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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Elucidation of the cellular and molecular mechanisms of the circadian clock, along with the realization that these mechanisms are operative in both central and peripheral tissues, has revolutionized circadian biology. Further, these observations have resulted in an explosion of interest in the health implications of circadian organization and disorganization at both molecular and physiological levels. Thus, recent research has implicated mutations and polymorphisms of circadian clock genes in diabetes and obesity, cardiovascular disease, and cancer. At the neuro-behavioral level, circadian clock genes have also been implicated in sleep disorders, drug and alcohol addiction, and other psychiatric conditions. While such findings are frequently described as revealing "non-circadian" effects of clock genes, it remains possible that most of these non-circadian effects are in fact secondary to the loss of cellular and systemic rhythmicity. This review summarizes the evidence linking circadian clock genes to biobehavioral dysregulation, and considers criteria for defining a pleiotropic clock gene effect as non-circadian.
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PMID:Circadian clock genes: non-circadian roles in sleep, addiction, and psychiatric disorders? 2030 70

Promoting successful cognitive aging is a topic of major importance to individuals and the field of public health. This review presents a coherent framework not only for evaluating factors, protective activities, and enhancing agents that have already been proposed, but also ones that will be put forward in the future. The promotion of successful cognitive aging involves the dual goals of preventing loss of information processing capacity and cognitive reserve, and enhancing brain capacity and cognitive reserve. Four major lines of evidence are available for evaluating whether a proposed factor promotes successful cognitive aging: 1) epidemiologic/cohort studies; 2) animal/basic science studies; 3) human "proof-of-concept" studies; and 4) human intervention studies. Each line of evidence has advantages and limitations that will be discussed. Through illustrative examples, we trace the ways in which each method informs us about the potential value of several proposed factors. Currently, lines of converging evidence allow the strongest case to be made for physical and cognitively stimulating activities. Although epidemiological data seem to favor the use of statins to lower the risk of dementia, more definitive recommendations await further randomized controlled studies. There is presently no clear evidence that antioxidants or Ginkgo biloba promote successful cognitive aging. The impact of resveratrol, fish oil, and a long list of other proposed agents needs to be determined. Clinicians remain well-positioned to identify and aggressively treat vascular risk factors, diabetes, sleep disorders, and other conditions that may reduce brain capacity, and to encourage activities that can build cognitive reserve.
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PMID:Promoting successful cognitive aging: a comprehensive review. 2030 77

The field of sleep medicine has grown exponentially worldwide. Sleep apnea is linked to the obesity epidemic, which, in some regions of the United States, affects more than one-third of the population. Sleep alterations increase the risk of cardiovascular and cerebrovascular pathology through a diversity of direct and indirect mechanisms. Recent investigations have found a clinical correlation between sleep disorders and diabetes. Obese pregnant women are at high risk for development of sleep apnea and preeclampsia. New studies have uncovered that restless legs syndrome and periodic limb movements may increase the risk of hypertension and vascular disease. Sudden death in sleep may be preventable if conditions that lead to sudden death are investigated. New neuroimaging techniques during sleep in patients with insomnia have uncovered metabolic overactivity in areas of the brain related to maintenance of wakefulness. Sleep neuroimaging promises to have research and clinical diagnostic applications.
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PMID:A review of frontiers in clinical sleep medicine. 2041 Aug 57

During the last 20 years, numerous clinical trials have examined the therapeutic usefulness of melatonin in different fields of medicine. The objective of this article is to review, in depth, the science regarding clinical trials performed to date. The efficacy of melatonin has been assessed as a treatment of ocular diseases, blood diseases, gastrointestinal tract diseases, cardiovascular diseases, diabetes, rheumatoid arthritis, fibromyalgia, chronic fatigue syndrome, infectious diseases, neurological diseases, sleep disturbances, aging and depression. Melatonin has been also used as a complementary treatment in anaesthesia, hemodialysis, in vitro fertilization and neonatal care. The conclusion of the current review is that the use of melatonin as an adjuvant therapy seems to be well funded for macular degeneration, glaucoma, protection of the gastric mucosa, irritable bowel syndrome, arterial hypertension, diabetes, side effects of chemotherapy and radiation in cancer patients or hemodialysis in patients with renal insufficiency and, especially, for sleep disorders of circadian etiology (jet lag, delayed sleep phase syndrome, sleep deterioration associated with aging, etc.) as well as in those related with neurological degenerative diseases (Alzheimer, etc.,) or Smith-Magenis syndrome. The utility of melatonin in anesthetic procedures has been also confirmed. More clinical studies are required to clarify whether, as the preliminary data suggest, melatonin is useful for treatment of fibromyalgia, chronic fatigue syndrome, infectious diseases, neoplasias or neonatal care. Preliminary data regarding the utility of melatonin in the treatment of ulcerative colitis, Crohn's disease, rheumatoid arthritis are either ambiguous or negative. Although in a few cases melatonin seems to aggravate some conditions, the vast majority of studies document the very low toxicity of melatonin over a wide range of doses.
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PMID:Clinical uses of melatonin: evaluation of human trials. 2042 9

