Actigraphy-based sleep characteristics and aortic stiffness: the Multi-Ethnic Study of Atherosclerosis

The study aimed to examine the association between objective estimates of sleep duration and quality and aortic stiffness while accounting for the potential confounding effect of sleep-disordered breathing. Participants were part of the Multi-Ethnic Study of Atherosclerosis Sleep study. Sleep duration and quality were assessed by 7-day wrist actigraphy, sleep-disordered breathing by home polysomnography, and aortic stiffness by magnetic resonance imaging–based aortic pulse wave velocity (aPWV), ascending and descending aorta distensibility. Aortic stiffness of participants with “normal” sleep duration (6-8 hours) were compared with those of “short” (<6 hours) and “long” sleep duration (>8 hours) adjusting for common cardiovascular risk factors and apnea-hypopnea index. The sample consisted of 908 participants (mean age 68.4 ± 9.1 years, 55.3% female). There was a significant linear trend of increased aPWV across short (n = 252), normal (n = 552), and long sleep durations (n = 104) (P for trend = .008). Multivariable analysis showed that people with short sleep duration had 0.94 m/s lower aPWV (95% CI: ?1.54, ?0.35), compared with those with normal sleep duration. In this ethnically diverse community cohort, habitual short sleep duration as estimated by actigraphy was associated with lower aortic stiffness.     

Incident diabetes mellitus may explain the association between sleep duration and incident coronary heart disease

Aims/hypothesis

Sleep duration is a risk factor for incident diabetes mellitus and CHD. The primary aim of the present study was to investigate, in sex-specific analyses, the role of incident diabetes as the possible biological mechanism for the reported association between short/long sleep duration and incident CHD. Considering that diabetes is a major risk factor for CHD, we hypothesised that any association with sleep duration would not hold for cases of incident CHD occurring before incident diabetes (‘non-diabetes CHD’) but would hold true for cases of incident CHD following incident diabetes (‘diabetes-CHD’).

Methods

A total of 6966 men and 9378 women aged 45–73 years from the Malmö Diet Cancer Study, a population-based, prospective cohort, who had answered questions on habitual sleep duration and did not have a history of prevalent diabetes or CHD were included in the analyses. Incident cases of diabetes and CHD were identified using national registers. Sex-specific Cox proportional hazards regression models were stratified by BMI and adjusted for known covariates of diabetes and CHD.

Results

Mean follow-up times for incident diabetes (n = 1137/1016 [men/women]), incident CHD (n = 1170/578), non-diabetes CHD (n = 1016/501) and diabetes-CHD (n = 154/77) were 14.2–15.2 years for men, and 15.8–16.5 years for women. In men, short sleep duration (< 6 h) was associated with incident diabetes (HR 1.35, 95% CI 1.01, 1.80), CHD (HR 1.41, 95% CI 1.06, 1.89) and diabetes-CHD (HR 2.34, 95% CI 1.20, 4.55). Short sleep duration was not associated with incident non-diabetes CHD (HR 1.35, 95% CI 0.98, 1.87). Long sleep duration (≥ 9 h) was associated with incident diabetes (HR 1.37, 95% CI 1.03, 1.83), CHD (HR 1.33, 95% CI 1.01, 1.75) and diabetes-CHD (HR 2.10, 95% CI 1.11, 4.00). Long sleep duration was not associated with incident non-diabetes CHD (HR 1.33, 95% CI 0.98, 1.80). In women, short sleep duration was associated with incident diabetes (HR 1.53, 95% CI 1.16, 2.01), CHD (HR 1.46, 95% CI 1.03, 2.07) and diabetes-CHD (HR 2.88, 95% CI 1.37, 6.08). Short sleep duration was not associated with incident non-diabetes CHD (HR 1.29, 95% CI 0.86, 1.93).

Conclusions/interpretation

The associations between sleep duration and incident CHD directly reflect the associations between sleep duration and incident diabetes. Incident diabetes may thus be the explanatory mechanism for the association between short and long sleep duration and incident CHD.

     

Sleep Disturbance and Total Sleep Time in Persons Living with HIV: A Cross-Sectional Study

Short and long sleep durations have been associated with inflammation and chronic diseases. To study the association between sleep duration/quality and HIV disease severity, a cross-sectional study was conducted in patients living with HIV (PLWHs) using self-administered questionnaires assessing total sleep time, insomnia (ICSD-3 criteria), and poor sleep quality (PSQI?>?5). Multivariable logistic regression identified the factors associated with sleep disorders and with HIV features. 640 Parisian ambulatory PLWHs were included. The prevalence of insomnia was 50 and 68% of patients had a PSQI?>?5. Patients with CD4 count?<?500 cells/mm³ were more likely to be long sleepers (>?8 h/day) (OR 1.49; 95% CI [1.10–1.99]: p?<?0.01), and less likely to be short sleepers (<?6 h/day) (OR 0.69; 95% CI[0.50–0.96]; p?=?0.04) or to experience insomnia (OR 0.59; 95% CI[0.40–0.86]; p?<?0.01). HIV features were not associated with a PSQI?>?5. Thus, insomnia and impaired sleep quality were highly prevalent in well-controlled PLWHs and the severity of HIV infection was associated with long sleep times.     

