Sleep and 24-h activity rhythms in relation to cortisol change after a very low-dose of dexamethasone

The hypothalamic-pituitary-adrenal (HPA) axis plays an important role in sleep. Nevertheless, the association of sleep and its 24-h organization with negative feedback control of the HPA axis has received limited attention in population-based studies. We explored this association in 493 mid

Associations of the 24-h activity rhythm and sleep with cognition: A population-based study of middle-aged and elderly persons

Background: Cognitive functioning changes with age, sleep, and the circadian rhythm. We investigated whether these factors are independently associated with different cognitive domains assessed in middle-aged and elderly persons. Methods: In 1723 middle-aged and elderly persons (age 62 ± 9.4 years, mean ± standard deviation, SD) of the Rotterdam Study, we collected actigraphy recordings of on average 138 h. Actigraphy was used to quantify 24-h rhythms by calculating the stability of the rhythm over days and the fragmentation of the rhythm. Sleep parameters including total sleep time, sleep-onset latency, and wake after sleep onset were also estimated from actigraphy. Cognitive functioning was assessed with the word learning test (WLT), word fluency test (WFT), letter digit substitution task (LDST), and Stroop color word test (Stroop). Results: Persons with less stable 24-h rhythms performed worse on the LDST (. B = 0.42 per SD increase, p = 0.004) and the Stroop interference trial (. B = -1.04 per SD increase, p = 0.003) after full adjustment. Similarly, persons with more fragmented rhythms performed worse on the LDST (. B = -0.47 per SD increase, p = 0.002) and the Stroop (.

Sleep apnea severity and depressive symptoms in a population-based study

Objectives: Sleep apnea and depression often co-occur in clinical studies, but population-based studies demonstrated mixed results. We determined the association of sleep apnea severity and depressive symptoms in a population-based sample. Design: Cross-sectional cohort study. Setting: Population-based. Participants: Four hundred ninety-one middle-aged and elderly persons of the Rotterdam Study (mean age 61.9. years; standard deviation, 5.4). Measurements: Polysomnography recordings were collected to calculate the apnea hypopnea index (AHI). Depressive symptoms were assessed with the Center for Epidemiologic Studies Depression Scale. Results: In the total sample, no associations for the severity of sleep apnea with depressive symptoms were found (multivariate adjusted: B = 0.032; 95% confidence interval [CI], - 0.057 to 0.122). Only in men we found some evidence for a curvilinear association of the severity of sleep apnea with depressive symptoms (multivariable adjusted: B = - 0.126; 95% CI, - 0.224 to - 0.028); men with an AHI between 5 and 15 (multivariable adjusted: B = 0.378; 95% CI, 0.037-0.718) or between 15 and 30 (multivariable adjusted: B = 0.502; 95% CI, 0.152-0.852) had significantly more depressive symptoms than those with an AHI equal to or greater than 30. Conclusions: In this population-based sample, the severity of sleep apnea is not consistently related to depressive symptoms, although there was some evidence for an association of AHI with depressive symptoms in men

Sleep and 24-h activity rhythms in relation to cortisol change after a very low-dose of dexamethasone

The hypothalamic-pituitary-adrenal (HPA) axis plays an important role in sleep. Nevertheless, the association of sleep and its 24-h organization with negative feedback control of the HPA axis has received limited attention in population-based studies. We explored this association in 493 middle-aged persons of the Rotterdam Study, a large population-based study (mean age 56 years, standard deviation: 5.3 years; 57% female). The negative feedback of the HPA axis was measured as the change in morning saliva cortisol after the intake of 0.25 mg dexamethasone the night before. Actigraphy allowed us to measure the stability and fragmentation of the activity rhythm and to estimate total sleep time, sleep onset latency and wake after sleep onset. A sleep diary kept during the week of actigraphy was used to assess self-reported total steep time, sleep onset latency, number of awakenings and perceived sleep quality. In our study, enhanced negative feedback of the HPA axis was found in association with unstable activity rhythms (B=0.106, 95% confidence interval (CI): 0.002; 0.210), total sleep time (B=0.108, 95%CI: 0.001; 0.215) and poor subjective sleep quality (B=0.107, 95%CI: 0.009; 0.206) after multivariate adjustment. These results indicated that the 24-h organization, duration and experience of sleep are all associated with the negative feedback control of the HPA axis. (C) 2015 Elsevier Ltd. All rights reserved

Fragmentation and stability of circadian activity rhythms predict mortality: the rotterdam study

Circadian rhythms and sleep patterns change as people age. Little is known about the associations between circadian rhythms and mortality rates. We investigated whether 24-hour activity rhythms and sleep characteristics independently predicted mortality. Actigraphy was used to determine the stability and fragmentation of the 24-hour activity rhythm in 1,734 persons (aged 45-98 years) from the Rotterdam Study (2004-2013). Sleep was assessed objectively using actigraphy and subjectively using sleep diaries to estimate sleep duration, sleep onset latency, and waking after sleep onset. The mean follow-up time was 7.3 years; 154 participants (8.9%) died. Sleep measures were not related to mortality after adjustment for health parameters. In contrast, a more stable 24-hour activity rhythm was associated with a lower mortality risk (per 1 standard deviation, hazard ratio = 0.83, 95% confidence interval: 0.71, 0.96), and a more fragmented rhythm was associated with a higher mortality risk (per 1 standard deviation, hazard ratio = 1.22, 95% confidence interval: 1.04, 1.44). Low stability and high fragmentation of the 24-hour activity rhythm predicted all-cause mortality, whereas estimates from actigraphy and sleep diaries did not. Disturbed circadian activity rhythms reflect age-related alterations in the biological clock and could be an indicator of disease

