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1.
Sleep Med ; 73: 202-207, 2020 09.
Article in English | MEDLINE | ID: mdl-32858331

ABSTRACT

Data regarding the possible relationship of insomnia and EDS with mortality are inconclusive. The aim of this study was to investigate the association between these sleep complaints and the risk of long-term (20 years) all-cause mortality in older adults. Between April 2000 and March 2001, 750 subjects aged 65 years and older, who resided in the seventh district of Udine, were recruited. Data on sociodemographic characteristics, past medical history, and pharmacological treatment were collected. Dementia was diagnosed using a comprehensive neurological and neuroradiological assessment. Older adults were interviewed by neuropsychologists trained in sleep disturbances in order to assess the presence of sleep complaints. Vital status was followed over 20 years until March 2020. Older male adults affected by insomnia and EDS were significantly more likely to die over the follow-up period. Indeed, males reporting poor sleep and daytime somnolence had a 60% and 48% higher chance of dying than subjects who were not affected by these sleep complaints, respectively. The HR was attenuated after adjusting for confounding variables among insomniacs, whereas that of somnolent men strengthened. Differently from men, insomnia and EDS did not have any impact on mortality in older women. In conclusion, older male adults affected by insomnia and EDS had a significant increased risk of mortality, which is independent of cancer, depression, dementia, cardiovascular diseases, and sleeping pill use.


Subject(s)
Disorders of Excessive Somnolence , Sleep Initiation and Maintenance Disorders , Aged , Disorders of Excessive Somnolence/epidemiology , Female , Humans , Male , Sleep , Sleep Initiation and Maintenance Disorders/epidemiology , Sleepiness , Surveys and Questionnaires
2.
Sleep Med ; 11(4): 372-7, 2010 Apr.
Article in English | MEDLINE | ID: mdl-20219426

ABSTRACT

OBJECTIVE: The occurrence of dementia among the elderly has been associated with several, often not modifiable, risk factors. Recent epidemiological studies focused their interest on a possible association between cognitive decline and sleep, a potentially modifiable risk factor. Due to controversial results and limitations of the previous studies, we decided to reexamine the relationship between disturbed sleep and cognitive impairment in the elderly. METHODS: Seven hundred fifty subjects aged 65years or older were recruited. The Mini-Mental State Examination (MMSE) and the Global Deterioration Scale (GDS) scores were used to evaluate the severity of cognitive decline. Diagnosis of dementia was made by means of the DSM-IV criteria. The older adults were interviewed in order to assess the presence of several sleep complaints (insomnia, snoring and/or witnessed sleep apneas, restlessness and/or leg jerks, sleepwalking and nightmares). Excessive daytime sleepiness was evaluated by means of a validated questionnaire. The principal caregiver of each older adult took part in the interview, providing the information if the subject was unable to answer because of mental impairment. RESULTS: Eighty-six individuals were diagnosed as demented; a large part of them (47.8%), in particular, were recognized as being affected by Alzheimer's disease. The prevalence of each sleep complaint in the older adults was as follows: insomnia 84.7%, snoring and/or witnessed sleep apneas 26.2%, restlessness and/or jerks in the legs 25.7%, sleepwalking 0.5%, nightmares 6.4% and daytime somnolence 30.6%. Among sleep disturbances, excessive daytime sleepiness was independently associated with the presence of dementia in the elderly. In addition, the frequency of excessive daytime sleepiness increased progressively across the different categories of cognitive decline, as measured by means of MMSE and GDS scores. CONCLUSIONS: Insomnia, the most common sleep complaint in our sample, was not associated with the presence of cognitive decline. As opposed to insomnia, excessive daytime sleepiness was significantly related to dementia. Further studies are needed in order to investigate the direction of this association and to evaluate the possible role of daytime somnolence as an early marker of neurodegenerative disease, particularly Alzheimer's disease, in some older adults.


Subject(s)
Cognition Disorders/epidemiology , Dementia/diagnosis , Dementia/epidemiology , Disorders of Excessive Somnolence/diagnosis , Disorders of Excessive Somnolence/epidemiology , Aged , Cognition Disorders/diagnosis , Female , Humans , Italy/epidemiology , Male , Middle Aged , Neuropsychological Tests , Population Surveillance/methods , Prevalence , Severity of Illness Index
3.
Arch Gerontol Geriatr Suppl ; (9): 325-31, 2004.
Article in English | MEDLINE | ID: mdl-15207430

ABSTRACT

Sleep in elderly people shows progressive changes caused by general aging processes. Several alterations are described in medical literature: changes of sleep/wake rhythm and modifications both in sleep duration and in sleep architecture. The aim of our study was to evaluate sleep disturbances in elderly people, with and without cognitive impairment,through a sleep questionnaire. Our population included 1000 subjects, over 65 years of age, stratified by sex and age. The first 600 interviews were included in this report. All patients underwent a mini mental state examination (MMSE) and a questionnaire concerning excessive daytime sleepiness. In our total sample, we found a high prevalence of excessive daytime sleepiness, insomnia, nighttime awakenings, snoring, restlessness and periodic leg movements during sleep. Patients with cognitive dysfunctions showed less difficulty in falling asleep and fewer nighttime awakenings; they snored less frequently and were the only ones to present enuresis and to fall off the bed. Moreover, patients with cognitive impairment presented excessive daytime sleepiness with variable intensity and frequency. In conclusion, our results indicate significant differences in sleep disorders between healthy subjects and patients cognitively impaired. Besides, our subjective evaluation seems to be a useful method to perform an assessment of sleep disturbances in elderly people.


