Sleep Archives - First Washington News

July 3, 2022

Sleep duration essential for heart health, new AHA recommendations say

An analog clock resting against the wall on top of a dresser — Sleep duration and quality are essential for cardiovascular health. Photo editing by Steve Kelly; Artur Debat/Getty Images

A new advisory published by the American Health Association (AHA) now includes sleep quality as one of the essential factors for optimal cardiac health.
The previous AHA advisory published in 2010 consisted of seven factors for assessing cardiac health, including physical activity, smoking, blood glucose levels, cholesterol levels, body mass index, and blood pressure.
Four of the existing factors—diet, smoking, blood lipids and glucose—were updated to also include nicotine via e-cigarettes and vapes.
The advisory now also highlights the role of mental health and socioeconomic and cultural factors such as racial discrimination in influencing cardiac health.

Cardiovascular disease (CVD) is the leading cause of death in the United States, accounting for 1 in 4 deaths each year. Notably, adopting healthier lifestyle practices can reduce the risk of CVD by around 80{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}.

A recent AHA presidential advisory published in the journal Circulationdescribes 8 lifestyle and health factors called Life’s Essential 8 that could help preserve optimal heart health and prevent CVD.

The AHA publishes advisories that highlight the current state of knowledge on cardiovascular health and key areas for future research. Such advisories can help inform decision-making by clinicians and the formulation of healthcare guidelines. However, such advisories only serve to inform and are not guidelines.

An AHA advisory published in 2010 outlined the construct or concept of cardiovascular health (CVH) to help promote the maintenance of optimal heart health throughout a person’s lifetime. This construct emphasizes the prevention of CVD and the improvement of cardiovascular health.

The initial formulation of CVH included seven health factors and behaviors called Life’s Simple 7. These seven components included diet, physical activity levels, cigarette smoke exposure, body mass index (BMI), blood cholesterol, blood glucose, and cholesterol levels.

According to threshold values defined by the AHA, an individual’s levels of each of these seven components were categorized as being poor, intermediate, or ideal. An individual with ideal CVH would have ideal levels of all seven components.

Numerous studies conducted since 2010 have shown that individuals with ideal CVH had a lower risk of cardiovascular disease. Moreover, studies suggest that optimal cardiovascular health is associated with a longer lifespan and better overall health, including a lower risk of dementia, cancer, and kidney disease.

While these studies emphasize the validity of the CVH construct, scientists and clinicians have encountered some limitations while using the original formulation of CVH.

For instance, some of the criteria used for assessing CVH were either too broad or lacked sensitivity to evaluate changes in CVH over time. Moreover, the original CVH construct did not include sleep and social factors.

This has led the American Health Association to revise the construct of CVH. The new CVH construct includes sleep as the eighth component and is now called Life’s Essential 8.

An important contribution of this new construct is the inclusion of criteria for assessing CVH in children and pregnant people. The new construct also incorporates evidence from studies showing that brain health and CVH are closely intertwined.

Described below are the changes included in the updated CVH construct.

The original CVH construct described the quantification of the seven health behaviors or factors using the categories of poor, intermediate, or ideal. However, the use of these categories rather than a continuous scoring system makes the construct less sensitive to changes in the health of an individual over time or differences amongst individuals.

For instance, the original construct categorizes individuals engaging in moderate to vigorous physical activity for 1 to 149 minutes as having intermediate physical activity levels. However, the original CVH construct would have categorized both individuals who engage in a few minutes of physical activity and those who engage in 149 minutes as having intermediate physical activity levels.

To remedy this, the AHA has developed a continuous scale from 0 to 100 to better quantify the levels of each health factor or behavior. The average score of the eight health components is then used to measure overall cardiovascular health on a scale from 0 to 100.

Diet

The 2010 construct of cardiovascular health was focused on the quantities of intake of five nutrients, which included whole grains, fish, fresh fruits and vegetables, sodium levels, and sugar-sweetened beverages. However, sodium or sugar intake can be hard to track.

Instead, the updated CVH construct focuses on the intake of whole foods and healthy eating patterns.

Moreover, there are cultural differences in eating patterns and the new CVH construct notes that there are multiple different strategies for achieving healthy eating patterns.

The new construct emphasizes the benefits of DASH– and Mediterranean-style eating patterns, which have been shown to reduce the risk of CVD.

Blood glucose

The new CVH construct now includes measures of glycated hemoglobin (HbA1c) along with blood glucose levels, which were included in the original formulation. Hemoglobin is a protein that allows red blood cells to transport oxygen to different parts of the body.

Glucose can also bind to hemoglobin to form glycated hemoglobin (HbA1c), and HbA1c levels reflect blood glucose levels over the previous 2 to 3 months.

