Risk of Atrial Fibrillation May be Higher in Patients with Sleep Apnea

ekg heart and sleep

New research, as presented at the 2017 ATS International Conference, found that patients with obstructive sleep apnea (OSA) are at a higher risk of developing atrial fibrillation (AF or a-fib).

Obstructive sleep apnea is characterized by symptoms of repeated events of shallow breathing with occasional cessations of breath during sleep.  These events cause decreased blood oxygen levels and severely disrupt sleep patterns.  A-fib is a heart arrhythmia characterized by an irregular or fast heartbeat, which can lead to heart problems and stroke.

Lead author of the study and assistant professor of medicine at Canada’s University of Ottawa, Dr. Tetyana Kendzerska, notes that the findings indicate there are strong biological connections linking OSA with increased risk of a-fib through a variety of mechanisms.  The evidence suggests that these mechanisms include metabolic abnormalities, cardiac stretch, sympathetic activity, and oxidative stress.

The research team in Canada analyzed medical records for 8,256 adults with an average age of 47 years, who were suspected of having OSA but did not have any known diagnosis of heartrate fluctuations or abnormalities, including a baseline a-fib.  Patients were followed for a total of 13 years, during which time 173 patients developed atrial fibrillation that led to hospitalization.

Researchers measured the severity of OSA to see if there were significant predictors to a-fib by looking at a couple of elements:

  1. The number of events the patient had per hour of sleep, with events defined as partially or completely stopping breathing.
  2. Time spent with oxygen saturation below normal levels (<90%) during sleep.

After this process, they controlled for already established risk factors for a-fib.

Patients who developed a-fib were current or former smokers, have several other diagnoses, and were older.  These and other risk factors were adjusted for in this research and the scientists found that desaturation during sleep continued to be a significant predictor of hospitalization for a-fib.  This is just about oxygen saturation, not the number of breathing cessation events the individual had.  Additionally, women were more likely than men to have a correlation between oxygen desaturation and hospitalization for a-fib.

Dr. Richard S. Leung, senior author of the research and assistant professor of medicine at the University of Toronto in Canada, notes that prior research shows us that women with OSA are at higher risk of heart disease and mortality.  An explanation for this, he notes, is endothelial dysfunction, a higher likelihood of developing systematic and pulmonary hypertension, as well as impaired heart rate responses.  However, additional research is necessary to confirm these findings and look at other potential mechanisms to the association.

The primary analysis did not include any mention of hypertension.  They note that this may be the cause or link between a-fib and OSA, so having it as part of the analysis would have diminished the association.  The secondary analysis, however, did add a control factor for hypertension, which continued to show a significant link between a-fib and oxygen desaturation.  This indicates that hypertension may be an intermediate step between OSA and a-fib.

There were a few limitations in this research, including having no data on CPAP adherence, which is the standard treatment for OSA.  Additionally, there was no information on whether the person’s hypertension was diagnosed and being treated.  Additional research is being performed by the researchers to connect emergency room visits for a-fib and an OSA diagnosis.

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Sleep Apnea Hits Low-Income African-American Children the Hardest

sleep apnea african american

New research shows that severe obstructive sleep apnea (OSA) in children is a major issue in Washington D.C.; however, it is more commonly found in African-American children from lower income households, and the diagnosis is usually delayed.  Findings were presented at the ATS 2017 International Conference.

Lead author of the study, Dr. Sasikumar Kilaikode Cheruveettara, from Children’s National Health System in D.C., notes that prior national and international studies found that children in lower income households were more likely to have obstructive sleep apnea.  The purpose of this new research was to determine if this was the case in Washington D.C., since the majority of the population is inner-city and low income.  The goal was to address the lack of information on OSA’s characteristics that present in children and adolescents in this minority.

Approximately 3% of American children have OSA, which interferes with their ability to function and leads to behavioral difficulties, along with other serious health problems like diabetes, heart disease, and obesity.

The research team, led by Dr. Kilaikode Cheruveettara, looked at past medical records of 150 children with severe obstructive sleep apnea, all of whom were seen in the Pediatric Sleep Center of Children’s National Health System in D.C.  Severe OSA means that the individual has 10+ events every hour.  An event is defined as the cessation of breathing, as would be measured in the initial polysomnography (sleep study).  Demographic variables were considered, especially with respect to race/ethnicity, socioeconomic status, and which neighborhood they lived in.

