Sleep Deprivation Research Articles

Cognitive and physical fatigue: the experience and consequences of brain fog after spontaneous coronary artery dissection, a qualitative study

Abstract Background Mild cognitive impairment (often subjectively referred to as "brain fog") and cognitive fatigue are common sequelae after acute coronary syndrome. However, little is known about the nature and impact of these experiences in spontaneous coronary artery dissection (SCAD) survivors. Purpose To understand if and how brain fog and cognitive fatigue are experienced following SCAD. Methods Participants were recruited from a larger SCAD genetics study database and were considered eligible if they had experienced SCAD within 12 months. Seven semi-structured online focus groups, with the primary aim of exploring psychosocial impacts of SCAD, were conducted between December 2021 and January 2022. Each focus group lasted for 1 hour 30 minutes and were led by investigators extensively experienced in qualitative research and cardiac rehabilitation. Interviews were digitally recorded, transcribed verbatim, and thematically analysed using Braun and Clark’s reflexive approach. Results Participants (n=30) had a mean age of 52.2±9.5 years and mostly female (n=27, 90%), partnered (n=27, 90%) and employed (n=27, 90%). Four main themes were identified: experiences of brain fog, perceived causes of brain fog, impacts of brain fog and coping with brain fog. Experiences of brain fog included memory lapses, difficulty concentrating and impaired judgement. Perceived causes of brain fog included medication, sleep deprivation and tiredness, and menopause and hormonal changes. The impacts of brain fog included rumination, changes in self-perception, disruption to hobbies and pastimes, and limitations at work. Coping mechanisms used for these challenges included reminders, setting expectations, being one's own advocate, making lifestyle adjustments, and support from peers. Conclusion Brain fog is commonly experienced by SCAD survivors and present challenges to normal life after SCAD. The impacts on daily life are varied, including those relating to self-perception and capacity to work. SCAD survivors reported difficulty understanding causes and found their own path to coping. Clinicians should be aware of these experiences as they are ideally placed to assist patients with these challenges.

Association of weekday-to-weekend sleep duration pattern with myocardial infarction: analysis of the NHANES 2017- 2020

Abstract Background Short sleep is linked to increased acute myocardial infarction (MI) risk.However, the association of weekend-to-weekday sleep patterns with MI in a nationally representative population remains unknown. The goal is to investigate how weekday and weekend sleep durations affect myocardial infarction (MI) in the general population, and if longer weekend sleep can offset insufficient weekday sleep's effects. Methods A cross-sectional study utilized data from the 2017-2020 NHANES to examine the relationship between sleep patterns and MI. Participants self-reported their average sleep durations on weekdays (1) and weekends (2), along with the calculated weekend-to-weekday sleep duration ratio (SDR) (3). Logistic regression models, adjusting for various factors, including demographics and comorbidities, were employed to analyze the association. Those with SDR > 1 had more weekend sleep, while an SDR = 1 indicated equal sleep durations. Results The study involved 9,205 adult participants, with a mean ± SD age of 68.8 ± 10.8 years and 30.7% being female. Among them, 4.65% (428 patients) had a history of MI. The mean ± SD of weekday and weekend sleep hours was 7.6 ± 1.7 and 8.3 ± 1.8 hours, respectively. For weekday sleep duration, after univariate analysis, individuals compared to those in Q1 were statistically significant 0.72 times less likely in Q2 and 1.4 times more likely in Q4 to experience MI . While MI was 0.76 times less likely to occur among participants in Q3, it was not statistically significant (95% CI Q2: 0.54, 0.96; Q4: 1.05, 1.76; Q3:0.57, 1.00). After adjusting, participants only in Q3 were statistically significant 0.71 times less likely to develop MI.(Q3: 95% CI 0.51, 0.99). For weekend sleep duration, the univariate analysis showed that individuals in Q2, Q3, and Q4 were significantly less likely to experience MI (OR = 0.63, 0.67, and 0.69; 95% CIs: 0.48-0.82, 0.51-0.87, 0.53-0.90, respectively) After adjusting, only participants in Q2 were statistically significant less likely to develop MI (OR = 0.71; 95% CI 0.52 - 0.96). For the weekend-to-weekday sleep duration ratio (SDR), after univariate analysis, individuals were statistically significant 0.54 times less likely, and 1.5 times more likely to experience MI in those whose SDR is more than 1, and those whose SDR equals 1, respectively (95% CI SDR > 1: 1.14, 1.98; SDR = 1: 0.39, 0.72). After adjusting, participants with SDR more than 1 were statistically significant 0.69 times less likely to develop MI. Conclusions Moderate sleep durations on weekdays (in Q3), weekends (in Q2), along with SDR more than 1, were negatively linked with MI in a general population. This implies that sleep durations on both weekends and weekdays have comparable associations with MI. Additionally, full recovery sleep on weekends following sleep-deprived weekdays, might reduce MI risk. Further studies are needed to explore impact of weekend and weekday sleep patterns on MI.Histogram and Margins plotTable of Odd ratios

