Scientific Letter
Sleep Duration and Cutaneous Melanoma Aggressiveness. A Prospective Observational Study in 443 Patients
Duración del sueño y agresividad del melanoma cutáneo. Un estudio observacional prospectivo con 443 pacientes
Jose Daniel Gómez Olivasa, Francisco Campos-Rodriguezb, Eduardo Nagorec, Luis Hernándezd, Valentin Cabriadae, Jorge Abadf, Olga Medianog, Esther Pastorh, Eusebi Chinerh, Manuel Sanchez de la Torrei, Irene Canoj, Maria Somozak, Alberto Garcia-Ortegaa, Grace Osculloa, Miguel Angel Martinez-Garcíaa,
Corresponding author
a Pneumology Department. Hospital Universitario y Politecnico La Fe, Valencia, Spain
b Pneumology Department Hospital Valme.IBiS, Sevilla, Spain
c Oncology Department, Instituto Valenciano de Oncología, Spain
d Pneumology Department Hospital General Alicante, Spain
e Pneumology Department Hospital Cruces, Bilbao, Spain
f Sleep Unit, Hospital Germans Trials i Pujol, Barcelona, Spain
g Pneumology Department Hospital de Guadalajara, Spain
h Pneumology Department Hospital San Juan Alicante, Spain
i Research Department, Hospital A. Vilanova, Lleida, Spain
j Pneumology Department, Hospital Getafe, Madrid, Spain
k Pneumology Department, Consorcio Sanitario Terrassa, Barcelona, Spain
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Hospital Universitario y Politecnico La Fe, Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Pneumology Department Hospital Valme.IBiS, Sevilla, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Oncology Department, Instituto Valenciano de Oncología, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Pneumology Department Hospital General Alicante, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Pneumology Department Hospital Cruces, Bilbao, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Sleep Unit, Hospital Germans Trials i Pujol, Barcelona, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Pneumology Department Hospital de Guadalajara, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Pneumology Department Hospital San Juan Alicante, Spain" "etiqueta" => "h" "identificador" => "aff0040" ] 8 => array:3 [ "entidad" => "Research Department, Hospital A. Vilanova, Lleida, Spain" "etiqueta" => "i" "identificador" => "aff0045" ] 9 => array:3 [ "entidad" => "Pneumology Department, Hospital Getafe, Madrid, Spain" "etiqueta" => "j" "identificador" => "aff0050" ] 10 => array:3 [ "entidad" => "Pneumology Department, Consorcio Sanitario Terrassa, Barcelona, Spain" "etiqueta" => "k" "identificador" => "aff0055" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Duración del sueño y agresividad del melanoma cutáneo. Un estudio observacional prospectivo con 443 pacientes" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1273 "Ancho" => 2508 "Tamanyo" => 204935 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Relationship between sleep duration and commonly used clinical markers of tumor aggressiveness in cutaneous melanoma. <span class="elsevierStyleItalic">p</span> values refer to sleep duration<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>8<span class="elsevierStyleHsp" style=""></span>h versus control group (sleep duration between 6 and 8<span class="elsevierStyleHsp" style=""></span>h). Results were adjusted for age, sex, apnea-hypopnea index, body mass index, presence of insomnia and intake of hypnotics. SL: Short sleep; LS: Long Sleep.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Both short and long sleep duration have been associated with an increased prevalence and incidence of cancer,<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1,2</span></a> but its relationship with cancer aggressiveness remains unknown. We have previously described an association between cutaneous melanoma and sleep-disordered breathing based on a prospective multicentric cohort.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> In the present paper, we describe the results of a post-hoc analysis aiming to evaluate the association between subjective sleep duration and objective parameters of melanoma aggressiveness.</p><p id="par0010" class="elsevierStylePara elsevierViewall">This is an observational, cross-sectional, multicenter study that included 443 consecutive patients with a diagnosis of melanoma from 29 Spanish hospitals. Patients were excluded if they had in situ melanoma or had received previous treatment with continuous positive airway pressure. The study was approved by the ethics committees of all the hospitals, and all the patients gave their informed consent. Each patient completed a clinical questionnaire which included anthropometric measurements, relevant antecedents, medication, sleep apnea symptoms, presence of insomnia and somnolence (Epworth Sleepiness Scale).