Most of the patients with severe OSA were African American.  These children had symptoms for an average of two years before being diagnosed, twice that of Caucasian children.  The areas that were most affected by this diagnosis had the largest proportion of minority children and low-income households.  This included most of Prince George County in Maryland, as well as D.C. neighborhoods with the highest poverty levels.

Dr. Kilaikode Cheruveettara noted that this research demonstrates the vital need to allocate more resources, education, and health care to minority communities in the inner-city regions to better catch and diagnose pediatric OSA.  These kids are already at increased risk of getting severe OSA because of prematurity, allergies, and asthma.  Lack of education and awareness delays diagnosis because parents and caregivers are unaware of symptoms and the need for treatment.

Additionally, Dr. Kilaikode Cheruveettara notes, future studies will focus on identifying barriers to diagnosing these children and getting early referrals.  He hopes to have more widespread awareness and area-focused education to help people observe and report signs and symptoms of OSA in children.

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Pollution May be Contributing to Sleep Disturbances

sleep disorders and polution

New research, as presented at the 2017 American Thoracic Society International Conference, found that exposure to increased levels of air pollution over an extended period may be making it difficult to get a good night’s sleep.

Lead author of the study, Martha E. Billings, MD, notes that studies in the past have shown a correlation between air pollution and increased heart disease, as well as decreased lung function and breathing problems; however, unfortunately, very little is known about pollution’s effects on sleep.  Dr. Billings is the assistant professor of medicine at the University of Washington, where the research was conducted.  She notes that she and her team theorized that since air pollution does cause irritation in the upper airway, congestion, and swelling, it may also be responsible for disruptions in the central nervous system and areas of the brain responsible for controlling our breathing while asleep.

Scientists performed a data analysis of 1863 people in the Multi-Ethnic Study of Atherosclerosis (MESA), who were also part their Sleep and Air Pollution studies.  The two most common air pollutants examined were PM2.5 (fine-particles) and NO2 (traffic-related/gas).  Data on measurements came from hundreds of Environmental Protection Agency and MESA Air monitoring sites located throughout the United States.  Additionally, information was gathered from local environment features and tools.  With this data, scientists determined an estimated air pollution level in or around each person’s home at two time points in the study: once at the end of the first year and again at five years.

Participants were asked to wear wrist actigraphy, which monitored and measured all movements, even small ones, during sleep.  This information helped researchers determine estimates of sleep and wake patterns over the course of one full week.  The data calculates sleep efficiency, which is a measurement tool that determines the amount of time a person spends in bed awake and asleep.  Analysis of this information led researchers to determine that sleep efficiency in 25% of the participants was less than 88%.  In addition, scientists studied pollution exposures to see if there was an association in those with low sleep efficiency.

Participants were split into fourths, which were determined according to the level of pollution.  The 25% of people with the most air pollution were then compared to the 25% of people who had the lowest pollution levels.

The analytical study found that those who had the highest exposure to NO2 over a period of five years were more likely (60%) to have low sleep efficiency when compared to people who had the lowest exposure to NO2.  Those who were exposed to higher levels of fine-particle pollution were almost 50% more likely to have decreased sleep efficiency.

Data was adjusted for several factors including body mass, obstructive sleep apnea, race/ethnicity, smoking status, income, age, and socioeconomic status.

Of interest in this research was how long-term exposure to air pollution affected sleep health.  Dr. Billings noted that there is likely an acute reaction to short-term exposure to increased air pollution, but the data was insufficient to support this theory.  The parent MESA study is currently reviewing the chronic side effects of elevated levels of pollution with regards to heart health.

Findings suggest that there may be a correlation between increased air pollution and poor sleep quality, just as high air pollution levels affect lung and heart health.  Improving the quality of the air, even if just within the home, could be a way for people to improve their sleep health and reduce health risks.

As expected, additional research is necessary to explore and discover any links between sleep and pollutants, especially with regards to the mechanisms that may be responsible for disrupting sleep patterns, such as traffic noise leading to poor sleep.


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Lonely Young Adults Suffer from Poor Sleep Quality

loneliness and poor sleep 2

More than 2000 young British adults were surveyed by scientists from King’s College London.  Findings suggest a link between poor sleep quality and loneliness.

The findings were published in the journal, Psychological Medicine, and noted that lonely people were 24% more likely to experience daytime sleepiness and difficulty concentrating on tasks.

