Background: Sedentary behaviour is waking activity in a seated or reclined position that involves little energy expenditure. It is gaining attention as an important cardiometabolic risk factor, independent of physical activity. Studies assessing the relationship between sedentary behaviour and cardiometabolic risk have not accounted for sleep duration as a potential covariate, although there is evidence that sleep duration may be related to both sedentary behaviour and cardiometabolic risk. Objectives: To examine the associations between sleep duration and sedentary behaviour in adults, and determine if sedentary behaviour is related to the metabolic syndrome (MetS) after controlling for sleep duration. Methods: This cross-sectional study used data from the 2003-2006 National Health and Nutrition Examination Survey, a representative sample of Americans. There were 1371 adults over the age of 20 that were studied. Average daily sedentary time and sleep duration were determined via 7-day accelerometry. Screen time (television, computer) was determined via questionnaire. The MetS was determined using standard criteria. Analysis of variance was used to examine relationships among sedentary time and screen time with sleep duration. Multiple logistic regression was used to examine associations between total sedentary time, screen time, and sleep duration with the MetS after controlling for several covariates. Results: Sedentary time and screen time did not vary across sleep duration quartiles (p=0.08 and p=0.87, respectively), and therefore were unrelated to sleep duration. The relative odds of the MetS was significantly higher in participants in the highest quartile of sedentary time than in participants in the lowest quartile (OR=1.60, 95% CI:1.05-2.45). The relative odds of the MetS was higher in participants in the highest screen time tertile than in participants in the lowest tertile (OR =1.67, 95% CI:1.13-2.48). Short sleep duration was not independently related to the MetS, but was borderline related to waist circumference (OR=1.25, 95% CI:0.85-1.84). Conclusion: Highly sedentary individuals and individuals with a high screen time are more likely to have the MetS, independent of sleep duration. Future studies in this area would benefit from using more advanced objective measures of sedentary behaviour and sleep duration and a prospective study design. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2013-10-29 15:40:55.494

ZUGZWANG is a proof-of-concept short horror film following Ian Sepela, a man being haunted by the Shadow Man, a sleep paralysis demon. He must confront his past to save himself and his mother from the Shadow Man’s clutches or lose their lives just like he’d lost his father’s to the Shadow Man twenty years prior.

Introdução: A doença arterial coronariana (DAC) constitui uma das principais causas de mortalidade mundial à despeito dos avanços no seu tratamento. Neste sentido, importantes comorbidades podem contribuir para este cenário desfavorável. Um dos fatores de pior prognóstico nos pacientes com DAC é a presença da doença renal crônica (DRC). Entre os potenciais novos candidatos para este prognóstico desfavorável, podemos citar os distúrbios do sono. Diversos estudos sugerem que a apneia obstrutiva do sono (AOS) e a curta duração do sono (CDS) isoladamente estão associados com piores desfechos cardiovasculares, incluindo uma maior incidência de DAC. No entanto, não está claro se a interação da AOS com a CDS está associada com pior função renal e com maior taxa de DRC em pacientes com DAC bem como maior taxa combinada de eventos cardiovasculares e não cardiovasculares. Métodos: Foram recrutados pacientes consecutivos com DAC estabelecida (pacientes com indicação clínica para a intervenção coronária percutânea, ICP) eletiva. Após a realização da ICP com implante de stent com sucesso (estenose residual < 20% e fluxo TIMI 2- 3), todos os pacientes foram submetidos à monitorização do sono com a poligrafia portátil (Embletta Gold®) por uma noite (ainda durante a internação hospitalar) e