Weekend compensatory sleep is associated with reduced risk of heart disease: a prospective UK Biobank-based cohort study

Abstract Background and Aims Influenced by the demands of school or work, people often fall out of sync with their circadian rhythms, which leads to sleeping in on days off. Despite this phenomenon, there is a lack of research examining whether compensatory weekend sleep has positive effects on heart health. Methods and results Our prospective cohort study utilized data from the UK Biobank (UKB) and encompassed 90,903 participants. To evaluate the relationship between compensated weekend sleep and heart disease. The sleep data was recorded by Axivity AX3 accelerometer from UKB and grouped by quartiles. Hospitalization records and cause of death registry information were used to diagnose various cardiac diseases including IHD, HF, AF, and stroke. Then multivariate Cox proportional hazard modeling was used to examine the potential impact of compensated sleep on the risk of heart disease. At a median follow-up time of up to 13.8 years, we found that participants in the compensatory sleep group(Q4) had a lower risk of having heart disease in the fully adjusted model (HR: 0.809, 95%CI: 0.766,0.854), which was not influenced by the effect of genetic risk for IHD, HF, or AF. These relationships were even more pronounced in the subgroup with daily sleep deprivation (HR:0.801, 95%CI: 0.718,0.894). Conclusion Sufficient compensatory sleep on weekends is linked to a low risk of heart disease, including IHD, AF, HF, and stroke, which is independent of genetic risk. And the association becomes even more pronounced among individuals who regularly experience inadequate sleep on weekdays.Visual abstract

Content validation of a test battery for assessing sleep quality in adolescents in Slovenia

Abstract Background Sleep constitutes a fundamental biological necessity, occupying approximately one-third of our lifespan. Consequently, the field of sleep research has experienced an increase in interest, prompted by the recognition of insufficient sleep as a significant public health challenge. As the majority of existing questionnaires in Slovenia have yet to undergo official translation and validation processes, the aim of our study was to conduct content validation of a questionnaire designed to assess the sleep quality among adolescents. Methods We developed a test battery for assessing the sleep quality of adolescents by combining a diverse array of questionnaires. We employed the Adolescent Sleep-Wake Scale, Pediatric Daytime Sleepiness Scale, Epworth Sleepiness Scale for Children and Adolescents, and Children’s Morningness-Eveningness Scale. Following the development of the entire test battery, a process of back-translation from English to Slovene occurred, followed by cultural adaptation. Results The designed questionnaire underwent content validation by a panel of 10 experts drawn from diverse disciplines. Evaluation of questionnaire items followed a planned methodology tailored for the content validation of measurement instruments, focusing on content relevance, clarity, and classification into subscales or factors. Our analysis revealed that the individual questionnaires demonstrate content validity, supported by notably high indices of content validity. Conclusions Translated questionnaires demonstrate decent content validity, thus rendering them valid clinical and research tools for assessing sleep quality in adolescents in Slovenia. Key messages • Our research indicates the availability of content-valid tools for sleep research. • Further investigation is needed to determine the reliability, specificity, sensitivity, and appropriateness of the factorial structure of measures for the quality of sleep.