</p><p id="par0015" class="elsevierStylePara elsevierViewall">Sleep duration was assessed by asking the patients the following question: How many hours of sleep (including naps) have you had on average in a 24-h period during the last year (year prior to the diagnosis of melanoma)? Participants estimated habitual sleep duration using full hour units. Snoring time was also quantified in the sleep study records.</p><p id="par0020" class="elsevierStylePara elsevierViewall">All patients underwent a sleep study by means of a home respiratory polygraphy and a peripheral blood test. Patients were divided into three groups depending on their daily sleep duration: appropriate sleep duration (between 6 and 8<span class="elsevierStyleHsp" style=""></span>h), short sleepers (<6<span class="elsevierStyleHsp" style=""></span>h) and long sleep duration (>8<span class="elsevierStyleHsp" style=""></span>h). The independent relationship between melanoma aggressiveness factors and sleep duration was determined by introducing into a multivariate logistical regression analysis those variables which could, in the opinion of the researchers, also have clinical importance as confounders: age, sex, AHI, BMI and hypnotics intake. This relationship was evaluated by Hazard Ratio (CI95%), considering the group of patients with appropriate sleep duration as the control group. The degree of melanoma aggressiveness was measured by histological variables such as the Breslow thickness, the tumor mitotic rate (≥5 vs. <5 mitoses per mm<span class="elsevierStyleSup">2</span>), the histological presence of ulceration and regression and positive sentinel lymph node (SLN) involvement. The cut-off points for the Breslow thickness were established at 1, 2 and 4<span class="elsevierStyleHsp" style=""></span>mm, according to international guidelines.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">443 patients were finally included in the study. Mean age was 55.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>15.3 years, and 50.6% were male. The mean BMI was 27.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.5<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span> and the median Epworth score was 6 (IQR: 3–8). The median of the Breslow thickness was 0.85<span class="elsevierStyleHsp" style=""></span>mm (IQR: 0.49–1.80). A Breslow thickness above 1, 2 and 4<span class="elsevierStyleHsp" style=""></span>mm was found in, respectively, 44, 22.3 and 8.8% of the patients. Ulceration was present in 16%, regression in 23.3%, and SLN was positive in 10.6% of patients. The median AHI was 8.6 (IQR: 2.8–20.2). The mean sleep duration was 7.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.27<span class="elsevierStyleHsp" style=""></span>h, with 4.7% sleeping <6<span class="elsevierStyleHsp" style=""></span>h, 77.9% between 6 and 8<span class="elsevierStyleHsp" style=""></span>h and 17.4%<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>8<span class="elsevierStyleHsp" style=""></span>h. 8.4% of the patients presented insomnia and 12% were taking hypnotic drugs. The sleep study time was 7.2<span class="elsevierStyleHsp" style=""></span>h (IQR: 6.6–8) and the snoring study time was 6.9<span class="elsevierStyleHsp" style=""></span>h (IQR: 6.5–7.7). The correlation between subjective sleep duration and snoring study time was <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.86, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.0001.</p><p id="par0030" class="elsevierStylePara elsevierViewall">There was a statistically significant correlation between sleep duration and the Breslow index (<span class="elsevierStyleItalic">r</span>: 0.26; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.001). Those patients with more aggressive melanoma (Breslow<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>mm vs <2<span class="elsevierStyleHsp" style=""></span>mm, and Breslow<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>mm versus <4<span class="elsevierStyleHsp" style=""></span>mm) presented longer sleep duration (8.1 vs. 7.1<span class="elsevierStyleHsp" style=""></span>h; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.0001 and 8.3 vs. 6.9<span class="elsevierStyleHsp" style=""></span>h; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.0001, respectively). Long sleepers presented, in comparison with those patients who slept less than 8<span class="elsevierStyleHsp" style=""></span>h, a significant increase in various systemic markers of inflammation like high-sensitivity C-reactive protein (hs CRP) (2.35 [2.3) vs 1.33 [2.5] mg/L; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.03), fibrinogen concentration (392 [97.1] vs.335 [92.7] mg/dL; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.01) and erythrocyte sedimentation rate (ESR) (17.4 [13.9] vs. 11.2 [9.1] mm1<span class="elsevierStyleHsp" style=""></span>h; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.01), as well as a higher AHI (19.8 [17.9] vs. 15.1 [16.1]; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.02).