Sleep problems may adversely affect neuronal health. We examined a subjective report of change (reduced duration and/or depth) in sleep pattern in relation to subsequent risk of incident all-cause dementia and Alzheimer disease (AD) over 9 years.
This longitudinal study used data from a population-based sample of 214 Swedish adults aged 75 and over who were dementia-free both at baseline and at first follow-up (3 years later). The sample was 80% female and, on average, 83.4 years of age at baseline. All participants underwent a thorough clinical examination to ascertain all-cause dementia and AD.
Forty percent of participants reported a change in sleep duration at baseline. Between the 6th and 9th year after baseline, 28.5% were diagnosed with all-cause dementia, 22.0% of whom had AD. Reduced sleep was associated with a 75% increased all-cause dementia risk (hazard ratio: 1.75; 95% confidence interval: 1.04-2.93; Wald = 4.55, df = 1, p = 0.035) and double the risk of AD (hazard ratio: 2.01; 95% confidence interval: 1.12-3.61; Wald = 5.47, df = 1, p = 0.019) after adjusting for age, gender, and education. The results remained after adjusting for lifestyle and vascular factors but not after adjusting for depressive symptoms. No evidence supported a moderating effect of the use of sleeping pills, and the sleep-dementia relationship remained after controlling for the presence of the apolipoprotein E e4 allele.
Self-reported sleep problems may increase the risk for dementia, and depressive symptoms may explain this relationship. Future research should determine whether treatment, in particular, behavioral or nonpharmacologic treatment, may represent one avenue toward reduction of dementia risk in late life.
The prevalence of daytime sleepiness and background factors associated with it were investigated in a study carried out at the UKK Institute. The inquiry took the form of a questionnaire mailed to 1600 people of middle age. Daytime sleepiness was found to be associated with disturbed night sleep. Women were more tired than men, but men slept more frequently during the day. Those suffering from tiredness complained of poor health more than other respondents. Traffic accidents and other mishaps attributable to tiredness had occurred in 1.3% of cases, and almost 5% of male respondents had dozed off while driving at least five times in their lives. The findings indicate a need for increased attention to disturbance of sleep and daytime sleepiness in routine health screening.
The objective of this study was to investigate the validity of the effort-reward imbalance (ERI) model in relation to disturbed sleep and fatigue.
The study population derived from a subset of the WOLF (WOrk, Lipids, Fibrinogen) cohort study of cardiovascular risk in a working population who replied to the ERI-questionnaire comprising 789 men and 214 women. Cox regression analysis was used to calculate the prevalence ratio (PR) for sleep disorders and fatigue in relation to the components of ERI.
As sleep disturbances and fatigue, based on literature, were defined to be represented by the uppermost quintile, 14% of the men and 23% of the women were affected by sleep disturbances while 14 and 26%, respectively, were affected by fatigue. Higher levels of exposure for the ERI components were associated with increased prevalence of sleep disturbances and fatigue. For men, the strongest association was seen between high overcommitment and fatigue (PR 5.77, 95% confidence interval 2.89-11.5). For women, high effort and sleep disturbances (PR 4.04, CI 1.53-10.7), high effort/reward ratio and sleep disturbances (PR 4.13, CI 1.62-10.5), and between low reward and fatigue (PR 4.36, CI 1.79-10.6) yielded the most obvious associations.
The present study adds sleep disturbances and fatigue to the list of adverse consequences of effort-reward imbalance.
We will review the epidemiology, risk factors, and consequences of obstructive sleep apnea (OSA) and short/long sleep duration. Obstructive sleep apnea is a disease characterized by recurrent upper airway obstruction during sleep. Obstructive sleep apnea is common, with moderate to severe disease present in approximately 9% of middle aged men and 4% of women. The prevalence of OSA in certain patient populations (such as elderly patients, hypertensive patients, patients with coronary disease, and prebariatric surgery patients) is even greater. There are a number or risk factors for disease including obesity, male sex, and family history. Obstructive sleep apnea negatively impacts quality of life and is also associated with a number of adverse safety and health consequences including cardiovascular disease and motor vehicle crashes. Short habitual sleep duration can result in excessive daytime sleepiness and reduced neurocognitive function. Sleep loss may have long-term health consequences and may lead to premature death, cardiovascular disease, and the development of diabetes.
Children with attention-deficit/hyperactivity disorder (ADHD) have high rates of sleep problems and sleep disorders. It is critical that pediatricians assess for sleep problems during the course of ADHD assessment and when treating children with stimulant medication. Sleep must be considered in the differential diagnosis and in terms of comorbidity with ADHD. The most common sleep problem in children with ADHD is insomnia, and the first line of treatment should be the implementation of behavioral interventions rather than medication. More research is needed to determine if children with ADHD respond to behavioral interventions in a similar manner as typically developing children.
This study explored the joint effect of two epidemics, sleep problems and metabolic syndrome (MetS), on the risk of coronary heart disease (CHD).