à actigrafia de pulso (Actiwatch 2, Respironics®) durante sete dias (após o retorno do paciente às atividades habituais). Definimos a AOS por um índice de apneia-hipopneia (IAH) >=15 eventos/hora e a CDS por <6 horas por noite de sono. Nós estratificamos a associação da AOS, da CDS e a interação de ambas baseada na taxa de filtração glomerular (TFG) e a presença de DRC com exame de creatinina coletado pré-ICP. Estimamos a TFG usando a equação do Chronic Kidney Disease: Epidemiology Consortium (CKD-EPI) de forma contínua e categorizada em dois níveis: TFG < 60mL/min/1.73 m2 (diminuição moderada a grave) e TFG > 60mL/min/1.73 m2 (normal ou levemente diminuído). Após o exame do sono, o seguimento clínico foi realizado por meio de ligações telefônicas e checagem dos prontuários com 1 mês, 6 meses e depois anualmente procurando avaliar a ocorrência de eventos cardiovasculares fatais e não fatais de forma sistematizada. Resultados: Foram estudados 262 pacientes (64,1% sexo masculino, idade média: 63±10 anos e índice de massa corpórea [IMC] 27,8±4,4 Kg/m2). A frequência da AOS e CDS foi de 58,4% e 25,6%, respectivamente. Pacientes com AOS apresentaram pior TFG em relação aos pacientes sem AOS (62±26 vs. 74±20 mL/min/1,73m2, p < 0,001) e consequentemente maior taxa de DRC (42,1 vs. 26,6%, p=0,009). Em contraste, a TFG foi similar nos pacientes com e sem CDS (65±29 vs. 68±23 mL/min/1,73m2, p=0,38) e uma frequência não significante de DRC (44.8 vs. 32.5%, p=0.07). Na análise multivariada, AOS, mas não a CDS, foi independentemente associada com a TFG: beta= -10,57 (-16,46 - - 4,68), p < 0,001) e com a DRC (OR=1,95; 95% IC=1,12-3.38, p=0,01). As interações da AOS e da CDS com a TFG e a presença da DRC não foram significantes. Os resultados permaneceram similares após avaliarmos a AOS (pelo IAH) e a duração do sono de forma continua ou ao classificarmos a CDS como < 5 horas. Em uma análise exploratória, após seguimento mediano foi de 25 meses, ocorreram 43 eventos cardiovasculares (15 infartos agudos do miocárdio; 1 revascularização do miocárdio; 6 acidentes vasculares cerebrais; 7 óbitos cardiovasculares e 14 reestenoses de stent). Considerando os eventos combinados, não encontramos até o momento diferenças significantes entre os grupos com AOS e CDS quando comparados aos respectivos grupos sem estes distúrbios. Conclusão: Em pacientes com DAC, a AOS, mas não a CDS, foi independentemente associada com pior TFG e DRC, marcadores de pior prognóstico nestes pacientes / Introduction: Coronary artery disease (CAD) is one of the main causes of worldwide mortality despite advances in the medical treatment. In this sense, important comorbidities can contribute to this unfavorable scenario. One of the factors associated with poor prognosis in patients with CAD is the presence of chronic kidney disease (CKD). Sleep disorders are potential new candidates contributing to poor prognosis in CAD as well. Although not consistent, several studies suggested that obstructive sleep apnea (OSA) or short sleep duration (SSD) are associated with a higher prevalence of CAD and poor cardiovascular outcomes, including higher CAD incidence. However, it is unclear whether the interaction of OSA with SSD is associated with lower renal function and higher frequency of CKD in patients with established CAD, as well as with increased rate of cardiovascular and non-cardiovascular events. Methods: Consecutive patients with established CAD (those with clinical indication for elective percutaneous coronary intervention, PCI) were recruited. After a successful PCI procedure (residual stenosis < 20% and TIMI 2-3 flow), all patients underwent sleep monitoring with portable polygraphy (Embletta Gold®) for one night (during hospital stay) and wrist actigraphy (Actiwatch 2, Respironics®) for seven days (after patient return to usual activities). We defined OSA by an apnea-hypopnea index (AHI) >= 15 events / hour and SSD for < 6 hours per night of sleep. We stratified the association of OSA, SSD and their interaction based on the eGFR and the presence of CKD