Discrepancies Between Self-Reported Usual Sleep Duration and Objective Measures of Total Sleep Time in Treatment-Seeking Overweight and Obese Individuals

To examine the agreement between actigraphy-estimated and self-reported sleep duration in obese individuals, we had 63 treatment seeking overweight/obese participants complete the Pittsburgh Sleep Quality Index (PSQI) and report sleep duration for weekends and weekdays, and compared their reports to 7 days of actigraphy. Actigraph total sleep time correlated r = .20-.31 with self-report and the absolute discrepancy averaged 51-54 minutes. Only 20 of the 32 subjects (62.5%) classified as short sleepers (<7 hours/night) by actigraphy were similarly classified by self-report. Poor sleep quality was associated with greater absolute discrepancy between actigraphy and self-report. The weak correlations between self-report and actigraph should be considered in future efforts to increase sleep duration to promote weight loss in obese individuals.     

Sputum Volume Predicts Sputum Mycobacterial Load during the First 2 Weeks of Antituberculosis Treatment

Disease severity in patients with pulmonary tuberculosis is associated with mycobacterial sputum load. To ascertain whether reduced sputum production during treatment is a useful clinical sign of improvement, we analyzed the mycobacterial loads of 5,552 sputum samples collected from 439 newly diagnosed sputum smear-positive tuberculosis patients who participated in six 14-day studies of antituberculosis treatment. Sputum volumes were categorized as low (<6 ml), medium (6 to 10 ml), or large (>10 ml), and mycobacterial load was measured by the time to positivity in liquid culture and the CFU counts on solid culture. The association of sputum volume with mycobacterial load was estimated with multiple linear regression models adjusted for repeated measures. The predictor variables were sputum volume category, treatment day, specific study , and the interaction of sputum volume category and treatment day. Mycobacterial load was significantly associated only with the day on treatment and sputum volume, which tended to decrease with ongoing treatment. With the volume held constant, each day on treatment decreased the log CFU by 0.082 (P < 0.001) and increased the time to positivity (TTP) by 1.04 h (P < 0.001). From low to medium and from medium to large sputum volumes, the log CFU/ml increased by 0.265 (P < 0.003) and 0.490 (P < 0.001), respectively, and the TTP decreased by 1.17 h (P < 0.001) and 1.30 h (P < 0.001), respectively, for a given day of treatment. The variability of the sputum load measurements increased with the day of treatment and lower sputum volumes. The significant association of sputum volume and mycobacterial load validates decreasing sputum production as a clinical sign of improvement during early antituberculosis treatment.     

Associations between gender and measures of daytime somnolence in the Sleep Heart Health Study

STUDY OBJECTIVES: To examine the relationship of gender to subjective measures of sleepiness, including the Epworth Sleepiness Scale (ESS), in a community-based population. DESIGN: A cross-sectional study. SETTING/PARTICIPANTS: Multicenter Sleep Heart Health Study participants (N = 6.440, 52% women) recruited from ongoing cohort studies. INTERVENTIONS: N/A. MEASUREMENTS: Scores from the ESS, Sleep Heart Health Study daytime sleepiness and feeling unrested questions, polysomnography results (respiratory disturbance index at 4% desaturation), as well as data on difficulty initiating and maintaining sleep, insufficient sleep, sedative use, alcohol use, cardiovascular or respiratory disease, frequent awakening due to leg cramps. RESULTS: Women reported feeling sleepy as often as men did (odds ratio [OR] = 1.06; confidence interval [CI], 0.86-1.32), but women were less likely to have an ESS score > 10 (adjusted OR = 0.77; CI, 0.66-0.90) and more likely to report feeling unrested (adjusted OR = 1.39; CI, 1.14-1.69) than men. In men, the ESS score was more strongly correlated with reports of feeling unrested or sleepy compared to women. CONCLUSIONS: Men and women answer questions on sleepiness differently. Findings indicate that using the ESS to detect subjective sleepiness is more likely to identify men with sleepiness. Since the ESS is more strongly related to other subjective measures in men, the ESS may be a more sensitive measure of subjective sleepiness in men than in women.     

