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1.
Pharmacotherapeutic management of sleep disorders in children with neurodevelopmental disorders.
Bruni, O, Angriman, M, Melegari, MG, Ferri, R
Expert opinion on pharmacotherapy. 2019;(18):2257-2271
Abstract
Introduction: Sleep disturbances are highly prevalent in children with neurodevelopmental disabilities. Without appropriate treatment, sleep disorders can become chronic and last for many years. However, there are no sleep medications approved by the United States Food and Drug Administration and only one has been approved by the European Medicines Agency for pediatric insomnia; thus, most medications are prescribed off-label.Areas covered: In this narrative review, the authors highlight and summarize the most common drugs and supplements used for the treatment of sleep problems in children with neurodevelopmental disabilities. Recommendations are formulated regarding the use of melatonin and melatonin receptor agonists, sedating antidepressants, antipsychotics, antihistamines, gabapentin, clonidine and orexin receptor antagonists, and benzodiazepines and hypnotic benzodiazepine receptor agonists.Expert opinion: The choice of pharmacological agents and their dosage should be individualized taking into consideration multiple factors, including the severity and type of sleep problem and the associated neurological pathology. Melatonin is widely used and safe in children with neurodevelopmental conditions. Gabapentin, clonidine, trazodone, and mirtazapine hold promise but require further study. Supplements (iron, vitamin D, and 5-hydroxytryptophan) might be helpful. Due to the lack of clinical data, there is still uncertainty concerning dosing regimens and tolerability.
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2.
Fatigue, Sleep, and Autoimmune and Related Disorders.
Zielinski, MR, Systrom, DM, Rose, NR
Frontiers in immunology. 2019;:1827
Abstract
Profound and debilitating fatigue is the most common complaint reported among individuals with autoimmune disease, such as systemic lupus erythematosus, multiple sclerosis, type 1 diabetes, celiac disease, chronic fatigue syndrome, and rheumatoid arthritis. Fatigue is multi-faceted and broadly defined, which makes understanding the cause of its manifestations especially difficult in conditions with diverse pathology including autoimmune diseases. In general, fatigue is defined by debilitating periods of exhaustion that interfere with normal activities. The severity and duration of fatigue episodes vary, but fatigue can cause difficulty for even simple tasks like climbing stairs or crossing the room. The exact mechanisms of fatigue are not well-understood, perhaps due to its broad definition. Nevertheless, physiological processes known to play a role in fatigue include oxygen/nutrient supply, metabolism, mood, motivation, and sleepiness-all which are affected by inflammation. Additionally, an important contributing element to fatigue is the central nervous system-a region impacted either directly or indirectly in numerous autoimmune and related disorders. This review describes how inflammation and the central nervous system contribute to fatigue and suggests potential mechanisms involved in fatigue that are likely exhibited in autoimmune and related diseases.
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3.
The Association between Sleep Duration and Metabolic Syndrome: The NHANES 2013/2014.
Smiley, A, King, D, Bidulescu, A
Nutrients. 2019;(11)
Abstract
BACKGROUND We aimed to assess the association of sleep with metabolic syndrome in the 2013/2014 National Health and Nutrition Examination Survey (NHANES). METHODS Sample size included 2737 out of 2013 and 2014 NHANES surveys. Cross-sectional study of metabolic syndrome and sleep duration was conducted. Metabolic syndrome was defined according to NCEP ATPIII (National Cholesterol Education Program Adult Treatment Panel III) criteria. Metabolic syndrome severity score was calculated based on actual measurement of each component, adjusted for sex and race. The generalized additive model (GAM) was built to assess the smooth relationship between metabolic syndrome/metabolic syndrome severity score and sleep duration. Adjustment of models were done for age, sex, race, and sitting time. The value of effective degree of freedom (EDF) formed by the GAM model shows the degree of curvature of the relationship. A value of 1 for EDF is translated as the linear shape of relationship. Values larger than one denote a more complex relationship between the response variable and the predicting one. RESULTS There was a U-shaped association between sleep duration and metabolic syndrome in univariable GAM (EDF = 2.43, p = 0.06) and multivariable GAM (EDF = 2.03, p = 0.20). The lowest risk of metabolic syndrome was observed in people sleeping 7 hours/night. There was a significant U-shaped association between sleep duration and metabolic syndrome severity score in multivariable GAM (EDF = 2.94, p = 0.0004). Similarly, the lowest mean metabolic syndrome severity score was observed in people sleeping 7 hours/night. There was an effect modification of sex and sleep duration indicating strong U-shaped relationship of metabolic syndrome severity score and sleep duration in women (EDF = 3.43, p = 0.00002) and semi-linear association in men (EDF = 1.76, p = 0.04). CONCLUSION Short and long sleep duration was associated with higher risk of metabolic syndrome and higher scores of metabolic syndrome severity score in women. Short sleep duration was associated with higher risk of metabolic syndrome and higher scores of metabolic syndrome severity score in men.