Association between objectively-measured sleep duration and early cardiac and hepatic imaging changes in adolescents: insights from the EnIGMA study

Abstract Introduction Inadequate sleep duration (SD) has been associated with adverse cardiovascular (CV) events in adults and adiposity in all life stages. Furthermore, previous cross-sectional studies have shown a possible association between self-reported SD and cardiac structural alterations as detected with echocardiography and cardiovascular magnetic resonance (MR), even in young healthy people. However, there is a lack of longitudinal studies demonstrating an association between objectively-measured SD and structural cardiac alterations. Purpose To assess the association between SD and MR-derived cardiac and hepatic parameters in adolescents. Methods This study used longitudinal data collected as part of the SI! Program for Secondary Schools trial in Spain (2017-2021), which enrolled 1326 participants (mean age: 12.5±0.5 years at baseline). Measurements were taken at three different time-points: baseline, 2-year follow-up and 4-year follow-up. SD and physical activity were assessed by accelerometry for seven consecutive days at each follow-up. The participants were offered to undergo a MR scan in the final follow-up as part of the Early imaging markers of unhealthy lifestyles in adolescents (EnIGMA) study. The imaging protocol included a cine SSFP to provide images for chamber size and function, myocardial tagging acquisitions to assess myocardial strain, T1 and T2 mapping sequences to provide precise myocardial relaxation time properties, and a liver mDixonQuant sequence to obtain liver fat content, using a 3-T scanner. The cumulative effect of the independent variable (SD) and the covariates was assessed using the area under the curve (AUC) method, calculating the integral of the curve parameters during the follow-up period for each subject. To facilitate interpretation, AUC values were divided by the years of follow-up. The participants were included in the analysis if they had available data for SD in at least 2 of the 3 time-points. The association between SD and the MR parameters was assessed by linear regression models. Results 109 participants (61 girls [56.0%]; mean age=16.0±0.5 years) were included in this study. Indexed left ventricular (LV) mass, as well as indexed end-diastolic biventricular volumes were higher in boys than in girls (Figure 1). SD AUC (hours/day) was independently and inversely associated with indexed LV mass and liver fat fraction in the unadjusted and adjusted (age, gender, physical activity, body mass index percentile, and systolic and diastolic blood pressure percentiles AUCs) models (Figure 2). There were no significant associations between the SD AUC and other MR-derived parameters. Conclusion Shorter SD is independently associated with initial stages of cardiac remodeling and liver fat accumulation as assessed with state-of-the-art MR as early as in adolescence. Considering these results, health promotion programs should be implemented early in life emphasizing the importance of good sleep habits.Participant characteristicsAssociation between SD and MR

Oliguria caused by dehydration in combat trauma (case series)

Background. A combat gunshot wound is significantly different from a civilian trauma. It is characterized by the prevalence of penetrating injuries, which increases the volume of blood loss at the pre-hospital stage, and the destruction of large masses of muscle tissue (rhabdomyolysis), which leads to acute kidney injury. Moreover, combat trauma occurs in conditions of chronic background stress as a result of severe emotional and physical strain, uncomfortable weather conditions, and deprivation of sleep, drinking and food. So, such a phenomenon as voluntary dehydration is common among soldiers in combat conditions. In wounded, oliguria is often considered a result of acute kidney injury, but it can also be a symptom of severe dehydration. The purpose of our work was to analyze three clinical cases of oliguria caused by dehydration in wounded with combat trauma to better understand the severity of the condition of such victims and to improve medical aid for them. Materials and methods. The article describes three cases of men aged 35, 50 and 44 years with combat gunshot wounds to the extremities, who were admitted to the tertiary care hospital on the second day after the injury with oliguria (0.18–0.19 ml/kg/hr) and high creatinine (333 to 457 μmol/L). Results. All three patients were conscious, breathing spontaneously, had stable hemodynamics, and moderate anemia after pre-hospital blood transfusions. Focused ultrasound study revealed hyperdynamic left ventricle and small inferior vena cava with complete inspiratory collapse, which suggested hypovolemia. Upon further investigation of the medical history, patients admitted not drinking any liquid for one to two days prior to injury. Tissue hydrophilicity test was conducted which showed severe dehydration in all three cases. Infusion volume was calculated using P.I. Shelestiuk nomogram (modified by O.V. Kravets et al.) and amounted to 60 ml/kg of balanced crystalloid solutions. Upon starting rehydration, diuresis was restored within two hours and amounted to 0.7–2.1 ml/kg/h in all three patients. Creatinine levels normalized in 2–4 days. Patients were transferred to another hospital in a moderate condition in 4–5 days. Conclusions. Oliguria is a frequent complication of combat gunshot injury. Although it is most often associated with acute kidney injury from rhabdomyolysis, it should also be considered that in a combat environment, soldiers’ access to water may be limited and the injury may be accompanied by dehydration. In the cases presented, the differential diagnosis of the causes of oliguria in the wounded made it possible to detect signs of severe dehydration, abstain from the inappropriate use of saluretics, quickly compensate for the fluid deficit, and to avoid the development of kidney damage and the need for renal replacement therapy.

