Direct and Indirect Relationships Between Impaired Sleep, Obesity Risk Factors and Overweight and Obesity

PurposeThe relationship between impaired sleep and overweight/obesity may be explained by sleep-disrupting behaviour that are practised by overweight people (e.g. night-eating, insufficient physical activity [PA], electronic device use) and stress/affective distress. Thus, we evaluated whether sleep parameters predicted overweight/obesity after taking into account the behaviour and affective state.MethodsOnline questionnaires asked about sleep quality, night-eating, PA, electronic device use and stress/affective distress at T1 (baseline) and T2 (3-months later). Height, weight and waist and hip circumference were measured. PA and sleep were assessed over 24-hours on two occasions using actigraphy in 161 participants at T1 and T2.ResultsAt T1, high body mass index (BMI)/waist-to-hip ratio (WHR) and obesity category were together related to more sleep disturbances (subjective) and longer awake time (objective), after controlling covariates (e.g. watching TV) and demographics (e.g. older age, male gender). At T2, high WHR was predicted by older age and male gender after controlling T1 WHR, demographics and covariates. Mediational analyses showed that sleep disturbances mediated nocturnal indigestion (NI) to BMI, poor subjective sleep quality mediated NI to WHR and high daytime dysfunction mediated NI to obesity category relationships.ConclusionMore time spent awake during the night (experienced as more sleep disturbances) was related to overweight/obesity indices even after taking into account other obesity risk factors (e.g. night-eating, insufficient PA, affect) and demographics. Mediational results suggest that NI parsimoniously explained the impaired sleep - overweight/obesity relationship.Level of Evidence: Level III, evidence obtained from well-designed cohort.

Sleep in Children With Pallister Killian Syndrome: A Prospective Clinical and Videopolysomnographic Study

Objectives: Pallister-Killian syndrome (PKS) is a rare genetic disorder with multi-organ involvement caused by mosaic tetrasomy of chromosome 12p. Although many caregivers report the presence of impaired sleep in their children, there are no clear data in the literature on this issue and no systematic study has ever been performed. With this study, we aimed to characterize the features of sleep in Pallister-Killian syndrome and identify the possible influence of clinical and demographic features. Moreover, our aim was to verify the effectiveness of conventional screening questionnaires in this particular group of patients.Methods: We prospectively enrolled 14 patients aged 1–17 years in collaboration with PKS Kids Italia ONLUS. The Sleep Disturbance Scale for Children (SDSC) questionnaire was administered to caregivers. Then, video polysomnography (VPSG) of at least 24 h was performed and results were compared with a same-aged control group.Results: A total of 92% of patients had abnormal SDSC scores, extremely high in the “disorder of initiating and maintaining sleep” (DIMS) and “sleep breathing disorders” (SBD) subscales. VPSG showed a significantly impaired macrostructure in PKS patients, with a higher Arousal Index (p < 0.00001) and percentage of time spent in N3 (p < 0.00001), and reduced Sleep Efficiency (p = 0.0006). After dividing both PKS and controls into two groups based on median age, some peculiarities emerged: the younger group had higher Awakenings Index (p = 0.0207) and percentage of time spent in N1 (p = 0.015) while the older group showed higher time in bed (TIB) (p = 0.0485), compared with controls. Due to poor compliance, the Apnea-Hypopnea Index (AHI) was evaluated only for 10 PKS children, being significantly increased (p = 0.0427) compared with controls. SBD subscale scores in SDSC were significantly related to AHI values in VPSG (p = 0.0099).Conclusions: This study constitutes the first attempt to describe the sleep pattern in PKS. Despite small numbers due to the rarity of the syndrome, our VPSG results confirm the high prevalence of sleep disorders (SDs) in these patients. It is therefore essential to investigate and treat them. The SDSC scale is a good screening tool for early detection also in these patients, with particular sensitivity in detecting breathing disorders.