Association of glucokinase regulatory gene polymorphisms with risk and severity of non-alcoholic fatty liver disease: an interaction study with adiponutrin gene

Background

Recent genome-wide association studies demonstrated an association between single nucleotide polymorphisms (SNPs) on the glucokinase regulatory gene (GCKR) with hepatic steatosis. This study attempted to investigate the association of GCKR rs780094 and rs1260326 with susceptibility to non-alcoholic fatty liver disease (NAFLD) and its severity.

Methods

The genotypes were assessed on 144 histologically confirmed NAFLD patients and 198 controls using a Sequenom MassARRAY platform.

Results

The GCKR rs1260326 and rs780094 allele T were associated with susceptibility to NAFLD (OR 1.49, 95 % CI 1.09–2.05, p = 0.012; and OR 1.51, 95 % CI 1.09–2.09, p = 0.013, respectively), non-alcoholic steatohepatitis (NASH) (OR 1.55, 95 % CI 1.10–2.17, p = 0.013; and OR 1.56, 95 % CI 1.10–2.20, p = 0.012, respectively) and NASH with significant fibrosis (OR 1.50, 95 % CI 1.01–2.21, p = 0.044; and OR 1.52, 95 % CI 1.03–2.26, p = 0.038, respectively). Following stratification by ethnicity, significant association was seen in Indian patients between the two SNPs and susceptibility to NAFLD (OR 2.64, 95 % CI 1.28–5.43, p = 0.009; and OR 4.35, 95 % CI 1.93–9.81, p < 0.0001, respectively). The joint effect of GCKR with adiponutrin rs738409 indicated greatly increased the risk of NAFLD (OR 4.14, 95 % CI 1.41–12.18, p = 0.010). Histological data showed significant association of GCKR rs1260326 with high steatosis grade (OR 1.76, 95 % CI 1.08–2.85, p = 0.04).

Conclusion

This study suggests that risk allele T of the GCKR rs780094 and rs1260326 is associated with predisposition to NAFLD and NASH with significant fibrosis. The GCKR and PNPLA3 genes interact to result in increased susceptibility to NAFLD.     

Association between subjective sleep duration on workdays or non-workdays and uncontrolled blood pressure in Southern China

Objectives

To examine the association between sleep duration on workdays or non-workdays and unsatisfactory blood pressure (BP) control in Southern China.

The association of insomnia with gastroesophageal reflux symptoms in biopsy-proven nonalcoholic fatty liver disease

Background

It is suggested that nonalcoholic fatty liver disease (NAFLD), including nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH), can be associated with insomnia and gastro-esophageal reflux disease (GERD). The relationship between GERD and insomnia in subjects with biopsy-proven NAFLD was investigated.

Methods

This study enrolled 123 patients with biopsy-proven NAFLD. Insomnia was assessed by the Athens Insomnia Scale (AIS), a self-assessment psychometric instrument designed to quantify sleep difficulty based on ICD-10 criteria; AIS scores ≥ 6 were considered positive for insomnia. GERD symptoms were evaluated using a frequency scale for the symptoms of GERD (FSSG); FSSG scores ≥ 8 were considered positive. Logistic regression models were used to evaluate the association of insomnia with GERD, after adjusting for potential confounders. Thirteen patients with GERD were treated with the proton pump inhibitor rabeprazole (RPZ; 10 mg/day), for 12 weeks.

Results

Of the 123 patients, 76 (62 %) were female and 87 (71 %) were obese, with 34 (28 %) having AIS scores ≥ 6 and 31 (25 %) having FSSG scores ≥ 8. Liver biopsy revealed that 40 patients (33 %) had NAFL and 83 (67 %) had NASH. FSSG and AIS scores were similar in the two groups. HOMA-IR, FSSG scores and γGT (GGT) concentrations were significantly higher in insomniacs than in non-insomniacs. Logistic regression analysis demonstrated that FSSG score and GGT concentration were independently associated with insomnia. RPZ treatment resulted in significantly reductions in both AIS and FSSG scores.

Conclusions

Nearly 30 % of patients with biopsy-proven NAFLD had insomnia, which was related to GGT and GERD and could be relieved by RPZ treatment.     

Association of Sleep Duration and Quality With Subclinical Atherosclerosis

Background

Sleep duration and quality have been associated with increased cardiovascular risk. However, large studies linking objectively measured sleep and subclinical atherosclerosis assessed in multiple vascular sites are lacking.