Original Contribution Fragmentation and Stability of Circadian Activity Rhythms Predict Mortality The Rotterdam Study Downloaded from

Circadian rhythms and sleep patterns change as people age. Little is known about the associations between circadian rhythms and mortality rates. We investigated whether 24-hour activity rhythms and sleep characteristics independently predicted mortality. Actigraphy was used to determine the stability and fragmentation of the 24-hour activity rhythm in 1,734 persons (aged 45-98 years) from the Rotterdam Study (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013). Sleep was assessed objectively using actigraphy and subjectively using sleep diaries to estimate sleep duration, sleep onset latency, and waking after sleep onset. The mean follow-up time was 7.3 years; 154 participants (8.9%) died. Sleep measures were not related to mortality after adjustment for health parameters. In contrast, a more stable 24-hour activity rhythm was associated with a lower mortality risk (per 1 standard deviation, hazard ratio = 0.83, 95% confidence interval: 0.71, 0.96), and a more fragmented rhythm was associated with a higher mortality risk ( per 1 standard deviation, hazard ratio = 1.22, 95% confidence interval: 1.04, 1.44). Low stability and high fragmentation of the 24-hour activity rhythm predicted all-cause mortality, whereas estimates from actigraphy and sleep diaries did not. Disturbed circadian activity rhythms reflect age-related alterations in the biological clock and could be an indicator of disease. circadian activity rhythm; elderly; mortality; sleep Abbreviations: ADL, activities of daily living; CI, confidence interval; HR, hazard ratio; PSQI, Pittsburgh Sleep Quality Index; SD, standard deviation. Most physiological processes, including body temperature, hormone secretion, and sleep-wake timing, are regulated in cycles that last approximately 24 hours, called circadian rhythms. Circadian rhythms and sleep patterns change as people age (1). Elderly people sleep less during the night, have more fragmented sleep, have more difficulty in falling asleep, tend to fall asleep and wake up earlier, take more naps, and report a lower sleep quality (2-6). The longitudinal associations of these changes with adverse health consequences and mortality are not well understood. In previous studies, investigators found that people who slept for short durations each night (≤6 hours) and had poor sleep quality had higher risks of diabetes and cardiovascular diseases Few studies have investigated the associations of circadian rhythms with mortality. In the elderly, the amplitude of several physiological circadian rhythms is reduced compared with that of younger people, as is the stability of the day-night rhyth

Use of selective serotonin reuptake inhibitors and sleep quality: A population-based study

Study Objectives: Poor sleep is a risk factor for the development and recurrence of depression. Selective serotonin reuptake inhibitor (SSRI) use is consistently associated with good subjective sleep in clinically depressed patient populations. However, studies in the general population are lacking. Our objective was to investigate the association between SSRIs and subjective sleep in a middle-aged and elderly population in a daily practice setting. Methods: We included participants from the prospective Rotterdam Study cohort. Participants had up to two subjective sleep measurements assessed with Pittsburgh Sleep Quality Index ([PSQI], number of measurements = 14,770). SSRI use was based on pharmacy records. We assessed the association between SSRIs and PSQI score and its sub-components, with nonusers of any antidepressant as reference. Analyses were, among others, adjusted for presence of depressive symptoms and concurrent psycholeptic drug use. Results: We included 9,267 participants, average baseline age 66.3 y (standard deviation 10.6), and 57.6% women. SSRI use was significantly associated with a 0.78-point lower PSQI score (95% confidence interval [CI]-1.11;-0.44) which reflects better sleep, compared with non-use. The association was more prominent in continuous SSRI users (-0.71 points, 95% CI-1.18;-0.24). Of the sub-components, SSRIs were associated with 0.70-h longer sleep duration (95% CI 0.56; 0.85), higher sleep quality, higher sleep efficiency, and in contrast more daytime dysfunction. Conclusions: SSRI use was associated with better subjective sleep, after adjustment for depressive symptoms and concurrent psycholeptic drug use. This suggests that, in clinical practice in the middle-aged and elderly population, the sleep quality of some persons may benefit from, continued, SSRI use

The Longitudinal and Cross-Sectional Associations of Grief and Complicated Grief With Sleep Quality in Older Adults

Objective/Background: About 15% of grievers experience complicated grief. We determined cross-sectional and longitudinal relations of grief and complicated grief with sleep duration and quality in the general population of elderly adults. Participants: We included 5,421 men and women from the prospective population-based Rotterdam Study. Methods: The Inventory of Complicated Grief was used to define grief and complicated grief. We assessed sleep with the Pittsburgh Sleep Quality Index. Results: After 6 years, 3,511 (80% of survivors) underwent the follow-up interview. Complicated grief was cross-sectionally associated with shorter sleep duration and lower sleep quality. These associations were explained by the presence of depressive symptoms. The prospective analyses showed that sleep duration and sleep quality did not decline further during follow-up of persons who experienced grief or complicated grief. Conclusion: In community-dwelling, middle-aged and older adults, persons with normal and complicated grief had both a shorter sleep duration and a lower sleep quality, mainly explained by de