15 Nov AHA23: Unexpected Link Between Sleep Apnea and Cardiovascular Events in Kidney Disease Patients
Posted at 20:35h
in AHA Journals, Author Interviews, Heart Disease, Kidney Disease, Obstructive Sleep Apnea, Sleep Disorders
MedicalResearch.com Interview with:
Lead Author: Rupak Desai, MBBS
Atlanta Veterans Affairs Medical Center
Independent Researcher, Atlanta, GA,
Presenter: Vamsikalyan Borra, MD
Resident Physician, Internal Medicine
University of Texas Rio Grande Valley, Weslaco, TX
MedicalResearch.com: What is the background for this study?
Response: The relationship between sleep apnea (OSA) and chronic kidney disease (CKD) is quite complex. OSA can cause hypoxia, activation of the sympathetic nervous system, and hypertension, all of which can have negative effects on kidney function. On the other hand, in patients with end-stage renal disease (ESRD), intensifying renal replacement therapy has shown some improvement in sleep apnea severity, suggesting a bi-directional relationship between the two conditions. While there are still uncertainties, recent studies have focused on understanding the interplay between OSA and CKD.
The role of CPAP therapy, a common treatment for OSA, in relation to CKD is not yet clear. Observational studies present findings regarding the impact of CPAPs on kidney function. However, researchers are actively investigating its cardiovascular benefits and its influence on the progression of CKD.
The objective of this study is to analyze the trends in composite cardiovascular events in hospital encounters among geriatric patients with CKD, comparing those with and without obstructive sleep apnea. Additionally, we are also investigating sex and racial disparities in trends of major adverse cardiovascular and cerebrovascular events (MACCE) among geriatric patients with obstructive sleep apnea (OSA). Furthermore, we are assessing the impact of continuous positive airway pressure (CPAP) treatment and dependence on MACCE outcomes in OSA patients
Valentina Paz[/caption]
Valentina Paz, M.Sc 
Joanna Gorgol[/caption]
Joanna Gorgol
PhD Student
University of Warsaw
MedicalResearch.com: What is the background for this study?
Response: People differ in the time when they prefer to wake up and fall asleep: some people prefer going to bed and waking up early, while others prefer later hours. Most of the population is somewhere between them. Research indicates that being a morning person is related to reporting higher satisfaction with life and conscientiousness. Studies also show the associations between being religious and having higher life satisfaction and conscientiousness. It seems that religiosity might mediate the relationship between morningness and higher life satisfaction. To better understand these associations we conducted two questionnaire-based studies of Polish adults, one with 500 participants and the other with 728 participants. All participants completed questionnaires measuring their chronotype, satisfaction with life, personality traits, and religiosity
Dr. Caraballo-Cordovez[/caption]
César Caraballo-Cordovez, MD
Dr. Kubik[/caption]
Martha Kubik, Ph.D., R.N.
Professor, School of Nursing
College of Health and Human Services
George Mason University
Member, U.S. Preventive Services Task Force
MedicalResearch.com: What is the background for this study?
Response: Obstructive sleep apnea is a health condition in which part or all of a person’s airway gets blocked during sleep, causing their breathing to stop and restart many times. Untreated sleep apnea is associated with heart disease, stroke, and diabetes. However, there is currently very limited evidence on screening people who don’t have signs or symptoms like snoring and excessive daytime sleepiness.
Dr. Shan[/caption]
Zhilei Shan, MD, PhD
Postdoctoral fellow on Nutritional Epidemiology
Harvard T.H. Chan School of Public Health
MedicalResearch.com: What is the background for this study?
Response: Unhealthy sleep behaviors and sleep disturbances are associated with higher risk of multiple diseases and mortality. The current profiles of sleep habits and disturbances, particularly the differences between workdays and free days, are unknown in the contemporary US.
MedicalResearch.com: What are the main findings?