The importance of sleep on health has only been recently recognized, and the general public and the medical community are not yet fully knowledgeable about this issue. The great majority of sleep research has been performed in whites of European descent and to a lesser extent in African Americans, making generalization of the findings to other ethnic and racial groups difficult. Very little sleep research has been done in U.S. Hispanics. However, based on the available literature and the high prevalence of risk factors in Hispanics, such as obesity, diabetes, living in the inner city, and use of alcohol, the prevalence of such important sleep disorders such as obstructive sleep apnea and sleep habits such as poor sleep hygiene are suspected to be high. There is also some evidence that acculturation to the U.S. life style may lead to worse sleep habits in Hispanics, including fewer hours of sleep. Two current large NIH sponsored studies of sleep in U.S. Hispanics promise to significantly add to the literature on various sleep disorders such as sleep disordered breathing, insomnia, restless legs syndrome, periodic limb movement disorder, and sleep habits such as short sleep duration and sleep hygiene.
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PMID:Sleep health in U.S. Hispanic population. 2061 56

Obstructive sleep apnea (OSA) is a common sleep disorder, and research on the effects of sleep apnea is important to gain insight into how sleep affects health. Untreated OSA has been associated with important health consequences, such as an increased risk for hypertension, cardiovascular disease and diabetes. Previous studies have shown that OSA also represents a risk factor for stroke. The relationship between OSA and stroke is particularly relevant, as stroke is the second leading cause of death globally. The reviewed article presents new data from the Sleep Heart Health Study, a longitudinal cohort study, which shows an association between incident stroke and untreated OSA of varying severity for men and possibly more severe OSA for women. The study is discussed in the context of the current state of knowledge about OSA, in particular its health consequences, and the general limitations in conducting research with OSA patients.
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PMID:Risk of stroke from sleep apnea in men and women. 2033 44

Strong associations of diabetes with sleep impairment have been frequently reported. In the present review, we discuss current evidence and hypotheses for how type 1 and type 2 diabetes mellitus are associated with sleep impairment. This association may be described as a vicious circle, where sleep disorders favor the development of type 2 diabetes or exacerbate the metabolic control of both types of diabetes, whereas diabetes itself, especially when associated with poor metabolic control, is often followed by sleep disorders. In this review, novel findings concerning the neuro-endocrine-metabolic mediation of the mentioned circle are highlighted. Understanding how this association occurs, the impact of sleep impairment on diabetes, and the impact of diabetes on the development or exacerbation of sleep disorders should lead to potential new therapeutic strategies for treating both conditions.
Diabetes Res Clin Pract 2011 Feb
PMID:Diabetes and sleep: a complex cause-and-effect relationship. 2081 Jan 83

Sleep disorders such as insomnia, obstructive sleep apnoea (OSA), excessive daytime sleepiness (EDS) and fatigue, sleep deprivation and restless legs syndrome (RLS) are increasingly seen in clinical practice. Sleep is considered vital for preserving daytime cognitive function and physiological well-being. Sleep insufficiency may have deleterious effects on work-life balance, overall health and safety. The consequential economic burden at both the individual and societal levels is significant. Moreover, sleep disorders are commonly associated with other major medical problems such as chronic pain, cardiovascular disease, mental illness, dementias, gastrointestinal disorders and diabetes mellitus. Thus, in order to properly care for patients presenting with sleep-related morbidity, and to reduce the consequential economic burden, accurate screening efforts and efficacious/cost-effective treatments need to be developed and employed.
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PMID:Economic implications of sleep disorders. 2093 85

Only recently has the perimenopause become recognized as a time when women are at risk for new onset and recurrence of major depression. Untreated depression at this time not only exacerbates the course of a depressive illness, but also puts women at increased risk for sleep disorders, cardiovascular disease, diabetes, and osteoporosis. Although antidepressant medication is the mainstay of treatment, adjunctive therapy, especially with estrogen replacement, may be indicated in refractory cases, and may speed the onset of antidepressant action. Many, but not all, studies, report that progesterone antagonizes the beneficial effects of estrogen. Although some antidepressants improve vasomotor symptoms, in general they are not as effective as estrogen alone for relieving these symptoms. Estrogen alone, however, does not generally result in remission of major depression in most (but not all) studies, but may provide benefit to some women with less severe symptoms if administered in therapeutic ranges. The selective serotonin reuptake inhibitors (SSRIs) in addition to estrogen are usually more beneficial in improving mood than SSRIs or estrogen treatment alone for major depression, whereas the selective norepinephrine and serotonin reuptake inhibitors do not require the addition of estrogen to exert their antidepressant effects in menopausal depression. In addition to attention to general health, hormonal status, and antidepressant treatment, the optimal management of perimenopausal depression also requires attention to the individual woman's psychosocial and spiritual well being.
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PMID:Optimal management of perimenopausal depression. 2107 7

Inadequate sleep and sleep disorders have important adverse consequences on multiple systems. This review covers three areas: (a) Genetic determinants of sleep disorders. Common gene variants with small effects have been identified for both restless legs syndrome and narcolepsy with cataplexy. Rare variants with large effects have been found in familial phase advance syndrome and in subjects with short sleep durations. (b) Obstructive sleep apnea (OSA). OSA is an oxidative stress disorder. Prospective cohort studies show an increased risk of cardiovascular events in patients with untreated severe OSA. (c) The impact of sleep disorders on obesity and diabetes. Inadequate sleep results in changes in insulin resistance and in hormone levels leading to increases in appetite. Hence, inadequate sleep is associated with development of obesity. OSA is also an independent risk factor for insulin resistance; treatment of OSA can improve insulin sensitivity.
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PMID:Update on sleep and its disorders. 2107 34


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