Elevated HbA1C levels are observed in individuals with diabetes and are associated with an increased risk of CVD.

Thenclusion of HbA1C along with blood glucose levels thus provides a more comprehensive measure of cardiovascular health.

Cholesterol levels

The original construct recommended the use of total cholesterol levels to assess CVH. Cholesterol in the blood includes high-density lipoproteins (HDL), low-density lipoproteins (LDL),very-low-density lipoproteins (VLDL), and triglycerides.

Higher HDL levels are associated with lower CVD risk, whereas non-HDL cholesterol, which includes LDL, VLDL, and lioprotein (a), is associated with an increased risk of CVD.

Life’s Essential 8 consists of non-HDL levels, instead of total cholesterol, as one of the 8 components to better reflect cardiovascular health.

Nicotine exposure, BMI, and blood pressure

The original construct only included cigarette use as an indicator of cardiovascular health. The nicotine exposure metric has now been expanded to include e-cigarettes, vaping, and exposure to second-hand smoke.

Life’s Essential 8 has retained the original definitions of ideal BMI and blood pressure described in Life’s Simple 7. The only change is that these metrics are now evaluated on a scale of 0 to 100.

The new addition: sleep

Studies have shown that inadequate or excessive sleep is associated with an increased risk of coronary heart disease. Although sleep duration is associated with the seven components included in the original construct, sleep quality can independently predict the risk of a cardiovascular event.

There is also some evidence to suggest that changing sleep duration can help modify the risk of cardiovascular disease.

The president of the AHA, Dr. Donald Lloyd-Jones, who led the advisory writing group, says:

“The new metric of sleep duration reflects the latest research findings: sleep impacts overall health, and people who have healthier sleep patterns manage health factors such as weight, blood pressure, or risk for Type 2 diabetes more effectively.”

“In addition, advances in ways to measure sleep, such as with wearable devices, now offer people the ability to reliably and routinely monitor their sleep habits at home,” he adds.

In addition to these eight factors, the new construct also highlights the role of psychological health and social factors in achieving cardiovascular health.

Stress and depression are associated with poor cardiovascular health most likely due to increased difficulty achieving a high cardiovascular health score, though depression itself may impact directly on cardiac health. In contrast, positive mental health is linked to better cardiovascular health.

Moreover, social factors such as socioeconomic position, racial discrimination, education levels, employment status, social isolation, and access to healthcare can also impact cardiovascular health.

“We considered social determinants of health carefully in our update and determined more research is needed on these components to establish their measurement and inclusion in the future,” Dr. Lloyd-Jones says.

“[S]ocial and structural determinants, as well as psychological health and well-being, are critical, foundational factors in an individual’s or a community’s opportunity to preserve and improve cardiovascular health.”
— Dr. Donald Lloyd-Jones

Dr. Sonia Anand, a professor of medicine at McMaster University, noted that the advisory was comprehensive but certain topics should receive more emphasis.

“Diet is always controversial and is very contextual; they do rely on U.S. data and metrics but this also limits the application to the U.S. population. They also mention the importance of considering social factors including ethnicity and race, along with diverse settings, and add a call for more research in this area. This is very important and to some, urgent,” she said.

“[The key gaps described by the advisory included information] on diverse populations/health equity, [and] this should be emphasized to ensure that funders of research and health promotion engage these communities in order to work within them to close these gaps,” she added.

March 24, 2022

Light exposure during sleep may increase diabetes risk

A table lamp that's switched on in a bedroom near the headboard. — Light exposure during sleep may increase the risk for heart disease, diabetes, and metabolic syndrome. Gregor Prelog/EyeEm/Getty Images

Researchers recently investigated the health effects of light exposure during sleep.
They found that light exposure during even one night of sleep increases heart rate while sleeping and impairs glucose metabolism the following morning.
They say that sleeping without exposure to light is likely beneficial for cardiometabolic health.

Exposure to artificial light at night is widespread globally and is linked to negative effects on health and well-being.

Researchers from Northwestern University in Chicago recently investigated the biological effects of different light exposure levels while sleeping.

They found that exposure to moderate ambient light during one night of sleep can impair glucose and cardiovascular regulation and increase risk factors for heart disease, diabetes, and metabolic syndrome.

The study appears in PNAS.

Another study, published in 2019, found that artificial light at night (ALAN), such as from a nightlight or television, is linked to obesity in women. These findings suggest that light exposure during sleep may negatively affect metabolic regulation.

Other research indicates that blue-enriched light exposure in the morning and evening alters glucose metabolism and increases insulin resistance compared with dim light exposure.

Another study found that higher levels of ALAN are linked to higher rates of type 2 diabetes among older adults.

The mechanisms underlying ALAN’s impact on metabolic functioning are poorly understood.