抑郁症脑磁共振成像与抗抑郁治疗临床改善间关系的研究进展

据世界卫生组织预测,到2030年抑郁症将会上升至世界疾病负担首位,到2040年抑郁症将是导致残疾的最常见的原因。研究表明,最多只有30%~40%的抑郁症患者在任何治疗中都会有缓解,目前抑郁症的治疗仍以经验性治疗为主,尚无临床实践中可用的生物标记物用于患者的个体化治疗。研究表明脑磁共振成像具有预测抗抑郁治疗后临床改善的潜在价值,本文主要从抑郁症的脑结构MRI和功能MRI两个方面综述抑郁症治疗前脑MRI改变与抗抑郁治疗临床改善间关系的研究。     

Associations of Sleep Duration and Screen Time with Incidence of Overweight in European Children: The IDEFICS/I.Family Cohort

IntroductionOver the past decades, children have been increasingly using screen devices, while at the same time their sleep duration has decreased. Both behaviors have been associated with excess weight, and it is possible they act as mutually reinforcing behaviors for weight gain. The aim of the study was to explore independent, prospective associations of screen time and sleep duration with incident overweight in a sample of European children.MethodsData from 4,285 children of the IDEFICS/I.Family cohort who were followed up from 2009/2010 to 2013/2014 were analyzed. Hours per day of screen time and of sleep duration were reported by parents at baseline. Logistic regression analyses were carried out in separate and mutually adjusted models controlled for sex, age, European country region, parental level of education, and baseline BMI z-scores.ResultsAmong normal weight children at baseline (N = 3,734), separate models suggest that every hour increase in screen time and every hour decrease in sleep duration were associated with higher odds of the child becoming overweight or obese at follow-up (OR = 1.16, 95% CI: 1.02–1.32 and OR = 1.23, 95% CI: 1.05–1.43, respectively). In the mutually adjusted model, both associations were attenuated slightly (screen time OR = 1.13, 95% CI: 0.99–1.28; sleep duration OR = 1.20, 95% CI: 1.03–1.40), being consistently somewhat stronger for sleep duration.Discussion/ConclusionBoth screen time and sleep duration increased the incidence of overweight or obesity by 13–20%. Interventions that include an emphasis on adequate sleep and minimal screen time are needed to establish their causal role in the prevention of overweight and obesity among European children.     

Integrating Couple Therapy With Individual Therapies and Antidepressant Medications in the Treatment of Depression

There is a growing body of literature linking marital dissatisfaction with the onset, maintenance, and remission of depression, as well as with outcome following treatments of depression. Furthermore, there have been several studies suggesting that couple therapy may be effective in the treatment of depression for dissatisfied partners. However, not all individuals improve following couple therapy, suggesting that there is room for further developments in improving outcome to couple therapy. One possibility is that outcome may be improved by integrating couple therapy with individual therapies and/or antidepressants in the treatment of depression. The advantages of such integrations are outlined, and points and methods of integrating couple therapy with empirically supported individual therapies and antidepressant medications are discussed.     

The Prevalence of Short Sleep Duration by Industry and Occupation in the National Health Interview Survey

Study Objectives:

To explore whether employment in industries likely to have non-standard work schedules (e.g., manufacturing and service) and occupations with long work-weeks (e.g., managerial/ professional, sales, and transportation) is associated with an increased risk of short sleep duration.

Design:

Cross-sectional epidemiologic survey.

Setting:

Household-based face-to-face survey of civilian, non-institutionalized US residents.

Participants:

Sample adults interviewed for the National Health Interview Survey in 1985 or 1990 (N = 74,734) or between 2004 and 2007 (N = 110,422). Most analyses focused on civilian employed workers interviewed between 2004 and 2007 (N = 66,099).