Comparative Analysis of 24-h Movement Behaviours in Non-Overweight and Overweight/Obese Children: Findings from the FAMIly Physical Activity, Sedentary Behaviour, and Sleep (FAMIPASS)

Background: Childhood overweight and obesity are global health concerns associated with insufficient physical activity (PA), excessive sedentary behaviour (SB), and inadequate sleep. This study aimed to determine whether differences exist in 24 h movement behaviours between Czech non-overweight children and children with overweight/obesity aged 3–10 years, with respect to their gender, age, or family socioeconomic status (SES). Methods: A total of 381 children (49.9% girls), aged 3–10 years, participated. Their PA, SB, and sleep were continuously monitored over a regular week using wrist-worn accelerometers. Weight status was determined by BMI z-scores, according to World Health Organization standards. SES was assessed using the Family Affluence Scale. Results: Non-overweight children had averages of 414 min of PA, 472 min of SB, and 554 min of sleep per day, while children with overweight/obesity had averages of 392 min of PA, 503 min of SB, and 545 min of sleep. Non-overweight children engaged in significantly more PA (22 min per day; p = 0.014) and significantly less SB (31 min per day; p = 0.002) than children with overweight/obesity. No significant differences were found between the weight groups in gender distribution, age, family SES, or maternal and paternal obesity. Conclusions: Non-overweight children exhibited higher levels of PA and lower levels of SB compared to their counterparts with overweight/obesity, independent of gender, age, or family SES. These findings highlight an association between daily movement behaviours and weight status in young children. Further research is needed to explore the impact of modifying PA and SB on weight outcomes.

Brief disruption of activity in a subset of dopaminergic neurons during consolidation impairs long-term memory by fragmenting sleep.

Sleep disturbances are associated with poor long-term memory (LTM) formation, yet the underlying cell types and neural circuits involved have not been fully decoded. Dopamine neurons (DANs) are involved in memory processing at multiple stages. Here, using both male and female flies, Drosophila melanogaster , we show that, during the first few hours of memory consolidation, disruption of basal activity of a small subset of protocerebral anterior medial DANs (PAM-DANs), by either brief activation or inhibition of the two dorsal posterior medial (DPM) neurons, impairs 24 h LTM. Interestingly, these brief changes in activity using female flies result in sleep loss and fragmentation, especially at night. Pharmacological rescue of sleep after manipulation restores LTM. A specific subset of PAM-DANs (PAM-α1) that synapse onto DPM neurons specify the microcircuit that links sleep and memory. PAM-DANs, including PAM-α1, form functional synapses onto DPM mainly via multiple dopamine receptor subtypes. This PAM-α1 to DPM microcircuit exhibits a synchronized, transient, post-training increase in activity during the critical memory consolidation window, suggesting an effect of this microcircuit on maintaining the sleep necessary for LTM consolidation. Our results provide a new cellular and circuit basis for the complex relationship between sleep and memory.

Effects of one-night partial sleep deprivation on perivascular space volume fraction: Findings from the Stockholm Sleepy Brain Study.

Sleep issues have been known to be associated with a variety of health risks. Recent research has shown the importance of sleep for brain clearance, with increases in brain clearance occurring during sleep. PVS seen on MRI are known to represent both influx and efflux pathways for the exchange of cerebrospinal fluid (CSF) and interstitial fluid (ISF) in the brain parenchyma, a key process underlying the waste clearance system. 1 Numerous recent studies have found links between sleep disruption and PVS volume changes. However, no study to date has been able to examine within-subject changes in PVS resulting from experimental manipulation of sleep. Our study represents the first within-subject study looking at the effects of partial sleep deprivation on PVS volume fraction using an automated PVS segmentation technique.

Predicting Drowsy Driver Break Taking During Long Drives.