The scientists recruited 20 young adults for a 3-day and 2-night laboratory stay. A week before the study, they measured participants’ sleep habits using actigraphy and sleep diaries.

The participants were then randomized to partake in one of two sleeping conditions:

The room light condition: Participants slept with a dim light of less than 3 lux (lx) on the first night and an overhead room light at 100 lx on the second night.
The dim light condition: Sleeping with a dim light of less than 3 lx on both nights

On Days 1 and 2 of the experiment, the participants provided blood samples before and after food intake to assess melatonin and blood glucose levels. They also underwent overnight polysomnography (PSG) to assess their sleep quality.

The participants also filled in surveys every 2 hours that they were awake to evaluate their subjective sleepiness, hunger, and mood changes.

Meanwhile, nurses collected blood pressure readings every hour, alongside heart rate readings every 4 hours.

The researchers found that exposure to a single night of 100 lx room lighting increased heart rate during sleep and insulin resistance the following morning.

Compared with the dim light condition, participants exposed to 100 lx lighting during sleep had more N2 sleep — one of the deeper stages of sleep — and less slow-wave sleep — which is important for memory consolidation. They also had less REM sleep — the dreaming phase of sleep.

The researchers noted no changes among PSG-derived measures of cortical arousal, sleep fragmentation, or wake-sleep stage stability and no difference in melatonin levels between the two groups. They say this might be because only 5-9{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of light is transmitted through closed eyelids.

When asked what may explain the link between ALAN and the observed effects on heart rate and glucose metabolism, Phyllis C Zee, MD., Ph.D., the correspondent author of the study, told Medical News Today:

“There are potentially three possibilities. [The first is that light] can cause awakening or arousal. We found small changes [in these measures, but they did not] correlate with an increase in insulin resistance. So this is unlikely to be a primary mechanism.”

“Secondly, light can affect the circadian clock and affect melatonin secretion. However, we found no significant difference in melatonin levels,” Dr. Zee added.

“[We thus hypothesize] that light activates brain regions that regulate the autonomic nervous system because there was a relationship between the changes in heart variability and insulin resistance,” she explained.

Dale Sandler, Ph.D., is a senior investigator and chief of the Epidemiology Branch of the National Institute of Environmental Health Services (NIEHS), who was not involved in the study. Dr. Sandler agreed with Dr. Zee but added that “subtle shifts in sleep stages could [also] play a role.”

The researchers concluded that avoiding ALAN may benefit cardiometabolic health.

When asked what limitations there may be to this research, Yong-Moon (“Mark”) Park MD, MS, Ph.D., assistant professor at the University of Arkansas, who was not involved in the study, toldMNT:

“The findings came from a study of 20 healthy young adults. So the results might not apply to people with different age groups and people with comorbidities. [Also], the effect of ALAN on cardiometabolic health may differ by sex and race/ethnicity, which was not addressed in this study.”

“As the authors mentioned, the effects of altering light intensities, duration, and wavelengths on cardiometabolic health were not assessed in this study. The [link between blue light and cardiometabolic dysfunction] may be important to look at in the future as the use of smartphones, tablets, and laptops have increased dramatically in the bedroom at night,” he added.

“The experiment only involved one night of sleep in room light for the exposed group,” added Dr. Sandler, “Obesity and diabetes do not develop overnight. What may be most important is long-term exposures, and it is possible that some effects that were not observed after one night could develop over constant longer-term exposure.”

“There are many things that contribute to risk for obesity, diabetes, and cardiometabolic dysfunction. Many of these factors are difficult for individuals to control. But turning off the lights at bedtime may be a simple thing that people can do to lessen the chances of developing these conditions.”

– Dr. Sandler

Posted on October 19, 2021
Sleep behavior linked to psychiatric conditions

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An impressive new examine appears to be at the one-way links in between psychiatric conditions and sleep actions. Steven Beijer/EyeEm/Getty Pictures

In a one-of-a-form review, researchers examined unique areas of slumber disturbance in people today living with psychiatric situations.

Making use of wrist accelerometers to produce objective data about rest, the researchers uncovered associations amongst sleep houses and big depressive problem, anxiety issues, bipolar disorder, and schizophrenia spectrum problem.

Just after analyzing the genomes of the individuals, the scientists concluded that even men and women with a genetic predisposition to these four psychiatric diagnoses experienced in the same way disturbed rest designs.

A assorted, multidisciplinary team of experts labored on a creative exploration structure to uncover rest styles in men and women living with mental wellness circumstances or a genetic predisposition to them. Their benefits show up in the journal PLOS Medication.

Employing the Uk Biobank, researchers were being in a position to assess the slumber exercise of 89,205 contributors. The British isles Biobank, a exclusive resource comprising information and facts from 50 {cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} a million volunteers, offers nameless health-related facts, this kind of as rest measures, clinical diagnoses, and genomic info.

