Association between obesity and self-reported sleep duration variability, sleep timing, and age in the Japanese population.

OBJECTIVE: The objective of this study was to investigate the association between obesity and sleep habits, including bedtime, wake-up time, and sleep duration variability over a week. METHODS: We analyzed 9289 participants in this study. Following a health examination, each participant self-reported their sleep habits using a standardized 19-item questionnaire. High sleep duration variability was defined as sleep varying ≥3h of the difference between the longest and shortest sleep durations reported over a week-long period. Late bedtime and early wake-up time were defined as 24:00h or later, and before 6:00h, respectively. Obesity was defined as a body mass index (BMI) of ≥25kg/m2. Subgroup analysis included age (younger group defined as age <65 years vs. elderly group defined as age ≥65 years). RESULTS: After adjusting for confounding factors and sleep duration, high sleep duration variability [odds ratio (OR), 1.20; p<0.005] was significantly associated with a high OR of obesity. Late bedtime (OR, 1.18; p<0.01) was significantly associated with a high OR of obesity, whereas early wake-up was not. In the subgroup analysis, high sleep duration variability had a significant association with the younger group (OR, 1.25; p<0.001), whereas late bedtime had a significant association with the elderly group (OR, 1.36; p<0.005). CONCLUSIONS: Inappropriate sleep habits, particularly high sleep duration variability in young individuals and late bedtime in the elderly, are associated with a high prevalence of obesity, independently of sleep duration.

Impact of sleep on osteoporosis: sleep quality is associated with bone stiffness index.

OBJECTIVE: The aim of the present study was to investigate the impact of sleep on osteoporosis. METHODS: The study used a baseline examination of the Hiroshima Sleep and Healthcare study, which was a cross-sectional and cohort study that addressed the association of sleep habits with lifestyle-related diseases. A total of 1032 participants (25-85 years of age) who underwent health examinations were included. Sleep habits, including its timing (bed time), quantity (time in bed [TIB]), and quality, were assessed using the Pittsburgh Sleep Quality Index (PSQI). The bone stiffness index (SI), a marker of osteoporosis, was measured using quantitative ultrasound systems. RESULTS: Bed time (r = 0.065, p <0.05), TIB (r = -0.064, p <0.05), and global PSQI score (r = -0.126, p <0.0001) significantly correlated with SI. Multiple regression analyses revealed that after adjusting for age, sex, body mass index, smoking, and alcohol intake, the global PSQI score (ß = -0.053, p <0.05) was significantly associated with SI, whereas bed time or TIB was not. Among each component of PSQI, sleep disturbances (ß = -0.084, p <0.005) were significantly associated with SI. CONCLUSION: Poor sleep quality may be associated with osteoporosis. In particular, increased sleep disturbances may be a key factor in the association between poor sleep quality and osteoporosis.

Complete spontaneous necrosis of hepatocellular carcinoma confirmed on resection: A case report.

INTRODUCTION: Complete spontaneous necrosis of hepatocellular carcinoma (HCC) without any pretreatment or angiography is rare. We present a rare case of spontaneous complete necrosis of HCC, as confirmed after hepatectomy. PRESENTATION OF CASE: The patient, a 74-year-old man with a history of alcoholic hepatitis, was referred to our hospital for confirmation of suspected HCC. In March 2015, abdominal ultrasonography detected a low echoic mass in segment 8 (S8) of the liver. Contrast-enhanced computed tomography (CT) imaging revealed interval growth of this tumor and showed that the tumor was well enhanced in the arterial phase and washed out in the portal and delayed phases. The serum alpha-fetoprotein level was elevated at 30.8ng/mL and the percentage of the L3 isoform was 25.5%. Two months later, CT imaging showed that the tumor was of low density and had decreased in size; no contrast enhancement of the tumor was seen. Spontaneous necrosis of the HCC was considered; however, as we could not exclude viable malignant cells in the tumor, we performed S8 segmentectomy of the liver. The resected tumor specimen had a thick fibrous capsule. Histopathological findings showed only granulation and necrotic tissue accompanied by bleeding and hemosiderosis. No viable tumor cells were observed. The serum alpha-fetoprotein level returned to the normal range one month after surgery. DISCUSSION: If spontaneous regression has occurred, there is a possibility of HCC recurrence and of remnant viable tumor cells. CONCLUSION: We present a rare case of complete spontaneous necrosis of HCC and strongly recommended surgical intervention.

Impact of non-dipping on cardiovascular outcomes in patients with obstructive sleep apnea syndrome.

