our search yielded 42 studies from 14 countries. The majority of studies (n = 19) enrolled adults, 10 studies enrolled college students, 13 enrolled children (high school or middle school aged). Results from the meta-analysis demonstrated behavioral sleep extension resulted in a significantly higher sleep duration as compared to control group or baseline, with pooled standardized mean difference (SMD) that was similar for both two-arm 0.80 (95 % CI 0.28 to 1.31; p < 0.01; I2 = 99.2%) and one-arm studies 0.75 (95% CI 0.39 to 1.11; p < 0.01; I2 = 86%), and there was significant heterogeneity among both study types. Subgroup analyses revealed that studies with direct interventions on sleep duration (i.e., specified the sleep schedule) had larger effects compared to indirect methods (coaching, educational approaches) and a greater number of curriculum components was associated with smaller effects. Results of this review demonstrate that sleep extension studies are effective at extending sleep in a variety of populations but improving the description of intervention methods and use of more rigorous study designs will improve the quality and reproducibility of this area of research.

3.
Sleep Breath ; 2021 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-34390444

RESUMO

PURPOSE: To evaluate the association between a novel integrated event-based and hypoxemia-based parameter of polysomnography (PSG), hypoxemic load or HL100, and fasting blood glucose (FBG) and hemoglobin A1c (HbA1c) levels. METHODS: Adult patients, who underwent an in-lab PSG at the University of Iowa Hospitals and Clinics with FBG or HbA1c levels, were included. Event-based parameter and hypoxemia-based parameter data were derived. HL100, defined as the integrated area of desaturation between the 100% oxygen saturation and the measured saturation levels during sleep divided by the total sleep time, was calculated by Python software. Demographic data and glycemic parameters within 1 year prior to PSG (FBG and HbA1c) were retrieved from chart review. Spearman correlation analysis and stepwise backward regression analysis were performed to determine independent predictors of FBG and HbA1c levels. RESULTS: Of the 467 patients who underwent an in-lab PSG, 218 had FBG levels, 84 had HbA1c levels, and 118 had both values. All event-based and hypoxemia-based parameters, including HL100, were significantly correlated to FBG and HbA1c levels. Stepwise backward regression analyses, adjusted for age, sex, body mass index, and diabetes status, revealed that log HL100 was significantly related to FBG (B = 23.9, p = 0.010), but none of log event-based or hypoxemia-based parameters were found to be significantly related HbA1c levels. CONCLUSIONS: HL100 was shown to be an independent predictor of FBG in this cohort, implying that any degree of desaturation below 100% could adversely affect glucose metabolism. HL100 may be useful for interpretation of sleep studies, risk stratification, and patient management purposes in the future.

4.
J Clin Sleep Med ; 17(8): 1563-1569, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34313215

RESUMO

STUDY OBJECTIVES: To explore the association of continuous positive airway pressure (CPAP) adherence with clinical outcomes in patients with type 2 diabetes and obstructive sleep apnea in a real-world setting. METHODS: This was a retrospective study of patients with type 2 diabetes diagnosed with obstructive sleep apnea between 2010 and 2017. CPAP adherence (usage for ≥ 4 h/night for ≥ 70% of nights) was determined from the first CPAP report following the polysomnography. Data including estimated glomerular filtration rate, hemoglobin A1c, systolic and diastolic blood pressure, lipid panel, and incident cardiovascular/peripheral vascular/cerebrovascular events were extracted from medical records. Mixed-effects linear regression modeling of longitudinal repeated measures within patients was utilized for continuous outcomes, and logistic regression modeling was used for binary outcomes. Models were controlled for age, sex, body mass index, medications, and baseline levels of outcomes. RESULTS: Of the 1,295 patients, 260 (20.7%) were CPAP adherent, 318 (24.5%) were CPAP nonadherent, and 717 (55.3%) had insufficient data. The follow-up period was, on average, 2.5 (1.7) years. Compared to those who were CPAP nonadherent, those who were adherent had a significantly lower systolic blood pressure (ß = -1.95 mm Hg, P = .001) and diastolic blood pressure (ß = -2.33 mm Hg, P < .0001). Among the patients who were CPAP adherent, a 17% greater CPAP adherence was associated with a 2 mm Hg lower systolic blood pressure. Lipids, hemoglobin A1c, estimated glomerular filtration rate, and incident cardiovascular/peripheral vascular/cerebrovascular events were not different between the 2 groups. CONCLUSIONS: Achieving CPAP adherence in patients with type 2 diabetes and obstructive sleep apnea was associated with significantly lower blood pressure. Greater CPAP use within patients who were adherent was associated with lower systolic blood pressure. CITATION: Sheth U, Monson RS, Prasad B, et al. Association of continuous positive airway pressure adherence with complications in patients with type 2 diabetes and obstructive sleep apnea. J Clin Sleep Med. 2021;17(8):1563-1569.


