Insomnia, sleeping less than six hours may increase risk of cognitive impairment

Middle-aged adults who report symptoms of insomnia and are sleeping less than six hours a night may be at increased risk of cognitive impairment, according to a study by Penn State College of Medicine researchers. The results may help health care professionals understand which patients who report insomnia are at increased risk for developing dementia.

Insomnia is characterized by reports of difficulty falling asleep, difficulty staying asleep, or waking up too early and not being able to get back to sleep. When these symptoms occur at least three nights a week and for at least three months, it is considered a chronic disorder. Researchers found that adults who reported insomnia and obtained less than six hours of measured sleep in the laboratory were two times more likely to have cognitive impairment than people with the same insomnia complaints who got six or more hours of sleep in the lab. The study results were published in the journal Sleep on Sept. 24.

According to Julio Fernandez-Mendoza, associate professor of psychiatry and behavioral health and sleep specialist at Penn State Health Sleep Research and Treatment Center, about 25% of the adult general population reports insomnia symptoms and another 10% suffers from chronic insomnia. He said that being able to distinguish which of these individuals are at risk for further adverse health conditions is critical.

“This study reinforces the need to objectively measure the sleep of adults who complain of insomnia,” Fernandez-Mendoza said. In previous research, the team found that adults with insomnia who obtained less than six hours of sleep were at risk for various cardiometabolic conditions, including hypertension, diabetes, heart disease or stroke and mental health problems, such as depression.

“These new results demonstrate that these middle-aged adults also have an increased risk of cognitive impairment, which can be an early indicator of future dementia in a significant proportion of them,” Fernandez-Mendoza said.

Researchers examined data from the Penn State Adult Cohort, a randomly-selected, population-based sample of 1,741 adults who had one measured night of sleep. Before having their sleep measured in a sound, light and temperature-controlled room, participants completed a clinical history, physical exam and questionnaire to identify self-reported sleep disorders, physical health conditions, mental health problems and substance use. They also were evaluated for cognitive impairment before sleeping in the laboratory, including receiving tests that assessed attention, memory, language and other measures.

Fernandez-Mendoza and colleagues found that adults who reported insomnia symptoms or chronic insomnia and slept less than six hours in the lab were two times more likely to have cognitive impairment when compared to good sleepers. They also found that this association was particularly strong for adults with coexisting cardiometabolic conditions and cognitive impairment, which may be an indicator of vascular cognitive impairment—a condition where poor cardiovascular health results in impaired brain function.

Adults who reported insomnia but who slept six or more hours in the lab were not at risk of cognitive impairment when compared to good sleepers. The research team accounted for potential differences in sociodemographic factors—including age, sex, race, ethnicity, years of education—and the presence of physical and mental health problems, including sleep apnea, as well as substance use, such as smoking and alcohol intake.

Fernandez-Mendoza said that only having one measured night of sleep limited the study’s conclusion to in-lab sleep studies and cautioned that these data do not prove causality. Nevertheless, they further show that insomnia, cognitive impairment and cardiometabolic conditions, like high blood pressure, diabetes and heart disease, often tend to co-occur in adults who get less than six hours of sleep in the lab but not in those who can sleep six hours or more, he highlighted.

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Coronavirus therapeutics 'more complicated' than vaccine, expert says

WHO warns of surge in coronavirus cases in Europe

EEurope is seeing more weekly coronavirus cases than it did in March’s peak; Amy Kellogg reports.

Editors of a highly respected medical journal discussed on Wednesday "Operation Warp Speed" and the government's response to COVID-19, focusing mostly on therapeutics.

"Operation Warp Speed" is the U.S. government's plan to quickly ramp up the development and production of vaccines, therapeutics and diagnostics.

“Therapeutics are, in a way, more complicated than vaccines," said Dr. Eric Rubin, editor-in-chief of the New England Journal of Medicine (NEJM). “There are a limited number of approaches to vaccination and a similarly limited number of endpoints, but for therapeutics, there is an enormously wide range of targets and goals.”

Rubin explained that therapeutics can take a number of approaches, like trying to target the virus, target the host or target the interface between the host and the virus, all possibly leading to different consequences. Researchers can opt for small synthetic molecules or large biological macromolecules, also leading to different development paths, he said.

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“Therapeutics are, in a way, more complicated than vaccines," said Dr. Eric Rubin, editor-in-chief of the New England Journal of Medicine (NEJM)." 
(iStock)

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“The development time from discovery all the way to a useful drug is even longer than in vaccines, it’s often extending for decades," he said.

Rubin said "Operation Warp Speed" set three criteria for supported therapeutics: the candidate has to be ready for clinical testing this fall, there must be strong preclinical data supporting its use, and any candidate chosen must be deliverable at scale by the end of 2020.