Interventions:

N/A

Measurements and Results:

The weighted prevalence of self-reported short sleep duration, defined as ≤6 h per day, among civilian employed workers from 2004-2007 was 29.9%. Among industry categories, the prevalence of short sleep duration was greatest for management of companies and enterprises (40.5%), followed by transportation/warehousing (37.1%) and manufacturing (34.8%). Occupational categories with the highest prevalence included production occupations in the transportation/warehousing industry, and installation, maintenance, and repair occupations in both the transportation/warehousing industry and the manufacturing industry. In the combined sample from 1985 and 1990, 24.2% of workers reported short sleep duration; the prevalence of short sleep duration was significantly lower during this earlier time period compared to 2004–2007 for 7 of 8 industrial sectors.

Conclusions:

Self-reported short sleep duration among US workers varies by industry and occupation, and has increased over the past two decades. These findings suggest the need for further exploration of the relationship between work and sleep, and development of targeted interventions for specific industry/occupation groups.

Citation:

Luckhaupt SE; Tak S; Calvert GM. The prevalence of short sleep duration by industry and occupation in the National Health Interview Survey. SLEEP 2010;33(2):149-159     

Gender Differences in the Cross-Sectional Relationships Between Sleep Duration and Markers of Inflammation: Whitehall II Study

Objective:

To examine the relationships between sleep and inflammatory markers because these may be important in the development of cardiovascular disease.

Methods and Results:

The relationship between self-reported sleep duration and interleukin-6 (IL-6) (n = 4642) and high-sensitivity C-reactive protein (hs-CRP) (n = 4677) was examined in individuals from the Whitehall II study. Following multiple adjustments, there were no overall linear or nonlinear trends between sleep duration and IL-6. However, in women but not men (interaction P < 0.05), levels of IL-6 tended to be lower in individuals who slept 8 hours (11% [95% confidence interval 4 to 17]) as compared to 7 hours. With hs-CRP, in the adjusted model, there was no association between hs-CRP and sleep duration in men. However, there was a significant nonlinear association in women, the level of hs-CRP being significantly higher in women short sleepers (5 hours or less) after multiple adjustments (P = 0.04) (interaction P < 0.05).

Conclusions:

No significant variation in inflammatory markers with sleep duration was observed in men. By contrast, both IL-6 and hs-CRP levels varied with sleep duration in women. The observed pattern of variation was different according to the inflammatory marker observed. Further longitudinal studies are required to fully investigate possible temporal relationships between short sleep and markers of inflammation.

Citation:

Miller MA; Kandala NB; Kivimaki M; Kumari M; Brunner EJ; Lowe GDO; Marmot MG; Cappuccio FP. Gender differences in the cross-sectional relationships between sleep duration and markers of inflammation: Whitehall II study. SLEEP 2009;32(7):857-864.     

Habitual Sleep Duration and Insomnia and the Risk of Cardiovascular Events and All-cause Death: Report from a Community-Based Cohort

Study Objectives:

To investigate the relationship between sleep duration and insomnia severity and the risk of all-cause death and cardiovascular disease (CVD) events

Design:

Prospective cohort study

Setting:

Community-based

Participants:

A total of 3,430 adults aged 35 years or older

Intervention:

None

Measurements and Results:

During a median 15.9 year (interquartile range, 13.1 to 16.9) follow-up period, 420 cases developed cardiovascular disease and 901 cases died. A U-shape association between sleep duration and all-cause death was found: the age and gender-adjusted relative risks (95% confidence interval [CI]) of all-cause death (with 7 h of daily sleep being considered for the reference group) for individuals reporting ≤ 5 h, 6 h, 8 h, and ≥ 9 h were 1.15 (0.91–1.45), 1.02 (0.85–1.25), 1.05 (0.88–1.27), and 1.43 (1.16–1.75); P for trend, 0.019. However, the relationship between sleep duration and risk of CVD were linear. The multivariate-adjusted relative risk (95% CI) for all-cause death (using individuals without insomnia) were 1.02 (0.86–1.20) for occasional insomnia, 1.15 (0.92–1.42) for frequent insomnia, and 1.70 (1.16–2.49) for nearly everyday insomnia (P for trend, 0.028). The multivariate adjusted relative risk (95% CI) was 2.53 (1.71–3.76) for all-cause death and 2.07 (1.11–3.85) for CVD rate in participants sleeping ≥9 h and for those with frequent insomnia.

