How does diurnal intermittent fasting impact sleep, daytime sleepiness, and markers of the biological clock? Current insights

Aljohara S Almeneessier,1,2 Ahmed S BaHammam1 1Department of Medicine, University Sleep Disorders Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 2Department of Family Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia Abstract: Mealtimes and feeding schedules may interfere with the circadian system and impact sleep. The practice of intermittent fasting (IF) in its different formats is increasing worldwide. However, most studies addressing the effect of IF on circadian rhythms, daytime sleepiness, and sleep architecture have been conducted during diurnal IF for Ramadan. In this article, we analyze the effect of diurnal IF on the circadian clock, sleep, and daytime sleepiness. In free-living, unconstrained environments that do not control for lifestyle changes such as sleep/wake schedules, sleep duration, and light exposure, studies have demonstrated sudden and significant delays in bedtime and wake time during diurnal intermittent fasting for Ramadan. However, subsequent studies that accounted for lifestyle factors and sleep/wake patterns have reported no changes in markers of the biological clock, daytime sleepiness, or sleep parameters. Nevertheless, several researchers have demonstrated a reduction in the proportion of rapid eye movement stage sleep as the significant alteration in sleep architecture during fasting. Keywords: mealtime, Ramadan, chronotype, sleep architecture, alertness, food, light, caloric restrictio

Exploring the relationship between burnout and emotional intelligence among academics and clinicians at King Saud University

Abstract Background Academics and clinicians are exposed to significant workload pressures and are at a high risk of stress and burnout. Objectives This study aimed to examine the relationship between burnout and emotional intelligence (EI) by comparing and corelating burnout and EI scores among academics and clinicians against several factors. Methods In this cross-sectional study, academics and clinicians at King Saud University and King Saud University Medical City and Affiliated Hospitals were invited to complete anonymous questionnaires: Maslach Burnout Inventory-Human Services Survey and the Trait Emotional Intelligence Questionnaire Short Form. The collected data were analyzed using the SPSS software for descriptive studies, group comparisons, regression analyses, and Pearson's (r) correlation tests. Results Study participants included 126 individuals (men = 65, 51.6%; women = 61, 48.4%). Of these, 65% were Saudi nationals and 35% were expatriates, and 76 were academics while 50 were clinicians. The mean (minimum to maximum) burnout total score was 55 ± 18.9 (8 to 97) and the global TEIQue-SF score ranged between 2.8 and 6.7 (5.04 ± 0.7). Burnout scores varied between departments and were higher among younger participants and non-Saudis. Age had a small direct correlation with self-control (r = .17, p = .05), and there was no statistically significant correlation with other EI factors. However, there was a moderate inverse correlation between age and emotional exhaustion (EE) (r = -0.33, p < 0.0001), and a small inverse correlation with depersonalization (DP) (r = -0.21, p = 0.02). T-tests demonstrated a statistically significant difference in EI factor "emotionality" among Saudis (5.2 ± .8) and non-Saudis (4.9 ± .8) (t124 = 2.2, p = 0.03), and for burnout subscales, there was a statistically significant difference in DP among Saudis (6.4 ± 4.8) and non-Saudis (8.5 ± 5.6), (p = 0.03). Moderate (r = -0.3, p = 0.01) and weak (r = -0.2, p = 0.05) negative correlations were found between EI factors and burnout subscales (EE, DP). Conclusion This study confirmed an inverse relationship between burnout and EI scores among academics and clinicians. The findings suggest the need for introducing measures and implementing a system for early detection of burnout among staff and providing support to enhance EI and requisite care for those undergoing burnout episodes