Assuntos
Diabetes Mellitus Tipo 2 , Apneia Obstrutiva do Sono , Pressão Positiva Contínua nas Vias Aéreas , Diabetes Mellitus Tipo 2/complicações , Humanos , Cooperação do Paciente , Estudos Retrospectivos , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/terapia
5.
J Sleep Res ; 30(5): e13327, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33792106

RESUMO

Obstructive sleep apnoea (OSA) is prevalent in obese women with gestational diabetes mellitus (GDM). The present pilot study explored associations between OSA severity and metabolites in women with GDM. A total of 81 obese women with diet-controlled GDM had OSA assessment (median gestational age [GA] 29 weeks). The metabolic profile was assayed from fasting serum samples via liquid chromatography-mass spectrometry (LC-MS) using an untargeted approach. Metabolites were extracted and subjected to an Agilent 1,290 UPLC coupled to an Agilent 6,545 quadrupole time-of-flight (Q-TOF) MS. Data were acquired using electrospray ionisation in positive and negative ion modes. The raw LC-MS data were processed using the OpenMS toolkit to detect and quantify features, and these features were annotated using the Human Metabolite Database. The feature data were compared with OSA status, apnea-hypopnea index (AHI), body mass index (BMI) and GA using "limma" in R. Correlation analyses of the continuous covariates were performed using Kendall's Tau test. The p values were adjusted for multiple testing using the Benjamini-Hochberg false discovery rate correction. A total of 42 women (51.8%) had OSA, with a median AHI of 9.1 events/hr. There were no significant differences in metabolomics profiles between those with and without OSA. However, differential analyses modelling in GA and BMI found 12 features that significantly associated with the AHI. These features could be annotated to oestradiols, lysophospholipids, and fatty acids, with higher levels related to higher AHI. Metabolites including oestradiols and phospholipids may be involved in pathogenesis of OSA in pregnant women with GDM. A targeted approach may help elucidate our understanding of their role in OSA in this population.

6.
BMC Res Notes ; 14(1): 145, 2021 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-33865450

RESUMO

OBJECTIVES: Prediabetes is prevalent in people living with HIV (PLWH). Insufficient and irregular sleep are linked to abnormal glucose metabolism. This study aimed to investigate the differences in sleep characteristics between PLWH with and without prediabetes, determine the acceptability/feasibility and effects of a pilot six-month intensive lifestyle intervention (ILI) program on glucose metabolism in those with prediabetes, and determine how sleep modulates these effects. RESULTS: Thirty-nine PLWH (20 normoglycemia and 19 prediabetes) participated. There were no differences in sleep characteristics between individuals with normoglycemia and prediabetes. Next, thirteen individuals with prediabetes completed a six-month ILI program. The ILI program resulted in significant body weight reduction at 6 months (63.5 ± 13.9 to 61.9 ± 14.0 kg, p = 0.012), which was maintained at 12 months (p < 0.001). Waist circumferences were significantly decreased at 12 months (85.4 ± 11.7 to 82.9 ± 12.7 cm, p = 0.014). An increase in sleep variability was significantly associated with an increase in 2-h plasma glucose, independent of changes in BMI (b = 0.603), and physical activity (b = 0.774). This pilot study suggested that ILI in PLWH with prediabetes is feasible and effective in improving metabolic control, with its effects possibly modulated by sleep variability. These findings should be confirmed in a larger study to reduce diabetes risk in this population. Trail registration: ClinicalTrial.gov, NCT03545217 (date of registration: May 22, 2018).