The current study investigated the factors that predict drowsy drivers' decisions regarding whether to take breaks versus continue driving during long simulator drives. Driver drowsiness contributes to substantial numbers of motor vehicle crashes, injuries, and deaths. Previous research has shown that taking a nap and consuming caffeine can temporarily mitigate drowsiness and enable continued safe driving. Ninety drivers completed a 150-mile highway drive in a driving simulator after a day of partial sleep restriction. Drivers passed several simulated rest areas where they could take breaks. To replicate drivers' motivation to reach their destination safely but also quickly, drivers were told that they would be paid more for completing the simulated drive faster but would forfeit their payment if they crashed. Break taking was predicted by drivers' self-ratings of drowsiness and by the severity of lane departures. However, even at the highest levels of drowsiness, most drivers bypassed simulated rest areas without stopping. In comparing self-rated drowsiness to drowsiness measured by eye closures, drivers often under- and over-estimate their own level of drowsiness. Drowsy drivers use their own self-assessed drowsiness when deciding whether to take breaks. These self-assessments are often incorrect, and even when drivers rate themselves as severely drowsy they are unlikely to stop to rest during long drives. The findings reveal the need for effective drowsy driving countermeasures to motivate drivers to stop to take breaks. Results underscore the need to educate and/or motivate drivers to respond sooner to warning signs of drowsiness.

Analysis of the relationship between sleep-related disorders and cadmium in the US population.

Cadmium is a heavy metal that accumulates in the body due to environmental and occupational exposure. The neurotoxicity of cadmium received increasingly attention in recent years. Sleeping is regulated and coordinated by nervous system, however, little is known about the relationship between cadmium and sleep. This study aimed to examine the relationship between blood cadmium concentrations and sleep-related disorders in US adults. This cross-sectional study used data on blood cadmium and sleep from the 2005-2008 and 2015-2020 National Health and Nutrition Examination Survey (NHANES). Weighted multiple regression, generalized weighted modeling, and weighted restricted cubic splines (RCS) were utilized to investigate the association between blood cadmium and sleep outcomes (sleep duration, trouble sleeping, symptoms of obstructive sleep apnea (OSA) and daytime sleepiness). Furthermore, subgroup analyses were conducted to investigate any differences in the associations between age, gender, ethnicity, education level, marital status, smoking status, alcohol consumption, diabetes mellitus (DM), cardiovascular disease (CVD) and hypertension groups. In 19,152 participants, the median blood cadmium concentration was 0.48 (IQR: 0.28, 0.82)μg/L. Compared with the lowest reference quartile, participants in the higher quartile had a significantly higher risk of insufficient sleeping (<7 h/night) in crude model (OR 1.53, 95% CI 1.33-1.74), Model 1 (OR 1.57, 95% CI 1.38-1.80) and Model 2 (OR 1.45, 95% CI 1.27-1.65). In the unadjusted model, individuals in the highest quartile of cadmium level had a significantly increased risk of OSA symptoms of 53% (OR = 1.53, 95% CI: 1.42, 1.65) compared with participants in the bottom quartile, and this risk increased by 35% (OR = 1.35, 95% CI: 1.23, 1.48) after adjusting for all covariates. Individuals in the highest quartile of cadmium level were 76% more likely to have a trouble sleeping than individuals in the lowest quartile in the unadjusted model (OR = 1.76, 95% CI: 1.31, 1.93), whereas in the fully adjusted model, this likelihood was 86% higher (OR = 1.86, 95% CI: 1.51, 1.96). A similar positive correlation was also observed for cadmium level and daytime sleepiness. However, no relationship was noted between cadmium and excessive sleep duration (≥9 h). A linear dose-response relationship was found between cadmium concentration and the risk of insufficient sleeping (P non-linearity = 0.321), OSA symptoms (P non-linearity = 0.176), trouble sleeping (P non-linearity = 0.682) and daytime sleepiness (P non-linearity = 0.565). Additionally, no significant interactions between cadmium concentrations and subgroup variables were identified (P for interaction>0.05). Insufficient sleep, symptoms of OSA, trouble sleeping and daytime sleepiness were found to have a positive association with the blood cadmium concentration in US adults. However, further prospective studies are necessary to establish whether there is a causal relationship between these factors.

