Christopher A. Magee

Relationships between self-rated health, quality of life and sleep duration in middle aged and elderly Australians

OBJECTIVE To determine whether sleep duration is associated with self-rated health and quality of life in adults residing in New South Wales, Australia. METHODS Cross-sectional data from the 45 and Up Study were used. Sleep duration, self-rated health, quality of life and other health-related variables were assessed using a self-report questionnaire. Multinomial logistic regression models were used to examine whether sleep duration predicted self-rated health and quality of life. RESULTS The sample included 63,408 adults aged 45-95 years. After controlling for a range of covariates, <6 h sleep (OR=1.49, 95% CI 1.31-1.70), 6 h sleep (OR=1.28, 95% CI 1.17-1.38) and ≥9 h sleep (OR=1.56, 95% CI 1.46-1.67) were associated with poorer self-rated health. Similarly, <6 h sleep (OR=1.80, 95% CI 1.57-2.07), 6 h sleep (OR=1.36, 95% CI 1.24-1.49) and ≥9 h sleep (OR=1.41, 95% CI 1.30-1.53) were associated with poorer quality of life. CONCLUSION Short and long sleep were significantly associated with poor self-rated health and lower quality of life in this large sample of middle aged and older Australian adults. While cross-sectional, these results add weight to recent data emphasising the importance of adequate sleep in physical and mental health.

Short Sleep Duration Is Associated with Risk of Future Diabetes but Not Cardiovascular Disease: a Prospective Study and Meta-Analysis

Epidemiologic studies have observed association between short sleep duration and both cardiovascular disease (CVD) and type 2 diabetes, although these results may reflect confounding by pre-existing illness. This study aimed to determine whether short sleep duration predicts future CVD or type 2 diabetes after accounting for baseline health. Baseline data for 241,949 adults were collected through the 45 and Up Study, an Australian prospective cohort study, with health outcomes identified via electronic database linkage. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals. Compared to 7h sleep, <6h sleep was associated with incident CVD in participants reporting ill-health at baseline (HR=1·38 [95% CI: 1·12-1·70]), but not after excluding those with baseline illness and adjusting for baseline health status (1·03 [0·88-1·21]). In contrast, the risk of incident type 2 diabetes was significantly increased in those with <6h versus 7h sleep, even after excluding those with baseline illness and adjusting for baseline health (HR=1·29 [1·08-1·53], P=0.004). This suggests the association is valid and does not simply reflect confounding or reverse causation. Meta-analysis of ten prospective studies including 447,124 participants also confirmed an association between short sleep and incident diabetes (1·33 [1·20-1·48]). Obtaining less than 6 hours of sleep each night (compared to 7 hours) may increase type 2 diabetes risk by approximately 30%.

Short and long sleep duration are associated with prevalent cardiovascular disease in Australian adults

A growing number of studies from a range of different countries have observed an association between sleep duration and cardiovascular disease. The objective of this paper was to examine the associations between sleep duration and prevalent cardiovascular disease in a large sample of Australian adults, and identify the sociodemographic and health‐related factors moderating these associations. Participants included 218 155 Australian adults aged 45 years and over. The results indicated that 6 h versus 7 h sleep was associated with increased odds of heart disease [odds ratio (OR) = 1.11 (1.06–1.17)], diabetes [OR = 1.15 (1.09–1.22)], stroke [OR = 1.25 (1.14–1.38)] and high blood pressure [OR = 1.08 (1.04–1.11)]. Long sleep (≥9 h sleep) was also related to elevated odds of heart disease [OR = 1.14 (1.09–1.19)], diabetes [OR = 1.25 (1.19–1.31)], stroke [OR = 1.50 (1.38–1.62)] and high blood pressure [OR = 1.04 (1.01–1.08)] compared to 7 h sleep. Some of these relationships varied by age, and were not evident in adults aged 75 years and over. The magnitude of some associations varied significantly by body mass index, smoking and physical activity. These findings provide further insight into the nature of the relationship between sleep and cardiovascular health.

