Eveningness Is Associated With Greater Depressive Symptoms in Type 2 Diabetes Patients: A Study in Two Different Ethnic Cohorts.

BACKGROUND: Eveningness is associated with greater depressive symptoms in the general population. Depression and type 2 diabetes (T2D) commonly coexist. We aimed to explore the association between morningness-eveningness and depressive symptoms in T2D patients in the United States and in Thailand. PARTICIPANTS: T2D patients (n = 182) from an endocrinology clinic in Chicago, Illinois, and six hospitals in Thailand (n = 251) were enrolled. METHODS: Diabetes history was collected. Depressive symptoms were assessed by the Center for Epidemiologic Studies Depression scale (CES-D). The Chicago cohort completed the Morningness-Eveningness Questionnaire (MEQ) and the Thai cohort completed the Composite Scale of Morningness (CSM). Sleep quality was assessed using the Pittsburg Sleep Quality Index (PSQI). RESULTS: The mean (SD) CES-D score was 13.7 (9.1) in Chicago and 11.9 (6.4) in Thailand. In Chicago participants, after adjusting for age, sex, ethnicity, hemoglobin A1c, insulin use, and PSQI score, greater eveningness (lower MEQ scores) was associated with higher CESD scores (B = -0.117, p = 0.048). In Thai participants, after adjusting for age, sex, and PSQI score, eveningness (lower CSM score) was associated with higher CES-D score (B = -0.147, p = 0.016). In both cohorts, however, eveningness was not independently associated with the likelihood of being in the at-risk range for clinical depression (CES-D ≥ 16). CONCLUSIONS: Eveningness is independently associated with greater depressive symptoms in T2D in two different ethnic cohorts. The results support the association between individual differences in circadian rhythms and psychological functioning in T2D.

Sleep Quality in Ulcerative Colitis: Associations with Inflammation, Psychological Distress, and Quality of Life.

PURPOSE: Treatment of ulcerative colitis (UC), given its chronicity and its associated disruptive and often distressing symptoms, is increasingly focusing on maximizing patient quality of life. Poorer quality of life has been found among patients with poor sleep quality, which is much more common in patients with UC than in the general population and may be associated with inflammation and psychological distress. METHOD: Forty-seven patients with UC (n = 11 flaring) completed measures of sleep quality, depression, state anxiety, gastrointestinal-related anxiety, perceived stress, and quality of life. Measures of inflammation were also obtained. RESULTS: Patients endorsed high rates of poor sleep quality, which was highly correlated with depression and poorer inflammatory bowel disease-related quality of life, but was generally not related to other areas of psychological functioning or inflammation. Sleep quality was significantly independently associated with depression and female gender. CONCLUSION: Poor sleep quality is prevalent in patients with UC and is strongly related to depression, suggesting that sleep and mood are important areas to assess in patients with UC in order to inform tailored treatment to improve quality of life.

Night-shift work is associated with poorer glycaemic control in patients with type 2 diabetes.

The circadian system plays a role in regulating metabolism. Night-shift work, a form of circadian misalignment, is associated with increased type 2 diabetes risk. This study aimed to determine if night-shift workers with type 2 diabetes experience poorer glycaemic control than non-shift workers. Patients with type 2 diabetes (104 unemployed, 85 day workers and 60 night-shift workers) participated. Sleep duration, sleep quality, morningness-eveningness preference, depressive symptoms and dietary intake were assessed using standardized questionnaires. Haemoglobin A1c levels were measured. Night-shift workers had significantly higher haemoglobin A1c levels compared with others, while there were no differences between day workers and unemployed participants (median 7.86% versus 7.24% versus 7.09%, respectively). Additionally, night-shift workers were younger, had a higher body mass index, and consumed more daily calories than others. Among night-shift workers, there were no significant differences in haemoglobin A1c levels between those performing rotating versus non-rotating shifts (P = 0.856), or those with clockwise versus counterclockwise shift rotation (P = 0.833). After adjusting for age, body mass index, insulin use, sleep duration, morningness-eveningness preference and percentage of daily intake from carbohydrates, night-shift work, compared with day work, was associated with significantly higher haemoglobin A1c (B = 0.059, P = 0.044), while there were no differences between unemployed participants and day workers (B = 0.016, P = 0.572). In summary, night-shift work is associated with poorer glycaemic control in patients with type 2 diabetes.

An Adaptive Treatment to Improve Positive Airway Pressure (PAP) Adherence in Patients With Obstructive Sleep Apnea: A Proof of Concept Trial.