Assuntos
Glicemia/metabolismo , Infecções por HIV/terapia , Estilo de Vida , Estado Pré-Diabético/terapia , Sono/fisiologia , Adulto , Idoso , Estudos Transversais , Dieta , Exercício Físico , Estudos de Viabilidade , Feminino , Infecções por HIV/sangue , Infecções por HIV/complicações , Estilo de Vida Saudável , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estado Pré-Diabético/sangue , Estado Pré-Diabético/complicações
7.
J Clin Sleep Med ; 2021 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-33729910

RESUMO

STUDY OBJECTIVES: To explore the association of continuous positive airway pressure (CPAP) compliance with clinical outcomes in patients with type 2 diabetes (T2D) and obstructive sleep apnea (OSA) in a real-world setting. METHODS: This was a retrospective study of patients with T2D diagnosed with OSA between 2010 and 2017. CPAP compliance (usage for ≥4 h/night for ≥70% of nights) was determined from the first CPAP report following the polysomnography. Data including estimated glomerular filtration rate (eGFR), hemoglobin A1C (HbA1c), systolic and diastolic blood pressure (SBP, DBP), lipid panel, and incident cardiovascular/peripheral vascular/cerebrovascular events (CVD, PVD, CVA) were extracted from medical records. Mixed-effects linear regression modeling of longitudinal repeated measures within patients was utilized for continuous outcomes, and logistic regression modeling was used for binary outcomes. Models were controlled for age, sex, body mass index, medications, and baseline levels of outcomes. RESULTS: Of the 1,295 patients, 260 (20.7%) were CPAP compliant, 318 (24.5%) were CPAP non-compliant, while 717 (55.3%) had insufficient data. The follow up period was on average 2.5 (1.7) years. Compared to those who were CPAP non-compliant, those who were compliant had a significantly lower SBP (ß=-1.95 mmHg, p=0.001) and DBP (ß=-2.33 mmHg, p<0.0001). Among the CPAP-compliant patients, a 17% greater CPAP compliance was associated with a 2 mmHg lower SBP. Lipids, HbA1c, eGFR and incident CVD/PVD/CVA were not different between the two groups. CONCLUSIONS: Achieving CPAP compliance in T2D patients with OSA was associated with significantly lower blood pressure. Greater CPAP use within compliant patients was associated with lower SBP.

8.
J Diabetes Investig ; 12(4): 516-526, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32815278

RESUMO

AIMS/INTRODUCTION: The Thai Type 1 Diabetes and Diabetes Diagnosed Before Age 30 Years Registry, Care and Network was established in 2014 and involved 31 hospitals. The objective of the registry was to evaluate glycemic control and complications of patients with type 1 diabetes. MATERIALS AND METHODS: Patients' demographics, clinical data, frequencies of daily self-monitoring of blood glucose (SMBG), glycemic control and complications were collected. RESULTS: Among the 1,907 type 1 diabetes patients, the mean age was 21.2 ± 11.3 years. The mean glycated hemoglobin level was 9.35 ± 2.41%, with significant variations among age groups (P < 0.001). Conventional insulin treatment and intensive insulin treatment were used in 43 and 57% of patients, respectively. Mean glycated hemoglobin levels were significantly higher in patients treated with conventional insulin treatment compared to those treated with intensive insulin treatment (9.63 ± 2.34 vs 9.17 ± 2.46%, P = 0.002). Compared to the conventional insulin treatment group, significantly more patients in the intensive insulin treatment group achieved good glycemic control (P < 0.001), and fewer had diabetic retinopathy (P = 0.031). The prevalence of microvascular complications increased significantly with age (P < 0.001). Multivariate analysis showed good glycemic control to be associated with age 25 to <45 years, intensive insulin treatment with SMBG three or more times daily and diabetes duration of 1 to <5 years. CONCLUSIONS: Most Thai type 1 diabetes patients were not meeting the recommended glycemic target. As a result of this study, the national program to improve the quality of diabetes treatment and education has been implemented, and the results are ongoing.