P069 Health professionals’ perceptions of sleep in palliative care: A qualitative study

Introduction Sleep is vital for all individuals however sleep difficulties are highly prevalent for those receiving palliative care. Impaired sleep impacts their everyday participation and overall health and wellbeing. Although sleep is recognised as an important factor for care, limited evidence exists regarding health professionals’ perceptions of sleep for patients receiving palliative. Methods A qualitative research design was used to investigate the perceptions and roles of health professionals in identifying and addressing sleep difficulties in patients receiving palliative care. In-depth semi-structured interviews were conducted with ten health professionals across six disciplines with minimum six months experience working in palliative care. Interviews were audio recorded, transcribed verbatim and thematically analysed. Pseudonyms were used to de-identify participants. Results Five themes were identified: (1) patient’s sleep is highly valued; (2) sleep in palliative care is complex; (3) perspectives and approaches to sleep management vary; (4) challenges in addressing sleep; and (5) health professionals desire for sleep knowledge. Discussion Findings highlight health professionals’ perceptions of sleep difficulties and consequential implications, and the importance of sleep for both patients and caregivers. Participants perceive priorities of care and limited resources and training in sleep management hindered their clinical practice in addressing sleep. Health professionals working in palliative care could benefit from reorienting practice, development of and access to up-to-date resources regarding sleep, and support to provide sleep education for patients and caregivers.

Medical Cannabis and Cannabinoids for Impaired Sleep: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Study Objectives We conducted a systematic review to explore the effectiveness of medical cannabis for impaired sleep. Methods We searched MEDLINE, EMBASE, CENTRAL and PsychINFO to January 2021 for randomized trials of medical cannabis or cannabinoids for impaired sleep vs. any non-cannabis control. When possible, we pooled effect estimates for all patient-important sleep-related outcomes and used the GRADE approach to appraise the certainty of evidence. Results Thirty-nine trials (5,100 patients) were eligible for review, of which 38 evaluated oral cannabinoids and 1 administered inhaled cannabis. The median follow-up was 35 days, and most trials (33 of 39) enrolled patients living with chronic cancer or noncancer chronic pain. Among patients with chronic pain, moderate certainty evidence found that medical cannabis probably results in a small improvement in sleep quality versus placebo (modeled risk difference [RD] for achieving the minimally important difference [MID], 8% [95% CI, 3 to 12]). Moderate to high certainty evidence shows that medical cannabis vs. placebo results in a small improvement in sleep disturbance for chronic non-cancer pain (modeled RD for achieving the MID, 19% [95% CI, 11 to 28]) and a very small improvement in sleep disturbance for chronic cancer pain (WMD of -0.19cm [95%CI, -0.36 to -0.03cm]; interaction p=0.03). Moderate to high certainty evidence shows medical cannabis, versus placebo, results in a substantial increase in the risk of dizziness (RD 29% [95%CI, 16 to 50], for trials with ≥3 months follow-up), and a small increase in the risk of somnolence, dry mouth, fatigue, and nausea (RDs ranged from 6% to 10%). Conclusion Medical cannabis and cannabinoids may improve impaired sleep among people living with chronic pain, but the magnitude of benefit is likely small.

Sleep, health, productivity, and the double-edged sword of technology

While technology has traditionally impaired sleep, it also has the potential to enable and reframe sleep as a productivity and health booster.

Poor quality of life and sleep in patients with adrenal insufficiency—another cause of increased mortality?

Background Patients with adrenal insufficiency (AI) are treated with glucocorticoid replacement therapy (GRT). Although current glucocorticoid regimens aim to mimic the physiological circadian rhythm of cortisol secretion, temporary phases of hypo- and hypercortisolism are common undesired effects which lead to a variety of consequences like increased cardiovascular risk and premature mortality. Additionally, poor quality of life (QoL) and impaired sleep have been reported. However, little is known about these topics regarding the effects of daily dosage, duration of therapy, and patients with different forms of AI (primary, PAI, and secondary, SAI). Methods In this study, 40 adults with AI substituted with hydrocortisone (HC) and 20 matched healthy controls completed questionnaires evaluating depressive symptoms, subjective health status, quality of sleep and daytime sleepiness. Furthermore, demographic data, dosage of HC, duration of therapy and co-medication were evaluated. Patients were compared in different groups. Results Patients assessed general health significantly worse than controls; likewise, daytime sleepiness was reported significantly more often. Depressive symptoms differed significantly in the two groups but did not reach clinically relevant scores. There was no difference between patients with PAI and SAI. High dosage of hydrocortisone had negative impact on mental health but not on sleep quality or daytime sleepiness. Conclusions The present data highlight that poor QoL and impaired sleep are still severe and underrated issues in current GRT and might be additional factors for premature mortality in patients with AI. Some AI patients reach normal or near-normal self-assessed QoL and sleep, even despite unphysiological replacement.

