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Gender and age are well-established determinants of health and sleep health that influence overall health, which also often varies by gender and age. Sleep architecture is an important component of sleep health. The goal of this analysis was to examine whether associations between age and sleep stages differ by gender in the absence of moderate-severe obstructive sleep apnea (OSA) in a rural setting in Brazil. This study conducted polysomnography recordings in the Baependi Heart Study, a cohort of Brazilian adults. Our sample included 584 women and 309 men whose apnea-hypopnea index was ≤15 events/h. We used splines to distinguish non-linear associations between age, total sleep time, wake after sleep onset (WASO), N2, N3, and rapid-eye-movement sleep. The mean (standard deviation; range) age was 47 (14; 18-89) years. All sleep outcomes were associated with age. Compared to men, women had more N3 sleep and less WASO after adjusting for age. Model-based comparisons between genders at specific ages showed statistically higher mean WASO for men at ages 60 (+13.6 min) and 70 years (+19.5 min) and less N3 for men at ages 50 (-13.2 min), 60 (-19.0 min), and 70 years (-19.5 min) but no differences at 20, 30, 40 or 80 years. The other sleep measures did not differ by gender at any age. Thus, even in the absence of moderate-severe OSA, sleep architecture was associated with age across adulthood, and there were gender differences in WASO and N3 at older ages in this rural community.
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OBJECTIVES: Comorbid depression is a highly prevalent and debilitating condition in middle-aged and elderly adults, particularly when associated with obesity, diabetes, and sleep disturbances. In this context, there is a growing need to develop efficient screening methods for cases based on clinical health markers for these comorbidities and sleep data. Thus, our objective was to detect depressive symptoms in these subjects, considering general biomarkers of obesity and diabetes and variables related to sleep and physical exercise through a machine learning approach. METHODS: We used the National Health and Nutrition Examination Survey (NHANES) 2015-2016 data. Eighteen variables on self-reported physical activity, self-reported sleep habits, sleep disturbance indicative, anthropometric measurements, sociodemographic characteristics and plasma biomarkers of obesity and diabetes were selected as predictors. A total of 2907 middle-aged and elderly subjects were eligible for the study. Supervised learning algorithms such as Lasso penalized Logistic Regression (LR), Random Forest (RF) and Extreme Gradient Boosting (XGBoost) were implemented. RESULTS: XGBoost provided greater accuracy and precision (87%), with a proportion of hits in cases with depressive symptoms above 80%. In addition, daytime sleepiness was the most significant predictor variable for predicting depressive symptoms. CONCLUSIONS: Sleep and physical activity variables, in addition to obesity and diabetes biomarkers, together assume significant importance to predict, with accuracy and precision of 87%, the occurrence of depressive symptoms in middle-aged and elderly individuals.
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Depressão , Diabetes Mellitus , Idoso , Pessoa de Meia-Idade , Humanos , Adulto , Depressão/diagnóstico , Depressão/epidemiologia , Inquéritos Nutricionais , Sono , Obesidade/epidemiologia , Aprendizado de MáquinaRESUMO
OBJECTIVES: Prior studies have examined sleep during the coronavirus disease 2019 (COVID-19) pandemic, but have few compared sleep measured both during and prior to COVID. We examined the impact of the COVID-19 pandemic on subjective sleep quality in general and separately by gender and age (<50 vs. ≥50 years). Further, we compared sleep quality between those who did and did not follow quarantine orders. METHODS: This sample is from the Baependi Heart Study, a family-based cohort of adults in South-eastern Brazil. Longitudinal data were from 417 individuals who completed the Pittsburgh Sleep Quality Index (PSQI) twice: between January 2010 and September 2014 (pre-COVID) and during the COVID-19 stay-at-home order March-June, 2020. Cross-sectional analysis included 800 participants. RESULTS: Mean (±SD) PSQI scores were significantly higher during than before COVID-19 (5.7 ± 3.8 vs. 5.0 ± 3.3, p < .01). This increase was significant among women and among adults ≥50 years but not in men or younger adults. The significant increase in PSQI was only observed in those who quarantined during COVID-19 (5.9 ±3.7 vs. 5.2 ±3.4, p < .01) and not those who did not quarantine (5.0 ± 3.7 vs. 4.5 ± 3, p = .12). In cross-sectional analyses, individuals who quarantined had higher PSQI scores than nonquarantined individuals (6.1 ± 3.9 vs. 5.0 ± 3.5, p < .01). The quarantine status-dependent differences were significant for women (6.4 ± 4 vs. 5.2 ± 3.7, p < .01) and older adults (6.6 ± 0.1 vs. 5.5 ± 3.3, p = .04). Differences by quarantine status were attenuated after adjusting for age and gender. CONCLUSIONS: Subjective sleep quality declined during the COVID-19 pandemic, particularly among women, older adults, and those compliant to quarantine orders.