9.
Sleep Breath ; 25(2): 1069-1074, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32951070

RESUMO

PURPOSE: Recent evidence suggests that diabetic retinopathy (DR) is associated with abnormal melatonin regulation, possibly related to dysfunction of the melanopsin-expressing intrinsically photosensitive retinal ganglion cells. This study explored melatonin regulation in type 2 diabetes (T2D) patients with DR and its relation to sleep and circadian functioning. METHODS: Thirty-five participants (10 non-diabetic controls, 10 T2D without DR, and 15 T2D with DR) were recruited. Overnight urine 6-sulfatoxymelatonin (aMT6s) and objective sleep and wrist activity (7-day actigraphy) were obtained. RESULTS: After adjusting for covariates, having T2D with DR was significantly associated with lower urinary aMT6s (ß = - 1.369, p = 0.004) compared with controls, while having T2D without DR was not (p = 0.418). T2D patients with DR reported poorer sleep quality (p = 0.014) and had greater variability of sleep duration (p = 0.017) than others, while no differences were found in sleep duration, efficiency, and rest-activity rhythm. After adjusting for covariates, lower nocturnal aMT6s was significantly associated with greater sleep variability. CONCLUSION: T2D patients with DR exhibited low overnight production of aMT6s which likely contributed to sleep irregularities possibly due to weak circadian signaling. Whether or not melatonin supplementation could improve health in T2D patients with DR remains to be explored.

10.
Sleep Med ; 78: 24-35, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33383394

RESUMO

OBJECTIVE: Sleep disturbances (insufficient or poor sleep quality) have been linked to abnormal glucose metabolism. This systematic review and meta-analysis aimed to explore the effects of behavioral and pharmacological sleep interventions on glucose metabolism. METHODS: Medline and Embase were used for systematic search. Studies reporting behavioral or pharmacological interventions in population with sleep disturbances, with measured outcomes of glucose metabolism and sleep parameters were selected. RESULTS: Twenty two studies were eligible for review (eight were conducted in people with type 2 diabetes). Studies were grouped into three types of intervention: sleep extension (n = 6), sleep education or cognitive behavioral therapy for insomnia (CBT-I, n = 6) and pharmacological interventions (n = 10). CBT-I and sleep education resulted in significantly improved self-reported sleep quality (Pittsburgh Sleep Quality Index, mean difference, MD, -1.31, 95% confidence interval (CI) -1.83, -0.80), non-significant reduction in hemoglobin A1c level (MD -0.35%, 95% CI -0.84, 0.13), and non-significant reduction in fasting glucose levels (MD -4.76 mg/dL, 95% CI -14.19, 4.67). Other studies were not eligible for meta-analysis due to heterogeneity of interventions or outcomes. Sleep extension was able to increase sleep duration by varying degrees in short sleepers, and five of six studies demonstrated relationships between the intervention and measures of insulin resistance. A majority of pharmacological intervention studies showed improved sleep but the effects on glucose metabolism were mixed. CONCLUSIONS: Available sleep interventions were effective in improving sleep but the effects on glucose metabolism were inconclusive. Larger randomized studies with consistent outcome measurements are needed to demonstrate this potential causal relationship.