Why Victimized Employees Become Less Engaged at Work: An Integrated Model for Testing the Mediating Role of Sleep Quality

Recent studies have shown that workplace victimization is negatively related to work engagement. The explanations for the underlying mechanisms, however, are still in a nascent stage. Drawing on the limited resource theory of self-regulation and research on workplace aggression and sleep, we develop and test an integrated model, which explains that victimized employees may have impaired sleep quality and thus have less energy and be less likely to be engaged in their work. The results of logistic regression and structural equation modeling analyses of large-scale survey data collected from 90,272 employees across the years 2010, 2011, 2014, and 2017, indicate that workplace victimization is negatively related to sleep quality and subsequent workplace engagement, even controlling for alternative explanations—job insecurity and basic psychological needs for competence, autonomy, and relatedness. Our findings advance our knowledge on the detrimental consequences of workplace victimization and suggest that, while unmet basic psychological needs matter, impaired sleep quality is one reason why victimized employees find it difficult to engage at work.

Pain sensitivity increases with sleep disturbance under predictable chronic mild stress in mice

Even though it has been well documented that stress can lead to the development of sleep disorders and the intensification of pain, their relationships have not been fully understood. The present study was aimed at investigating the effects of predictable chronic mild stress (PCMS) on sleep–wake states and pain threshold, using the PCMS rearing conditions of mesh wire (MW) and water (W) for 21 days. Exposure to PCMS decreased the amount of non-rapid eye movement (NREM) sleep during the dark phase. Moreover, the chronicity of PCMS decreased slow-wave activity (SWA) during NREM sleep in the MW and W groups in both the light and dark phases. Mechanical and aversively hot thermal hyperalgesia were more intensified in the PCMS groups than the control. Higher plasma corticosterone levels were seen in mice subjected to PCMS, whereas TNF-α expression was found higher in the hypothalamus in the W and the trigeminal ganglion in the MW group. The W group had higher expression levels of IL-6 in the thalamus as well. The PCMS paradigm decreased SWA and may have intensified mechanical and thermal hyperalgesia. The current study also suggests that rearing under PCMS may cause impaired sleep quality and heightened pain sensation to painful mechanical and aversively hot thermal stimuli.

Comparison of sleep between youth elite amateur athletes and professional athletes

Recent studies suggest that professional athletes seem to experience significant sleeping problems. However, little is still known about the occurrence of sleeping challenges at different stages of an athletic career. This descriptive study aimed to compare the sleep of professional athletes with younger elite amateur athletes. A total of 401 sportsmen, 173 youth elite amateur athletes and 228 professional athletes fulfilled a validated questionnaire. The self-estimated quality of sleep (on a linear scale 0–10) was significantly better in youth, being 7.9 compared to 7.4 (p < 0.001). The professional athletes had a significantly higher risk for sleeping problems, especially during the competitive season (OR = 7.3, 95% confidence interval 4.1–12.9) and they also used significantly more sleep medications (OR = 8.3, 95% confidence interval 1.7–4.1). Interestingly, majority of youth athletes (85.4%) had received adequate sleep counselling compared with professional athletes (58.1%), (p < 0.001). Furthermore, 75.8% of professional athletes considered that additional sleep counselling would improve their performance compared with only 45.6% of youth athletes (p < 0.001). Our study demonstrates that compared with the younger counterparts, professional athletes experience impaired sleep quality and significantly more sleeping problems. There may be various underlying factors to induce the problems. The early intervention with sleep counselling may play an important role in preventing these problems and, therefore, it is recommended to be integrated in athletes’ overall training process.