Despite the benefits of positive airway pressure (PAP) treatment, rates of adherence to treatment are suboptimal. This proof-of-concept study assessed the feasibility, acceptability, and clinical significance of an adaptive treatment strategy to improve adherence to PAP. All participants first completed a brief educational intervention. Those who did not show at least a 25% increase in PAP use were randomized to receive a second, more intensive intervention, either motivational enhancement treatment or self-management treatment. Results suggested adequate feasibility and acceptability. In addition, participants demonstrated significant increases in objective PAP use, improvements in sleep quality, and decreases in daytime sleepiness. This study represents a first step in the development and validation of an adaptive treatment strategy to improve PAP adherence.

Managing severe obesity: understanding and improving treatment adherence in bariatric surgery.

Severe obesity (body mass index ≥40 kg/m2) is a chronic disease that is associated with significantly increased risk of serious and chronic health problems as well as impaired quality of life. For those with severe obesity, bariatric surgery is the most effective treatment for significant and long-term weight loss and resolution of comorbid medical conditions, particularly diabetes. Long-term success is thought to depend to some degree on the patient's ability to adhere to a complex set of behaviors, including regular attendance at follow up appointments and following stringent dietary, exercise, and vitamin recommendations. Here, we summarize the current research on behavioral adherence in patients with severe obesity presenting for bariatric surgery and we highlight challenges and make recommendations for improved self-management before and after surgery.

Night eating in patients with type 2 diabetes. Associations with glycemic control, eating patterns, sleep, and mood.

Night eating is a complex behavior associated with disruptions in eating, sleep, and mood regulation. While night eating has been associated with alterations in neuroendocrine functioning, night eating and Night Eating Syndrome (NES) are not well understood in patients with prevalent metabolic conditions, such as diabetes. In this study, 194 adults with Type 2 diabetes completed questionnaires assessing night eating symptoms as well as eating, sleep, and depressive symptoms. Glycemic control data, as measured by hemoglobin A1c (HbA1c), were gathered from patient medical charts. Results indicated that 7% of participants met criteria for NES. Increased symptoms of night eating were associated with poorer glycemic control and disruptions in eating, sleep, and mood, including significantly increased likelihood of having HbA1c levels >7% and endorsing clinical levels of depressive symptoms. Increasing understanding of the relationship between night eating and metabolic and psychosocial functioning in patients with diabetes may provide new avenues for treatment of these patients.

Dietary self-monitoring in patients with obstructive sleep apnea.

Self-monitoring of food intake is a cornerstone of behavioral weight loss interventions, but its use has not been evaluated in the treatment of obese patients with obstructive sleep apnea (OSA). This pilot study described patterns of adherence to dietary self-monitoring in obese patients with OSA and determined associations between self-monitoring and weight loss, psychosocial functioning, and adherence to continuous positive airway pressure treatment. Participants completed a 6-week behavioral weight loss intervention focused on dietary self-monitoring. Approximately one-third of participants were adherent to self-monitoring throughout the course of the intervention and experienced more weight loss than those who did not self-monitor regularly. More frequent dietary self-monitoring also appeared to be associated with adherence to other health behaviors. These preliminary data suggest that use of dietary self-monitoring may be beneficial for promoting weight loss and adherence to other important health behaviors in OSA patients.

Sleepiness, parkinsonian features and sustained attention in mild Alzheimer's disease.

BACKGROUND: we previously demonstrated that patients with mild Alzheimer's disease and parkinsonian features (AD + PF) are at a higher risk of having daytime sleepiness than mild AD patients without PF (AD - PF). OBJECTIVE: to determine whether AD + PF patients demonstrate a known a consequence of daytime sleepiness, reduced performance-based sustained attention, compared with AD - PF patients. METHODS: a nocturnal polysomnogram and a next-day multiple sleep latency test (MSLT) were performed. Between MSLT nap opportunities, a 10-min psychomotor vigilance test (PVT) was administered and analysed for reciprocal mean response times (IMEAN), number of lapses (LAPSE) and reciprocal mean slowest 10% (ISLOW). RESULTS: a total of 35 patients met criteria (AD + PF, n = 16; AD - PF, n = 19). Comparatively, the AD + PF group had slower IMEAN results [F((1,28)) = 6.64, P < 0.05] and higher LAPSE rates [F((1,27)) = 7.57, P < 0.05]. ISLOW measures were not different between groups. When accounting for MSLT results, IMEAN and LAPSE results were no longer significantly different between groups during morning tests, but remained significantly different on afternoon tests. CONCLUSION: PFs in mild AD are associated with decreased sustained attention as measured by the PVT. Sleepiness did not fully account for the impairment in sustained attention, suggesting that the presence of PFs has an independent negative association with sustained attention in mild AD.

