Sabrina Hense

Agreement of different methods for assessing sleep characteristics: a comparison of two actigraphs, wrist and hip placement, and self-report with polysomnography

OBJECTIVE To assess the agreement of sleep parameters measured by two actigraphs (SOMNOwatch plus, ActiGraph GT3X+) at two different placements (wrist, hip) and of self-reported sleep with polysomnography (PSG). METHODS We estimated agreement with PSG for total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), number of awakenings after sleep onset (NASO), and sleep efficiency (SE%) for 100 participants of the general population, aged 18-75 years by judging mean differences to PSG and intervals of agreement using Bland-Altman plots. RESULTS Mean difference to PSG for TST was 8.3 min (95% confidence intervals [CI] -7.4; 24.1) for SOMNOwatch plus (wrist), 39.8 min (95% CI 24.3; 55.3) for self-report, -79.0 min (95% CI -89.0; -68.9) for SOMNOwatch plus (hip), and -81.1 min (95% CI -91.9; -70.4) for GT3X+ (hip), respectively. The width of intervals of agreement differed with the placement of the devices. Mean differences to PSG were higher for hip-based measurements compared with wrist placement for most parameters. CONCLUSIONS Agreement of sleep parameters assessed by actigraphy with PSG differs with the placement of the device and is limited for hip-based measurements. Agreement of self-report with PSG is comparable to that of actigraphy for some parameters.

Sleep Duration and Overweight in European Children: Is the Association Modified by Geographic Region?

STUDY OBJECTIVES To investigate differences and a possible effect modification by geographical region in the association between sleep duration and overweight. DESIGN Cross-sectional. SETTING Primary schools and preschools in 8 European countries. PARTICIPANTS 7867 children aged 2 to 9 years. INTERVENTIONS Not applicable. MEASUREMENTS Nocturnal sleep duration was assessed as part of a parental 24-h recall. Height and weight were measured by standardized procedures across centers. Data on personal, social, environmental and behavioral factors were collected using a standardized parental questionnaire. RESULTS Sleep duration differed (P < 0.001) between European regions and normal vs. overweight children. A dose-dependent inverse association between sleep duration and overweight could be seen, with crude odds ratios ranging from 1.73 (99% CI 1.33; 2.25) for sleeping between 10 and 11 h to 3.81 (99% CI 2.85; 5.09) for sleeping less than 9 h (reference category > 11 h). This persisted after adjustment, but remained significant only for sleeping less than 9 h per night (north: OR = 1.70; 99% CI 1.13; 2.58 vs. south: OR = 2.84; 99% CI 1.57; 5.12) if stratified by region. No effect modification by region could be found, but adjustment for region accounted for changes in the effect estimate for sleeping less than 9 h (OR = 2.22; 99% CI 1.64; 3.02). The association was stronger in school children than in preschool children. CONCLUSION Geographic region and related aspects-even if they do not seem to modify the association between sleep and overweight-should in any case be taken in consideration as a confounding factor on this association.

Attributable risks for childhood overweight: evidence for limited effectiveness of prevention

OBJECTIVE: Calculation of attributable risks (ARs) of childhood overweight to estimate effectiveness of prevention strategies. METHODS: We used pooled data of 4 population-based German studies including 34 240 children and adolescents aged 3 to 18 years to calculate the impact of familial, social, “early life”, and lifestyle factors on overweight. ARs (joint for all determinants as well as partial risks) were calculated. RESULTS: The prevalence of childhood overweight was 13.4%. Successfully tackling all determinants can reduce overweight by 77.7% (ie, from 13.4% to 3.0%; = joint AR) with partial effects of treating parental overweight (42.5%); improving social status (14.3%); reducing media time to <1 hour per day (11.4%); and not smoking during pregnancy, low weight gain during pregnancy, and breastfeeding (together 9.5%), respectively. Improving all preventable risk factors (ie, early life factors and lifestyle) the effect is 9.2%. Media time has the strongest effect. CONCLUSIONS: The determinants identified explained 78% of the prevalence of overweight. Taking into account the partial ARs, the effectiveness of lifestyle interventions to prevent overweight in children is limited. Our data argue in favor of interventions aimed at families and social environments, with a major focus on promoting a lower screen time and computer use in children.

Effect of the IDEFICS multilevel obesity prevention on children's sleep duration.

According to recent findings, short sleep duration is associated with overweight in children. However, primary prevention efforts aimed at achieving adequate sleep among children are scarce. Therefore, the ‘Identification and prevention of Dietary‐induced and lifestyle‐induced health EFfects In Children and infantS’ (IDEFICS) study implemented a multilevel intervention that included sleep duration as a key behavioural target. The aim of this study is to evaluate sleep duration among children participating in the IDEFICS study.

SP6-13 Sleep duration and overweight in European children: is the association modified by geographic region?

