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Nightly Nicotine Withdrawal In Smokers May Contribute To Restless Sleep New research shows that cigarette smokers are four times as likely as nonsmokers to report feeling unrested after a night's sleep. The study, appearing in the February issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians (ACCP), also reveals that smokers spend less time in deep sleep and more time in light sleep than nonsmokers, with the greatest differences in sleep patterns seen in the early stages of sleep. Researchers speculate that the stimulating effects of nicotine could cause smokers to experience nicotine withdrawal each night, which may contribute to disturbances in sleep. "It is possible that smoking has time-dependent effects across the sleep period," said study author Naresh M. Punjabi, MD, PhD, FCCP, Johns Hopkins University School of Medicine, Baltimore, MD. "Smokers commonly experience difficulty falling asleep due to the stimulating effects of nicotine. As night evolves, withdrawal from nicotine may further contribute to sleep disturbance." Dr. Punjabi and colleagues from Johns Hopkins University School of Medicine compared the sleep architecture of 40 smokers with that of a matched group of 40 nonsmokers, all of whom underwent home polysomnography. Previous studies comparing smokers and nonsmokers have primarily used subjective measures of sleep; what makes this recent study unique is the study population, the use of objective measure of sleep, and the quantitative nature of the analysis. Unlike most studies on sleep comparing smokers and nonsmokers, Dr. Punjabi's study included smoking and nonsmoking subjects who were free of most medical comorbidities and medication use. "Finding smokers with no health conditions was challenging. But in order to isolate the effects of smoking on sleep architecture, we needed to remove all factors that could potentially affect sleep, in particular, coexisting medical conditions," said Dr. Punjabi. "In the absence of several medical conditions, sleep abnormalities in smokers could then be directly associated with cigarette use." An additional strength of this study was that sleep architecture was analyzed using both the conventional method of visual classification of electroencephalogram (EEG) patterns and through power spectral analysis of the EEG, which relies on a mathematical analysis of different frequencies contained within the sleep EEG. "Previous sleep studies have relied on visual scoring of sleep stages, which is time-consuming and subject to misclassification," said Dr. Punjabi. "Spectral analysis allows us to more objectively classify the sleep EEG signals and helps detect subtle changes that may have been overlooked with visual scoring." Visual scoring of sleep staging showed similar results between smokers and nonsmokers. However, spectral analysis showed that smokers had a lower percentage of delta power, or deep sleep, and a higher percentage of alpha power, or light sleep. When asked about sleep quality, 22.5 percent of smokers reported lack of restful sleep compared with 5.0 percent of nonsmokers. Spectral analysis also showed that the largest difference in sleep architecture occurred at the onset of sleep, which supports the premise that nicotine's effects are strongest in the early stages of sleep and potentially decrease throughout the sleep cycle. The researchers speculate the results of their study may have significant future implications in the area of smoking cessation. "Many smokers have difficulty with smoking cessation partly because of the sleep disturbances as a result of nicotine withdrawal," said Dr. Punjabi. "By understanding the temporal effects of nicotine on sleep, we may be able to better tailor nicotine replacement to minimize the withdrawal effects that smokers experience, particularly during sleep." Smokers also reported more caffeine use than nonsmokers. However, caffeine consumption was not associated with the results of the EEG spectral analysis or lack of restful sleep. "The long-term effects of smoking on respiratory and cardiovascular health are well-known," said Alvin V. Thomas, Jr., MD, FCCP, and President of the ACCP. "However, this study is significant because it suggests that smokers may also be deprived of the much-needed restorative effects of sleep. This study provides yet one more reason to stop smoking or to never start." ---------------------------- Article adapted by Medical News Today from original press release. ---------------------------- ACCP represents 17,000 members who provide patient care in the areas of pulmonary, critical care, and sleep medicine in the United States and throughout the world. The ACCP's mission is to promote the prevention and treatment of diseases of the chest through leadership, education, research, and communication. For more information about the ACCP, please visit the ACCP Web site at http://www.chestnet.org/. Source: Jennifer Stawarz American College of Chest Physicians
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The results raise the possibility that treatments to reduce uric acid might slow the decline of renal function in patients with diabetes. "Thus we have the hope of having a means to thwart the loss of kidney function while function is still in a relatively preserved stage," comments Dr. Elizabeth T. Rosolowsky of Joslin Diabetes Center, Boston. The researchers measured serum uric acid concentration in 675 patients with type 1 diabetes. On screening tests, 311 patients had small amounts of the protein albumin in the urine. This result--called microalbuminuria--is generally regarded as a harbinger of kidney function loss in diabetic kidney disease (nephropathy). The other 364 patients had normal urine albumin levels. None of the patients had higher levels of albumin (albuminuria) representing more advanced diabetic nephropathy. Nevertheless, one in five had some impairment of kidney function on a standard test, the glomerular filtration rate. "Our research showed that loss of kidney function takes place even in the absence of albuminuria in patients with type 1 diabetes," says Dr. Rosolowsky. In contrast, the serum uric acid level was consistently related to kidney function--the higher the uric acid, the lower the kidney function. "The serum concentration of uric acid in these patients varied in a manner consistent with its having played a role in this early loss of kidney function," according to Dr. Rosolowsky. Urine albumin is commonly measured to identify patients with type 1 diabetes at risk of developing nephropathy. "Historically, it was believed that the start of kidney function loss happened only when the amount of leakage of albumin into the urine had reached a certain level," Dr. Rosolowsky explains. "However, recent studies by our group have suggested that kidney function loss may start much earlier in some patients with type 1 diabetes." Other studies have suggested that increased serum uric acid levels are associated with loss of kidney function, and may even be a causative factor. If higher uric acid levels do contribute to loss of kidney function, then the findings may offer a new approach to treating diabetic kidney disease. "The serum uric acid concentration is modifiable by drugs or by decreasing the intake of dietary protein, the main source of uric acid," says Dr. Rosolowsky. "If follow-up studies, already underway, demonstrate that serum uric acid concentration predicts the course of early decline in kidney function, then clinical trials would be justified to test whether modifying serum uric acid concentration also modifies the course of renal function decline in type 1 diabetic patients with high normoalbuminuria or microalbuminuria." Adapted from materials provided by American Society of Nephrology, via EurekAlert!, a service of AAAS.
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