Response: In this nationally representative cross-sectional analysis with 9004 adults aged 20 years or older, differences in sleep patterns between workdays and free days were observed. The mean sleep duration was 7.59 hours on workdays and 8.24 hours on free days (difference, 0.65 hour). The mean sleep and wake times were at 11:02 PM and 6:41 AM, respectively, on workdays and 11:25 PM and 7:41 AM, respectively, on free days (differences, 0.23 hour for sleep time and 1.00 hour for wake time). With regard to sleep disturbances, 30.5% of adults experienced 1 hour or more of sleep debt,46.5% experienced 1 hour or more of social jet lag, 29.8% had trouble sleeping, and 27.2% experienced daytime sleepiness.
Dr. Robbins[/caption]
Rebecca Robbins, Ph.D.
Instructor in Medicine
Associate Scientist, Division of Sleep and Circadian Disorders
Investigator, Division of Sleep and Circadian Disorders
Departments of Medicine and Neurology
Brigham and Women's Hospital
MedicalResearch.com: What is the background for this study?
Response: Teens face myriad challenges to sleep, ranging from biological factors, including a preference for later bedtimes and increased need for sleep, to social factors, including social pressures and increased academic workloads, all limiting teenagers in their ability to keep a healthy sleep schedule.
In a nationally representative sample, we explored the prevalence of another potential barrier to sleep among teens, which are a set of beliefs that are held in the population, yet are actual counter to scientific principles regarding sleep and circadian rhythms.
Dr. Malin[/caption]
Steven K. Malin, PhD, FACSM (he/him)
Associate Professor
Department of Kinesiology and Health | School of Arts and Sciences
Division of Endocrinology, Metabolism and Nutrition | Robert Wood Johnson Medical School
Institute of Translational Medicine and Science
New Brunswick, NJ 08901
MedicalResearch.com: What is the background for this study?
Response: Type 2 diabetes is a condition where blood glucose (sugar) is elevated in the blood. This can be problematic as it leads to blood vessel damage and the promotion of cardiovascular disease. Nearly 30 million people in the U.S. have type 2 diabetes, making it a major public health issue. The cause is not entirely clear, but many, including our team view insulin resistance as a central culprit.
Insulin resistance is when the body does not respond well to the hormone insulin. Insulin is vital because it promotes glucose uptake into tissues, like skeletal muscle. Two reasons that are often used to explain the development of insulin resistance include: poor diet (e.g. high sugar and/or high fat coupled with excess calories) and a lack of physical activity. However, more recently, a lack of sleep has been raised as another critical behavioral factor contributing to insulin resistance. Thus, targeting a healthy diet, activity and sleep pattern is thought to prevent the transition from health to insulin resistance and type 2 diabetes.
Dr. Duffy[/caption]
Jeanne Duffy, MBA, PhD
Associate Professor of Medicine
Division of Sleep and Circadian Disorders
Harvard Medical School
MedicalResearch.com: What is the background for this study?
Response: Aging is associated with changes in sleep timing, quality and duration, and even older adults without chronic medical problems have shorter and more disrupted sleep than young adults. Many prescription sleep aids increase the risk of nighttime falls, have
adverse effects on next‐day cognition, and are associated with increased mortality, and so are not recommended for long-term use in older adults. In previous studies, we and others have shown that melatonin, a hormone secreted at night, increases sleep duration in young adults but only when administered during the day when endogenous melatonin levels are low. We wanted to explore whether melatonin could improve the sleep of healthy adults and whether, like young adults, its impact depends on when during the day the person is trying to sleep.
Dr. Ying-Hui Fu[/caption]
Ying-Hui Fu, PhD
Professor, Neurology
Weill Institute for Neurosciences
UCSF
MedicalResearch.com: What is the background for this study?
Response: Most people are aware that a lack of sleep is associated with all sorts of health issues. However, familial natural short sleeper (FNSS) individuals sleep 4-6.5 hours a night most of their live and stay healthy. We set out to determine whether natural short sleep mutations can offer protection from various diseases. We chose Alzheimer as an example to start.