Rubin said the criteria “strictly limit” the potential candidates. However, antibody-based therapies were said to have several advantages due to their well-understood development and production processes, in addition to their relatively known safety margins.

It was noted that small molecules like the experimental antiviral remdesivir and dexamethasone were previously shown to have some success. While the former can benefit patients earlier on in infection, the latter showed to lower the fatality rate of patients with more severe disease.

While remdesivir may benefit patients earlier on in infection, dexamethasone showed to lower the fatality rate of patients with more severe disease. 
(iStock)

“Dexamethasone sets a very high bar because it’s cheap and widely available and most of the other things that we’re talking about are antibodies or expensive small molecules so they’ll have to do better than dexamethasone in order to be widely adopted," Rubin said.

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These small molecules were said to have unique properties, and it’s difficult to generalize between them, even within the same chemical class. Each drug has its own pharmacology, subject to investigation and safety testing.

Rubin explained that “often times, it’s very difficult to guess what the issues are going to be for a small molecule as opposed to some of the, for example, antibodies, so there are often not very good guesses about potential toxicities before you get into people.”

Dr. Lindsey Baden, deputy editor of NEJM and co-principal investigator for Moderna’s Phase 3 trial, is involved with "Operation Warp Speed." Baden questioned how to bring out the best in the U.S. government, industry and academia to create a fast, appropriate response to the global health crisis.

“It’s a real balance because we don’t want to get lost in for-profit considerations but we also need responses that are temporally appropriate, so speed, and how to do things quickly in response to this pandemic that is spreading so fast,” Baden said. “It’s something that the different communities haven’t always thought about together that this crisis forced us to [do]

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"I think the speed with which this response is occurring on the biomedical side is encouraging in many ways despite some failings in our response," Baden added.

Finally, Baden addressed the question on the minds of many: How can drug developers speed along these clinical trials without risking safety in the end product?

“There are ways to take risks in manufacturing that are financial that don’t engender safety risks in the studies and those financial risks have to be thought about in the manufacturing side and the delivery side, that I would argue are appropriate risks in this setting," Baden said, elaborating on the nations' daily new case and death count, which is around 36,000 and 750, respectively, per the AP.

He said shaving off a week, month or just a day "has significant potential implications," given the widespread disease.

Click here to listen to the NEJM interview.

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Fewer kids may be carrying coronavirus without symptoms than believed, study says

(HealthDay)—Are infected-but-healthy children major “silent spreaders” of the new coronavirus? New research out of northern Italy, once a COVID-19 hotspot, suggests they might not be.

Rigorous COVID-19 testing of children and adults admitted to a hospital in Milan for reasons other than coronavirus found that just over 1% of kids tested positive for SARS-CoV-2, compared to more than 9% of adults.

That suggests a very low rate of asymptomatic infection among children, and does “not support the hypothesis that children are at higher risk of carrying SARS-CoV-2 asymptomatically than adults,” the researchers reported in the Sept. 14 online edition of JAMA Pediatrics.

One U.S. expert in infectious disease found the report encouraging.

“Since the start of the pandemic it has been very difficult to determine what the actual role of children in the spread of the virus is,” said Dr. Amesh Adalja, senior scholar at the Center for Health Security at Johns Hopkins University, in Baltimore.

“It is becoming clear that they do not amplify this virus the way they do influenza when it comes to community spread,” Adalja said.

In the new study, physicians led by Dr. Carlo Agostoni, of the Ca’Granda Foundation Maggiore Polyclinic Hospital in Milan, conducted two sets of nasal swab tests, up to two days apart, on 214 newly admitted patients.

Eighty-three of these new admissions were children and 131 were adults. All were admitted to the hospital in March and April, at the height of northern Italy’s COVID-19 outbreak. However, all of the patients were admitted for reasons unconnected to COVID-19, and none had shown any symptoms of the illness.

So how many were secretly carrying the virus nonetheless? Based on the swab tests, only 1.2% of the pediatric patients turned up positive for infection, compared to 9.2% of adults.

The low rate of carriage among kids in a city with a burgeoning number of COVID-19 cases suggests “that [children’s] role as facilitators of the spreading of SARS-CoV-2 infection could be reconsidered,” the study authors wrote.

Still, the researchers stressed that this is a small sample from just one hospital, so the findings shouldn’t be considered definitive.

And of course community outbreaks of COVID-19 tied to asymptomatic but infected children are happening in the United States. On Friday, researchers from the U.S. Centers for Disease Control and Prevention issued a report on a cluster of cases originating from two Salt Lake City day care facilities. The report found that 12 youngsters infected with coronavirus (only three showed any symptoms) enrolled at two day care centers easily passed SARS-CoV-2 to at least 12 family members, one of whom ended up hospitalized.