King’s College researchers define loneliness as the distress felt when a person feels their social and personal relationships are inadequate.  This is different from social isolation, in which people can still be isolated without feeling lonely, or feel lonely while surrounding by people.

Many studies have looked at the effects of loneliness in the elderly; however, not many realize the problem is common in the younger generation as well.  Reports from the Mental Health Foundation indicate that people between 18 and 34 years of age experience the most loneliness.  Unfortunately, however, very little is known about how loneliness affects overall sleep health in young adults, hence the reason for this research.

Scientists gathered sample data from the Environmental Risk Longitudinal Twin Study.  This included 2232 twins between 18 and 19 years of age, all of whom were born in Wales and England.  Loneliness was measured using responses to four questions:

  1. How often do you feel you lack companionship?
  2. How often do you feel left out?
  3. How often do you feel isolated from everyone else?
  4. How often do you feel alone?

Sleep quality over a period of one month was measured as well, including how long it takes for the individuals to fall asleep and how many disturbances they experience throughout the night.  Furthermore, they were asked about any daytime dysfunctions like having trouble staying awake throughout the day.

Essentially, about 25% to 30% of individuals reported sometimes feeling lonely, and an additional 5% reported feeling lonely frequently.  Even after adjusting for mental health concerns like anxiety and depression, which are linked to loneliness and sleep problems, scientists still found a link between poor sleep and loneliness.

A theory for why lonely people have restless sleep is that they may feel less safe; therefore, scientists looked at how past experiences of violence – such as from child maltreatment, crime, or abuse – impacted their sleep difficulties.  Interestingly, the link between poor sleep and loneliness was 70% stronger in those who were exposed to severe violence.  Several biological processes are considered that could explain the link, especially with respect to increased stress responses.  Additionally, prior research indicates that lonely people experience changes in cortisol levels, which shows that there is some form of activation in the stress response.  This physiological change may be playing a role in these individuals’ sleep problems.

One of the researchers in the study, Professor Louise Arseneault, from King’s College London Institute of Psychiatry, Pyschology & Neuroscience, notes that poor sleep quality is just one of the things that compounds loneliness.  These findings highlight how important it is to identify, target, and treat negative thought behaviors and perceptions that surround feelings of loneliness.

Additionally, Professor Arseneault noted that the young people in this study are currently in college, away from home for the first time.  That can certainly make loneliness worse; therefore, it is crucial that they receive the support they need to address these feelings and avoid mental health problems down the road that can result from poor sleep.

Another researcher, Timothy Matthews, added his thoughts about the findings.  He noted that the team identified an additional culprit to the link: violence.  It made the association between poor sleep and loneliness even stronger, compounding sleep problems and confirming the theory that many people who are lonely have sleep problems because they feel unsafe.  We are in our most vulnerable state when we’re asleep, so it would make sense that someone with past exposure to severe violence would have trouble being and sleeping alone, as they can’t be as vigilant with their safety.  Isolation from others makes it even more difficult for them to get restful sleep.  It is critical to understand that loneliness may contribute to pre-existing issues, so proper support and treatment can be tailored to that individual.

References: https://www.eurekalert.org/pub_releases/2017-05/kcl-liy051617.php

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Study Shows Tai Chi Restores Sleep Health

tai chi and sleep

Insomnia sufferers know the struggle – worrying about sleep loss makes getting to sleep at night even more difficult.  Research finds that 30% of breast cancer survivors with insomnia are also suffering from fatigue, higher risk of disease, and depression.

There is new research that offers hope, however.  A UCLA study found that tai chi, which is a combination of slow, fluid movements and meditation, has similar positive effects to cognitive behavioral therapy.  CBT is the gold standard and first line of treatment for insomnia, especially in cancer survivors.  Both tai chi and CBT show enduring benefits over the course of one year.

These results were published in the Journal of Clinical Oncology.  The findings showed significant improvements in sleep quality and the health of insomniac breast cancer survivors who practiced tai chi.  They saw further benefits in the improvement of depression and fatigue.  Both CBT and tai chi showed almost identical rates of improvements in insomnia symptoms and remission.

Many accrediting and authoritative agencies and institutions believe that CBT, which is a form of talk therapy, is the optimal choice for treatment in this population.  CBT focuses on identifying and changing negative thoughts and behaviors related to sleep, which are likely negatively affecting the ability to fall and stay asleep.