Dr. Cortese[/caption]
Rene Cortese, PhD
Assistant Professor
Department of Child Health – Child Health Research Institute
Department of Obstetrics, Gynecology and Women’s Health
School of Medicine
Core Faculty - MU Institute for Data Science and Informatics
University of Missouri
Columbia, MO 65212
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Obstructive sleep apnea (OSA) affects 22 million people in the U.S. and is linked to a higher risk of hypertension, heart attacks, stroke, diabetes, and many other chronic conditions.
We have found that untreated OSA also accelerates the biological aging process, and that appropriate treatment can slow or possibly reverse the trend. Age acceleration testing involves a blood test that analyzes DNA and uses an algorithm to measure a person’s biological age. The phenomenon of a person’s biological age surpassing their chronological age is called “epigenetic age acceleration” and is linked to overall mortality and to chronic diseases.
Dr. Fernandez-Mendoza[/caption]
Julio Fernandez-Mendoza, PhD, CBSM, DBSM
Associate Professor of Psychiatry & Behavioral Health
Sleep Research & Treatment Center
Director, Behavioral Sleep Medicine Program
Penn State Health Milton S. Hershey Medical Center
MedicalResearch.com: What is the background for this study? Is insomnia familial?
Response: Consistent research has shown that about 25% of school-age children have insomnia symptoms consisting of difficulties initiating or maintaining sleep. However, what has remained unknown is to what extent those insomnia symptoms persist all the way into adulthood, or whether they developmentally remit (go away with age) as the child grows into adolescence or young adulthood. This is the question that our study focused on.
Dr. Ferrara[/caption]
Michele Ferrara, PhD.
Professor of Psychobiology and Physiological Psychology
Chair of the Psychology Didactic Council
Department of Biotechnological and Applied Clinical Sciences
University of L'Aquila
MedicalResearch.com: What is the background for this study?
Response: During the current period of social distancing, the pervasive increase in the use of electronic devices (smartphones, computers, tablets and televisions) is an indisputable fact. Especially during the long lockdown period of Spring 2020, technologies played a pivotal role in coping with the unprecedented and stressful isolation phase. However, exposure to backlit screens in the hours before falling asleep can have serious repercussions on sleep health: on the one hand, by mimicking the effects of exposure to sunlight, and thus interfering with the circadian rhythm of the hormone melatonin, and on the other hand, counteracting the evening sleepiness due to the emotionally and psycho-physiologically activating contents.
In light of this assumption, we decided to test longitudinally during the third and the seventh week of lockdown a large Italian sample (2123 subjects) through a web-based survey. We assessed sleep disturbances/habits and the occurring changes of electronic device usage in the 2 hours before the sleep onset.
Dr. Gamboa Madeira[/caption]
Sara Gamboa Madeira
Medical Doctor - General & Family Physician
PhD Student - EnviHealth&Co - Faculty of Medicine
Lisbon University
MedicalResearch.com: What is the background for this study?
Response: One in every five employees work in shifts across Europe1. Shift work have been associated with an increased risk for several cardiovascular diseases2 and three main mechanism have been proposed: unhealthy behaviours, disturbed sleep, and circadian misalignment.
This study focused on the role of circadian misalignment, which we assessed via social jetlag. Social jetlag is calculated using the Munich Chronotype Questionnaire3 by the difference between sleep behaviour on free-days (mainly driven by the individual “biological clock”, also called chronotype) and sleep behaviour on workdays (mainly drive by the “social clock”, namely work schedules). Chronotype is an individual feature which ranges from early/morning people to late/evening people (from proverbial lark to owls), with the majority of the population falling in between as a Gaussian distribution. Therefore higher levels of social jetlag mean a greater mismatch between what your biological clock need (e.g. go to sleep at 9pm) and what your social obligations impose on you (e.g. work until midnight).
Dr. Dunietz[/caption]
Galit Levi Dunietz MPH, PhD
Assistant Professor
Dr. Braley[/caption]
Dr. Grant[/caption]
Leilah K. Grant, PhD
Postdoctoral Research Fellow in Medicine
Brigham and Women’s Hospital
Harvard Medical School
MedicalResearch.com: What is the background for this study?