with the creatinine collected pre PCI procedure. We estimated eGFR using the Chronic Kidney Disease: Epidemiology Consortium (CKD-EPI) equations and categorized into two levels: eGFR < 60mL / min / 1.73 m2 (moderate to severe decrease) and eGFR > 60mL / min / 1.73 m2 (normal or mildly decreased). After the sleep study, clinical follow-up was performed through phone calls and medical records revisions at 1 month, 6 months, and then annually, searching for the occurrence of fatal and non-fatal cardiovascular events in a systematized way. Results: A total of 262 patients (64.1% males, mean age: 63±10 years and body mass index [BMI] 27.8±4.4 kg/m2) were studied. The frequencies of OSA and SSD were 58.4% and 25.6%, respectively. Patients with OSA had lower eGFR compared to patients without OSA (62±26 vs. 74±20 mL/min/1.73m2, p < 0.001) and consequently a higher rate of CKD (42.1 vs. 26.6%, p=0.009). In contrast, eGFR was similar in patients with and without SSD (65±29 vs. 68±23 mL/min/1.73 m2, p=0.38) and a no significance frequency of CKD (44.8 vs. 32.5%, p=0.07). In the multivariate analysis, AOS, but not SSD, was independently associated with eGFR (-10.57 (-16.46 - -4.68), p < 0.001) and with CKD (OR = 1.95, 95% CI=1.12-3.38, p=0.01). The interactions of OSA and SSD with eGFR and the presence of CKD were not significant. These results remained unchanged after evaluating AHI and sleep duration as continuous variables or setting SSD as < 5 hours. In an exploratory analysis, after a median follow up of 25 months, forty-three cardiovascular events (15 episodes of acute myocardial infarction, 1 coronary artery bypass graft, 6 strokes, 7 deaths and 14 stent restenosis). Considering the combined events, we did not find significant differences between OSA and SSD groups and their counterparts so far. Conclusion: In patients with CAD, OSA, but not SSD was independently associated with lower GFR and CKD, markers of poor prognosis in these patients

Insufficient sleep may be associated with obesity via increased energy intake and/or decreased energy expenditure. The present study therefore aimed to investigate effects of sleep restriction on energy balance in healthy young adults. Participants (14 men, 13 women) aged 35.3 ± 1.0 y with 23.6 ± 0.2 kg/m2 BMI completed a randomized, crossover study exposed to short and habitual sleep with 4 wk washout. Controlled diets were provided during the first 4 d, followed by 2 d of ad libitum eating. Ad libitum energy intake, energy expenditure and physical activity level were determined as well as energy balance and body weight. Results showed that ad libitum energy intake (p = 0.031), as well as total fat (p = 0.018) increased after short compared with habitual sleep, but physical activity level, energy expenditure, energy balance, and body weight remained unaffected by sleep duration. In conclusion, sleep deprivation elevates energy intake, which may lead to positive energy balance over time and increase the risk of weight gain and/or obesity.

Insufficient sleep may be associated with obesity via increased energy intake and/or decreased energy expenditure. The present study therefore aimed to investigate effects of sleep restriction on energy balance in healthy young adults. Participants (14 men, 13 women) aged 35.3 ± 1.0 y with 23.6 ± 0.2 kg/m2 BMI completed a randomized, crossover study exposed to short and habitual sleep with 4 wk washout. Controlled diets were provided during the first 4 d, followed by 2 d of ad libitum eating. Ad libitum energy intake, energy expenditure and physical activity level were determined as well as energy balance and body weight. Results showed that ad libitum energy intake (p = 0.031), as well as total fat (p = 0.018) increased after short compared with habitual sleep, but physical activity level, energy expenditure, energy balance, and body weight remained unaffected by sleep duration. In conclusion, sleep deprivation elevates energy intake, which may lead to positive energy balance over time and increase the risk of weight gain and/or obesity.