Assuntos
Terapia Cognitivo-Comportamental , Diabetes Mellitus Tipo 2 , Transtornos do Sono-Vigília , Glucose , Humanos , Sono , Transtornos do Sono-Vigília/terapia
11.
Nutrients ; 12(9)2020 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-32899917

RESUMO

BACKGROUND: Although the body of evidence indicates clear benefits of dietary modifications for prevention of type-2 diabetes mellitus (T2DM), it may be difficult for healthcare providers to recommend which diet interventions or dietary factors are appropriate for patients as there are too many modalities available. Accordingly, we performed an umbrella review to synthesize evidence on diet interventions and dietary factors in prevention of T2DM. METHODS: Medline and Scopus databases were searched for relevant studies. Systematic reviews with meta-analyses of randomized-controlled trial or observational studies were eligible if they measured effects of diet interventions and/or dietary factors including dietary patterns, food groups, and nutrients on risk of T2DM. The effect of each diet intervention/factor was summarized qualitatively. RESULTS: Sixty systematic reviews and meta-analyses were eligible. Results of the review suggest that healthy dietary patterns such as Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets, and high consumption of whole grains, low-fat dairy products, yogurt, olive oil, chocolate, fiber, magnesium, and flavonoid significantly reduced the risk of T2DM. In contrast, high glycemic index and glycemic load diets, high consumption of red and processed meat, and sugar or artificial sugar-sweetened beverages significantly increased risk of T2DM. Prescribing diet interventions with or without physical activity interventions significantly decreased risk of T2DM in both high-risk and general population. CONCLUSION: High consumption of Mediterranean and DASH diet, and interventions that modified the quality of diet intake significantly reduced risk of T2DM especially in the high-risk population. These lifestyle modifications should be promoted in both individual and population levels to prevent and decrease burden from T2DM in the future.


Assuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Dieta Saudável/métodos , Adulto , Dieta Mediterrânea , Abordagens Dietéticas para Conter a Hipertensão , Feminino , Índice Glicêmico , Carga Glicêmica , Humanos , Estilo de Vida , Masculino , Metanálise como Assunto , Pessoa de Meia-Idade , Fatores de Risco , Comportamento de Redução do Risco , Revisões Sistemáticas como Assunto
14.
AIDS Res Ther ; 17(1): 25, 2020 05 24.
Artigo em Inglês | MEDLINE | ID: mdl-32448349

RESUMO

BACKGROUND: Metabolic complications in human immunodeficiency virus (HIV)-infected individuals are common. Prediabetes represents a high risk for future diabetes development. This study aimed to determine the prevalence, diagnostic methods, and associated factors of prediabetes among HIV-infected individuals receiving antiretroviral therapy (ART). METHODS: A cross-sectional study was conducted among HIV-infected adults without a history of diabetes who were receiving ART. Fasting plasma glucose (FPG), 2-hour plasma glucose (2-h PG) after a 75-g oral glucose tolerance test, and hemoglobin A1c (HbA1c) were assessed. RESULTS: A total of 397 patients with a mean age of 47.0 ± 9.8 years and 55.7% male, were studied. All received ART with undetectable plasma viral load. The mean duration of ART was 9.6 ± 5.2 years, and the mean CD4 cell count was 554 ± 235 cells/mm3. Among the patients, 28 (7.1%) had first-diagnosed diabetes, and 133 (33.5%) patients had prediabetes. Glycemia estimation by FPG, 2-h PG, and HbA1c showed a prediabetes prevalence of 17.4%, 14.7%, and 12.5%, respectively. The kappa statistics for the agreement of FPG and 2-h PG, HbA1c and 2-h PG, and HbA1c and FPG were 0.317, 0.429, and 0.396, respectively. In multivariate analysis, hypertension [odds ratio (OR) 3.38; 95% confidence interval (CI), 1.16-9.91; p = 0.026), and triglycerides > 150 mg/dL (OR 2.11; 95% CI, 1.01-4.44; p = 0.047) were factors significantly associated with prediabetes. CONCLUSIONS: Prediabetes among HIV-infected individuals receiving ART is common. The agreements of glycemia estimation methods are minimal to weak. HbA1c may underestimate prediabetes prevalence. Using FPG together with HbA1c increases the detection rate to approximately three-quarters of prediabetes patients. HIV-infected individuals who had hypertension and hypertriglyceridemia should be regularly assessed for prediabetes. Trial registration ClinicalTrial.gov, NCT03545217. Registered 1 June 2018-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03545217.