Subject(s)
Dementia/epidemiology , Sleep Wake Disorders/epidemiology , Aged , Aged, 80 and over , Circadian Rhythm , Dementia/diagnosis , Disorders of Excessive Somnolence/epidemiology , Female , Humans , Male , Neuropsychological Tests , Prevalence , Severity of Illness Index , Sleep Disorders, Circadian Rhythm/diagnosis , Sleep Disorders, Circadian Rhythm/epidemiology , Sleep Wake Disorders/diagnosis , Surveys and Questionnaires
4.
Eur J Immunol ; 30(11): 3140-6, 2000 Nov.
Article in English | MEDLINE | ID: mdl-11093128

ABSTRACT

Activation of phagocytes by lipopolysaccharide (LPS) causes synthesis and secretion of various mediators of inflammation. CD14, a glycosylphosphatidylinositol-anchored monocytic antigen serving as receptor for LPS, and members of the family of Toll-like receptors mediate cellular activation in response to LPS. Here we investigated whether expression of MHC class II molecules modified the response to LPS. Comparing LPS responsiveness of human and murine cells differing for expression of MHC class II molecules, we found that lack or a low level of expression of MHC class II molecules resulted in diminished secretion of pro-inflammatory cytokines following stimulation with LPS. Thus, expression of MHC class II molecules modifies LPS responsiveness, a finding suggesting that these molecules contribute to the pathogenesis not only of exotoxin-triggered toxic shock but also of endotoxin-triggered septic shock. Additionally to their role in antigen-specific immunity MHC class II molecules may influence the inflammatory response triggered by microbial constituents.


Subject(s)
Histocompatibility Antigens Class II/immunology , Immunity, Innate , Lipopolysaccharides/immunology , Animals , Humans , Mice , Mice, Knockout
5.
Microbes Infect ; 1(8): 589-99, 1999 Jul.
Article in English | MEDLINE | ID: mdl-10611735

ABSTRACT

Proteophosphoglycan (PPG) is a newly described mucin-like glycoprotein found on the surface of Leishmania major promastigotes and secreted in the culture supernatant. We show here that antigenically similar PPGs are present in several Leishmania species. PPG could also be detected on the surface of amastigotes and in small, parasite-free vesicles in infected macrophages. Because of the similarity of its carbohydrate chains to lipophosphoglycan, a parasite receptor for host macrophages, PPG was tested for binding to macrophages. PPG bound to macrophages and was internalized in a time-dependent manner. PPG inhibited the production of tumor necrosis factor-alpha and synergized with interferon-gamma to stimulate the production of nitric oxide by macrophages. PPG may contribute to the binding of Leishmania to host cells and may play a role in modulating the biology of the infected macrophage at the early stage of infection.


Subject(s)
Leishmania major/immunology , Leishmania major/metabolism , Macrophages, Peritoneal/immunology , Macrophages, Peritoneal/parasitology , Membrane Proteins/immunology , Membrane Proteins/metabolism , Proteoglycans/immunology , Proteoglycans/metabolism , Protozoan Proteins , Animals , Antigens, Protozoan/chemistry , Antigens, Protozoan/immunology , Antigens, Protozoan/metabolism , Antigens, Protozoan/pharmacology , Cells, Cultured , Drug Synergism , Endocytosis , Fluorescent Antibody Technique , Glycosphingolipids/chemistry , Interferon-gamma/pharmacology , Kinetics , Leishmania donovani/chemistry , Leishmania donovani/immunology , Leishmania major/chemistry , Leishmania major/growth & development , Leishmania mexicana/chemistry , Leishmania mexicana/immunology , Lipopolysaccharides/antagonists & inhibitors , Lipopolysaccharides/pharmacology , Lysosomes/metabolism , Macrophages, Peritoneal/drug effects , Macrophages, Peritoneal/metabolism , Membrane Proteins/chemistry , Membrane Proteins/pharmacology , Mice , Mice, Inbred C3H , Nitric Oxide/biosynthesis , Nitric Oxide/metabolism , Proteoglycans/chemistry , Proteoglycans/pharmacology , Tumor Necrosis Factor-alpha/biosynthesis , Tumor Necrosis Factor-alpha/immunology
6.
Demography ; 34(2): 295-309, 1997 May.
Article in English | MEDLINE | ID: mdl-9169284

ABSTRACT

In this study, we use data from the Demographic and Health Surveys to examine the relationship between household structure and childhood immunization in Niger and Nigeria. We show that household structure is an important determinant of childhood immunization in Nigeria: Children from nuclear, elementary polygynous, and three-generational households are worse-off than those from laterally extended households. However, the lower odds of full immunization among children from three-generational and elementary polygynous households are attributable to low economic status and low maternal education levels, respectively. In Niger, household structure does not have a significant effect on children's likelihood of being fully immunized.


Subject(s)
Child Welfare , Family Characteristics , Family , Immunization , Nuclear Family , Adult , Child, Preschool , Educational Status , Health Surveys , Humans , Infant , Logistic Models , Mothers/education , Niger , Nigeria , Odds Ratio , Poverty
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