Sleep, dietary intake and physical activity changes with onset of shift work in intern paramedics

Paramedic work is associated with high staff turn-over, insufficient sleep and adverse health outcomes. Our understanding of the relationship between paramedic work and the health behaviours that may precede adverse health outcomes is limited, as few longitudinal studies have examined health behaviours in workers before they commence on the road work. Such research is needed to inform evidence-based recommendations specifically for new paramedics. The current observational cohort study examined self-reported sleep, dietary intake and physical activity in 21 intern paramedics: 15 female and 6 male (median age: 23.0 years [interquartile range (IQR): 4.0]) from an Australian ambulance service. A subset of participants ( n = 16) provided fasting blood samples for cardiometabolic markers (cholesterol, triglycerides and fasting glucose). Data were collected quarterly (pre-shift work, 3 months, 6 months, 9 months and 12 months post commencement). Linear mixed models showed that the first 12 months of shift work were associated with poorer sleep quality ( p = .036), consumption of fewer kilojoules ( p = .026), reduced saturated fat consumption ( p = .005) and lower sodium ( p = .043) and sugar ( p = .038) intake. There were significant increases in leisure time physical activity ( p = .008). This study shows negative changes in sleep quality and improvements in diet and leisure time physical activity during the first 12 months of paramedic work. Individual differences observed in this study, and ongoing suboptimal dietary intake, highlight a need for larger studies with more participants and a focus on personalised strategies for new recruit paramedics.

Evaluation of metabolic and haematological impacts of light-at-night exposure on adult male Wistar rats under sleep restriction condition.

Health implications of shift work could not be completely due to exposure to light-at-night (LAN). This study evaluated metabolic and haematological impacts of LAN exposure on adult male Wistar rats under sleep restriction condition. The animals were grouped into control (n=8) and LAN exposed (n=8) groups. The controls were sleep restricted (SR) by gentle handling. In addition to SR, the LAN exposed group were exposed to LAN during the first five hours of scotophase for six weeks. Body weight, fasting blood glucose, lipid profile, full blood counts, CD4+ cells, malondialdehyde, superoxide dismutase and catalase were all assessed using their respective protocols. Statistical Package for Social Sciences (SPSS Version 20) was used to analyze and Mean±SEM was used to analyze and summarize the data. Intergroup differences were investigated using Student’s t-test and p≤ 0.05 was considered statistically significant. The results have shown that LAN-exposed rats eat less and have gained more body weight than controls. LAN-exposed rats also had higher fasting blood glucose. On the contrary, there is no statistical difference between the two groups for markers of oxidative stress, triglyceride-glucose index, high-density lipoprotein, and atherogenic index of plasma. In conclusion, the present study has shown that LAN exposure could cause metabolic and hematological impairments in sleep-restricted, Wistar rats. Hence, it might predispose exposed subjects to obesity, diabetes mellitus and adverse cardiovascular events.

Scrolling Your Sleep Away: The Effects of Bedtime Device Use on Sleep Among Young Adults with Poor Sleep.

Many young adults report sleep problems, including insufficient sleep and poor sleep quality. Young adults are heavily reliant on electronic devices, even using them during bedtime with adverse effects on sleep. Given the importance of adequate sleep, the present study examined the daily association between using electronic devices during bedtime and sleep in a diverse sample of young adults with poor sleep. We analyzed data from a pilot randomized controlled trial in which young adults with poor sleep [n = 46; 84% female; mean age 19.3 (SD = 2.9); 30% Asian, 19% Black/African American, 9% multiracial; 34% Hispanic/Latino] wore an electronic sleep tracking device (Fitbit Charge 3) and completed daily sleep diaries including questions about sleep and bedtime routine for 4 weeks following a behavioral sleep intervention. The effect of bedtime device use on sleep latency-time needed to fall asleep-and sleep duration was estimated by generalized linear mixed models (GLMM), adjusting for weeknights/weekend nights. Bedtime device use on a given night was significantly associated with shorter self-reported sleep duration (b = - 19.80, p = .011), but not with sleep latency. Concordance between the self-reported and Fitbit-measured sleep variables was low, and bedtime device use was not associated and Fitbit-measured sleep variables. Using electronic devices before bed negatively affected self-reported sleep duration the following night. This finding highlights the importance of minimizing nightly device use among young adults with poor sleep and suggests that the inconsistency between self-reported sleep and device use warrants further investigation.

Patient-reported mental health problems and clinical outcomes in adults with non-dialysis chronic kidney disease.