15.
Sleep Disord ; 2020: 8518396, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32308998

RESUMO

Background: Data in the literature has shown poor sleep quality to be frequently observed in hospitalized patients and known to be associated with poor treatment outcome. Many factors may impact poor sleep quality, and there is currently limited available data. We aim to determine the prevalence of poor sleep quality and associated factors in patients admitted to internal medicine wards as well as the change of sleep quality over time after admission. Methods: An analytic observational study was conducted at the internal medicine wards at the King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Patients were personally interviewed to evaluate the history of sleep quality at home, sleep quality after the first and the third days of admission, and potential associated factors. The Pittsburgh Sleep Quality Index and screening questionnaires for the common diseases associated with poor sleep quality were also utilized. The logistic regression analysis was used to determine the independent factors which led to poor sleep quality. Results: Data were collected from 96 patients during the period of June 2015 to February 2016. The mean age of the patients was 50.8 ± 16.7 years, and 51% were male. Infectious disease was the most common principal diagnosis accounted for 29.2%. The results show high prevalence of poor sleep quality after the first night of admission compared to baseline sleep quality at home (50% vs. 18.8%; p < 0.001). After 3 days of admission, the prevalence of poor sleep quality was reduced to the level close to baseline sleep quality at home (28.1% vs. 18.8%; p = 0.13). Multivariate analysis demonstrated that light exposure and pain were the main independent factors for poor sleep quality on the first day (odds ratio 6.68; 95% CI 2.25-19.84) and on the third day (odds ratio 3.47; 95% CI 1.24-9.71), respectively. Conclusions: This is the first study conducted on the sleep quality of hospitalized patients that included the follow-up period during hospital admission. Our study demonstrated high prevalence of poor sleep quality in hospitalized patients on the first day. Interestingly, the sleep quality was partly improved during hospitalization. Light exposure and pain were demonstrated to be the factors associated with poor sleep quality.

16.
Nutrients ; 12(4)2020 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-32326404

RESUMO

Unhealthy diet is a significant risk factor for cardiovascular diseases (CVD). Therefore, this umbrella review aims to comprehensively review the effects of dietary factors, including dietary patterns, food groups, and nutrients on CVD risks. Medline and Scopus databases were searched through March 2020. Systematic reviews with meta-analyses (SRMA) of randomized controlled trials (RCTs) or observational studies measuring the effects of dietary factors on CVD risks were eligible. Fifty-four SRMAs, including 35 SRMAs of observational studies, 10 SRMAs of RCTs, and 9 SRMAs of combined RCT and observational studies, were included for review. Findings from the SRMAs of RCTs suggest the significant benefit of Mediterranean and high-quality diets for lowering CVD risk, with pooled risk ratios (RRs) ranging from 0.55 (95%CI: 0.39-0.76) to 0.64 (95%CI: 0.53-0.79) and 0.70 (95%CI: 0.57-0.87), respectively. For food nutrients, two SRMAs of RCTs found that high intake of n-3 polyunsaturated fatty acid (PUFA) significantly reduced CVD risks, with pooled RRs ranging from 0.89 (95%CI: 0.82, 0.98) to 0.90 (95%CI: 0.85-0.96), while evidence of efficacy of n-6 PUFA and combined n-3 and n-6 PUFA were inconsistent. Moreover, results from the SRMAs of RCTs did not find a significant benefit of a low-salt diet and low total fat intake for CVD prevention. For food groups, results from the SRMAs of cohort studies suggest that high intakes of legumes, nuts, and chocolate, as well as a vegetarian diet significantly reduced the risk of coronary heart disease, with pooled RRs of 0.90 (95%CI: 0.84-0.97), 0.68 (95%CI: 0.59-0.78), 0.90 (95%CI: 0.82-0.97), and 0.71 (95%CI: 0.57-0.87), respectively. Healthy dietary patterns had a significant benefit for CVD prevention. With the substitutional and synergistic interactions between different food groups and nutrients, dietary recommendations for CVD prevention should be focused more on healthy dietary patterns than single food groups or nutrients.


