Jared Kaltwasser

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Teens and young adults who stay up late or do not get enough sleep have a greater risk of using cannabis or binge drinking, according to a new report.

which is being presented at the Virtual Sleep 2021 meeting

, is one of several new studies to describe the health and behavioral consequences of poor sleep habits.

, Ph.D., of the University of Pittsburgh’s Center for Sleep and Circadian Science, and colleagues, used data from multiple years from the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA) study to identify 831 teens and young adults between the ages of 12 and 21 for whom sleep and drug use data were available. Just over half (423) were females.

The participants were asked about a number of sleep variables — including sleep quality, daytime sleepiness, and Circadian pattern Those data were compared to responses related to substance use the following year.

Overall, Hasler and colleagues found greater eveningness (being awake and alert at night) and later weekend midsleep (the midpoint between sleep onset and end) were associated with a greater likelihood of cannabis use the following year. Greater eveningness and shorter sleep duration correlated with greater number of days of cannabis use the following year.

Likewise, greater eveningness, increased daytime sleepiness, and shorter sleep duration correlated with more severe alcohol binge drinking the following year.

When the data were broken up by age group, the link between sleep patterns and cannabis use disappeared for college-age students, but persisted for middle and high school students.

In a press release, Hasler said the data suggest middle and high school students are at a particularly high risk for sleep-related substance-abuse risk, in part because of their school schedules.

“The particular pattern of sleep predictors in the middle school and high school sample is consistent with the ‘circadian misalignment’ caused by early school start times,” he said.

The American Academy of Sleep Medicine, which is hosting the Sleep 2021 conference, recommends that school start times for middle and high schools be no earlier than 8:30 a.m. in order to give teenagers adequate time to sleep.

Hasler and colleagues’ findings align with earlier research. A separate longitudinal study of teenagers, 

, found sleep patterns were predictive of future alcohol, marijuana, and cigarette use, with less sleep correlating to a greater likelihood of using those substances 2 years later.

Only about one quarter of US high schoolers get sufficient sleep at night, according to the Centers for Disease Control and prevention.

Other research has shown links between sleep and substance abuse in adults.

 of adults found that sleep disorders were predictive of drug use, with as many as 1 in 5 patients treated for sleep disorders also reporting being treated for a drug use disorder and 12% being treated for alcohol use disorder.

Hasler said the good news is that these types of behaviors are reversible with intervention.

“Sleep is modifiable behavior, and perhaps easier to modify than going after substance use directly,” he said, adding that studies of college-age teens suggest they are more willing to consider changing sleep habits than substance-use habits, which may create an opportunity to address both.

“[F]ocusing on improving teen sleep—including through delaying school start times—may be an underutilized but effective approach to reducing risk for problematic substance use.”

Articles

Study shows an association between greater "eveningness" (being awake and alert at night) and cannabis use and binge drinking. 

Teen Sleep Problems Linked To Later Drug Use

New evidence is lending credence to the idea that sleep plays an important role in the prevention of Alzheimer’s disease (AD).

 are part of a larger trend in sleep research looking for possible associations between sleep problems and a variety of neurological disorders.

At the center of the new report is the brain’s 

, which has been described as a drainage system that clears toxins out of the brain. The system mainly functions at night, suggesting that sleep is an important factor in the waste-clearing process.

As Anthony L. Komaroff, M. D., described it in a 

 the glymphatic system, mingles “fresh” cerebrospinal fluid (CSF) with waste product–rich brain interstitial fluid (ISF) rich in brain-related waste products and flushes it out of the bran and into the circulation. 

In the “brain waste” are the toxic beta-amyloid and tau proteins. The cause of Alzheimer's is still elusive, but theories point to he buildup of those proteins as playing a role in the development of Alzheimer’s.

 study, corresponding author Xiao Liu, Ph.D., and colleagues from Pennsylvania State University examined global brain activity and its impact on toxin buildup. They wondered whether tracking neuronal activity would uncover connections between the levels of such activity and the risk of Alzheimer’s.

Liu and colleagues enrolled 118 subjects who were participants in the Alzheimer’s Disease Neuroimaging Initiative project. Of those, 7 had been diagnosed with Alzheimer’s, 62 with mild cognitive impairment, and 18 had been diagnosed with significant memory concerns. The study also included 31 people as  healthy controls.