</p><p id="par0035" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows that long sleepers were 1.53, 1.72 and 2.84 times more likely to present a more aggressive melanoma (Breslow index above 1, 2 and 4<span class="elsevierStyleHsp" style=""></span>mm) compared to the control group, after adjustment for age, gender, BMI, AHI, intake of hypnotic drugs and presence of insomnia. Similarly, long sleepers had an increased risk of SLN positive, presence of tumor ulceration and a high tumor mitotic rate.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">As far as we know, this is the first study to analyze the relationship between longer sleep duration and the aggressiveness of a cancer. Of note, this association was not caused by the presence of confounders such as obesity, sleep apnea, age, gender, hypnotics intake or insomnia. Various mechanisms have been postulated to explain this relationship, including various deregulations of the immune system (especially reductions in natural killer cell activity),<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> increased sleep fragmentation<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> and increased systemic inflammation.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">6,7</span></a> In fact, our study shows that long sleepers presented greater systemic inflammation (increased levels of US-CRP, ESR and fibrinogen).</p><p id="par0045" class="elsevierStylePara elsevierViewall">The main limitation of our study was the fact that the evaluation of sleep duration was subjective, as is the case in most of the similar studies published to date on this topic. However, there was a very strong correlation between the subjective sleep duration and the snoring study time (while the patients are supposed to be sleeping). Moreover, some authors<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> have observed in large series that those patients with self-reported sleep<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>7<span class="elsevierStyleHsp" style=""></span>h per night overestimated their real sleep duration by an average of 0.3<span class="elsevierStyleHsp" style=""></span>h, while this overestimate was even higher (1.3<span class="elsevierStyleHsp" style=""></span>h) in patients who slept<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>h. These circumstances would minimize any error derived from our analysis since, even assuming this situation, the vast majority of the patients in our study would remain in the same analysis group. Moreover, the percentage of patients with abnormal sleep time was 22%, which could affect the conclusions. Finally, we did not include the presence of anxiety or depression as a covariate, but we did include the intake of hypnotics and other psychotropic medication, which is closely associated with anxiety and depression.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In conclusion, we found for the first time a positive relationship between a long sleep duration and some markers of melanoma aggressiveness. Future studies are needed to investigate the main pathophysiological mechanisms that could explain this association and the prognostic relevance of this finding.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors have nothing to declare in relation to this manuscript.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1273 "Ancho" => 2508 "Tamanyo" => 204935 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Relationship between sleep duration and commonly used clinical markers of tumor aggressiveness in cutaneous melanoma. <span class="elsevierStyleItalic">p</span> values refer to sleep duration<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>8<span class="elsevierStyleHsp" style=""></span>h versus control group (sleep duration between 6 and 8<span class="elsevierStyleHsp" style=""></span>h). Results were adjusted for age, sex, apnea-hypopnea index, body mass index, presence of insomnia and intake of hypnotics. SL: Short sleep; LS: Long Sleep.