So as millions of children head back to school, uncertainty as to their role in the spread of COVID-19 continues, Adalja said.

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Less than half of people in England understand current lockdown rules

Under half (45%) of people in England report having a “broad understanding” of the current lockdown rules, compared to 90% across the UK during the strict lockdown period, finds UCL’s COVID-19 Social Study.

Levels in Scotland and Wales have also fallen but are higher than those in England, with reported levels of understanding at 75% and 61% respectively. Complete understanding has fallen even further, with only 14% of adults in England reporting understanding the rules completely as lockdown eased, compared to 18% in Wales and 27% in Scotland.

Launched in the week before lockdown started, this ongoing study is funded by the Nuffield Foundation with additional support from Wellcome and UK Research and Innovation (UKRI). It is the UK’s largest study into how adults are feeling about the lockdown, government advice and overall wellbeing and mental health with over 70,000 participants who have been followed across the last 19 weeks.

Access to healthcare has also fallen during the lockdown, with one in 10 people across the UK reporting being unable to see or speak with a GP about their physical health, one in 20 unable to speak to a professional about their mental health, and one in five not telling a GP about symptoms of an illness when they usually would have done (even when appointments to see GPs were available). Groups who faced the most barriers included younger adults, women, individuals from BAME backgrounds, and people with physical and mental health conditions.

People with a diagnosed mental health condition were significantly more likely to have not spoken to a mental health professional when they usually would have done, with a fifth reported not being able to access professional mental health support during lockdown.

Lead author, Dr. Daisy Fancourt (UCL Epidemiology & Health Care) said: “Our study shows that as lockdown measures have eased at different rates in each nation of the UK, levels of understanding around what is and isn’t permissible have dropped, especially amongst younger adults. This could possibly reflect difficulties in applying the rules to more complex life scenarios amongst younger adults, or may be reflective of the different amounts of time spent following the news on COVID-19 amongst different age groups. The general drop-off in understanding could be due to unclear messaging from the government, or a reduction in interest and engagement from people, especially with the cessation of the daily Downing Street coronavirus briefing in late June.”

Depression and anxiety levels, life satisfaction, and happiness have all shown improvements across every socio-demographic subgroup examined, and loneliness levels have also decreased further, showing the first clear pattern of decrease in 19 weeks. However there has been little change in people reporting major or minor stress due to catching COVID-19, unemployment, finance, or getting food.

Cheryl Lloyd, education program head at the Nuffield Foundation said: “With concerns growing over a second wave of COVID-19 it is concerning that many people in England report not understanding the current government guidance. As another Nuffield-funded study by the Reuters Institute has shown, people are less likely to access news about COVID-19 on a daily basis now that lockdown has eased. With the rules changing regularly, this may be a factor in the public not understanding the government guidance.”

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Why COVID-19 poses greater risks for men than women

While it’s not exactly clear why, the finding itself is certain: Men are suffering worse fates than women when it comes to COVID-19, regardless of geography or age. A variety of data from outbreaks across the world has established this fact, and experts like Johns Hopkins biologist Sabra Klein are trying to understand more.

Last month, Klein contributed to a viewpoint in the Journal of Critical Investigations calling for broader study of how biological sex differences between men and women affect outcomes with COVID-19—which she and colleagues believe should be a significant consideration for developing effective treatments and vaccines.

Earlier this week, Klein joined fellow Johns Hopkins University researchers in for a webinar exploring sex and gender dimensions of coronavirus. That talk was hosted by two research units Klein co-chairs, the Center for Women’s Health, Sex, and Gender and a specialized center under the National Institutes of Health that studies sex and age differences in influenza immunity.

The Hub reached out to Klein for more insights on what the scientific community knows so far about the different outcomes between men and women who contract COVID-19.

What is the evidence showing different outcomes for men and women who contract COVID-19?

Around the world, on every continent, we’re observing that men are significantly more likely to be hospitalized with severe COVID-19, and men are also significantly more likely to die from COVID-19. Some studies are showing the risks are twofold for men. Women are contracting the virus at same rates as men, but they are more likely to recover.

Because these findings are cutting across social and cultural boundaries, that strongly suggests the biological difference between males and females is contributing. That likely doesn’t tell the full story, however—social and lifestyle factors may certainly be influencing the trends, but we need to understand more.

What might be the possible explanations for the discrepancy?

I am hypothesizing that because women typically have a more rapid and robust immune response to viruses than men, this may be one factor contributing to female-biased protection against SARS-CoV-2, the virus that causes COVID-19. There are data from early outbreaks in Wuhan, China, for example, that show women clear the virus more quickly than men.

