Physical activity can improve sleep quality and sleep disorder outcomes
1. This systematic review found that all studies reported an association between physical activity and improved sleep quality and reduced severity of sleep disorders.
2. However, physical activity duration, time, and frequency were important. High-intensity physical activity for more than 90 minutes was associated with worse sleep quality.
Evidence Rating Level: 1 (Excellent)
Sleep disorders and disruptions in sleep quality are highly prevalent and can negatively impact quality of life. Physical activity is associated with increased melatonin production, reduced stress, and improved mood, all of which can assist with sleep. However, the role that physical activity plays in improving sleep quality and sleep disorder outcomes is not well elucidated. Therefore, this systematic review evaluated the current literature on the association between physical activity, sleep quality, and sleep disorders.
Of 413 identified records, 23 studies were included. Studies were included if they investigated the relationship between physical activity and sleep quality or sleep disorder outcomes and were published in English within the last ten years. There were no restrictions on participant age, study setting, or health conditions. Commentaries, letters to the editor, and narrative and scoping reviews were excluded. The review was carried out according to PRISMA guidelines. The study quality was assessed using the Newcastle-Ottawa Scale and the Cochrane Collaboration’s Risk of Bias tool. The primary outcome was the association between physical activity and sleep quality or sleep disorder outcomes.
The results found that all studies reported a positive association between physical activity and sleep quality and reduced sleep disorder severity. However, the duration and time of physical activity were important. For example, one study found that high-intensity physical activity for more than 90 minutes was negatively associated with sleep quality. Another study found that intense physical activity six or more times per week was associated with worsening insomnia symptoms. However, the review was limited because most studies exploring the impact of physical activity on sleep disorders looked at insomnia, while other common sleep disorders, such as restless leg syndrome and sleep apnea, were not adequately explored. Nonetheless, the study demonstrated that physical activity can positively affect sleep quality and sleep disorder outcomes, depending on the intensity and duration.
1. This retrospective cohort study found that poor sleep quality and increased light exposure at night were associated with more symptoms of stress and depression during the 3rd trimester of pregnancy.
2. However, poor sleep quality, but not light exposure, was associated with worsening anxiety and depression levels during the 2nd trimester.
Evidence Rating Level: 2 (Good)
Psychological wellbeing is essential during pregnancy for optimal birth outcomes. However, pregnant women are particularly susceptible to stress, anxiety, and depression, which can negatively impact pregnancy outcomes. Sleep and light exposure at night are two factors linked to psychological wellbeing during pregnancy. However, the role of these factors on psychological wellbeing during pregnancy and the interplay between these factors remains poorly understood. Therefore, the present study investigated the relationship between sleep quality, light exposure at night, and psychological wellbeing during the 2nd and 3rd trimesters of pregnancy.
The study included 169 patients who were randomly selected from government maternity clinics in Malaysia between 2019 and 2021. Participants were included if they were aged 20-48 years, had a single pregnancy, and were literate in English or Bahasa Malaysia. Participants were excluded if they had multiple pregnancies, were shift workers, or had serious health conditions, including gestational diabetes, hypertension, pre-eclampsia, or anemia. Information on demographics and medical history was obtained from self-administered questionnaires and a review of antenatal health records. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI), and light exposure was measured using the Harvard Light Exposure Assessment (H-LEA). Psychological wellbeing was evaluated with the Depression, Anxiety, and Stress Scale-21 (DASS-21). The primary outcome was the association between sleep quality, light exposure, and psychosocial wellbeing during pregnancy.
The results demonstrated that in the 3rd trimester, both light exposure and poorer sleep quality were associated with poorer psychological wellbeing in pregnant women. Specifically, light exposure between 10 p.m. and 1 a.m. was associated with stress and depression during the 3rd trimester. Meanwhile, during the 2nd trimester, only poor sleep quality was associated with worsened wellbeing, while light exposure did not seem to have an impact. However, the study was limited by the self-reported nature of sleep quality and light exposure, which may have introduced recall bias. Nonetheless, the study demonstrated that poor sleep quality and high light exposure at night may negatively impact psychological wellbeing during the later stages of pregnancy.
Obstructive sleep apnea and vitamin D deficiency are closely linked
1. In this systematic review and meta-analysis, patients with obstructive sleep apnea (OSA) had lower 25-hydroxyvitamin D (25-OHD) levels and a higher prevalence of vitamin D deficiency than those without OSA.
2. However, continuous positive airway pressure (CPAP) treatment was not associated with significant changes in serum 25-OHD levels in patients with OSA.
Evidence Rating Level: 1 (Excellent)
Both obstructive sleep apnea (OSA) and vitamin D deficiency are associated with cardiovascular risks. Vitamin D deficiency is associated with several respiratory conditions, and the relationship between this deficiency and OSA is being recognized as increasingly important. However, the relationship between vitamin D deficiency and OSA is complex and remains poorly understood. Therefore, this study aimed to better characterize the relationship between vitamin D deficiency and OSA by comparing the prevalence of vitamin D deficiency in those with and without OSA and determining the impact of continuous positive airway pressure (CPAP) on vitamin D levels.
Of 883 identified records, 28 studies were included from database inception to March 2023. Studies were included if they were conducted on patients 18 years and older who had a diagnosis of OSA confirmed by polysomnography and investigated one of the following: OSA levels in individuals with and without OSA, serum 25-hydroxyvitamin D (25-OHD) levels among patients with OSA, the effect of CPAP treatment on vitamin D levels, or the effects of vitamin D supplementation on OSA severity. Studies were excluded if inadequate data was reported or if OSA was not confirmed in the study participants. The primary outcome was the difference in the serum 23-OHD levels amongst different groups.
The results demonstrated that patients with OSA had lower 25-OHD levels and a higher prevalence of vitamin D deficiency than those without OSA. This relationship was not significantly impacted by body mass index (BMI), age, or geographical latitude. However, treatment with CPAP was not associated with significant changes in serum 25-OHD levels in patients with OSA. However, the review was limited by only including studies published in English, which may have affected the generalizability of the findings. Nonetheless, the study added further evidence to suggest a link between OSA and vitamin D deficiency.
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