Mental health affects well-being and physical health. Among adults with chronic kidney disease (CKD), mental health (MH) problems are common and can induce adverse clinical outcomes. We examined the association between patient-reported MH problems and clinical outcomes in adults with non-dialysis CKD. This prospective observational study included 1,879 participants from the KNOW-CKD (KoreaN Cohort Study for Outcomes in Patients With CKD). Patients-reported MH problems were determined using four indicators of the Korea National Health and Nutrition Examination Survey questionnaire. We described the cross-sectional differences in health-related quality of life according to MH problems. We prospectively evaluated the hazard ratio (HR) of all-cause death and end-stage kidney disease (ESKD) according to the MH problems for a median follow-up of 6.4 years. The participants (mean age 53 years; 61.6% male) had patient-reported MH problems of inadequate sleep duration (17.4%), subjective distress (27.3%), depressive symptoms (13.2%), and suicidal ideation (16.8%). In the fully adjusted Cox proportional model, poor MH (≥2 problems) was associated with a high risk of ESKD (HR, 1.46; 95% confidence interval [CI], 1.18-1.08) and death (HR, 1.55; 95% CI, 1.04-2.32) compared with good MH. Furthermore, the single indicator of suicidal ideation was associated with a high risk of ESKD (HR, 1.37; 95% CI, 1.11-1.69) and death (HR, 1.98; 95% CI, 1.34-2.92). Patient-reported MH problems are common in adults with CKD. Poor MH and only suicidal ideation are associated with a high risk of ESKD and early death. Age and sex modify the association between poor MH and adverse clinical outcomes in non-dialysis CKD.

Exploring the Relationship Between Social Media Use and Symptoms of Depression and Anxiety Among Children and Adolescents: A Systematic Narrative Review.

Social media use is ubiquitous to the lives of children and adolescents. The body of research investigating its potential impact on mental health has risen exponentially. We systematically reviewed the present literature exploring potential linkages between social media use and symptoms of depression and anxiety in this vulnerable group. Using the Preferred Reporting Items for Systematic Reviews and Meta-analyses framework, articles were searched across Medline, EMBASE, CINAHL, and PsycINFO databases from inception to February 2024. Quantitative studies with social media as exposure and anxiety/depressive symptoms as outcomes in children and adolescents 5-18 years of age were included. Of the 4850 studies retrieved, 67 fulfilled the inclusion criteria. The most frequent measures of social media were "time spent on social media" and "frequency of use." Depressive symptoms were the outcome of 61 studies, whereas anxiety was measured in 27 studies. Most studies were of fair quality (n = 53). A meta-analysis was not possible due to study heterogeneity. Our review shows that (1) problematic social media use is associated with depressive and anxiety symptoms among children and adolescents, (2) duration of social media use was more consistently linked with anxiety and depression in girls compared with boys, and (3) mediating and moderating mechanisms were sleep deprivation, social comparison, and feedback-seeking behaviors, exercise, social support, and type of social media use. Qualitative work and robust large-scale longitudinal observations using a person-specific approach are needed to further our understanding of the impact of social media use on depression and anxiety in children and adolescents.

Inadequate sleep as a limiting factor in achieving remission in patients with rheumatoid arthritis

IntroductionGood sleep has a restorative effect at the cellular level and helps maintain the body's homeostasis. ObjectivesGiven our clinical experiences, we propose that sleep quality should be evaluated in patients with rheumatoid arthritis. Poor sleep quality should be considered as a factor that may impact clinical outcomes in patients with rheumatoid arthritis. Materials and methodsWe researched medical literature on clinical and physiological pathways associated with sleep quality. ResultsThere is evidence that interleukin-6 and tumor necrosis factor have a role in inflammatory and immune imbalance as well as in sleep disturbance in patients with rheumatoid arthritis, which leads to the chronic inflammatory process seen in these patients. Most patients with rheumatoid arthritis report sleep problems, be it insomnia or other complaints of non-refreshing sleep. Lack of sleep or poor sleep patterns in these patients further compromise their quality of life. In patients with RA, aetiologies such as restless leg syndrome (RLS), sleep apnoea syndrome, and Temporomandibular Joint Dysfunction (TMJ) syndromes might contribute to sleep disturbances. This lack of restful sleep might limit our goal, as treating physicians, to achieve remission states in these patients. ConclusionsIt is our opinion that sleep quality evaluation must be addressed, monitored, and treated as part of the management of patients with RA. Bad sleep adds an additional burden to disease activity in patients with RA, besides, it limits patients’ possibility of achieving disease remission.