The study group is part of the Finnish middle-aged men who participated in the first screening for the Helsinki Heart Study (HHS) in 1981-1982. At that time, three components of MetS were measured: body mass index, HDL cholesterol, and blood pressure. Later, in 1986-1988, they were given a psychosocial questionnaire including items on sleep problems. Of the respondents, 2753 formed our study group and were followed up using population-based registers until 1995. The relative risks (RR) of CHD were estimated using Cox's regression models.
When several sleep problems were present simultaneously, some increased CHD risk was observed. However, when considered jointly with MetS, insomnia or daytime fatigue approximately doubled the CHD risk and the presence of insufficient sleep more than tripled the risk. Among those who had MetS only, the RR was 2.55, and among those with both insufficient sleep and MetS the RR was 9.36 (95% confidence interval: 4.60-19.04; P for interaction 0.09) when compared to those with no insufficient sleep and no components of MetS.
The interaction occurred when all three measured MetS components were present, suggesting that co-occurrence of these two epidemics may predict growing public health problems.
Previous epidemiological studies have suggested that psychiatric symptoms are associated with obesity and abdominal distribution of body fat in women. The aim of the present study was to examine this in middle-aged men. In 1992 a cluster selected cohort of 1040 men born in 1944 (participation rate 79.9%) was examined. Registrations of symptoms of depression and anxiety, sleep disturbances, psychosomatic disease as well as degree of life satisfaction were analyzed in relation to body mass index (BMI) and the waist/hip circumference ratio (WHR). In univariate analyses both BMI and WHR correlated with these factors. BMI and WHR were, however, closely interrelated (p = 0.61), necessitating analyses of separate, independent relationships in multivariate analyses. When adjusted for WHR all the significant relationships with BMI disappeared. In contrast the WHR, adjusted for BMI, showed remaining significant associations with the use of anxiolytics (p = 0.018), hypnotics (p = 0.029), antidepressive drugs (p = 0.008), degree of melancholy (p = 0.002), and life satisfaction (p = 0.002, negative), difficulties to sleep (p = 0.014) and fall asleep (p = 0.047), tendency to wake up from sleep (borderline, p = 0.070) and dyspepsia (p
Center of Expertise for Health and Work Ability, Finnish Institute of Occupational Health, Topeliuksenkatu 41 a A, 00250 Helsinki, Finland. Helena.Miranda@ttl.fi
Risk factors for low-back pain are known to co-occur, but their joint effect has not often been studied. Little is also known about the variation of the risk factors or their effects with age.
This prospective study assessed the 1-year incidence of low-back pain by age group in a Finnish industrial population. The effects of the baseline variables on the risk of low-back pain in the follow-up were estimated with a log-binomial regression.
Among 2256 blue- and white-collar workers free of low-back pain 12 months preceding the baseline, 21% reported low-back pain after 1-year of follow-up. Physical work load (sum of heavy lifting, awkward postures, and whole-body vibration) predicted low-back pain among those younger than 50 years [highest relative risk (RR) 2.4, 95% confidence interval (95% CI) 1.4-4.2], whereas health behavior (sum of smoking, overweight, and lack of physical exercise) increased the risk only among those 50 years or older (RR up to 2.8, 95% CI 1.4-5.4). Mental stress, dissatisfaction with life, and sleep problems were significant predictors in the group of 40- to 49-year-old workers. Work-related psychosocial factors were not associated with the outcome.
In this study, workers of different ages were affected by slightly different risk factors. The results support the provision of health promotion and stress management as part of programs to prevent work-related low-back pain. In particular, aging workers may benefit from such an integrated approach. More prospective studies on the joint effects of age-specific risk factors of low-back pain are warranted.
The information on night-time symptoms in chronic obstructive pulmonary disease (COPD) is sparse. We investigated the prevalence of night-time dyspnoea in 6616 individuals with COPD recruited from the general population in the Copenhagen area, Denmark, and described characteristics and prognosis of subjects with this symptom. The prevalence of night-time dyspnoea was 4.3%: 2.1% in Global Initiative for Chronic Obstructive Lung Disease (GOLD) group A, 12.9% in GOLD B, 2.6% in GOLD C and 16.3% in GOLD D. Compared with individuals without night-time dyspnoea, those with night time dyspnoea had lower forced expiratory volume in 1 s, higher daytime dyspnoea scores (modified Medical Research Council scale) and more wheezing, more often had chronic mucus hypersecretion, ischaemic heart disease and atrial fibrillation, and more often reported stress, nervousness and tiredness. After adjustment for age and sex, the presence of night-time dyspnoea was associated with future COPD exacerbations (hazard ratio (HR) 2.3, 95% CI 1.7-3.0), hospital admissions due to COPD (HR 3.2, 95% CI 2.3-4.4) and mortality (HR 1.7, 95% CI 1.2-2.3). Prevalence of night-time dyspnoea in COPD increases with disease severity according to both spirometric and clinical GOLD classification, and is associated with presence of daytime respiratory symptoms and cardiac comorbidities. Night-time dyspnoea is a significant predictor of poor prognosis in individuals with COPD.
Notes
Comment In: Eur Respir J. 2014 Jun;43(6):1560-224881057