Assuntos
Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Dieta Saudável , Ácidos Graxos Ômega-3/administração & dosagem , Chocolate , Dieta com Restrição de Gorduras , Dieta Mediterrânea , Dieta Hipossódica , Dieta Vegana , Fabaceae , Humanos , Metanálise como Assunto , Nozes , Estudos Observacionais como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Revisões Sistemáticas como Assunto
17.
Eur Respir J ; 56(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32265303

RESUMO

In January 2019, a European Respiratory Society research seminar entitled "Targeting the detrimental effects of sleep disturbances and disorders" was held in Dublin, Ireland. It provided the opportunity to critically review the current evidence of pathophysiological responses of sleep disturbances, such as sleep deprivation, sleep fragmentation or circadian misalignment and of abnormalities in physiological gases such as oxygen and carbon dioxide, which occur frequently in respiratory conditions during sleep. A specific emphasis of the seminar was placed on the evaluation of the current state of knowledge of the pathophysiology of cardiovascular and metabolic diseases in obstructive sleep apnoea (OSA). Identification of the detailed mechanisms of these processes is of major importance to the field and this seminar offered an ideal platform to exchange knowledge, and to discuss pitfalls of current models and the design of future collaborative studies. In addition, we debated the limitations of current treatment strategies for cardiometabolic complications in OSA and discussed potentially valuable alternative approaches.


Assuntos
Doenças Cardiovasculares , Apneia Obstrutiva do Sono , Doenças Cardiovasculares/terapia , Humanos , Irlanda , Medicina de Precisão , Sono , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/terapia
18.
Sleep Health ; 6(4): 469-477, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32321687

RESUMO

OBJECTIVES: To investigate associations between self-reported sleep duration and cardiometabolic (CM) risk factors in African-origin adults residing in five countries spanning the epidemiologic transition. DESIGN: Cross-sectional. SETTING AND PARTICIPANTS: Ghanaian (n = 491), South African (n = 503), Jamaican (n = 508), Seychellois (n = 501) and American (n = 480) men and women. MEASUREMENTS: Self-reported sleep duration was obtained using questionnaires. Sex- and site-stratified logistic regression analyses investigated relationships between sleep duration, individual CM risk factors and a binary CM risk variable (presence of ≥3 CM risk factors), adjusting for age, physical activity and education. RESULTS: Sleep duration distributions varied by cohort: 44.5%, 41.4%, 35.9%, 16.8% and 2.5% of American, Jamaican, Seychellois, Ghanaian and South African men reported <7 h sleep per night respectively (p < 0.001). Similarly, 42.6%, 28.6%, 25.2%, 12.8% and 1.5% of American, Jamaican, Seychellois, Ghanaian and South African women reported <7 h sleep respectively (p < 0.001). American men reporting ≤6 h sleep were more likely to be in the elevated CM risk group (OR: 2.52, 95%CI: 1.02, 6.22, p = 0.045) and to have a high waist circumference (OR: 2.44, 95%CI: 1.07, 5.57, p = 0.034) compared to those reporting 8 h sleep. Jamaican women reporting ≤6 h sleep (OR: 2.53, 95%CI: 1.19, 5.36, p = 0.016) and American women reporting 7 h sleep (OR: 2.71, 95%CI: 1.17, 6.26, p = 0.002) were more likely to be obese than those reporting 8 h sleep. CONCLUSIONS: Associations between short sleep and CM risk factors were only evident in the American men and women and Jamaican women. Future interventions to address CM risk and sleep health may need to be country-specific when targeting high-risk populations.