Obstructive sleep apnea syndrome (OSAS) is a risk factor for cardiovascular events. However, it is unclear how OSAS contributes to the events. We investigated the impact of non-dipping on the incidence of cardiovascular events in a retrospective cohort study comprising 251 patients with OSAS. OSAS was diagnosed by overnight polysomnography and all patients underwent 24-h ambulatory blood pressure monitoring. Non-dipping was diagnosed when reduction in sleep blood pressure was <10% of awake blood pressure. Over a mean 43-month follow-up period, 15 patients (6.0%) developed cardiovascular events including stroke, heart failure, and ischemic heart disease. Significantly higher cardiovascular events were observed in the non-dipping group than those without it by Kaplan-Meier analyses. Cox regression analysis revealed that the presence of non-dipping was significantly and independently associated with the incidence of cardiovascular events (hazard ratio, 3.88; 95% confidence interval, 1.19-17.41; p < 0.05), after adjusting for severity of OSAS, and CPAP therapy. Thus, non-dipping was a marker for a poor prognosis in patients with OSAS.

The relationship between morning hypertension and sleep quality in patients with obstructive sleep apnea syndrome.

This study aimed to investigate the prevalence of abnormal diurnal blood pressure (BP) profiles in patients with obstructive sleep apnea syndrome (OSAS) in relation to the data of a sleep study. Total 103 patients newly diagnosed with OSAS underwent overnight polysomnography and 24-hour ambulatory BP measurements. Patients without morning or nocturnal hypertension (control group), patients with morning hypertension but not nocturnal hypertension (surge-type group), and patients with both morning and nocturnal hypertension (sustained-type group) were compared. Morning hypertension was present in 54 patients (16 surge-type and 38 sustained-type). The apnea-hypopnea index and sleep efficiency were higher and lower, respectively, in the sustained-type group than in the other groups. Slow-wave sleep incidence was significantly lower in the sustained-type and surge-type groups than in the control group. These results suggest that approximately half the OSAS patients displayed morning hypertension, the sustained-type being more common than the surge-type. Poor sleep quality plays an important role in the pathogenesis of morning hypertension in both the sustained- and the surge-type group.

Age-related differences in the mechanism of nondipping among patients with obstructive sleep apnea syndrome.

The frequency of nondipper (those lacking the normal drop in nocturnal blood pressure [BP]) is high in patients with obstructive sleep apnea syndrome (OSAS). The objective of this study is to investigate age-related differences in the nocturnal BP profile of patients with OSAS. The study subjects included 214 patients with polysomnography-diagnosed OSAS. The status of dipper or nondipper was determined by 24-hour ambulatory BP measurements. We divided the subjects into three groups by age (younger, middle-aged, and elderly) and compared the frequency and sleep profiles of nondippers in the different age groups. The prevalence of nondippers was significantly higher in the elderly OSAS group than in the younger and middle-aged OSAS groups (69% vs. 45%, 47%; P < .05). In the younger OSAS group, nondippers, when compared with dippers, were characterized by higher apnea-hypopnea index (AHI, 48.2 ± 27.1 vs. 37.4 ± 23.0 times/h, P < .05), whereas in the middle-aged and elderly OSAS groups, the AHI of nondippers was almost identical to that of dippers. On the other hand, in the elderly OSAS group, nondippers, when compared with dippers, had shorter periods of slow wave sleep as measured by nonrapid eye movement stage 3-4, whereas nondippers and dippers in the other two age groups were not different in terms of slow wave sleep. These results indicate age-related differences in major mechanisms leading to nondipping. Severe apnea causes nondipping only in young OSAS patients, whereas disturbance of sleep quality plays a more important role in elderly OSAS patients.

Liver disease in hepatitis C virus carriers identified at blood donation and their outcomes with or without interferon treatment: Study on 1019 carriers followed for 5-10 years.

AIM: To portray liver disease and project outcomes in carriers of hepatitis C virus (HCV) in the general population. METHODS: Liver disease was evaluated in 1019 individuals who were found with HCV infection at blood donation, and they were followed for 5-10 years with or without receiving interferon (IFN). RESULTS: At baseline, chronic hepatitis was detected in 529 (51.9%) HCV carriers and more frequently in men than in women (62.6% [299/478]vs 42.5% [230/541], P < 0.01); cirrhosis was diagnosed in five (0.5% [three men included]) and hepatocellular carcinoma (HCC) in one (0.1% [man]). Of the carriers who were followed for 5 years or longer, loss of HCV-RNA from serum was achieved in 61 (31.0%) of the 197 treated with interferon (IFN) and only one of the 211 (0.5%) without IFN (P < 0.0001). HCC developed in 14 carriers including six ofthe 211 (2.8%) without IFN and eight of the 197 (4.1%) with IFN (six non-responders included). Follow ups of the 949 carriers identified age (P < 0.002), male gender (P < 0.01) and cirrhosis at the baseline (P < 0.0001) as factors contributing to the development of HCC. Cumulative incidence rates of HCC during 10 years among carriers found with chronic hepatitis increased in parallel with the age at the baseline. CONCLUSION: Identification of HCV carriers in the general population and treating those indicated with IFN would help decrease the development of HCC and lift its medical, as well as economic, burdens off society.