Mindfulness Intervention Decreases Frequency and Severity of Flares in Inactive Ulcerative Colitis Patients: Results of a Phase II, Randomized, Placebo-Controlled Trial.

BACKGROUND: Ulcerative Colitis (UC) is a chronic, inflammatory disease, characterized by symptomatic periods (flare) interspersed with asymptomatic periods (remission). Evidence suggests that psychological stress can trigger flare. Studies have shown that mindfulness interventions (MI) reduce stress, foster more adaptive coping, and improve quality of life, but have been minimally used for UC patients. The objective of this study was to determine whether participation in an MI results in improvements in UC disease course and inflammatory cascades, mindfulness, perceived stress, and other psychological outcomes in inactive UC patients with limited or no exposure to past MI. METHODS: Participants were randomized to an 8-week MI or control group. Biological and psychological assessments were performed at baseline, post 8-week course, and at 6- and 12-months. RESULTS: Forty-three participants enrolled. The MI increased the state of mindfulness and mindfulness skills, decreased perceived stress and stress response in patients with inactive UC. The MI intervention significantly decreased the incidence of flare over 12 months (P < .05). None of the UC patients in the MI flared during 12 months, while 5 of 23 (22%) control group participants flared during the same period. CONCLUSIONS: MIs could be considered as adjuvant treatment for a subset of UC patients with high perceived stress and low state of mindfulness.The trial was registered at clinicaltrials.gov as NCT01491997.

Inactive ulcerative colitis patients were randomized to a mindfulness intervention or control group. Biological and psychological assessments were performed over 12 months. The intervention significantly decreased the incidence of flares, increased the state of mindfulness and mindfulness skills, and decreased perceived stress and the stress response.

A survey of psychological assessment on interdisciplinary craniofacial teams.

OBJECTIVE: To explore the role of mental health professionals on craniofacial teams and determine how craniofacial teams assess for psychological concerns in their patient populations. DESIGN: Online and paper surveys. PARTICIPANTS: A total of 55 craniofacial team coordinators and 40 mental health professionals who are team members participated in this study. RESULTS: Results indicated that teams in 2007 generally viewed psychological services on their teams similarly to teams assessed in 1987. Most teams do not use formal measures in their assessment of psychological concerns, and they provide feedback via discussions with the families. Mental health professionals assess a wide variety of potential areas of concern and are generally satisfied with the referral sources available to their patients. CONCLUSIONS: Craniofacial teams appear to practice in a manner consistent with professional standards, and these teams seem to value the inclusion of mental health professionals as part of the interdisciplinary team. Implications and limitations including response rate are discussed.

Remotely Delivered Interventions for Obesity Treatment.

PURPOSE OF REVIEW: This review synthesizes recent research on remotely delivered interventions for obesity treatment, including summarizing outcomes and challenges to implementing these treatments as well as outlining recommendations for clinical implementation and future research. RECENT FINDINGS: There are a wide range of technologies used for delivering obesity treatment remotely. Generally, these treatments appear to be acceptable and feasible, though weight loss outcomes are mixed. Engagement in these interventions, particularly in the long term, is a significant challenge. Newer technologies are rapidly developing and enable tailored and adaptable interventions, though research in this area is in its infancy. Further research is required to optimize potential benefits of remotely delivered interventions for obesity.

Relationship between depression, sleep quality, and hypoglycemia among persons with type 2 diabetes.

OBJECTIVE: We analyzed two cohorts of people with type 2 diabetes to evaluate the relationships between depression, sleep quality, and history of hypoglycemia. RESEARCH DESIGN AND METHODS: Two adult cohorts from Chicago (n = 193) and Bangkok, Thailand (n = 282) with type 2 diabetes completed questionnaires to assess sleep quality, depressive symptoms, and hypoglycemia frequency. Proportional odds logistic regression models for each cohort adjusted for duration of therapy, insulin and sulfonylurea management, and other factors. RESULTS: Those with hypoglycemia in both cohorts had a longer duration of diabetes, greater use of insulin, and worse sleep quality. The Chicago cohort used less sulfonylureas but had higher depressive symptom scores. The Thailand cohort had greater sulfonylurea use. In the final Thailand regression model, depressive symptoms were independently associated with hypoglycemia frequency. In both final Chicago and Thailand models, sleep quality was not associated with hypoglycemia frequency. CONCLUSIONS: In the Thailand cohort, depressive symptoms were associated with hypoglycemia frequency.