The study’s subjects underwent resting-state fMRI scans in order to measure global brain activity and CSF flow. The same scan was completed to years later, and investigators compared the findings to neurobiological and neuropsychological markers of Alzheimer’s, including levels of beta-amyloid.

They found that the link between global fMRI activity and CSF influx correlated with AD pathology. The strength of the connection between neuronal activity and CSF flow was stronger in healthy controls and weaker in patients with Alzheimer’s or who were at higher risk of the disease.

“The finding highlights the potential role of low-frequency (<0.1 Hz) resting-state neural and physiological dynamics in the neurodegenerative diseases, presumably due to their sleep dependent driving of cerebrospinal fluid flow to wash out brain toxins,” Liu said, in a press release.

Liu added that additional research should be directed at better understanding how global brain activity and its associated physiological modulations affect glymphatic clearance and neurodegenerative diseases more broadly.

Komaroff, who is a clinical epidemiologist not than a sleep expert, said the links between the glymphatic system, “brain waste,” sleep deprivation, and other neurological disorders could be more extensive than previously realized. He told 

 that it is clear that sleep plays an important physiological function so gaining a better understanding of it is critical.

“I think that any activity that humans are biologically forced to do, and to spend about a third of their lives doing, is very important to understand, both because it’s intrinsically interesting, and because having a better understanding of the biological reasons for sleep is likely to improve human health,” he said.

 Patients with Alzheimer’s disease or who were at high risk for the disease had a weaker correlation between brain activity and cerebrospinal fluid flow while sleeping.

Study Suggests Neuronal Activity, Brain Waste Clearance During Sleep Correlates With Alzheimer’s Risk

Pharmaceutical maker Roche says its monoclonal antibody (atezolizumab) Tencentriq has been shown to be successful at reducing the risk of recurrence or death in a subset of patients with non-small-cell lung cancer (NSCLC) whose tumors express at least 1% programmed death-ligand 1 (PD-L1).

The findings come from new interim results from the phase III IMpower010 study. Roche 

 ahead of the American Society of Clinical Oncology’s 2021 annual meeting, which takes place next month.

About half of people with stage I-III lung cancer will experience recurrence following surgery. The IMpower010 study is a global, open-label, randomized trial comparing atezolizumab with best supportive care in patients with Stage IB-IIIA NSCLC who have undergone surgical resection and up to 4 cycles of adjuvant cisplatin-based chemotherapy. 

The 1,005 people randomized into the trial were split in half, with one arm receiving up to 16 cycles of atezolizumab or best supportive care. The primary endpoint was disease-free survival in PD-L1-positive patients in stages II-IIIA, all randomized patients in stages II-IIIA, and stage IB-IIIA patients in an intent-to-treat group.

The new interim data specifically deal with patients in the PD-L1-positive group. Among those patients, Roche said, atezolizumab following chemotherapy and surgery improved DFS by 34% (hazard ratio [HR]=0.66, 95% CI: 0.50-0.88). The median DFS was 35.3 months for the best-supportive-care arm, but median DFS had not yet been reached in the atezolizumab arm.

“These landmark phase III data demonstrate for the first time that cancer immunotherapy can bring a clinically meaningful improvement to certain people with early lung cancer in the adjuvant setting,” said Roche’s chief medical officer, Levi Garraway, MD, PhD, in a press release. Garraway added that the data could lead to a new approach to the treatment of early-stage lung cancer.

The company also released results from the larger study population. They showed that, in all randomized stage II-IIIA participants, the drug improved DFS by 21% (HR=0.79, 95% CI: 0.64-0.94). Overall, that translated to a median DFS of 42.3 months for patients in the atezolizumab group versus 35.3 months in the best supportive care group.

Follow-up will continue in the overall intent-to-treat population, the company said.

Julia R. Gralow, MD, chief medical officer at ASCO, said the data mark the first time an immunotherapy has been shown to be effective in early-stage lung cancer.

“The IMpower010 trial demonstrates that, for certain patients, atezolizumab can delay progression to advanced disease, and perhaps even the need for more aggressive therapy,” she said, in a press release. “This could be an important advance in our understanding of immunotherapy and a step forward for many patients with lung cancer.”

The therapy led to adverse events in 92.7% of patients, versus 70.7% in the best supportive care group. About 1 in 5 patients in the therapy group (21.8%) had grade 3-4 adverse events, versus 11.5% in the control group. Adverse events led to treatment withdrawal for 18.2% of patients in the atezolizumab group, but no such withdrawals were noted in the best supportive care group.