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COVID-19 , Idoso , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pandemias , População Rural , SARS-CoV-2 , Qualidade do SonoRESUMO
It is well established that the oldest chronotype questionnaire, the morningness-eveningness questionnaire (MEQ), has significant heritability, and several associations have been reported between MEQ score and polymorphisms in candidate clock genes, a number of them reproducibly across populations. By contrast, there are no reports of heritability and genetic associations for the Munich chronotype questionnaire (MCTQ). Recent genome-wide association studies (GWAS) from large cohorts have reported multiple associations with chronotype as assessed by a single self-evaluation question. We have taken advantage of the availability of data from all these instruments from a single sample of 597 participants from the Brazilian Baependi Heart Study. The family-based design of the cohort allowed us to calculate the heritability (h2) for these measures. Heritability values for the best-fitted models were 0.37 for MEQ, 0.32 for MCTQ, and 0.28 for single-question chronotype (MEQ Question 19). We also calculated the heritability for the two major factors recently derived from MEQ, "Dissipation of sleep pressure" (0.32) and "Build-up of sleep pressure" (0.28). This first heritability comparison of the major chronotype instruments in current use provides the first quantification of the genetic component of MCTQ score, supporting its future use in genetic analysis. Our findings also suggest that the single chronotype question that has been used for large GWAS analyses captures a larger proportion of the dimensions of chronotype than previously thought.
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Ritmo Circadiano , Estudo de Associação Genômica Ampla , Ritmo Circadiano/genética , Estudos de Coortes , Humanos , Sono/genética , Inquéritos e QuestionáriosRESUMO
Individual variability in diurnal preference or chronotype is commonly assessed with self-report scales such as the widely used morningness-eveningness questionnaire (MEQ). We sought to investigate the MEQ's internal consistency by applying exploratory factor analysis (EFA) to determine the number of underlying latent factors in four different adult samples, two each from the United Kingdom and Brazil (total N = 3,457). We focused on factors that were apparent in all samples, irrespective of particular sociocultural diversity and geographical characteristics, so as to show a common core reproducible structure across samples. Results showed a three-factor solution with acceptable to good model fit indexes in all studied populations. Twelve of the 19 MEQ items in the three-correlated factor solution loaded onto the same factors across the four samples. This shows that the scale measures three distinguishable, yet correlated constructs: (1) items related to how people feel in the morning, which we termed efficiency of dissipation of sleep pressure (recovery process) (items 1, 3, 4, 5, 7, 9, 13, and 19); (2) items related to how people feel before sleep, which we called sensitivity to buildup of sleep pressure (items 2, 10, and 12); and (3) peak time of cognitive arousal (item 11). Although the third factor was not regarded as consistent since only one item was common among all samples, it might represent subjective amplitude. These results suggested that the latent constructs of the MEQ reflect dissociable homeostatic processes in addition to a less consistent propensity for cognitive arousal at different times of the day. By analyzing answers to MEQ items that compose these latent factors, it may be possible to extract further knowledge of factors that affect morningness-eveningness.