Remote assessments and behavioral interventions in post-bariatric surgery patients.

Sustained weight loss and health improvements after bariatric surgery require long-term monitoring and, for a significant minority of patients, postoperative intervention. Unfortunately, many patients demonstrate difficulty engaging in long-term follow-up and treatment due to time restrictions, geographic limitations, and financial burden. Conducting assessments and interventions remotely may help to mitigate these barriers, allowing for greater access to care and improved outcomes. This review will summarize the results of research using remote methods to conduct assessments and implement interventions with patients after bariatric surgery. Benefits and challenges of implementing these approaches will be highlighted, and future directions in this area will be discussed.

Measurement of adherence in bariatric surgery: a systematic review.

After bariatric surgery, rates of adherence to behavioral recommendations, including attending regular appointments and following specific dietary, physical activity, and vitamin use recommendations, tend to be highly variable across studies. Lack of consistency in measurement of adherence is a likely contributor to this variability, making it challenging to determine the prevalence and impact of nonadherence in this population. PubMed was searched for articles measuring behavioral adherence or compliance in patients after bariatric surgery, resulting in 85 articles. Articles were reviewed for the definition and measurement of adherence in each area (appointment attendance, as well as dietary, physical activity, and vitamin use adherence), and on the use and reporting of recommended adherence measurement strategies. Over half of the articles measured adherence to appointment attendance. Significant variability was found across adherence definitions and measurement methods, and use of recommended adherence measurement strategies was poor. Adherence was mostly commonly measured via self-report (either verbal or written) using cutoffs for adherent versus nonadherent behavior. Over half of studies assessed adherence up to ≥2 years postsurgery. Recommendations for ways to improve adherence measurement in patients who have had bariatric surgery are outlined.

Mindfulness-Based Interventions in Inflammatory Bowel Disease.

Mindfulness-based interventions may be beneficial psychosocial treatments for improving the health and well-being of patients with inflammatory bowel disease. This article reviews eight studies, assessing seven psychosocial interventions, which include mindfulness and/or meditation components. Strongest effects of the interventions were found in quality of life and anxiety/depression, with inconsistent or minimal changes in other psychosocial areas, such as perceived stress and in disease-related outcomes and other physiologic functioning. Mindfulness interventions for patients with inflammatory bowel disease may be a supplemental treatment option to improve quality of life and distress in this population, although results are preliminary and interventions require additional testing.

Daily weight monitoring as a method of weight gain prevention in healthy weight and overweight young adult women.

Experimental research is needed to examine whether weight monitoring impacts weight and whether it has unintended harmful effects. This study randomly assigned 49 first-year university women (body mass index: 20-30 kg/m2) to daily weight monitoring or a control condition and measured weight, mood, body dissatisfaction, and unhealthy weight control behaviors at baseline and 8 weeks, and weight at 20-week follow-up. No harmful effects of daily weighing were detected; acceptability and adherence were high. Weight monitoring did not impact weight; both groups showed little weight gain. Results suggest that weight monitoring has minimal harmful effects and may be useful for preventing weight gain.

Getting personal: a review of sexual functioning, body image, and their impact on quality of life in patients with inflammatory bowel disease.

BACKGROUND: Inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis, is a chronic relapsing disorder associated with distressing physical and psychological symptoms. Many patients with IBD have impaired quality of life. Sexual functioning and body image are rated high among concerns of patients with IBD and may impact quality of life. A better understanding of the roles of sexual functioning and body image in quality of life for patients with IBD is needed because improvement in quality of life is a primary therapeutic goal. The aim of this review was to summarize the current literature on sexual functioning and body image in patients with IBD, emphasizing their impact on quality of life. METHODS: An electronic search of the literature was conducted using the PubMed, PsycINFO, and Cochrane databases. Key phrases included: "Ulcerative Colitis/Crohn's disease/Inflammatory Bowel Disease and sexual function," and "Ulcerative Colitis/Crohn's disease/Inflammatory Bowel Disease and body image." The search produced 1284 citations. We identified 56 studies, which were conducted from 1990 through April 2014, written in English, and included at least 10 adults with IBD. CONCLUSIONS: Few studies have tested directly the association between quality of life and sexual functioning and body image among patients with IBD. Results preliminarily suggest a positive relationship between quality of life and sexual functioning and body image postoperatively among patients with IBD. Future studies comprised of patients who have not had surgery are necessary to better understand the relationship between sexual functioning, body image, and quality of life in patients with active and inactive IBD.