Conclusions:

Sleep duration and insomnia severity were associated with all-cause death and CVD events among ethnic Chinese in Taiwan. Our data indicate that an optimal sleep duration (7–8 h) predicted fewer deaths.

Citation:

Chien K; Chen P; Hsu H; Su T; Sung F; Chen M; Lee Y. Habitual sleep duration and insomnia and the risk of cardiovascular events and all-cause death: report from a community-based cohort. SLEEP 2010;33(2):177–184.     

高血压病患者睡眠质量与焦虑抑郁情绪的相关性研究

目的研究高血压病患者睡眠质量,焦虑抑郁情绪以及之间的相关性。方法对80例确诊的高血压病患者同时进行匹兹堡睡眠质量指数(PSQI)、焦虑自评量表(SAS)和抑郁自评量表(SDS)评定。结果PSQI总均分为10.86±5.10;SAS总分为41.03±8.89,焦虑症状的出现率为22.51;SDS总分为39.51±8.87,抑郁症状的出现率为20.85。焦虑抑郁症并存11例,占15.49。SAS与SDS间存在显著的正相关(r=0.934,P<0.01)。PSQI总分与焦虑和抑郁情绪均呈显著正相关。结论高血压病患者睡眠质量与焦虑抑郁情绪之间具有相关性,在药物控制血压的同时,有效的心理干预治疗同样具有重要的作用。     

人格-健康关系模型述评

对人格—健康关系模型的探讨日益为研究者所重视 ,并已成为心理学的一个重要研究领域。文章追溯了人格—健康关系研究的渊源 ,介绍了 4种主要的人格—健康关系模型 ,并在此基础上简要地进行了分析与评价     

Association of Sleep Duration with Mortality from Cardiovascular Disease and Other Causes for Japanese Men and Women: the JACC Study

Study Objectives:

To examine sex-specific associations between sleep duration and mortality from cardiovascular disease and other causes.

Design:

Cohort study.

Setting:

Community-based study.

Participants:

A total of 98,634 subjects (41,489 men and 57,145 women) aged 40 to 79 years from 1988 to 1990 and were followed until 2003.

Interventions:

N/A.

Measurements and Results:

During a median follow-up of 14.3 years, there were 1964 deaths (men and women: 1038 and 926) from stroke, 881 (508 and 373) from coronary heart disease, 4287 (2297 and 1990) from cardiovascular disease, 5465 (3432 and 2033) from cancer, and 14,540 (8548 and 5992) from all causes. Compared with a sleep duration of 7 hours, sleep duration of 4 hours or less was associated with increased mortality from coronary heart disease for women and noncardiovascular disease/noncancer and all causes in both sexes. The respective multivariable hazard ratios were 2.32 (1.19–4.50) for coronary heart disease in women, 1.49 (1.02–2.18) and 1.47 (1.01–2.15) for noncardiovascular disease/noncancer, and 1.29 (1.02–1.64) and 1.28 (1.03–1.60) for all causes in men and women, respectively. Long sleep duration of 10 hours or longer was associated with 1.5- to 2-fold increased mortality from total and ischemic stroke, total cardiovascular disease, noncardiovascular disease/noncancer, and all causes for men and women, compared with 7 hours of sleep in both sexes. There was no association between sleep duration and cancer mortality in either sex.

Conclusions:

Both short and long sleep duration were associated with increased mortality from cardiovascular disease, noncardiovascular disease/noncancer, and all causes for both sexes, yielding a U-shaped relationship with total mortality with a nadir at 7 hours of sleep.

Citation:

Ikehara S; Iso H; Date C; Kikuchi S; Watanabe Y; Wada Y; Inaba Y; Tamakoshi A. Association of sleep duration with mortality from cardiovascular disease and other causes for Japanese men and women: the JACC study. SLEEP 2009;32(3):259–301.