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Ritmo Circadiano , Sono , Adulto , Brasil , Análise Fatorial , Humanos , Inquéritos e Questionários , Reino UnidoRESUMO
CONTEXT: Metabolic syndrome (MetS) is a complex condition comprising a 'clustering' of components representing cardiometabolic risk factors for heart disease and diabetes; its prevalence rate is high and consequences serious. Evidence suggests that light exposure patterns and misalignment of circadian rhythms might contribute to MetS etiology by impacting energy metabolism and glucose regulation. OBJECTIVE: We hypothesised that individuals with MetS would show disrupted circadian and sleep parameters alongside differences in light exposure profiles. We investigated this using data from a cohort study in Brazil. METHODS: Data from 103 individuals from the Baependi Heart Cohort Study aged between 50 and 70 were analysed. Motor activity and light exposure were measured using wrist-worn actigraphy devices. Cardiometabolic data were used to calculate the number of MetS components present in each participant, and participants grouped as MetS/non-MetS according to standard guidelines. Between-group comparisons were made for the actigraphy measures; additionally, correlation analyses were conducted. RESULTS: Motor activity and circadian profiles showed no differences between groups. However, the MetS group presented lower light exposure during the day and higher light exposure at night. Correlation analyses, including all participants, showed that greater daytime light exposure and greater light exposure difference between day and night were associated with reduced MetS risk (a lower number of MetS components). Also, the light exposure difference between day and night correlated with body mass index across all participants. CONCLUSIONS: The observed results suggest a direct association between light exposure and MetS which appears to not be attributable to disruptions in circadian activity rhythm nor to sleep parameters. This link between light exposure patterns and MetS risk could inform possible prevention strategies.
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Luz , Síndrome Metabólica/etiologia , Actigrafia/métodos , Idoso , Brasil/epidemiologia , Ritmo Circadiano , Estudos de Coortes , Correlação de Dados , Feminino , Glucose/metabolismo , Humanos , Masculino , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Obesidade/epidemiologia , Prevalência , SonoRESUMO
Studying communities at different stages of urbanisation and industrialisation can teach us how timing and intensity of light affect the circadian clock under real-life conditions. We have previously described a strong tendency towards morningness in the Baependi Heart Study, located in a small rural town in Brazil. Here, we tested the hypothesis that this morningness tendency is associated with early circadian phase based on objective measurements (as determined by dim light melatonin onset, DLMO, and activity) and light exposure. We also analysed how well the previously collected chronotype questionnaire data were able to predict these DLMO values. The average DLMO observed in 73 participants (40 female) was 20:03 ± 01:21, SD, with an earlier average onset in men (19:38 ± 01:16) than in women (20:24 ± 01:21; P ≤ .01). However, men presented larger phase angle between DLMO and sleep onset time as measured by actigraphy (4.11 hours vs 3.16 hours; P ≤ .01). Correlational analysis indicated associations between light exposure, activity rhythms and DLMO, such that early DLMO was observed in participants with higher exposure to light, higher activity and earlier light exposure. The strongest significant predictor of DLMO was morningness-eveningness questionnaire (MEQ) (beta=-0.35, P ≤ .05), followed by age (beta = -0.47, P ≤ .01). Sex, light exposure and variables derived from the Munich chronotype questionnaire were not significant predictors. Our observations demonstrate that both early sleep patterns and earlier circadian phase have been retained in this small rural town in spite of availability of electrification, in contrast to metropolitan postindustrial areas.
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Relógios Circadianos/fisiologia , Ritmo Circadiano/fisiologia , Melatonina/metabolismo , População Rural , Sono/fisiologia , Inquéritos e Questionários , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
AIM: To test the association between cardiometabolic risk factors and subjective sleep quality assessed by the Pittsburgh sleep quality index (PSQI), independent of obstructive sleep apnea (OSA) and sleep duration. METHODS: A total of 573 participants from the Baependi Heart Study, a rural cohort from Brazil, completed sleep questionnaires and underwent polygraphy for OSA evaluation. Multivariable linear regression analysis tested the association between cardiovascular risk factors (outcome variables) and sleep quality measured by PSQI, adjusting for OSA and other potential confounders (age, sex, race, salary/wage, education, marital status, alcohol intake, obesity, smoking, hypertension, and sleep duration). RESULTS: The sample mean age was 43 ± 16 years, 66% were female, and mean body mass index (BMI) was 26 ± 5 kg/m2. Only 20% were classified as obese (BMI ≥30). Overall, 50% of participants reported poor sleep quality as defined by a PSQI score ≥5. A high PSQI score was significantly associated with higher very-low-density lipoprotein (VLDL) cholesterol levels (beta = 0.392, p = 0.012) and higher triglyceride levels (beta = 0.017, p = 0.006), even after adjustments, including the apnea-hypopnea index. Further adjustments accounting for marital status, alcohol intake, and medication use did not change these findings. No significant association was observed between PSQI scores and glucose or blood pressure. According to PSQI components, sleep disturbances (beta = 1.976, p = 0.027), sleep medication use (beta = 1.121, p = 0.019), and daytime dysfunction (beta = 1.290, p = 0.024) were significantly associated with higher VLDL serum levels. Only the daytime dysfunction domain of the PSQI components was significantly associated with higher triglyceride levels (beta = 0.066, p = 0.004). CONCLUSION: Poorer lipid profile was independently associated with poor sleep quality, assessed by the PSQI questionnaire, regardless of a normal sleep duration and accounting for OSA and socio-economic status.
