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1.
Obesity (Silver Spring) ; 23(12): 2491-8, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26727118

RESUMO

OBJECTIVE: Sleep duration is associated with obesity and cardiometabolic disease. It is unclear, though, how these relationship differs across age groups. METHODS: Data from 2007 to 2008 National Health and Nutrition Examination Survey (NHANES) were used, including respondents aged 16+ with complete data (N = 5,607). Sleep duration and age were evaluated by self-report, and body mass index (BMI) was assessed objectively. Sleep duration was evaluated continuously and categorically [very short (≤4 h), short (5-6 h), and long (≥9 h) versus average (7-8 h)]. Age was also evaluated continuously and categorically [adolescent (16-17 years), young adult (18-29 years), early middle age (30-49 years), late middle age (50-64 years), and older adult (≥65 years)]. RESULTS: There was a significant interaction with age for both continuous (Pinteraction = 0.014) and categorical (Pinteraction = 0.035) sleep duration. A pseudo-linear relationship was seen among the youngest respondents, with the highest BMI associated with the shortest sleepers and the lowest BMI associated with the longest sleepers. This relationship became U-shaped in middle-age, and less of a relationship was seen among the oldest respondents. CONCLUSIONS: These findings may provide insights for clinical recommendations and could help to guide mechanistic research regarding the sleep-obesity relationship.


Assuntos
Fatores Etários , Índice de Massa Corporal , Obesidade/fisiopatologia , Sono/fisiologia , Adolescente , Adulto , Idoso , Doenças Cardiovasculares/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Obesidade/complicações , Autorrelato , Transtornos do Sono-Vigília/etiologia , Fatores de Tempo , Adulto Jovem
2.
Ann Fam Med ; 12(4): 302-9, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25024237

RESUMO

PURPOSE: Metabolic, hormonal, and hemostatic changes associated with pregnancy loss (stillbirth and miscarriage) may contribute to the development of cardiovascular disease (CVD) in adulthood. This study evaluated prospectively the association between a history of pregnancy loss and CVD in a cohort of postmenopausal women. METHODS: Postmenopausal women (77,701) were evaluated from 1993-1998. Information on baseline reproductive history, sociodemographic, and CVD risk factors were collected. The associations between 1 or 2 or more miscarriages and 1 or more stillbirths with occurrence of CVD were evaluated using multiple logistic regression. RESULTS: Among 77,701 women in the study sample, 23,538 (30.3%) reported a history of miscarriage; 1,670 (2.2%) reported a history of stillbirth; and 1,673 (2.2%) reported a history of both miscarriage and stillbirth. Multivariable-adjusted odds ratio (OR) for coronary heart disease (CHD) for 1 or more stillbirths was 1.27 (95% CI, 1.07-1.51) compared with no stillbirth; for women with a history of 1 miscarriage, the OR=1.19 (95% CI, 1.08-1.32); and for 2 or more miscarriages the OR=1.18 (95% CI, 1.04-1.34) compared with no miscarriage. For ischemic stroke, the multivariable odds ratio for stillbirths and miscarriages was not significant. CONCLUSIONS: Pregnancy loss was associated with CHD but not ischemic stroke. Women with a history of 1 or more stillbirths or 1 or more miscarriages appear to be at increased risk of future CVD and should be considered candidates for closer surveillance and/or early intervention; research is needed into better understanding the pathophysiologic mechanisms behind the increased risk of CVD associated with pregnancy loss.


Assuntos
Aborto Espontâneo , Doenças Cardiovasculares/etiologia , Pós-Menopausa , Natimorto , Saúde da Mulher , Idoso , Doença das Coronárias/etiologia , Feminino , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Razão de Chances , Gravidez , Estudos Prospectivos , Risco , Fatores de Risco , Acidente Vascular Cerebral/etiologia
3.
Phys Med Rehabil Clin N Am ; 25(2): 471-89.e1-50, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24787344

RESUMO

Most clinical guidelines do not recommend routine use of epidural steroid injections for the management of chronic low back pain. However, many clinicians do not adhere to these guidelines. This comprehensive evidence overview concluded that off-label epidural steroid injections provide small short-term but not long- term leg-pain relief and improvement in function; injection of steroids is no more effective than injection of local anesthetics alone; post-procedural complications are uncommon, but the risk of contamination and serious infections is very high. The evidence does not support routine use of off-label epidural steroid injections in adults with benign radicular lumbosacral pain.