Atezolizumab already has 4 indications in NSCLC in addition to indications in extensive-stage small cell lung cancer, among other indications. In addition to the IMpower010 study, the drug is also being studied across a variety of cancer types and settings.

Jared Kaltwasser is a healthcare writer in Iowa.

Patients who were PD-L1 positive with early stage non-small-cell lung cancer had better results and a lower risk of death or progression compared to a cohort on best supportive care.

Atezolizumab Extends Disease-Free Survival in Patients with PD-L1 Positive Early NSCLC

Smartphone use before bedtime has been linked with lower-quality sleep, but a new study suggests a popular feature designed to combat the problem is ineffective.

, found the use of Apple’s “Night Shift” feature did not have a significant impact on a patient’s sleep quality. However, avoiding phone use in the last hour before bedtime did make a difference, though only in the study volunteers who were not sleep deprived.

Apple’s iPhone includes a mode called “Night Shift.” The feature, and similar features on other smartphones, reduces short-wavelength light emissions in the minutes before sleep based on the theory that such “blue light filtering” can reduce the negative sleep impacts of screen exposure before bed.

, Ph.D., of Cincinnati Children’s Hospital Medical Center, and colleagues, wanted to understand how, if at all, such features can affect sleep quality in young adults. To find out, the investigators recruited 167 young adults between the ages of 18 and 24. Participants were instructed to spend at least eight hours in bed at night and placed in one of three phone-usage groups. One group was told not to use their phones in the hour before bed. A second group was told they could use their phones with Night Shift enabled in the hour before bed. The final group was told to use their phones normally, without Night Shift. The participants’ sleep was tracked using wrist-worn accelerometers and their iPhone use was monitored using the commercially available “Moment” app.

The results showed a clear trend, but it had nothing to do with Night Shift.

“[D]espite having instructed all study participants to spend at least eight hours in bed with the intention to sleep, we observed that the total average sleep duration for this population was 6.82 hours during our sleep modification window,” the investigators wrote. The sleep amount did not significantly vary based on device use. Patients who didn’t use their phones before sleep averaged 400.79 minutes of sleep per night, those who used Night Shift had 406.93 minutes, and those who used their phone normally slept an average of 404.80 minutes. Sleep latency, a measure of how long it takes to fall asleep, was also similar among the groups.

The participants’ average sleep efficiency, the time spent in bed versus time spent sleeping, was under 85%. Such low sleep efficiency is generally categorized as “poor” sleep, though the authors said the low percentage could be because the study required them to stay in bed longer than they normally would.

“Contrary to our original hypotheses, we did not detect differences in sleep outcomes across the three experimental groups,” Duraccio and her colleagues wrote. “Our three study groups demonstrated comparable means for total sleep time, time taken to fall asleep, amount of time spent awake after falling asleep, and sleep efficiency regardless of their group assignment.”

However, the investigators said their findings might merely be evidence that when a person is sleep deprived, the lack of sleep overrides any sleep differences that might be caused by phone use.

When the analysis was restricted only to participants who got more sleep than the population average, the investigators started to see a difference. In participants with higher-than-average sleep, no phone use led to significantly better sleep quality (more efficient sleep and less time awake during sleeping hours). Yet, even in the group of longer sleepers, there was no significant difference between those who used their phones with Night Shift and those who did not; the impact was only seen when participants avoided phone use altogether.

Duraccio and colleagues said their study shows that the problem of smartphones impacting sleep is more complicated than blue light.

“We conclude that aspects of phone use beyond short-wavelength light must be contraindicative to sleep, such as engagement in stimulating activities (e.g., social networking, texting) that increases physiological arousal that makes sleep difficult,” they said. “Future research that examines these unique contributions of phone use on sleep outcomes is critical.”

Young adults did not have significantly better sleep when using blue light filters on their smartphones in the hour before bed, according to a new study.

Jared Kaltwasser

Articles

Teen Sleep Problems Linked To Later Drug Use

Study Suggests Neuronal Activity, Brain Waste Clearance During Sleep Correlates With Alzheimer’s Risk

Atezolizumab Extends Disease-Free Survival in Patients with PD-L1 Positive Early NSCLC

‘Night Shift’ Feature on iPhone Does Not Help Sleep Quality, Say Researchers