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Lipídeos/sangue , População Rural , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/fisiopatologia , Sono/fisiologia , Adulto , Brasil , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Masculino , Obesidade , Polissonografia , Fatores de Risco , Inquéritos e QuestionáriosRESUMO
Significant questions remain unanswered regarding the genetic versus environmental contributions to racial/ethnic differences in sleep and circadian rhythms. We addressed this question by investigating the association between diurnal preference, using the morningness-eveningness questionnaire (MEQ), and genetic ancestry within the Baependi Heart Study cohort, a highly admixed Brazilian population based in a rural town. Analysis was performed using measures of ancestry, using the Admixture program, and MEQ from 1,453 individuals. We found an association between the degree of Amerindian (but not European of African) ancestry and morningness, equating to 0.16 units for each additional percent of Amerindian ancestry, after adjustment for age, sex, education, and residential zone. To our knowledge, this is the first published report identifying an association between genetic ancestry and MEQ, and above all, the first one based on ancestral contributions within individuals living in the same community. This previously unknown ancestral dimension of diurnal preference suggests a stratification between racial/ethnic groups in an as yet unknown number of genetic polymorphisms.
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Ritmo Circadiano , Indígenas Norte-Americanos/genética , Adulto , População Negra/genética , Brasil , Estudos de Coortes , Etnicidade , Feminino , Frequência do Gene , Homeostase , Humanos , Masculino , Pessoa de Meia-Idade , Polimorfismo Genético , População Rural , Sono , Inquéritos e Questionários , População Urbana , População Branca/genéticaRESUMO
PURPOSE: Cardiovascular disease (CVD) is a major challenge to global health. The same epidemiological transition scenario is replayed as countries develop, but with variations based on environment, culture and ethnic mixture. The Baependi Heart Study was set up in 2005 to develop a longitudinal family-based cohort study that reflects on some of the genetic and lifestyle-related peculiarities of the Brazilian populations, in order to evaluate genetic and environmental influences on CVD risk factor traits. PARTICIPANTS: Probands were recruited in Baependi, a small rural town in the state of Minas Gerais, Brazil, following by first-degree and then increasingly more distant relatives. The first follow-up wave took place in 2010, and the second in 2016. At baseline, the study evaluated 1691 individuals across 95 families. Cross-sectional data have been collected for 2239 participants. FINDINGS TO DATE: Environmental and lifestyle factors and measures relevant to cardiovascular health have been reported. Having expanded beyond cardiovascular health outcomes, the phenotype datasets now include genetics, biochemistry, anthropometry, mental health, sleep and circadian rhythms. Many of these have yielded heritability estimates, and a shared genetic background of anxiety and depression has recently been published. In spite of universal access to electricity, the population has been found to be strongly shifted towards morningness compared with metropolitan areas. FUTURE PLANS: A new follow-up, marking 10â years of the study, is ongoing in 2016, in which data are collected as in 2010 (with the exception of the neuropsychiatric protocol). In addition to this, a novel questionnaire package collecting information about intelligence, personality and spirituality is being planned. The data set on circadian rhythms and sleep will be amended through additional questionnaires, actimetry, home sleep EEG recording and dim light melatonin onset (DLMO) analysis. Finally, the anthropometric measures will be expanded by adding three-dimensional facial photography, voice recording and anatomical brain MRI.