Developing forebrain synapses are uniquely vulnerable to sleep loss

Sleep is an essential behavior that supports lifelong brain health and cognition. Neuronal synapses are a major target for restorative sleep function and a locus of dysfunction in response to sleep deprivation (SD). Synapse density is highly dynamic during development, becoming stabilized with maturation to adulthood, suggesting sleep exerts distinct synaptic functions between development and adulthood. Importantly, problems with sleep are common in neurodevelopmental disorders including autism spectrum disorder (ASD). Moreover, early life sleep disruption in animal models causes long-lasting changes in adult behavior. Divergent plasticity engaged during sleep necessarily implies that developing and adult synapses will show differential vulnerability to SD. To investigate distinct sleep functions and mechanisms of vulnerability to SD across development, we systematically examined the behavioral and molecular responses to acute SD between juvenile (P21 to P28), adolescent (P42 to P49), and adult (P70 to P100) mice of both sexes. Compared to adults, juveniles lack robust adaptations to SD, precipitating cognitive deficits in the novel object recognition task. Subcellular fractionation, combined with proteome and phosphoproteome analysis revealed the developing synapse is profoundly vulnerable to SD, whereas adults exhibit comparative resilience. SD in juveniles, and not older mice, aberrantly drives induction of synapse potentiation, synaptogenesis, and expression of perineuronal nets. Our analysis further reveals the developing synapse as a putative node of convergence between vulnerability to SD and ASD genetic risk. Together, our systematic analysis supports a distinct developmental function of sleep and reveals how sleep disruption impacts key aspects of brain development, providing insights for ASD susceptibility.

Pyroptosis: An Accomplice in the Induction of Multisystem Complications Triggered by Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a common respiratory disorder, primarily characterized by two pathological features: chronic intermittent hypoxia (CIH) and sleep deprivation (SD). OSA has been identified as a risk factor for numerous diseases, and the inflammatory response related to programmed cell necrosis is believed to play a significant role in the occurrence and progression of multisystem damage induced by OSA, with increasing attention being paid to pyroptosis. Recent studies have indicated that OSA can elevate oxidative stress levels in the body, activating the process of pyroptosis within different tissues, ultimately accelerating organ dysfunction. However, the molecular mechanisms of pyroptosis in the multisystem damage induced by OSA remain unclear. Therefore, this review focuses on four major systems that have received concentrated attention in existing research in order to explore the role of pyroptosis in promoting renal diseases, cardiovascular diseases, neurocognitive diseases, and skin diseases in OSA patients. Furthermore, we provide a comprehensive overview of methods for inhibiting pyroptosis at different molecular levels, with the goal of identifying viable targets and therapeutic strategies for addressing OSA-related complications.

20 Co-occurring behaviours of concern and sleep problems in children with neurodevelopmental disorders

Abstract Background Many children with neurodevelopmental disorders (NDDs) have behaviours of concern (BoC). These behaviours, such as aggression and self-injury, can impair functioning, cause distress to the child and caregivers, and threaten physical safety. This population also commonly experiences chronic and frequent sleep problems including issues falling asleep and staying asleep. Studies in sub-populations of NDDs suggest insufficient sleep is related to worsening BoC. Therefore, sleep may be a modifiable risk factor in children with NDDs and BoC. However, no studies have systematically characterized co-occurring behaviour and sleep problems in the general NDD population. To our knowledge this is the first study to take a transdiagnostic approach in assessing the co-occurrence of sleep problems and BoC in children with NDDs, and systematically characterizing BoC and sleep problems by their type and severity. Objectives To assess the co-occurrence of BoC and sleep problems in a population of children with diverse NDDs and systematically characterize both BoC and sleep problems. Design/Methods A literature review and clinical experience informed the creation of a REDCap database. Medical information, the nature, frequency, and severity of BoC and sleep problems, and other relevant information (e.g., demographics, medications) were included. Charts from children ages 2-18 years who visited the Child Development Centre for consultation from May – October 2022 and had confirmation of an NDD diagnosis were manually reviewed. Results 241 children met eligibility criteria. Of children with data available for both sleep and behaviour, 55% had co-occurring behaviour and sleep problems. These children displayed aggression (75%) and self-injury (49%) more frequently than children who had behaviours but no sleep problems (66% and 34%, respectively). Children with co-occurring behaviours and sleep problems were more likely to have severe BoC, including severe aggression (48%) and self-injury (45%), compared to children who had behavioural concerns but no sleep problems (21% and 20%, respectively). Conclusion The majority of children with NDDs have co-occurring BoC and sleep problems. This co-occurrence was related to increased frequency and severity of BoC in children with NDDs. Addressing sleep problems may represent a previously underrecognized therapeutic target to address BoC in this population.