Relationships among sleep timing, sleep duration and glycemic control in Type 2 diabetes in Thailand.

There is evidence that the sleep and circadian systems play a role in glucose metabolism. In addition to physiological factors, sleep is also affected by behavioral, environmental, cultural and social factors. In this study, we examined whether morning or evening preference, sleep timing and sleep duration are associated with glycemic control in patients with type 2 diabetes residing in Thailand. Two hundred and ten type 2 diabetes patients who were not shift workers completed an interview and questionnaires to collect information on diabetes history, habitual sleep duration and sleep timing. Chronotype, an individual's tendency for being a "morning" or "evening" person, was assessed using the Composite Score of Morningness (CSM), which reflects an individual's subjective preference for activities in the morning or evening, as well as mid-sleep time on weekend nights (MSF), which reflects their actual sleep behavior. Most recent hemoglobin A1c (HbA1c) values were retrieved from medical records. Evening preference (as indicated by lower CSM), later bedtime on weekends, and shorter sleep duration correlated with higher HbA1c (r = -0.18, p = 0.01; r = 0.17, p = 0.01 and r = -0.17, p = 0.01, respectively), while there was no association between MSF or wake up time and glycemic control. In addition, later bedtime on weekends significantly correlated with shorter sleep duration (r = -0.34, p < 0.001). Hierarchical regression analyses adjusting for age, sex, body mass index, insulin use and diabetes duration revealed that later bedtime on weekends was significantly associated with poorer glycemic control (B = 0.018, p = 0.02), while CSM was not. Mediation analysis revealed that this association was fully mediated by sleep duration. In summary, later bedtime on weekends was associated with shorter sleep duration and poorer glycemic control in patients with type 2 diabetes. It is likely that patients with later weekend bedtimes curtail their sleep by waking up earlier. Exploring the potential reasons for this phenomenon (e.g. cultural influences, metropolitan lifestyle, environmental factors, family and social obligations) specific to a Thai population may help identify behavioral modifications (i.e. earlier bedtime and/or sleep duration extension) that could possibly lead to improved glycemic control in this population.

Development of a novel mindfulness and cognitive behavioral intervention for stress-eating: a comparative pilot study.

Stress-related eating is increasingly cited as a difficulty in managing healthy eating behaviors and weight. However few interventions have been designed to specifically target stress-related eating. In addition, the optimal target of such an intervention is unclear, as the target might be conceptualized as overall stress reduction or changing emotional eating-related thoughts and behaviors. This pilot study compared the effects of three interventions targeting those components individually and in combination on stress-related eating, perceived stress, and weight loss to determine whether the two intervention components are effective alone or are more effective when combined. Fifty-three overweight participants (98% female) who reported elevated levels of stress and stress-eating and were at risk for obesity were randomly assigned to one of three six-week interventions: a modified mindfulness-based stress reduction (MBSR) intervention, a cognitive behavioral stress-eating intervention (SEI), and a combined intervention that included all MBSR and SEI components. All three interventions significantly reduced perceived stress and stress-eating, but the combination intervention resulted in greater reductions and also produced a moderate effect on short term weight loss. Benefits persisted at six week follow-up.The pattern of results preliminarily suggests that the combination intervention (MBSR+SEI) may yield promise in the treatment of stress-related eating.

Mindfulness meditation as an intervention for binge eating, emotional eating, and weight loss: a systematic review.

Mindfulness-based approaches are growing in popularity as interventions for disordered eating and weight loss. Initial research suggests that mindfulness meditation may be an effective intervention for binge eating; however, no systematic review has examined interventions where mindfulness meditation was the primary intervention and no review has examined its effect on subclinical disordered eating or weight. Using the PRISMA method for systematic reviews, we reviewed 14 studies that investigated mindfulness meditation as the primary intervention and assessed binge eating, emotional eating, and/or weight change. Results suggest that mindfulness meditation effectively decreases binge eating and emotional eating in populations engaging in this behavior; evidence for its effect on weight is mixed. Additional research is warranted to determine comparative effectiveness and long-term effects of mindfulness training.