Immune-mediated comorbidities in Saudi patients with narcolepsy

Majed Alomar,1 Aljohara S Almeneessier,1,2 Awad H Olaish,1 Abdulrahman Alshiban,1 Abdullah Alomar,1 Ahmed S BaHammam1,31The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 2Family and Community Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 3The Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in the Kingdom of Saudi Arabia, King Saud University, Riyadh, Saudi ArabiaBackground: Autoimmunity has been proposed as a cause of narcolepsy. A few studies have assessed comorbid autoimmune diseases in patients with narcolepsy, with conflicting results; however, no study has assessed autoimmune diseases in Arab narcolepsy patients. This study aimed to assess the coexistence of immune-mediated conditions such as allergies, autoimmune diseases, and autoinflammatory diseases in patients with narcolepsy type 1 (with cataplexy) (NT1) and narcolepsy type 2 (without cataplexy) (NT2).Methods: Personal and family history of autoimmune/autoinflammatory and allergic disorders was collected using a questionnaire in 80 consecutive Saudi patients with narcolepsy (46 NT1 and 24 NT2), who were diagnosed according to the International Classification of Sleep Disorders, Third Edition. The control group comprised 222 adults from the general population.Results: Comorbid autoimmune/autoinflammatory diseases were reported by 21.4% of the NT1 patients, and 12.2% of the controls, with no significant difference between cases and controls in a model adjusted for confounding covariates. However, allergic disorders were significantly more prevalent among NT1 patients. Both comorbid autoimmune/autoinflammatory and allergic disorders were significantly more prevalent among NT2 patients compared to controls. No differences in demographic and clinical characteristics were detected between narcolepsy patients with and without autoimmune/autoinflammatory diseases.Conclusion: NT1 is not associated with increased comorbid autoimmune diseases in the studied sample of Saudi patients. However, autoimmune diseases are associated with NT2, and allergic disorders are associated with both NT1 and NT2. These findings suggest the existence of dysregulation in the immune system of narcolepsy patients that requires further research.Keywords: cataplexy, hypersomnolence, hypersomnia, allergy, narcoleps

Medieval Islamic scholarship and writings on sleep and dreams

Islamic civilization between the 7th and the 15th centuries made great contributions to the development of science and medicine, and discoveries made during this time formed the basis for the emergence of the European Renaissance. Muslims view sleep as one of the great signs of Allāh, and a number of Muslim scholars studied and wrote on sleep and dreams. However, Muslim scholars' contributions to this topic have not been adequately represented in modern scholarship. Islamic scholars did far more than simply act as the preservers of the antiquity and Greek knowledge, but rather laid significant foundation, translation, interpretation, and transference of knowledge and experience, and have contributed original works in many fields of science and medicine including sleep. This brief article introduces some of the writings by Muslim scholars and philosophers about the importance of sleep, some sleep disorders, and dreams

Medical comorbidities in Saudi patients with narcolepsy: a case-control study

Objective: This case-control study sought to assess comorbid medical disorders in patients with narcolepsy type-1 (NT-1) and type-2 (NT-2). Material and Methods: he study comprised 80 consecutive Arab (Saudi) patients with narcolepsy (NT-1=56 and NT-2=24) and a control group of 211 adults matched for age, sex, and body mass index (BMI). Data were collected from cases and controls based on a predesigned questionnaire that was formulated based on previous studies to evaluate the chosen medical comorbidities. Results: Narcolepsy patients had a higher prevalence of hypothyroidism and hyperlipidemia and a higher prevalence of high-risk for OSA than controls. Hyperlipidemia was more common in cases than controls, 8 (10%) vs. 3 (1.4%), p=0.002. After adjusting for age, sex, and BMI, the odds-ratios for hypothyroidism and high risk for OSA in the NT-1 group was 5.49 (95% CI, [0.8 - 38.6]) and 69.99 ((95%CI [20.6 -237.4]), respectively, and in the NT-2 group, 12.5, 95%CI [1.6-97.7], and 33.3, 95%CI [8.2-135.7], respectively. Conclusion: Arab (Saudi) narcolepsy patients had a higher association with hypothyroidism, hyperlipidemia, and a higher risk of OSA than controls

Family violence among female medical students: Its prevalence and impact on their mental health status – A cross-sectional study