Assuntos
Corticosteroides/administração & dosagem , Dor Lombar/tratamento farmacológico , Manejo da Dor/métodos , Radiculopatia/tratamento farmacológico , Corticosteroides/efeitos adversos , Adulto , Idoso , Avaliação da Deficiência , Relação Dose-Resposta a Droga , Medicina Baseada em Evidências , Feminino , Seguimentos , Humanos , Incidência , Injeções Epidurais , Dor Lombar/diagnóstico , Dor Lombar/epidemiologia , Região Lombossacral , Masculino , Pessoa de Meia-Idade , Medição da Dor , Radiculopatia/diagnóstico , Radiculopatia/epidemiologia , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento , Estados Unidos/epidemiologia
4.
Nat Sci Sleep ; 5: 93-107, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23901303

RESUMO

Habitual sleep duration has been associated with cardiometabolic disease, via several mechanistic pathways, but few have been thoroughly explored. One hypothesis is that short and/or long sleep duration is associated with a proinflammatory state, which could increase risk for cardiovascular and metabolic diseases. This hypothesis has been largely explored in the context of experimental sleep deprivation studies which have attempted to demonstrate changes in proinflammatory markers following acute sleep loss in the laboratory. Despite the controlled environment available in these studies, samples tend to lack generalization to the population at large and acute sleep deprivation may not be a perfect analog for short sleep. To address these limitations, population based studies have explored associations between proinflammatory markers and habitual sleep duration. This review summarizes what is known from experimental and cross-sectional studies about the association between sleep duration, cardiovascular disease, and proinflammatory biomarkers. First, the association between sleep duration with both morbidity and mortality, with a focus on cardiovascular disease, is reviewed. Then, a brief review of the potential role of proinflammatory markers in cardiovascular disease is presented. The majority of this review details specific findings related to specific molecules, including tumor necrosis factor-α, interleukins-1, -6, and -17, C-reactive protein, coagulation molecules, cellular adhesion molecules, and visfatin. Finally, a discussion of the limitations of current studies and future directions is provided.

5.
J Clin Hypertens (Greenwich) ; 15(8): 593-9, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23889723

RESUMO

The association between obstructive sleep apnea (OSA) and hypertension by race/ethnicity has not been well characterized in a national sample. Adult participants in the 2007-2008 National Health and Nutrition Examination Survey were reviewed by self-report of sleep apnea diagnosis, snorting, gasping or stopping breathing during sleep, and snoring to derive whether OSA was probable (pOSA). Multivariable logistic regression determined whether pOSA predicted hypertension in the overall cohort, and by body mass index (BMI) group and ethno-racial strata. pOSA predicted hypertension in several groups: (1) Within BMI strata, there was a significant association among overweight individuals [odds ratio [OR], 1.82; 95% confidence interval [CI], 1.26-2.62); (2) In race/ethnicity subgroups, the association was significant among Hispanic/Latinos (OR, 1.69; 95% CI, 1.13-2.53) and whites (OR, 1.40; 95% CI, 1.07-1.84); (3) In models stratified by both race/ethnicity and BMI, pOSA predicted hypertension among overweight black/African Americans (OR, 4.74; 95% CI, 1.86-12.03), overweight whites (OR, 1.65; 95% CI, 1.06-2.57), and obese Hispanic/Latino participants (OR, 2.01; 95% CI, 1.16-3.49). A simple, self-report tool for OSA was strongly associated with hypertension, and may serve as a potential future opportunity for OSA diagnosis.


Assuntos
Grupo com Ancestrais do Continente Africano/etnologia , Grupo com Ancestrais do Continente Europeu/etnologia , Hispano-Americanos/etnologia , Hipertensão/etnologia , Apneia Obstrutiva do Sono/etnologia , Adulto , Índice de Massa Corporal , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Obesidade/etnologia , Prevalência , Estados Unidos/epidemiologia
6.
Sleep ; 36(5): 769-779E, 2013 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-23633760

RESUMO

STUDY OBJECTIVES: We hypothesize that extremes of sleep duration are associated with elevated C-reactive protein (CRP), a pro-inflammatory marker for cardiovascular disease risk. DESIGN: Cross-sectional. SETTING: Population-based research. PARTICIPANTS: Nationally representative sample of 2007-2008 National Health and Nutrition Examination Survey participants (n = 5,587 adults). INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Associations between CRP and self-reported total sleep time (TST) were examined. Explanatory models considered contributions of sex, age, race/ethnicity, body mass index (BMI), and BMI squared (BMI2). Models also explored the role of insomnia symptoms, sleep apnea, active medical illness, and antidiabetic/antihypertensive treatment. Differential patterns among race/ethnicity groups were examined using interactions and stratified analyses. Nonlinear relationships between CRP and TST were assessed using polynomial and multinomial regression models (< 5, 5, 6, 7, 8, 9, and > 9 h). Linear and squared terms were significant in all models in the complete sample, with notable differences by sex and ethnoracial group. Overall, in models adjusted for sociodemographics and BMI, different patterns were observed for non-Hispanic white (elevated CRP for < 5 h and > 9 h), black/African-American (elevated CRP for < 5 h and 8 h), Hispanic/Latino (elevated CRP for > 9 h), and Asian/ Other (higher in 9 and > 9 h and lower in 5 h and 6 h) groups. Ethnoracial groups also demonstrated patterning by sex. CONCLUSION: In a representative sample of American adults, elevated CRP was associated with extreme sleep durations. Sex, race/ethnicity, sleep disorders, and medical comorbidity influenced these associations. Differences in CRP along these dimensions should be considered in future research on sleep related disparities influencing cardiometabolic disease risk.