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4.
Self-regulation and social behavior during sleep deprivation.
Dorrian, J, Centofanti, S, Smith, A, McDermott, KD
Progress in brain research. 2019;:73-110
Abstract
An emerging literature is specifically focusing on the effects of sleep deprivation on aspects of social functioning and underlying neural changes. Two critical facets of social behavior emerge that are negatively impacted by sleep deprivation-self-regulation, which includes behavioral and emotional regulation, and social monitoring, which includes perceiving and interpreting cues relating to self and others. Sleep deprived individuals performing tasks with social components show altered brain activity in areas of the prefrontal cortex implicated in self-control, inhibition, evaluation, and decision-making, in proximity to mesocorticolimbic pathways to reward and emotional processing areas. These cognitive changes lead to increased reward seeking and behaviors that promote negative health outcomes (such as increased consumption of indulgence foods). These changes also lead to emotional disinhibition and increased responses to negative stimuli, leading to reductions in trust, empathy, and humor. Concomitant attentional instability leads to impaired social information processing, impairing individual and team performance and increasing likelihood of error, incident, and injury. Together, changes to reward seeking, the foundational components of social interaction, and interpretation of social cues, can result in unpleasant or deviant behavior. These behaviors are perceived and negatively responded to by others, leading to a cycle of conflict and withdrawal. Further studies are necessary and timely. Educational and behavioral interventions are required to reduce health-damaging behaviors, and to reduce emotionally-laden negative interpretation of sleep-deprived exchanges. This may assist with health, and with team cohesion (and improved performance and safety) in the workplace and the home.
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5.
Effects of sleep restriction on metabolism-related parameters in healthy adults: A comprehensive review and meta-analysis of randomized controlled trials.
Zhu, B, Shi, C, Park, CG, Zhao, X, Reutrakul, S
Sleep medicine reviews. 2019;:18-30
Abstract
This review aimed to provide a comprehensive examination of the effect of sleep restriction on metabolism-related parameters by synthesizing the emerging, best evidence. A systematic search was conducted in six electronic databases from inception to January 2018. We identified 41 randomized controlled trials using sleep restriction intervention. The outcomes included: subjective hunger, appetite-regulating hormones, changes in brain activity, energy intake and expenditure, weight change, insulin sensitivity or resistance. Sleep restriction resulted in a significant increase in subjective hunger on a 100 mm scale (mean difference = 13.4, p < 0.001). Participants consumed 252.8 more kcal/d (p = 0.011) under sleep restriction than under normal sleep. Partial sleep restriction resulted in a 0.34 kg weight gain (p = 0.003). Sleep restriction also decreased insulin sensitivity (standardized mean difference = -0.70, p < 0.01). Significant changes in brain activity in response to food stimuli were observed under sleep restriction, particularly regions related to cognitive control and reward. Overall, we did not find strong evidence supporting the significant impact of sleep restriction on mean leptin or ghrelin levels or energy expenditure. Findings from this review enhanced our knowledge about the detrimental effects of sleep restriction on metabolism and provided novel directions in preventing metabolic diseases including obesity and diabetes.
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6.
Sleep and Nutrition Interactions: Implications for Athletes.