Assuntos
Afro-Americanos/estatística & dados numéricos , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Fatores de Risco Cardiometabólico , Síndrome Metabólica/etnologia , Sono , Adulto , Estudos Transversais , Feminino , Gana/epidemiologia , Humanos , Jamaica/epidemiologia , Masculino , Fatores de Risco , Autorrelato , Seicheles/epidemiologia , África do Sul/epidemiologia , Inquéritos e Questionários , Fatores de Tempo , Estados Unidos/epidemiologia
19.
Indian J Crit Care Med ; 24(1): 6-10, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32148342

RESUMO

Purpose: Poor sleep quality in intensive care unit (ICU) can be associated with poor outcome. Excessive noise and lights in ICU are known to disrupt patients' sleep by causing arousals. Study design: A prospective randomized controlled study. Materials and methods: The patients admitted to the medical ICU were prospectively included and randomized to receive earplugs and eye masks or no intervention during their first 5 nights in ICU. Their arousal index and other sleep parameters were measured during the first night by polysomnography. Secondary outcomes including wrist actigraphy profiles and subjective sleep quality were recorded during all study nights. Results: Seventeen patients were enrolled. Eight patients were randomized to earplugs and eye masks group and nine patients were randomized to control group during their first 5 nights in the ICU. The use of earplugs and eye masks demonstrated the trend toward lower arousal index during the first night (21.15 (14.60) vs 42.10 (18.20) events per hour, p = 0.086) and increased activity index (activity count/hour) (16.12 (7.99) vs 10.84 (10.39) count/hour, p = 0.059) compared to control group. Polysomnography and actigraphy did not demonstrate good agreement. Conclusion: The use of earplugs and eye masks has a trend toward reduction in arousal index and increased activity in patients admitted to ICU. Limited sample size most likely explained insignificant difference in outcomes. Wrist actigraphy did not accurately measure sleep parameters in ICU patients. Trial registration: www.clinicaltrials.in.th, TCTR20170727003. How to cite this article: Arttawejkul P, Reutrakul S, Muntham D, Chirakalwasan N. Effect of Nighttime Earplugs and Eye Masks on Sleep Quality in Intensive Care Unit Patients. Indian J Crit Care Med 2020;24(1):6-10.

20.
Sleep Med ; 68: 27-30, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32018189

RESUMO

BACKGROUND: Gut microbiota has been linked to obesity and glucose metabolism. Insufficient sleep is also known to be associated with insulin resistance, and sleep extension was reported to improve glucose metabolism in short sleepers. This study aimed to explore whether sleep extension was associated with changes in gut microbiota and whether there was a relationship with glucose parameters. METHODS: We performed a secondary analysis of eight short-seeping but otherwise healthy subjects who participated in a cross over study of two-week home sleep extension and two weeks of habitual sleep. After each sleep condition, stool samples were collected and glucose parameters were obtained. Stool DNA extraction was performed and 16S rRNA was sequenced by MiSeq™. The resulting sequence data were processed to infer relative abundances of taxa present and then analyzed to detect any differences in the abundances of the taxa or overall diversity of the microbiome. RESULTS: Mean (SD) sleep duration during habitual sleep and sleep extension was 5.58 (0.53) and 6.60 (0.43) hours/night, respectively. Using the Bray-Curtis index, there was no significant dissimilarity of the genus-level microbial community between the two sleeping conditions (ADONIS, R2 = 0.017, p = 0.988 and ANOSIM, R = -0.131, p = 0.991). Within-sample microbial diversity (ie, the Shannon index) also did not find significant differences (p = 0.861). There was no significant relationship between per-individual dissimilarity and objective and subjective sleep variables, or glycemic parameters. Only higher sleep efficiency was related to higher abundance of the phyla Tenericutes. CONCLUSION: Two-week sleep extension in short sleepers was not associated with changes in gut microbiota.


Assuntos
Microbioma Gastrointestinal , Estudos Cross-Over , Fezes , Humanos , RNA Ribossômico 16S/genética , Sono
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