Unfortunately, however, CBT is often too expensive, and there are woefully few professionals who specialize in this field.  Dr. Michael Irwin, lead author of the study and a professor of psychiatry at UCLA, says this means that many people are not getting the treatment they need because of finances, so these new findings suggest a more affordable, yet equally effective treatment alternative.

Dr. Irwin suggests that there is a need for community-based interventions like tai chi.  This practice is often free or at a low cost, and many can be found at community centers, in parks, or at libraries.  An additional benefit is that tai chi can be learned in the comfort of your own home using instructional videos.

In the past, Dr. Irwin and colleagues performed studies with tai chi and found that the relaxation techniques used in this art significantly slows the breathing, reduces inflammation in cancer survivors, and suggests a lower risk for disease and cancer recurrence.

For this most recent study, scientists recruited 90 breast cancer survivors to test the efficacy of tai chi on insomnia.  All recruits had difficulty sleeping at least three nights a week.  They also reported feeling symptoms of daytime fatigue and depression.  Respondents were aged between 42 and 83 years.  Each person was assigned at random either to receive weekly CBT or weekly tai chi instruction for a total of three months.  The tai chi taught in this setting was a Westernized form called tai chi chih.

Over the following 12 months, UCLA researchers evaluated each participant at regular intervals to look for any signs of insomnia, fatigue, or depression.  Further, they wanted to see if the participant was showing any amount of improvement.

After 15 months, approximately half of the recruits from both groups (43.7% in CBT an 46.7% in Tai chi) showed clinical improvement in their insomnia.

Dr. Irwin notes that those who survive breast cancer are not generally quick to go to a doctor with insomnia or depression.  These results impacted that outcome, with robust benefits in something outside the gold standard of treatment for insomnia.

Many of the recruits continued with their tai chi practice on their own after the completion of the study.  This reflects the motivation among those survivors.  For the most part, these survivors are frequently looking for healthy lifestyle and behavior changes that take a mindfulness approach, because they believe these methods to be ultimately helpful in protecting them against disease, decline, and recurrence.

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Sleeping Pills Increase Risk of Hip Fracture in Older Adults

fractures and sleep

New research out of Cardiff University and King’s College London has found that older adults who were recently prescribed popular the sleep drugs, benzodiazepine or another ‘Z-drug’ are at least two and a half times more likely to suffer a hip fracture within the first two weeks of treatment than people who do not use any sleep pills.

Professor at Cardiff University School of Medicine and Institute of Psychiatry, Dr. Ben Carter, noted that these types of medications, especially ‘Z-drugs,’ are quickly growing in popularity, with doctors using them as their first line of treatment for sleep problems.  However, Dr. Carter notes that there is no evidence to show that they are safer to use than the older drug, benzodiazepine, with respect to risk of hip fracture.

Researchers note that this study indicates that both medications greatly increase the risk of hip fracture when prescribed as a new medication in older patients.

This research included a group of people over the age of 65 who were prescribed a hypnotic medication; findings showed that new users were two and a half times more likely to have a fracture when compared to other people of the same age who were not taking any hypnotics.  There was a 20% higher risk of hip fracture in long-term (more than 30 days) hypnotic medication users, but about 53% increased risk of fraction in medium-term (between 15 to 30 days) users.

Additionally, Dr. Carter notes that careful consideration of this increased fracture risk should be given during the medical decision-making process.  It is important for providers to focus on other clinically effective measures to reduce the risk during the first days of treatment.  These measures include things like removing hazards from the home, visual correction, medication reconciliation, and strength training.

The findings in this research validate those of prior studies that link hypnotic medication use in older adults with increased risk of dependence, cognitive decline, accidents, and fractures.  Furthermore, these particular drugs cause debilitating side effects like delayed reaction times, impaired balance, and drowsiness, creating more risk to older patients.

The article, Benzodiazepines, Z-drugs and the risk of hip fracture: A Systematic Review and Meta-Analysis,’ was published this month in the journal, PLOS ONE.

 Reference:  https://www.eurekalert.org/pub_releases/2017-04/cu-nps042617.php

Rachael Herman is a professional writer with an extensive background in medical writing, research, and language development.