To start with author Dr. Michael Wainberg and co-writer Dr. Shreejoy Tripathy spoke with Professional medical Information These days to go over their findings.

Both of those Dr. Wainberg and Dr. Tripathy are fascinated by the British isles Biobank’s prospective to connection health care diagnoses to participants’ authentic-time wellbeing data. In addition, each scientists are intrigued by the connection in between sleep and psychiatric conditions.

Dr. Tripathy describes sleep and psychiatric issues as a “bidirectional marriage: [P]oor sleep contributes to lousy psychological well being, and vice versa.”

The researchers made the decision to research the rest length and snooze excellent of 89,205 British isles Biobank contributors and see no matter if they could correlate these results with psychiatric disorders.

The slumber steps that they assessed ended up: bedtime, wake-up time, sleep period, wake soon after slumber onset, slumber performance, selection of awakenings, period of longest sleep bout, amount of naps, and variability in bedtime and snooze length.

On the other hand, the scientists did not cease there. They also seemed at people today with identified psychiatric issues and people who possessed a genetic predisposition to psychological wellbeing conditions.

The researchers leveraged a unique facet of the British isles Biobank, in which members wore an accelerometer — a gadget that measures a person’s movement — for 7 complete days. Dr. Tripathy described:

“[Accelerometers] are not measuring a brain wave. They capture features of slumber, in particular duration [and] how numerous instances you are waking up at evening. Slumber disturbances, specifically slumber top quality disturbances, [such as] the quantity of situations you wake up for each evening, which is important, and which is the value of these devices.”

Dr. Wainberg notes that accelerometers insert an objective evaluate of snooze disturbance, citing prior investigation that disclosed that self-noted actions of sleep do not correspond very well with direct measurements.

For case in point, in the cited study, persons incorrectly assessed rest length by as considerably as 72 minutes.

In an unprecedented way, these scientists calculated 10 houses of sleep in folks dwelling with 1 of 4 psychiatric diagnoses: big depressive problem, anxiousness disorders, bipolar condition/mania, and schizophrenia spectrum diseases.

They also provided polygenic threat scores — based on human genome information from the British isles Biobank — for main depression, bipolar dysfunction, and schizophrenia. Dr. Wainberg described to MNT what polygenic threat scores represent:

The crew identified that rest improvements ended up pervasive amid people dwelling with psychological wellness situations. Dr. Wainberg defined that “whether it is bipolar/mania, schizophrenic spectrum, anxiousness, or depressive problems, it was a ubiquitous improve in each slumber measure.”

The researchers found that 8.5 out of 10 sleep accelerometer-derived slumber actions in people today with a psychiatric analysis were disturbed.

Rest performance was a lot more disrupted than sleep duration. For people today carrying just one of the 4 diagnoses, as very well as those people with an elevated polygenic hazard rating for mental well being ailments, the scientists observed far more awakenings at night time, much more daytime napping, and higher bedtime variability.

Though the noticed changes have been considerable, the effects ended up smaller. Dr. Tripathy believes that this is possible an averaging outcome. “[M]any individuals calculated may perhaps be in remission, and only some might be actively suffering from an exacerbation of their disorder,” he explained.

He mentioned to MNT: “It averages out to a fairly compact improve. That is not to say that person persons [for example] in a depressive episode would not have much larger changes.”

Can this examine in any way tutorial potential analysis and wellness interventions? Initially, the researchers are even handed about drawing diagnostic or prognostic conclusions from their information.

Dr. Wainberg concurred with Dr. Tripathy regarding the worth of accelerometers contributing objective evidence about slumber effectiveness in men and women residing with mental well being situations. On the other hand, he also concluded:

“Sleep is a thing we must be knowledgeable of and asking about in the context of psychological overall health.”

To MNT, Dr. Tripathy mused, “[I] am fired up about the use of at-household sleep gadgets — by the prospect of offering these equipment to individuals who are searching for treatment method for psychological illness and [seeing] if sleep improves as other indices of psychological sickness enhance!”

A power of the study was that the researchers replicated their conclusions throughout ancestries and sexes, such as individuals with historic underrepresentation in health-related research. Regarding the limitations of the analyze, the experts admit:

United kingdom Biobank individuals are volunteers, possibly introducing a bias towards healthful folks.

There could be a appreciable time lag in between the date of prognosis and the accelerometry measurements.

The group could not conclude causality, only note an affiliation.

Accelerometry is not as fully correct or thorough as slumber studies, regarded as polysomnography, which are the gold common for snooze analysis.

The authors also notice the need for potential transdiagnostic scientific tests of sleep and psychopathology that “more exactly look at how sleep parameters change across phases of psychological illness.”