Response: The prevalence of obesity increases in women around the age of menopause which increases the risk of diseases like diabetes and heart disease. Changes in hormones, like estrogen, are thought to contribute to weight gain during menopause, but other common symptoms of menopause such as sleep interruption may also play a role. While short sleep is known to adversely affect metabolism, little is known about the metabolic consequences of the type of sleep disruption most common in menopausal women – increased nighttime awakenings (i.e., sleep interruption) caused by hot flashes, but no change in overall sleep duration. We therefore did this study to see how an experimental model menopause-related sleep interruption would affect metabolic outcomes that may contribute to weight gain. 
Dr. Batool-Anwar[/caption]
Salma Batool-Anwar, MBBS, MPH
Instructor, Harvard Medical School
Pulmonary and Critical Care, Sleep Medicine
Brigham and Women's Faulkner Hospital
MedicalResearch.com: What is the background for this study?
Response: A well functioning sleep-wake cycle is vital to our health and prevention of chronic diseases.
During previous disaters sleep disturbances have been reported.
When Massachusetts governor declared a state of emergency in March’20, we hypothesized that sleep duration would be adversely affected by covid-19 related lockdown and stress.
The study was approved by the institutional review board and information was collected retrospectively using the electronic medical records. 
Nathan B. Warren[/caption]
Nathan Warren is a Ph.D. candidate in marketing at the University of Oregon. His research examines how people respond when social norms, such as masculinity norms, are disrupted by social change. He hopes that his research can empower people who are struggling to adapt to changing norms to live healthier, happier, and more productive lives. For more information on his research, please visit: www.nathanwarrenresearch.com
[caption id="attachment_55579" align="alignleft" width="150"]
Dr. Troy Campbell[/caption]
Dr. Troy Campbell is a behavioral scientist (PhD, Duke University), former marketing professor (University of Oregon), former art, film, and psychology scholar (UC Irvine), professional designer and researcher (Netflix Insights, Disney Imagineering, UnitedHealth) and currently chief scientist at On Your Feet. Troy believes everything can be awesome when you start with the right science and follow with the right creative process, and he hopes his professional services or public guides can help his clients make something awesome and impactful. For more information on Troy Campbell, please visit: www.troy-campbell.com
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: In the United States, the average American sleeps less than the minimum seven hours of sleep per night recommended by the Center for Disease Control, and nearly half of Americans report negative consequences from insufficient sleep. This problem appears to be especially prevalent in men, who report getting significantly less sleep, on average, than women.
A cultural complication is the notion that getting less than the recommended amount of sleep signals something positive about an individual. For example, US President Donald Trump has boasted about getting less than four hours of sleep per night and regularly derogates his political opponent Joe Biden as “Sleepy Joe.”
"The Sleep-Deprived Masculinity Stereotype," a new paper in the Journal of the Association for Consumer Research, examines a possible stereotype connecting sleep and masculinity along with its underlying mechanisms and its social implications.
Authors Nathan B. Warren and Troy H. Campbell conducted 12 experiments involving 2,564 American participants to demonstrate that a sleep-deprived masculinity stereotype exists. In one experiment, participants were asked to imagine seeing a man shopping for a bed. Then, a salesperson asked the man, “How much do you normally sleep?” The results found that the mean masculinity rating for participants in the lots of sleep condition was significantly lower than the mean masculinity rating for participants in the little sleep condition.
In another experiment, participants were asked to ascribe different attributes to a male character, assigned to either a “very masculine and manly” man or a “not very masculine and not very manly” man. Participants in the masculine condition described their character sleeping 33 minutes less sleep per night than the characters described in the not masculine condition. A final experiment showed that participants who imagined stating they sleep more than average felt significantly less masculine than participants who imagined stating they sleep less than average.
Collectively, the experiments found that men who sleep less are seen as more masculine and more positively judged by society. The same patterns were not consistently observed for perceptions of women. 
Dr. Moline[/caption]
Margaret Moline, PhD
Executive Director, Neurology Business Group, Eisai, Inc
Lemborexant International Program Lead and Global Medical Lead
MedicalResearch.com: What is the background for this study? What are the main findings?