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Attention and Creativity Suffer in Young Adults Who Alternate Between Sleep Deprivation and Sleep Marathons

sleep and creativity

New research from Baylor University shows that young adults who frequently alternate between skimping on sleep and sleep marathons have worse creativity and attention, especially if they are working on big projects.

Study co-author, Michael Scullin, from Baylor Sleep Neuroscience and Cognition Laboratory, who is also an assistant professor of psychology and neuroscience, notes that those who had more variability in their sleep each night were more likely to show  decline in their cognitive abilities throughout the week.

Especially in the heat of major school projects, students will intentionally lose sleep to get the work done, but then they follow that up with a marathon, doing this repeatedly throughout the school year.  The many deadlines and tasks associated with big projects outnumber those that come with exams, and these tasks and deadlines contribute to the variability in sleep.

These findings were published in the Journal of Interior Design, and it was specifically for those students in the interior design program; however, findings also had implications for those in the graphic design, architecture, art, and other programs that use studio-based instruction.

Assistant professor of interior design at Baylor’s, Elise King, noted that some students believe that sleep deprivation is a sort of badge of honor.  Working late is not seem as procrastination.  Instead, it is seen to be a tradition, or a culture, that is a normal part of a curriculum based in a studio.  This, they believe, helps students prepare for their career.

King notes that most people do not understand the difference between being a decorator and being an interior designer, so those in the interior design field tend to work harder to show their differences.  Recently, however, Ms. King noted professors and administrators have seen consequences to that type of thinking, including depression, mental health issues, and anxiety.  Furthermore, they recognize the dangers to driving while sleep deprived.

There is a common myth among designers, which is that the best designs are only going to come in the middle of the night.  That is a myth, however, and the truth is quite the opposite, in that regular and consistent habitual behaviors are just as important as the length of sleep you receive each night.

Executive attention functions, such as intense focus, planning, decision-making, and self-correction are negatively affected by irregular sleep patterns.  The study found that erratic sleep patterns also contribute to a decline in creativity.

The recommended amount of sleep for young adults is seven to nine hours each night; however, the 28 interior design students that were part of the Baylor study experienced fragmented sleep and shorter durations.  Just one person slept seven hours a night, and 79% got fewer than seven hours at least three nights a week.

Dr. Scullin noted that most of the students thought they were getting at least four more hours of sleep each night than what they were actually getting.

School projects for interior design are generally lengthy, with deadlines and due dates lurking several weeks or months in the future.  Most students have several projects they are trying to juggle, all of which have different tasks and deadlines.  The stress of trying to manage all these projects likely contributes to the cycle of several days’ sleep deprivation followed by several catch-up days.

Actigraphy was used to measure sleep patterns in these students, all of whom wore wristbands to sense and track their movements.  Participants were asked to keep a daily diary of the quality and quantity of their sleep as well.

Like a Fitbit device, the wristbands detect movements and arousals, but they are far more reliable and sensitive.

Students were asked to complete two testing sessions to look at their executive attention and creativity.  Each session was done in a laboratory for about one hour.  They were done on the first and last days of the study, both at the same time of day.

Creativity is described as someone’s ability to link things that, at first sight, seem to be unrelated.  Another of the tests looks at that ability.  For example, students were asked to choose a fourth word to connect three loosely related words, such as shoulder, sweat, and sore.

Generally, most students thought of words that were related to exercise; however, there was really no single type of exercise that really worked to connect the three words.  The ‘correct’ answer to link those three words was not exercise related at all, but instead it was a creative word, ‘cold.’

Working memory, or executive attention, allows people to store short-term memories while doing other tasks unrelated to that memory.  In this research, students were asked to complete tasks that had a black and white grid with squares.  Students had to make a quick decision on whether the grid was symmetrical.  These types of decisions on symmetry are easy to make; however, after several rounds, a different-colored grid was shown to the participants.  It was highlighted in red, and students repeated the cycle several times before having to recall the locations of the squares in the correct order.  Cycling between these two tasks proved to be a challenge for the students, especially with regards to keeping the square locations in mind.

Researchers note that additional investigations into how students respond to this cultural sleep behavior will be needed to determine true effects.  This research should have a bigger range of students in various studio-based programs across multiple universities.

Programs for interior design are changing fast, because people are now open to discussions about curriculum.  They are now willing to reduce the pressure put on students and focus on encouraging them to live a healthier life instead.