Examining the pathways linking chronic sleep restriction to obesity

A growing number of studies have identified chronic sleep restriction as a potential risk factor for obesity. This could have important implications for how obesity is prevented and managed, but current understanding of the processes linking chronic sleep restriction to obesity is incomplete. In this paper, we examined some of the pathways that could underlie the relationship between chronic sleep restriction and obesity. This involved exploring some of the potential environmental, health, behavioral, and sociodemographic determinants of chronic sleep restriction, which require further investigation in this context. Three pathways that could potentially link chronic sleep restriction to obesity were then examined: (1) altered neuroendocrine and metabolic function, (2) impaired glucose regulation, and (3) waking behavior. The selected pathways linking chronic sleep restriction to obesity reviewed in this paper are presented in a schematic representation; this may be used to guide future research in this area. This area of research is important because it may lead to more effective interventions and strategies to combat the present obesity epidemic.

A link between chronic sleep restriction and obesity : Methodological considerations

Emerging evidence suggests that chronic sleep restriction contributes to obesity. Targeting short sleep duration may therefore offer a novel and effective method of preventing and treating obesity. However, this area of research is only in its infancy, and a complete understanding of how chronic sleep restriction and obesity are linked is currently lacking. The aim of this paper is to briefly review epidemiological evidence for an association between chronic sleep restriction and obesity in adults, and outline the key methodological limitations of these studies. Particular attention is paid to the methods used to measure sleep and obesity, as well as the need to control for potential confounding variables. Methodological recommendations are provided for future studies that will facilitate a more complete understanding of how chronic sleep restriction and obesity are linked in the general population. This has implications for the development of public health programmes that target sleep as a modifiable risk factor for obesity.

Being a Girl in a Boys' World: Investigating the Experiences of Girls with Autism Spectrum Disorders during Adolescence.

This study investigates the experiences of adolescent girls with autism spectrum disorders (ASD) during adolescence. Semi-structured interviews were conducted with three mother–daughter dyads and two additional mothers. A range of issues were highlighted covering physical, emotional, social and sexual domains. Some of these issues were similar to those experienced by boys with ASD during adolescence, such as negative implications of late diagnosis, challenges of transitioning to and coping with high school, ‘hands-on’ role of parents into adolescence, difficulties adjusting to the increased demands of adolescent hygiene routines, and the importance of learning personal boundaries in interactions with others. Other issues discussed were of particular relevance to adolescent girls with ASD, such as difficulties socialising with neurotypically developing girls, sex-specific puberty issues, and sexual vulnerabilities. This study highlights an important research area and is a preliminary step towards understanding the experiences of adolescent girls with ASD and their families.

Factors associated with short and long sleep.

OBJECTIVE Short (<7 h) and long sleep durations (> or = 9 h) have recently been linked with increased mortality in the US, Europe and Asia, but little is known about the sleep patterns of Australian adults. The present study examined the sleep habits of Australian adults and identified socio-demographic and health-related factors associated with short and long sleep. METHODS This study analyzed cross-sectional and self-reported data from 49,405 Australian adults aged 45 to 65 years collected between 2006 and 2008. Socio-demographic and health-related factors were entered into multinomial logistic regression models predicting self-reported sleep duration. RESULTS Short and long sleep were reported by 16.6% and 13.9% of participants respectively. Short sleep was associated with long working hours (odds ratio [OR]=1.17, 95% confidence interval (CI): 1.08, 1.28) and obesity (OR=1.29, 95% CI: 1.19, 1.41); long sleep was associated with recent treatment for cancer (OR=1.64, 95% CI: 1.34, 2.02) and heart attack/angina (OR=1.58, 95% CI: 1.19, 2.09). CONCLUSIONS Short and long sleep were common in this sample of middle aged Australian adults. The determinants of short sleep have potential public health implications and could be targeted to prevent morbidity and mortality associated with short sleep.