Introduction An association between sleep duration and overweight has been reported from several countries. Comparability of those results is limited by reasons of methodological differences. In a multi-center study we analysed this association in children from northern and southern Europe. Objectives To investigate differences and a possible effect modification by geographical region in the association between sleep duration and overweight. Methods In the IDEFICS-Study we examined 16.223 children (2–9 years) from eight European countries. Sleep was assessed by means of a parental 24h-Recall. Logistic regression models were applied to analyse the association between overweight and sleep duration and to test for effect modification by region. Results A dose dependent association between sleep duration and overweight was seen. This persisted after adjustment, but remained significant only for sleeping <9h if stratified by region (north:OR 2.0; 99% CI 1.3 to 3.2 vs south:OR 2.5; 99% CI 1.4 to 4.3). No effect modification by region was found. The association was stronger in older children. Conclusion Geographic region and related aspects do not modify the association between sleep and overweight, but should be taken in consideration as a confounding factor on this association.

Estimation of Background Incidence Rates of Guillain-Barré Syndrome in Germany - A Retrospective Cohort Study with Electronic Healthcare Data

Background: The Guillain-Barré syndrome (GBS) occurs after infections and as an adverse reaction to vaccines. No detailed information on incidence rates (IRs) in Germany is available. Methods: This retrospective cohort study estimated age- and sex-specific IRs of GBS in Germany in the years 2007-2009 based on electronic healthcare data from the German Pharmacoepidemiological Research Database (GePaRD). Two case definitions were applied. GBS cases had a main discharge diagnosis of GBS. GBS_PROCEDURE cases in addition had codes for relevant diagnostic procedures. Crude and standardized IRs (SIRs) with 95% confidence intervals were stratified by year, age group, sex, region and season. IR ratios (IRRs) for each stratification factor were calculated by multivariable Poisson regression. Results: Among 13,297,678 persons, 889 (693) incident GBS (GBS_PROCEDURE) cases were identified. Overall SIRs per 100,000 person years were 2.4 (2.2-2.5) for GBS and 1.8 (1.7-2.0) for GBS_PROCEDURE. (S)IRs increased with age, peaking in the age group 70-79 years (IR GBS: 5.5 (4.7-6.5)) and were higher in males than in females (e.g., IR GBS: IRR = 1.5 (1.3-1.7)) and in February-April, as compared to the rest of the year. No regional pattern was observed. Conclusion: (S)IRs of GBS in Germany differed by age, sex and season and were comparable to those found in other studies. Results might be used as a comparator in vaccine safety monitoring.

Sleep duration and overweight

ZusammenfassungSchlafmangel ist aufgrund seiner vielfältigen Auswirkungen, deren Wirkmechanismen wir erst zu verstehen beginnen, als ernst zu nehmender Risikofaktor mit großer Public-Health-Relevanz zu sehen. Dies wird auch durch die steigende Zahl an Studien belegt, die sich speziell mit der Frage nach dem Zusammenhang zwischen Schlafdauer und Übergewicht befassen. Die vorliegende Arbeit gibt einen Überblick sowohl über den aktuellen Stand der Forschung zu diesem Thema als auch über mögliche biologische Mechanismen. Die Evidenz aus epidemiologischen Studien deutet sowohl bei Kindern als auch bei Erwachsenen auf einen Zusammenhang zwischen kurzer Schlafdauer und Übergewicht hin. Die Ergebnisse bei Kindern sind konsistenter als bei Erwachsenen. Als Ursache für den Zusammenhang werden mehrere Mechanismen diskutiert. Dabei stehen vor allem hormonelle Veränderungen im Fokus. Um Schlaf in eine umfassende Strategie zur Bekämpfung von Übergewicht einbeziehen zu können, sind nun Interventionsstudien erforderlich, die einen potenziellen protektiven Effekt einer verlängerten Schlafdauer untersuchen.AbstractSleep deprivation is considered a serious risk factor with a relevant public health impact due to its multiple effects, which we are just beginning to understand. This is underlined by the growing number of studies in recent decades that have investigated the association between sleep duration and overweight. This review gives an overview of the current state of research and potential biological mechanisms. Evidence from epidemiological studies suggests an association between short sleep duration and overweight in children as well as in adults. Different biological mechanisms have been discussed in this context with a special focus on hormonal changes as the potential mediator. To include sleep in a comprehensive strategy to prevent overweight, interventional studies that analyze the potentially protective effect of prolonged sleep duration are necessary.Sleep deprivation is considered a serious risk factor with a relevant public health impact due to its multiple effects, which we are just beginning to understand. This is underlined by the growing number of studies in recent decades that have investigated the association between sleep duration and overweight. This review gives an overview of the current state of research and potential biological mechanisms. Evidence from epidemiological studies suggests an association between short sleep duration and overweight in children as well as in adults. Different biological mechanisms have been discussed in this context with a special focus on hormonal changes as the potential mediator. To include sleep in a comprehensive strategy to prevent overweight, interventional studies that analyze the potentially protective effect of prolonged sleep duration are necessary.