 Reference:  https://www.eurekalert.org/pub_releases/2017-04/bu-ass042117.php

Rachael Herman is a professional writer with an extensive background in medical writing, research, and language development.

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Body Temperature, Sleep, and the Circadian Rhythm

sleeping woman

An early study published this week in Neurology, a journal of the American Academy of Neurology, showed that brain injury patients have fluctuating body temperatures that are directly related to their level of consciousness.

Dr. Christine Blume, PhD, from the University of Salzburg in Austria led the study.  She noted that the findings suggest the circadian rhythm in brain injury patients who were in a coma may have better test scores in recovery if their body temperatures are similar to a healthy person’s.  This was noticeable especially regarding arousal, a necessary component of regaining consciousness.

Circadian rhythm, or the biological clock, is a cluster of carrying rhythms in the body’s functions; they are the cycles our body goes through daily, telling us when to eat, sleep, and wake up.  This clock regulates many functions in the body, including internal body temperature, which is generally set by the environment, such as darkness or daylight.

Healthy people have body temperature variations that closely correlate with their sleep-wake cycle, with their patterns being controlled by the biological clock.  Many studies have indicated that sleep disruption and a chaotic sleep-wake cycle may negatively affect the immune system and short-term memory.  In normal cycles, the core temperature in the body fluctuates at regular intervals and can drop 1-2 degrees in the early hours of the morning.

In this recent research, the team analyzed 18 brain injury patients. Some patients had unresponsive wakefulness syndrome and others were in a minimally conscious state.  A vegetative state, or unresponsive wakefulness syndrome, is characterized by the patient waking up from a coma by opening his or her eyes and then going back to sleep, but remaining unresponsive.  The other group of patients, those in a minimally conscious state, were also in a coma and woke up, but they showed signs of awareness.

Scientists monitored these patients for one week, recording body temperatures with sensors placed on top of the skin.  The temperature data allowed researchers to determine the length of each person’s circadian rhythm.  The temperature cycles ranged anywhere between 23.5 to 26.3 hours.

Scientists used the Coma Recovery Scale-Revised to evaluate each person’s level of consciousness.  This scale measures the ability to open his or her eyes with and without stimulation, as well as how he or she responded to sound.  Findings showed that people who had a body temperature pattern that was closely aligned with a 24-hour rhythm had better scores.

Dr. Blume noted that this research, for the first time, makes an association between body temperature in relationship to the circadian rhythm and the arousal in patients who have suffered a brain injury.  This is important because arousal is a necessary component of consciousness.  Variations in the biological clock should be watched closely by doctors who are diagnosing and treating brain injury patients.

It is important to consider the time of day the patients are tested.  Treating providers can consider creating a sleep lab that is similar to the light/dark environment that is necessary to achieve a normal sleep-wake cycle.  This type of testing and treatment may bring brain injury patients closer to waking up.

Eight patients received bright light stimulation for a week.  Researchers found that two patients had positive responses, and Dr. Blume believes that larger studies will give us a better idea of its efficacy.

MRI data was not available for review of the brain damage at the time of the study, which limited the findings.  It would have been helpful to look at the hypothalamus, which is the part of the brain that stores the body’s biological clock.

For future research, Dr. Blume suggests looking at the relationship between other rhythms, like rest-activity cycles, and the body temperature fluctuations.


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Sleep Deprivation Can Lead to Loss of Bone Formation

A widespread problem people have is insufficient sleep. A new study has been done on men to see if there is a link to a chronic disease risk factor of bone loss and insufficient sleep. Insufficient sleep may be an unrecognized risk factor for bone loss. On Saturday, the results of this study will be presented at the Endocrine Society’s 99th annual meeting in Orlando, FL.

The study consisted of 10 healthy men. After three weeks of insufficient sleep consecutively, the study found reduced levels of a marker of bone formation in their blood. This is compared to people who have suffered from jet lag or shift work. The biological marker of bone resorption, or breakdown wasn’t changed on these men.

Research was done by Christine Swanson, M.D. while she was a fellow at Oregon Health & Science University in Portland, Oregon, with Drs. Eric S. Orwoll and Steven A. Shea.  Research showed osteoporosis and bone fractures could come from the altered bone balance from insufficient sleep.

There are 54 million Americans with low bone mass or osteoporosis, but there is no clear cause for osteoporosis in 50 percent of Americans. It would help explain why there is no clear cause if it related to chronic sleep disturbance.