Rotating night shift work,sleep, and colorectal adenoma in women

Purpose

This study aims to investigate the associations of rotating night shift work history and sleep duration with risk of colorectal adenoma.

Methods

We evaluated 56,275 cancer-free participants of the Nurses’ Health Study II, who had their first colonoscopy or sigmoidoscopy between 1991 and 2011; rotating night shift work and sleep duration were reported by mailed questionnaire. Multivariable-adjusted logistic regression was used to estimate relative risks (RR) of colorectal adenoma, with 95% confidence intervals (CI), across categories of rotating night shift work history (none, 1–4, 5–9, and ≥10 years) and sleep duration (≤5, 6, 7, 8, and ≥9 h/day).

Results

We found no association between duration of rotating night shift work and occurrence of colorectal adenoma (p-trend across shift work categories = 0.5). Women with the longest durations of rotating night shift work (≥10 years) had a similar risk of adenoma compared to women without a history of rotating night shift work (multivariable-adjusted RR = 0.96, 95% CI = 0.83–1.11). Similarly, there were no associations of shorter or longer sleep durations with adenoma risk (p-trend = 0.2 across sleep durations of ≤5 through 7 h/day and p-trend = 0.5 across sleep durations of 7 through ≥9 h/day). Results were similar when we examined associations according to adenoma location and subtype.

Conclusions

Our results do not support an association between rotating night shift work or sleep duration and risk of colorectal adenoma in women.

     

Association of sleep duration with metabolic syndrome and its components in children and adolescents; a propensity score-matched analysis: the CASPIAN-V study

Objective

This study aims to evaluate the association of sleep duration with metabolic syndrome (MetS) and its components in a pediatric population.

Methods

This multi-centric cross-sectional study was conducted in 2015 in 30 provinces of Iran. Participants consisted of 4200 school students aged 7–18 years, studied in a national school-based surveillance program (CASPIAN-V). Physical examinations and laboratory tests were performed using standard protocols. The analysis was conducted based on the propensity score matching and conditional logistic regression was used to evaluate the association of short sleep (less than 8 h a day) and the onset of sleep with MetS and its components. Results of conditional logistic regression was reported as odds ratios (OR) and 95% confidence intervals (CI).

Results

Overall, 3843 of participants completed the survey (response rate: 91.5%). Their mean (SD) age was 12.3 (3.2) years and 50.6% were boys. In the multivariate model, individuals who slept less than 8 h a day had significantly higher odds of MetS (OR 2.05, 95% CI 1.19–3.63) and high blood pressure (BP) (OR 1.46, 95% CI 1.04–2.06). Association between short sleep duration with other MetS components (including abdominal obesity, hypertriglyceridemia, hyperglycemia, and low levels of high-density lipoprotein-cholesterol was not statistically significant (P?>?0.05). Moreover, association between the onset of sleep with MetS and its components was not statistically significant (P?>?0.05).

Conclusion

Short sleep duration is associated with increased risk of MetS and high BP in children and adolescents. The clinical impact of current findings should be assessed in future longitudinal studies.

     

The Prevalence and Clinical Correlates of Nonalcoholic Fatty Liver Disease (NAFLD) in African Americans: The Multiethnic Study of Atherosclerosis (MESA)

Background and Aims

Nonalcoholic fatty liver disease (NAFLD) is the number one cause of liver disease in the United States. The prevalence rates in African Americans (AA), while significantly lower than other ethnic groups with similar known risk factors, have been quoted as high as 24 %. We aim to determine if the presence of NAFLD in African Americans is associated with lower triglyceride and/or higher HDL-c levels and if NAFLD risk factors in African Americans differ from other ethnic groups.

Methods

A total of 3,056 participants of the Multi Ethnic Study of Atherosclerosis were included in this study. We utilized the baseline serum, anthropometric and radiographic measurements obtained between 2000 and 2002. NAFLD was defined as liver spleen ratio <1 from CT measurements.

Results

The prevalence of NAFLD was and 11 % in AA. We found that age, education, triglyceride levels, HDL-c levels, waist circumference and HOMA-IR were independent correlates of NAFLD in this population. Among those with NAFLD, AA had significantly lower triglyceride levels than Hispanics [125 mg/dl (95 % CI 107–143) versus 192 mg/dl (95 % CI 169–215), p < 0.001] and Caucasians [185 mg/dl (95 % CI 161–209), p = 0.001]. Serum HDL-c was significantly higher in AA with NAFLD (47 mg/dl; 95 % CI 45–50) when compared to Hispanics (44 mg/dl; 95 % CI 43–66, p = 0.02) and Caucasians (44 mg/dl; 95 % CI 42–46, p = 0.02) with NAFLD.

Conclusions

This study demonstrated that the clinical correlates of NAFLD in African Americans are similar to the correlates of NAFLD in other ethnic groups. Our data also suggests that when evaluating African Americans for NAFLD risk, lower cutoff values should be used to define abnormal triglyceride levels.