HPV vaccine uptake after introduction of the vaccine in Germany: An analysis of administrative data

In Germany, vaccination against human papilloma virus (HPV) has been recommended by the German Standing Vaccination Committee (STIKO) for girls aged 12–17 years since March 2007. The vaccine is free of charge for this age group. Additionally, some statutory health insurance providers (SHI) offer reimbursement for women aged 18–26 years. Currently available information on the uptake or coverage of HPV vaccination is limited to specific regions, age groups, or study populations. This report describes the HPV vaccine uptake in 2008 for females aged 12–26 years in Germany on a broad regional level based on data from one large SHI. HPV vaccinations were identified by outpatient codes used for reimbursement of vaccine administration. Vaccine uptake was calculated by dividing the number of females, who received at least one HPV vaccine dose by the number of female insurees in the respective age group. The overall study population consisted of 317 234 females, of whom 77 350 received at least one HPV vaccine dose in 2008. Vaccine uptake was 32.2% in the recommended age group, with a peak age at 14–16 years. In the age group of females aged 18–26 years, where HPV vaccination was not officially recommended by the STIKO, uptake was 12.3%. Vaccine uptake in 2008 reflects an early stage after the recommendation of HPV vaccination in 2007. Future changes in vaccine uptake should be further and more promptly monitored.

Schlafdauer und Übergewicht

ZusammenfassungSchlafmangel ist aufgrund seiner vielfältigen Auswirkungen, deren Wirkmechanismen wir erst zu verstehen beginnen, als ernst zu nehmender Risikofaktor mit großer Public-Health-Relevanz zu sehen. Dies wird auch durch die steigende Zahl an Studien belegt, die sich speziell mit der Frage nach dem Zusammenhang zwischen Schlafdauer und Übergewicht befassen. Die vorliegende Arbeit gibt einen Überblick sowohl über den aktuellen Stand der Forschung zu diesem Thema als auch über mögliche biologische Mechanismen. Die Evidenz aus epidemiologischen Studien deutet sowohl bei Kindern als auch bei Erwachsenen auf einen Zusammenhang zwischen kurzer Schlafdauer und Übergewicht hin. Die Ergebnisse bei Kindern sind konsistenter als bei Erwachsenen. Als Ursache für den Zusammenhang werden mehrere Mechanismen diskutiert. Dabei stehen vor allem hormonelle Veränderungen im Fokus. Um Schlaf in eine umfassende Strategie zur Bekämpfung von Übergewicht einbeziehen zu können, sind nun Interventionsstudien erforderlich, die einen potenziellen protektiven Effekt einer verlängerten Schlafdauer untersuchen.AbstractSleep deprivation is considered a serious risk factor with a relevant public health impact due to its multiple effects, which we are just beginning to understand. This is underlined by the growing number of studies in recent decades that have investigated the association between sleep duration and overweight. This review gives an overview of the current state of research and potential biological mechanisms. Evidence from epidemiological studies suggests an association between short sleep duration and overweight in children as well as in adults. Different biological mechanisms have been discussed in this context with a special focus on hormonal changes as the potential mediator. To include sleep in a comprehensive strategy to prevent overweight, interventional studies that analyze the potentially protective effect of prolonged sleep duration are necessary.Sleep deprivation is considered a serious risk factor with a relevant public health impact due to its multiple effects, which we are just beginning to understand. This is underlined by the growing number of studies in recent decades that have investigated the association between sleep duration and overweight. This review gives an overview of the current state of research and potential biological mechanisms. Evidence from epidemiological studies suggests an association between short sleep duration and overweight in children as well as in adults. Different biological mechanisms have been discussed in this context with a special focus on hormonal changes as the potential mediator. To include sleep in a comprehensive strategy to prevent overweight, interventional studies that analyze the potentially protective effect of prolonged sleep duration are necessary.

Further potentially carcinogenic effects of chronodisruption.

In addition to the suppression of melatonin production and circadian disruption with deregulation of peripheral growth control functions as discussed in the article, we would like to mention further pathophysiological mechanisms that are fundamental to chronodisruption and may therefore promote the development of cancer (1). Sleep disruption as a consequence of shift work can result in disruption of the hypothalamic-pituitary gland axis, which in turn triggers an increased release of glucocorticoids. A resulting chronic suppression of immune response after years of exposure may increase the susceptibility to developing cancer. In addition to changes to activity periods and dietary habits, night work can cause further lifestyle changes, for example with regard to alcohol and tobacco consumption, and may thus indirectly affect the pathogenesis of cancer. Even though the evidence is inconclusive regarding the cancer-protective effects of vitamin D (2), night work may result in lower exposure to UV light and therefore reduced production of vitamin D, which, for example, may facilitate the development of colorectal cancer. How molecular-biological mechanisms in nocturnal exposure to light and chronodisruption influence the risk of disease is an important research field in occupational epidemiology. In the future it will be importance to study which shift roster triggers relevant chronodisruption. The increasing use of longitudinal study designs with prospective assessment of shift-work systems-as it would be possible for example in the context of the national cohort-can make a valuable contribution to this important research field.