Coherence in children with Attention-Deficit/Hyperactivity Disorder and excess beta activity in their EEG

OBJECTIVE This study investigated differences in coherence measures between two groups of children with Attention-Deficit/Hyperactivity Disorder (ADHD) - with the typical EEG profile (increased theta and decreased beta activity), and with excess beta activity - and a normal control group. METHODS Thirty-four children with ADHD were included in each of the typical and excess beta groups, and were age and sex matched with 34 control subjects. EEG was recorded from 21 sites during an eyes-closed resting condition. Wave-shape coherence was calculated for eight intrahemispheric and eight interhemispheric electrode pairs, for the delta, theta, alpha and beta bands. RESULTS In comparison to the controls, the typical ADHD group primarily had increased intrahemispheric theta and beta coherence at short-medium inter-electrode distances, and increased interhemispheric coherence for theta in the frontal and central/parietal/occipital regions. Their laterality effect for interhemispheric short-medium inter-electrode distances was reduced in the theta band. Differences between the excess beta group and the control group were primarily found in laterality of the intrahemispheric theta coherence at short-medium electrode distances, and increased interhemispheric theta coherence in the frontal regions. Reduced delta coherence in the temporal regions was also found. CONCLUSIONS These results suggest that ADHD children with excess beta power have an underlying brain dysfunction in the frontal lobes which is found in common with children with the typical EEG profile. However a number of qualitative differences exist which could be associated with other aspects of the ADHD diagnosis or another comorbid condition. SIGNIFICANCE This is the first study to investigate EEG coherence in ADHD children who have increased beta power.

Family-focused autism spectrum disorder research: A review of the utility of family systems approaches:

A family member with an autism spectrum disorder presents pervasive and bidirectional influences on the entire family system, suggesting a need for family-focused autism spectrum disorder research. While there has been increasing interest in this research area, family-focused autism spectrum disorder research can still be considered relatively recent, and there are limitations to the existing literature. The purpose of this article is to provide theoretical and methodological directions for future family-focused autism spectrum disorder research. In particular, this article proposes Family Systems approaches as a common theoretical framework for future family-focused autism spectrum disorder research by considering theoretical concepts such as Boundaries, Ambiguous Loss, Resilience and Traumatic Growth. We discuss reasons why these concepts are important to researching families living with autism spectrum disorder and provide recommendations for future research. The potential for research grounded in Family Systems approaches to influence clinical support services is also discussed.

Age and gender effects in EEG coherence: II. Boys with attention deficit/hyperactivity disorder

OBJECTIVE This study investigated intra-hemispheric and inter-hemispheric EEG coherences as a function of age in boys with different subtypes of Attention Deficit/Hyperactivity Disorder (AD/HD), in comparison with a control group of normal boys. METHODS Three groups of 40 children (AD/HD combined type, AD/HD inattentive type, and normal controls) participated. Each group contained 8 males in each 1 year band from 8 to 12 years. EEG was recorded from 21 sites during an eyes-closed resting condition. Wave-shape coherence was calculated for 8 intra-hemispheric electrode pairs (4 in each hemisphere), and 8 inter-hemispheric electrode pairs, within each of the delta, theta, alpha and beta bands. RESULTS Developmental effects in intra-hemispheric coherences at shorter and longer inter-electrode distances generally supported Thatchers two-compartment model. Control boys showed evidence of development in longer-range inter-hemispheric coherences which was not apparent in AD/HD boys. Boys with AD/HD of the combined type showed qualitatively different anomalies than boys with AD/HD of the inattentive type. CONCLUSIONS EEG coherences in normal boys of this age range develop systematically with age in a non-linear fashion. Boys with AD/HD do not show this development. They display coherence anomalies which differ in nature between DSM-IV subtypes, suggesting differences which are not relatable to simple symptom severity. SIGNIFICANCE The data reported here indicate differences in the development of EEG coherences in boys with AD/HD, and point to differences between the AD/HD subtypes which may help understanding of the disorder.