Doherty, R, Madigan, S, Warrington, G, Ellis, J
Nutrients. 2019;(4)
Abstract
This narrative review explores the relationship between sleep and nutrition. Various nutritional interventions have been shown to improve sleep including high carbohydrate, high glycaemic index evening meals, melatonin, tryptophan rich protein, tart cherry juice, kiwifruit and micronutrients. Sleep disturbances and short sleep duration are behavioural risk factors for inflammation, associated with increased risk of illness and disease, which can be modified to promote sleep health. For sleep to have a restorative effect on the body, it must be of adequate duration and quality; particularly for athletes whose physical and mental recovery needs may be greater due to the high physiological and psychological demands placed on them during training and competition. Sleep has been shown to have a restorative effect on the immune system, the endocrine system, facilitate the recovery of the nervous system and metabolic cost of the waking state and has an integral role in learning, memory and synaptic plasticity, all of which can impact both athletic recovery and performance. Functional food-based interventions designed to enhance sleep quality and quantity or promote general health, sleep health, training adaptations and/or recovery warrant further investigation.
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7.
Maternal Sleep in Pregnancy and Postpartum Part II: Biomechanisms and Intervention Strategies.
Carroll, JE, Teti, DM, Hall, MH, Christian, LM
Current psychiatry reports. 2019;(3):19
Abstract
PURPOSE OF REVIEW As described in Part I of this two-part review, maternal sleep has wide-ranging implications for maternal health and overall family functioning. In addition, poor sleep quality and insufficient sleep are highly prevalent and characterized by considerable racial disparities. RECENT FINDINGS Part II of this review discusses physiological mechanisms, including inflammation and appetite hormones, by which sleep impacts multiple facets of women's health during pregnancy and postpartum. These mechanisms are increasingly being delineated, but require further study and better integration with studies of behavioral and physical health outcomes. Further, there are multiple potential strategies for improving maternal sleep, providing the opportunity to tailor treatment approaches to individual needs. Ultimately, as a critical health behavior that is amenable to intervention, sleep provides a promising future direction for measurably impacting clinically relevant health parameters in women of childbearing age.
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8.
Promoting Mental Health and Wellness in Youth Through Physical Activity, Nutrition, and Sleep.
Hosker, DK, Elkins, RM, Potter, MP
Child and adolescent psychiatric clinics of North America. 2019;(2):171-193
Abstract
The medical benefits to youth conferred by physical activity, balanced nutrition, and quality sleep have been increasingly encouraged by medical and mental health providers. Emerging evidence continues to reveal benefits for youth mental health and well-being, including for youth with psychiatric disorders. This evidence seems multifactorial through both neurobiological and psychosocial systems, with common mechanisms present between physical activity, nutrition, and sleep. This article reviews the benefits of optimizing physical activity, nutrition, and sleep; how to assess these lifestyle domains with patients and their parents; and appropriate interventions to optimize well-being in youth.
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9.
Effects of obesity therapies on sleep disorders.
Xanthopoulos, MS, Berkowitz, RI, Tapia, IE
Metabolism: clinical and experimental. 2018;:109-117
Abstract
Obesity is a significant risk factor for obstructive sleep apnea syndrome (OSAS), and has also been linked to reductions in sleep quality and quantity. Weight loss has been shown to be an effective treatment for improving OSAS; however, there is a high degree of variability in improvements of OSAS in response to weight loss. There are three modalities of obesity therapies: 1) lifestyle modification, which includes changes in dietary intake and physical activity, along with behavioral interventions; 2) pharmacologic agents; and 3) bariatric surgery. Individuals have a highly variable response to the various obesity interventions, and maintenance of weight loss can be especially challenging. These factors influence the effect of weight loss on sleep disorders. There is still a need for large, well-controlled studies examining short- and long-term efficacy of weight loss modalities and their impact on long-term treatment of OSAS and other sleep parameters, particularly in youth. Nonetheless, given our current knowledge, weight reduction should always be encouraged for people coping with obesity, OSAS, and/or sleep disruptions and resources identified to assist patients in choosing a weight loss approach that will benefit them the most.
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10.
Sleep in Normal Aging.
Li, J, Vitiello, MV, Gooneratne, NS
Sleep medicine clinics. 2018;(1):1-11
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Abstract
Sleep patterns change with aging, independent of other factors, and include advanced sleep timing, shortened nocturnal sleep duration, increased frequency of daytime naps, increased number of nocturnal awakenings and time spent awake during the night, and decreased slow wave sleep. Most of these changes seem to occur between young and middle adulthood; sleep parameters remain largely unchanged among healthy older adults. The circadian system and sleep homeostatic mechanisms become less robust with normal aging. The amount and pattern of sleep-related hormone secretion change as well. The causes of sleep disturbances in older adults are multifactorial.