AbstractObjectivesViolence against women is recognized worldwide as a major public health problem. Studies show that violence affects the mental well-being of the victims. The study explores the prevalence of family violence among Saudi female medical students and its relationship with students' mental well-being and seeks to identify the effect of violence on students' academic achievements.MethodsThis was a cross-sectional study on 1st- to 5th-year Saudi female medical students, utilizing a validated violence screening questionnaire that asked the respondents about how often they were physically Hurt, Insulted, Threatened with harm, and Screamed at (HITS). Furthermore, the study administered a validated mental well-being questionnaire, the Mental Health Inventory 5 (MHI-5), for the assessment of the mental status of the respondents. The analyses included simple univariate analyses, bivariate analyses and linear regression modelling.ResultsOf the total of 460 Saudi female medical students, 363 (79%) students participated in this study. Nineteen (5.3%) students confirmed being the victims of family violence. The victims had a mean MHI-5 score of 52%. A negative correlation was observed between violence and mental well-being scores. Significant association between the MHI-5 score and academic achievement was observed.ConclusionThe prevalence of family violence in this study is less than the reported figures in other studies. We could not demonstrate a direct relationship between family violence and academic achievement. Students' academic achievement was indirectly associated with the presence of family violence through changes in mental well-being

The effects of diurnal intermittent fasting on proinflammatory cytokine levels while controlling for sleep/wake pattern, meal composition and energy expenditure.

PURPOSE:This study aimed to assess the effect of diurnal intermittent fasting (DIF) during and outside of the month of Ramadan on plasma levels of interleukin (IL)-1β, IL-6, and IL-8, while controlling for sleep/wake pattern, sleep length and quality, meal composition, energy consumption and expenditure, and light exposure. DIF outside of the month of Ramadan was performed to evaluate the effect of DIF in the absence of the way of life accompanying Ramadan. METHODS:Twelve healthy male volunteers with a mean age of 25.1 ± 2.5 years arrived to the sleep laboratory on 4 times: 1) adaptation, 5 weeks before Ramadan; 2) 4 weeks before Ramadan while performing DIF for 1 week (fasting outside of Ramadan; FOR); 3) 1 week before Ramadan (non-fasting baseline; non-fasting BL); and 4) After completing 2 weeks of Ramadan while performing DIF. Plasma levels of cytokines were assessed using enzyme-linked immunoassays at 22:00, 02:00, 04:00, 06:00, and 11:00. RESULTS:During DIF, there was a significant decrease in the levels of cytokines, particularly, IL-1β and IL-6, in most measurements compared to non-fasting BL. This reduction was more obvious during the FOR period. There were no significant changes in the circadian phase of the measured cytokines reflected by the acrophase of the measured variables during fasting (FOR and Ramadan) compared to non-fasting BL. CONCLUSION:Under controlled conditions, DIF led to significantly decreased plasma levels of cytokines (IL-1β, IL-6, and IL-8), particularly IL-1β and IL-6 across 24 h. DIF had no effect on the circadian patterns of the measured cytokines as shown by cosinor analysis

The effects of diurnal intermittent fasting on the wake-promoting neurotransmitter orexin-A

BACKGROUND: Food restriction has been demonstrated to increase the alertness in different species and to increase the levels of the wake-promoting neurotransmitter orexin. We hypothesized that diurnal intermittent fasting (DIF) increases orexin-A levels during fasting. Therefore, we conducted this study to assess the effects of DIF, during the month of Ramadan, on orexin, while controlling for lifestyle changes that may accompany Ramadan such as sleep duration, bedtime and wake time, energy expenditure, light exposure, and food. METHODS: Eight young healthy volunteers (mean age, 25.4 ± 3.5 years) reported to the laboratory on three occasions: (1) 4 weeks before Ramadan while performing DIF for 1 week outside the month of Ramadan (fasting outside Ramadan); (2) 1 week before Ramadan (nonfasting baseline) (BL); and (3) during the 2nd week of Ramadan while performing DIF (Ramadan). Plasma levels of orexin-A were measured using an enzyme immunoassay five times at 22:00, 02:00, 04:00, 06:00, and 11:00. Caloric intake, light exposure, and sleep schedule were maintained during the participants' stays in the laboratory in the three study periods. RESULTS: Orexin-A levels increased in the daytime during fasting and decreased at night compared to BL. The differences in orexin-A levels between DIF and BL were significant at 06:00, 11:00, 22:00, and 02:00. CONCLUSIONS: DIF increases orexin-A levels in the plasma during fasting hours. This finding supports findings from animal studies showing that fasting increases alertness