A sex difference in immune responses that control and clear SARS-CoV-2 suggests there there’s a difference between sexes affecting immunity. We have data for other viruses illustrating that sex differences in immunity are caused by genetic as well as hormonal differences between women and men. For example, in females, hormones such as estrogen and progesterone may be protective against the virus, and it’s possible testosterone does the opposite for men.

Scientists are also looking into the role of the ACE-2 receptor, which is found on the cells lining the lung and airways and is used by the SARS-CoV-2 virus to enter cells. From what we know about this receptor, from other conditions such as hypertension and kidney disease, ACE-2 expression is greater in males than in females. We also know from work in the kidneys that estrogen downregulates the expression of ACE-2,which could be a plausible biological explanation for reduced severity of the virus in women.

How is the factor of age overlapping with all of this?

It turns out the male bias severity is happening across a diverse range of ages. A very large JAMA study on cases in New York City, for example, looked at ages 30 through 90, and found that males were significantly more likely to be hospitalized or die regardless of age. Another study in The Lancet examining ages 20 upwards in European countries also shows this trend across ages. What we’re seeing in ages 60 years and older is that this is where we find the most severe outcomes of death.

You said that social and cultural factors may also be playing a role.

My colleague Rosemary Morgan, in international health, is studying this; she specializes in gender-associated factors that impact health and disease, including COVID-19. We know that biological differences are only part of the story of what make men and women different. It also has to do with our behavior and even the social and cultural norms that define our roles and responsibilities. For example, females may be more likely to be frontline workers, which could create more risks for exposure. In terms of lifestyle, men tend to be more likely to be smokers, which is a risk factor, and they’re less likely to seek out medical care when there’s a problem. And with COVID-19, if men are less likely to engage in behaviors like mask-wearing and hand-washing, that may increase risks.

There are also underlying conditions such as hypertension, heart disease, and diabetes, which men are statistically more likely to have and some of which can be attributed to lifestyle factors, that also amplify risks with COVID-19.

What are the implications of all of this for treatment and vaccines?

As my colleagues and I wrote in the Journal of Critical Investigations, we need to be ensuring a large prism of men and women take part in the numerous clinical trials for vaccines and we need to be able compare outcome data between men and women. Formulating vaccines should take into account the differences.

Vaccines are just one arm of how we’re addressing protections from COVID-19, however. Another is therapeutics. We have data from the past showing more adverse reactions for women than men with antiviral drugs, and it’s important to be aware of that. We don’t want the reaction to the drug to be worse than the condition it’s trying to treat.

What are you researching right now related to this issue?

I’m one of the partners working with Hopkins immunologist Arturo Casadevall on the promising treatment of convalescent plasma, which uses antibodies of recovered COVID-19 patients to boost immunity in others. Personally, that’s giving me lots of fabulous serological data to use to characterize differences between men and women in antibody responses to SARS-CoV-2.

My colleague Sean Leng at the School of Medicine and I have also won a grant to study differences in immune responses to the virus in older adults, the people who are most at risks of severe outcomes.

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Sean Lowe Doesn't Want 'More Than 4 Kids,' but Catherine Giudici Will Decide

The more, the merrier! Sean Lowe and his wife, Catherine Giudici, aren’t done expanding their family after welcoming their third child.

“We’ve talked about adopting a fourth child,” the former Bachelor, 36, recently told Us Weekly while promoting his Gillette partnership. “I don’t know if we’re done having biological children. I kind of hope that we are, because I think if we do end up adopting … that’d be a lot of kids.”

Since the Texas native doesn’t “want more than four” children, their future family plans are “still up in the air.”

The Bachelorette alum, who shares Samuel, 3, Isaiah, 2, and Mia, 5 months, with the Washington native, 34, went on to tell Us, “I imagine Catherine will make the ultimate decision, as I will have to defer to her. … At some point, I would like to get out of diapers, so that would be nice.”

Giudici gave birth to their daughter in December 2019, and her older bothers have had “a really easy adjustment.” Lowe explained, “The only thing that they get in trouble for is they love on her too much. Man, they just constantly want to give her kisses so sometimes I just have to tell them, ‘Guys, you’ve got to give her some air. She cannot breathe. You have to stop kissing her for a minute.’”

The little one is “a super happy baby,” the For the Right Reasons author told Us. “She just smiles and laughs all the time.”

When it comes to Mia’s latest milestones, she’s eating baby food, sitting up with assistance and becoming more aware of her surroundings.

“It’s fun to realize what she’s learning at a young age, and then to think about how she’s going to continue to transform into this little kid over the next six or 12 months or so,” Lowe gushed.

He and Giudici tied the knot in 2014 in California after meeting and falling in love on season 17 of The Bachelor.

Lowe has been working with Gillette to encourage dads to show off clean-shaven faces on social media with the hashtag #BabyFace as a commitment to develop strong bonds with their babies.

With reporting by Sarah Hearon

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