Circadian disruption has your internal body clock offset by the environment, and either your 24 hours is shorter or it is longer. This depends on whether you have a later chronotype, where you go to bed later, or early chronotype, where it’s early to bed and early to rise.  The Centers for Disease Control and Prevention reported that insufficient sleep affects more than 25% of the U.S. population occasionally, and another 10% frequently. The study with these men also analyzed if there were health consequences of sleep restriction combined with circadian disruption.

sleep and skeletal
sleep and skeletal

This study was comparable to flying four time zones west every day for three weeks.  For three weeks, in a lab the subjects went to sleep each day for four hours later than the prior day making it a 28-hour day.  In a 24-hour period, the men were only allowed to sleep 5.6 hours. This part of the study was done to emulate people that work night shifts, otherwise known as shift work. At the beginning of the study, bloodwork was taken on each of the men and then again after the 3 weeks. The bloodwork measured bone biomarkers after sleep deprivation. During this 3-week study the men ate the same number of calories and nutrients. Out of the 10 men, 6 were between the ages of 20 to 27 and 4 were between 55 and 65.

There was limited funding, so the study couldn’t exam the serum from women; however, there are plans in the future to investigate sex differences to see if there is a sleep-bone relationship.

All the men in the study after three weeks had reduced levels of a bone formation marker compared to the beginning of the study. This reduction is called PINP. Additionally, the younger men had a greater decline. There was a 27% decline in the younger men versus 18% in the older. The study revealed old bone could break down without new bone being formed, while the levels of the bone resorption marker CTX did not change at all.

While bone growth and accrual are crucial for long-term skeleton health, this data is suggesting that sleep disruption earlier in life is detrimental to bone metabolism. There will need to be another study to see if there will be differences in the data with women.

Reference: https://www.eurekalert.org/pub_releases/2017-04/tes-psd033117.php

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Depression Linked to Diabetics Who Prefer Later Sleep-Wake Times

diabetes and sleep

New research finds that type 2 diabetics who prefer evening activities and consider themselves night owls are more likely to have symptoms of depression than early birds.  This is true regardless of sleep quality.  These findings will be presented at the 99th annual meeting of the Endocrine Society in Orlando, Florida this Saturday.

Lead author of the study and associate professor at Mahidol University Faculty of Medicine in Thailand, Dr. Sirimon Reutrakul, notes that this research is important because of the high prevalence of depression in type 2 diabetics.  Furthremore, Dr. Reutrakul reminds readers that prior studies have linked untreated depression to poor patient outcomes and compliance with treatment plans, putting them at greater risk of complications.

Past studies on the general public have shown that people with a later chronotype (those who prefer going to bed later and waking up later) were more likely to have symptoms of depression than those with an early chronotype.  Dr. Reutrakul and her team decided to look just at type 2 diabetics since they have such a high risk of depression.  The goal was to determine whether a later chronotype was directly associated with depression in patients with this chronic condition.

The researchers anticipated that chronotypes would differ depending on geographic location, with those near the equator preferring earlier activities; therefore, they studied two separate groups of diabetic patients in different geographical regions: Thailand and Chicago.

There were 194 patients in the Chicago group, with 70% of them being women.  There was a similar group in Thailand, which had 282 patients, 67% of which were women.  All respondents were asked to complete questionnaires about depression, preferred times of activity and sleep, and sleep quality.  Those in the Chicago group completed the surveys between February and April.  Those in Thailand, however, answered questionnaires throughout the entire year to determine if there were any seasonal variations.

In both groups, however, more depression symptoms were reported by those who preferred later activities and sleep than by those who were early to bed and early to rise.  This finding was true even after researchers adjusted for age, sex, sleep quality, and other factors that could contribute to depression.

Dr. Reutrakul notes that findings indicate there is a link between cognitive or psychological functioning and the circadian rhythm of those with type 2 diabetes.  She did note, however, that there is no evidence of cause and effect, so the association is only modest.

She stated that additional research is necessary to explore different combinations of interventions that may help modify or synchronize the biological clock, such as melatonin and light therapy.  Understanding the relationship between the biological clock and depression symptoms presents an opportunity for discovering different treatment strategies that would improve the mental and physical health of diabetes patients.

 Reference:  https://www.eurekalert.org/pub_releases/2017-04/tes-lst033117.php

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