Obstructive sleep apnea and objective short sleep duration are independently associated with the risk of serum vitamin D deficiency

BACKGROUND:Studies demonstrate an association between vitamin D (25(OH)D) deficiency and sleep disturbances, such as obstructive sleep apnea (OSA) and short sleep duration. However, to date, no studies have concurrently and objectively evaluated the effect of these factors on 25(OH)D. OBJECTIVES:To evaluate whether OSA and objective short sleep duration are independently associated with reduced 25(OH)D in an adult population sample. METHODS:A cross-sectional study included 657 individuals from the city of Sao Paulo, Brazil, as part of the ERA project. Participants fulfilled questionnaires and underwent clinical evaluation, polysomnography and blood sample collection for 25(OH)D quantification. OSA was classified into three categories (mild, moderate and severe). The risk of 25(OH)D deficiency was considered as levels<30 ng/mL. Short sleep duration was defined as total sleep time<6 hours. RESULTS:The risk of 25(OH)D deficiency was observed in 59.5% of the sample, affecting more individuals of the female gender, obese, with African American ethnicity, and those that were smokers, sedentary and presented hypertension and diabetes. In the final logistic model adjusted for age, gender, ethnicity, obesity, smoking, hypertension, diabetes, sedentary lifestyle, seasonality and creatinine serum levels, both OSA and short sleep duration showed significant independent associations with the risk of 25(OH)D deficiency (moderate OSA: OR for 25(OH)D<30 = 2.21, 95% CI: 1.35-3.64, p<0.01; severe OSA: OR for 25(OH)D<30 = 1.78, 95% CI: 1.06-3.00, p = 0.03; short sleep duration: OR for 25(OH)D<30 = 1.61, 95% CI: 1.15-2.26, p = 0.01). After a subgroup analysis, similar results were observed only in participants ≥50 years. CONCLUSION:OSA and short sleep duration are independently associated with the risk of 25(OH)D deficiency in an adult population. Age-related changes in vitamin D metabolism and the frequency of sleep disorders may be involved in these associations. Future studies exploring whether 25(OH)D levels may modulate OSA and sleep curtailment-related outcomes are needed

PPCR Optional Lecture 16 2017

To help PPCR students to learn statistic

Under-diagnosis of Dementia in Nursing Home Residents: A scoping Review

As per the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5), dementia is diagnosed when there is evidence of decline in activities of daily living (ADL) as well as decline in cognitive ability in one or more of the following domains: complex attention, executive ability, learning and memory, language, perceptual - motor - visual perception, praxis and social cognition (1). Progression of these deficits to the extent one’s ability to conduct activities of daily living is impaired is one of the major reasons for older individuals transition to residential aged care facilities (RACF) or nursing homes (2,3,4,5). Dementia is a significant public health issue in Australia and a health condition that is highly prevalent amongst residents of RACF (6,7). Under-diagnosis of dementia may affect the quality of care provided to the RACF residents, eventually impacting their health-related outcomes (8). Overarching this issue is the fact that funding allocation to RACF for the care of residents is dependent on whether the diagnosis of dementia is present or not (9). It is estimated that three quarters of people living with dementia globally are living without the diagnosis made (7,8). More than 50% of residents living with dementia in RACF are said to have not been diagnosed as living with dementia (8,9,10,11). The issue of under-diagnosis likely begins before entry into the RACF given that a 2017 meta-analysis of 23 studies found that more than 63% of people living with dementia in the community had not been diagnosed with dementia (12). The same study also revealed that the true prevalence of dementia in RACF was double that reported, meaning that half of the residents were not diagnosed (12). Similar results were also reported by another study focusing on diagnosis of dementia in RACF residents (13). Findings from Australian studies have identified similar gaps in the diagnosis of dementia. The South Australian Longitudinal Frailty In Residential Sector over Time [FIRST] Study of RACF residents speculated that dementia might not have been diagnosed in almost half of the residents given that 75.6% of residents were identified as possibly living with dementia when using the Dementia Severity Rating Scale (DSRS), whilst a diagnosis of dementia was recorded in the medical records for only 37.1% residents (14). In another Australian study, 83% of residents scored 4 or more on the Psychogeriatric Assessment Scale (PAS-cog) suggesting the presence of dementia but only 65% had a recorded diagnosis of dementia (15). Clearly, the degree of under-diagnosis reported varies according to the method used to identify dementia (16). Methods that are used to make the diagnosis of dementia in RACF can range from a diagnosis recorded in medical records, to scales used to screen for dementia risk and all the way up to a more definitive diagnosis by clinical experts (e.g., geriatricians, neurologists or expert panels). It is important to be cognizant of the fact that screening tools such as the DSRS and PAS-cog only identify the risk of dementia and that too with varying performance. The DSRS for example, was able to differentiate between mild cognitive impairment and dementia with a sensitivity of 41% and specificity of 79% or a post-test probability of 74% (16). Additionally, the study design can also influence the reported prevalence for dementia with prevalence varying depending on if the prevalence was estimated at the time of admission to RACF or cross-sectionally, where the prevalence of dementia was determined for all residents at the time the study was conducted (16). Ensuring that those living with dementia are diagnosed in a timely manner is important (15,16) as a missed diagnosis could result in the resident missing out on funding allocations (e.g., dementia supplement) that would enable the resident to receive increased care hours (17,18,19,20). A timely diagnosis also facilitates conversations regarding the medical management of residents including future care planning (21). It is no surprise therefore that timely diagnosis has been identified as an essential care requirement as per the National Health and Medical Research Council (NHMRC) guidelines (21). Timely dementia diagnosis has also been highlighted as a priority area for action in the National Framework for Action on Dementia (22)

Objective short sleep duration is associated with the activity of the hypothalamic-pituitary-adrenal axis in insomnia

Objective To evaluate the association between objective short sleep duration in patients with insomnia and changes in blood parameters related to hypothalamic-pituitary-adrenal (HPA) axis activity.Method A cross-sectional pilot study was conducted in 30 middle-aged adults with chronic insomnia who were divided into 2 groups according to polysomnography (PSG) total sleep time (TST) (TST > 5h and < 5h). All patients underwent subjective analysis of sleep quality, anthropometric measurements, PSG, and determination off asting blood parameters.Results The results revealed lower sleep efficiency and higher sleep latency for those with a TST < 5h. The subjective sleep quality was worse in the TST < 5h. Significantly, higher glucose and cortisol levels were observed with a TST < 5h. Glucose, cortisol and ACTH levels were inversely correlated with the PSG total sleep time.Conclusion Patients with insomnia with objective short sleep duration had HPA-associated endocrine and metabolic imbalances chronically linked to increases in cardiovascular risk observed with this more severe insomnia phenotype

Multiple logistic regression analysis^* estimating adjusted odds ratios for the risk of low serum 25(OH)D (<30 ng/mL compared to ≥30 ng/mL).

<p>Multiple logistic regression analysis^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0180901#t003fn001" target="_blank">*</a>} estimating adjusted odds ratios for the risk of low serum 25(OH)D (<30 ng/mL compared to ≥30 ng/mL).</p

Participants characteristics by categories of serum 25(OH)D among 657 individuals participating in the ERA study.

<p>Participants characteristics by categories of serum 25(OH)D among 657 individuals participating in the ERA study.</p