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sleep duration and the risk of breast cancer: the Ohsaki Cohort Study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Kakizaki" 1 => "S. Kuriyama" 2 => "T. Sone" 3 => "K. Ohmori-Matsuda" 4 => "A. Hozawa" 5 => "N. Nakaya" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/sj.bjc.6604684" "Revista" => array:6 [ "tituloSerie" => "Br J Cancer" "fecha" => "2008" "volumen" => "99" "paginaInicial" => "1502" "paginaFinal" => "1505" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18813313" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0050" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Associations of self-reported sleep duration and snoring with colorectal cancer risk in men and women" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "X. Zhang" 1 => "E.L. Giovannucci" 2 => "K. Wu" 3 => "X. Gao" 4 => "F. Hu" 5 => "S. Ogino" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5665/sleep.2626" "Revista" => array:6 [ "tituloSerie" => "Sleep" "fecha" => "2013" "volumen" => "36" "paginaInicial" => "681" "paginaFinal" => "688" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23633750" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0055" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sleep-disordered breathing is independently associated with increased aggressiveness of cutaneous melanoma: a multicenter observational study in 443 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.A. Martinez-Garcia" 1 => "F. Campos-Rodriguez" 2 => "E. Nagore" 3 => "A. Martorell" 4 => "J.L. Rodriguez-Peralto" 5 => "E. Riveiro-Falkenbach" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.chest.2018.07.015" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2018" "volumen" => "154" "paginaInicial" => "1348" "paginaFinal" => "1358" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30059679" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0060" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Melanoma staging: evidence-based changes in the American Joint Committee on Cancer Eighth edition cancer staging manual" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.E. -Gershenwald" 1 => "R.A. Scolyer" 2 => "K.R. Hess" 3 => "V.K. Sondak" 4 => "G.V. Long" 5 => "M.I. Ross" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3322/caac.21409" "Revista" => array:6 [ "tituloSerie" => "CA Cancer J Clin" "fecha" => "2017" "volumen" => "67" "paginaInicial" => "472" "paginaFinal" => "492" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29028110" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0065" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of sleep and circadian rhythm on human circulating immune cells" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Born" 1 => "T. Lange" 2 => "K. Hansen" 3 => "M. Molle" 4 => "H.L. Fehm" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Immunol" "fecha" => "1997" "volumen" => "158" "paginaInicial" => "4454" "paginaFinal" => "4464" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9127011" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0070" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sleep disturbance, sleep duration, and inflammation: a systematic review and meta-analysis of cohort studies and experimental sleep deprivation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.R. Irwin" 1 => "R. Olmstead" 2 => "J.E. Carroll" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.biopsych.2015.05.014" "Revista" => array:6 [ "tituloSerie" => "Biol Psychiatry" "fecha" => "2016" "volumen" => "80" "paginaInicial" => "40" "paginaFinal" => "52" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26140821" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0075" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sleep duration and biomarkers of inflammation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.R. Patel" 1 => "X. Zhu" 2 => "A. Storfer-Isser" 3 => "R. Mehra" 4 => "N.S. Jenny" 5 => "R. Tracy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/sleep/32.2.200" "Revista" => array:6 [ "tituloSerie" => "Sleep" "fecha" => "2009" "volumen" => "32" "paginaInicial" => "200" "paginaFinal" => "204" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19238807" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0080" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sleep duration: how well do self-reported reflect objective measures? The CARDIA Sleep Study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D.S. Lauderdale" 1 => "K.L. Knutson" 2 => "L.L. Yan" 3 => "K. Liu" 4 => "P.J. Rathouz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/EDE.0b013e318187a7b0" "Revista" => array:6 [ "tituloSerie" => "Epidemiology" "fecha" => "2008" "volumen" => "19" "paginaInicial" => "838" "paginaFinal" => "845" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18854708" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03002896/0000005700000012/v2_202112040821/S0300289620304038/v2_202112040821/en/main.assets" "Apartado" => array:4 [ "identificador" => "49741" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Scientific Letters / Cartas científicas" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000005700000012/v2_202112040821/S0300289620304038/v2_202112040821/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289620304038?idApp=UINPBA00003Z" ]
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