Sleep restriction and delayed sleep associate with psychological health and biomarkers of stress and inflammation in women.

STUDY OBJECTIVES: Despite strong associations between sleep duration and health, there is no clear understanding of how volitional chronic sleep restriction (CSR) alters the physiological processes that lead to poor health in women. We focused on biochemical and psychological factors that previous research suggests are essential to uncovering the role of sleep in health. DESIGN: Cross-sectional study. SETTING: University-based. PARTICIPANTS: Sixty female participants (mean age, 19.3; SD, 2.1 years). MEASUREMENTS: We analyzed the association between self-reported volitional CSR and time to go to sleep on a series of sleep and psychological health measures as well as biomarkers of immune functioning/inflammation (interleukin [IL]-1ß), stress (cortisol), and sleep regulation (melatonin). RESULTS: Across multiple measures, poor sleep was associated with decreased psychological health and a reduced perception of self-reported physical health. Volitional CSR was related to increased cortisol and increased IL-1ß levels. We separately looked at individuals who experienced CSR with and without delayed sleep time and found that IL-1ß levels were significantly elevated in CSR alone and in CSR combined with a late sleep time. Cortisol, however, was only elevated in those women who experienced CSR combined with a late sleep time. We did not observe any changes in melatonin across groups, and melatonin levels were not related to any sleep measures. CONCLUSIONS: New to our study is the demonstration of how an increase in a proinflammatory process and an increase in hypothalamic-pituitary-adrenal axis activity both relate to volitional CSR, with and without a delayed sleep time. We further show how these mechanisms relate back to psychological and self-reported health in young adult women.

Travels with HIV: the compliance and health of HIV-infected adults who travel.

We examined the effects of travel on the health of a group of HIV-infected adults (n = 89) cared for in a public hospital HIV clinic. In a period of 2 years, 45% travelled to a median of 3 US destinations for at least one week and 20% travelled to at least one international destination for a mean duration of 20 days. At the time of completion of the survey, the majority of these patients were severely immunosuppressed (median CD4+ count, 120/mm3). A physician was consulted concerning travel before 53% of the trips, but only one person consulted a travel medicine expert. All but one patient (98%) who was receiving medical therapy carried sufficient supplies of medication; 95% estimated their compliance with medication at 75% or better. None of the travellers to developing countries received gamma globulin, but one received yellow fever vaccine. Fifteen travellers (43%) became ill either during their trip or immediately thereafter; 3 required hospitalization. While most illnesses were not severe, 4 patients developed potentially life-threatening infections including coccidioidomycosis, cryptococcosis, PCP, and bacterial pneumonia. This survey provides information by which the clinician can anticipate the health care needs of HIV-infected patients who travel. HIV-infected patients should be more aware of the necessity for medical counsel prior to travel.

Frequency of Travel of Adults Infected with HIV.

Background: Little is known about the frequency and pattern of travel in the HIV-infected population. Method: A test questionnaire administered to patients cared for at a public hospital HIV clinic examined the frequency, destinations, and motivations for travel of persons with HIV disease. Results: Of 89 persons surveyed, 46% had traveled within the preceding 2 years within the United States for a minimum of 1 week, or to a foreign destination. Forty patients (45%) had traveled to a mean of 3.4 destinations within the United States for an average trip duration of 16 days. In addition, 18 patients (20%) had traveled to at least one foreign country for an average of 20 days. Of the 25 foreign destinations that were specified, 15 (60%) were in lesser developed countries. Patients stated that they undertook 30% of their trips because they thought it was their last chance to travel. At the time of completion of the survey, the majority of those patients who had traveled were severely immunosuppressed (median CD4+ count, 120/mm3). Conclusions: These data provide information by which the clinician can anticipate the health care needs of patients who travel and develop appropriate travel medicine guidelines. (J Travel Med 2:85-88, 1995)