Assuntos
Proteína C-Reativa/metabolismo , Grupos Étnicos , Grupo com Ancestrais do Continente Europeu , Transtornos do Sono-Vigília/sangue , Transtornos do Sono-Vigília/etnologia , Adulto , Idoso , Biomarcadores/sangue , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Autorrelato , Fatores Sexuais , Estados Unidos
7.
J Womens Health (Larchmt) ; 22(6): 477-86, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23651054

RESUMO

BACKGROUND: Long and short sleep duration are associated with increased risk for coronary heart disease (CHD) and cardiovascular disease (CVD); however, evidence is inconsistent. We sought to identify whether self-reported sleep duration and insomnia, based on a validated questionnaire, are associated with increased incident CHD and CVD among postmenopausal women. METHODS: Women's Health Initiative Observational Study Participants (N=86,329; 50-79 years) who reported on sleep at baseline were followed for incident CVD events. Associations of sleep duration and insomnia with incident CHD and CVD were evaluated using Cox proportional hazards models over 10.3 years. RESULTS: Women with high insomnia scores had elevated risk of CHD (38%) and CVD (27%) after adjustment for age and race, and in fully adjusted models (hazard ratio [HR]=1.19, 95% confidence interval [CI] 1.09-1.30; 1.11 95% CI 1.03-2.00). Shorter (≤5 hours) and longer (≥10 hours) sleep duration demonstrated significantly higher incident CHD (25%) and CVD (19%) in age- and race-adjusted models, but this was not significant in fully adjusted models. Formal tests for interaction indicated significant interactions between sleep duration and insomnia for risk of CHD (p<0.01) and CVD (p=0.02). Women with high insomnia scores and long sleep demonstrated the greatest risk of incident CHD compared to midrange sleep duration (HR=1.93, 95% CI 1.06-3.51) in fully adjusted models. CONCLUSIONS: Sleep duration and insomnia are associated with CHD and CVD risk, and may interact to cause almost double the risk of CHD and CVD. Additional research is needed to understand how sleep quality modifies the association between prolonged sleep and cardiovascular outcomes.


Assuntos
Doença das Coronárias/fisiopatologia , Distúrbios do Início e da Manutenção do Sono/fisiopatologia , Sono/fisiologia , Idoso , Doença das Coronárias/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Pós-Menopausa , Estudos Prospectivos , Distúrbios do Início e da Manutenção do Sono/complicações , Fatores de Tempo , Saúde da Mulher
8.
J Am Coll Cardiol ; 61(23): 2346-54, 2013 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-23583242

RESUMO

OBJECTIVES: The aim of this study was to examine the independent and joint associations of sitting time and physical activity with risk of incident cardiovascular disease (CVD). BACKGROUND: Sedentary behavior is recognized as a distinct construct beyond lack of leisure-time physical activity, but limited data exist on the interrelationship between these 2 components of energy balance. METHODS: Participants in the prospective Women's Health Initiative Observational Study (n = 71,018), 50 to 79 years of age and free of CVD at baseline (1993 to 1998), provided information on sedentary behavior, defined as hours of sitting/day, and usual physical activity at baseline and during follow-up through September 2010. First CVD (coronary heart disease or stroke) events were centrally adjudicated. RESULTS: Sitting ≥10 h/day compared with ≤5 h/day was associated with increased CVD risk (hazard ratio: 1.18, 95% confidence interval: 1.09 to 1.29) in multivariable models including physical activity. Low physical activity was also associated with higher CVD risk (p for trend < 0.001). When women were cross-classified by sitting time and physical activity (p for interaction = 0.94), CVD risk was highest in inactive women (≤1.7 metabolic equivalent task-h/week) who also reported ≥10 h/day of sitting. Results were similar for coronary heart disease and stroke when examined separately. Associations between prolonged sitting and risk of CVD were stronger in overweight versus normal weight women and women 70 years of age and older compared with younger women. CONCLUSIONS: Prolonged sitting time was associated with increased CVD risk, independent of leisure-time physical activity, in postmenopausal women without a history of CVD. A combination of low physical activity and prolonged sitting augments CVD risk.


Assuntos
Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Atividade Motora/fisiologia , Comportamento Sedentário , Saúde da Mulher , Fatores Etários , Idoso , Índice de Massa Corporal , Doenças Cardiovasculares/fisiopatologia , Estudos de Coortes , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Análise Multivariada , Sobrepeso/epidemiologia , Pós-Menopausa/fisiologia , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Medição de Risco , Taxa de Sobrevida , Fatores de Tempo , Estados Unidos
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