Pakistan Journal of Medical & Health Sciences

Sleep Disorders as an Emerging Cardiometabolic Risk Factor: Why Clinicians Must Take It Seriously

NAVEED SHUJA — 2026-01-30

Sleep has traditionally been viewed as a passive physiological state; however, contemporary research now positions it as a central component of cardiometabolic health¹. Sleep disorders which include obstructive sleep apnea, insomnia, restless legs syndrome, circadian rhythm disturbances, and chronic sleep deprivation are increasingly recognized as independent risk factors contributing to metabolic syndrome, type 2 diabetes mellitus, hypertension, obesity, and cardiovascular morbidity². Despite this growing body of evidence, sleep is one of the most neglected aspects of routine clinical evaluation, particularly in cardiology, endocrinology, and primary care settings³. As cardiometabolic diseases continue to rise in South Asia and worldwide, sleep must be considered a vital variable in both prevention and disease modification⁴.

Sleep Disorders as the Missing Component in Cardiometabolic Assessment

Clinicians routinely focus on traditional risk determinants such as hypertension, dyslipidemia, smoking, sedentary lifestyle, hyperglycemia, and obesity⁵. However, sleep disturbances exert equally powerful effects on cardiometabolic physiology⁶. Many patients with poorly controlled hypertension, unexplained weight gain, or rapidly worsening metabolic syndrome often harbor unrecognized sleep disorders⁷. In South Asian clinical settings, sleep problems are under-screened primarily due to time constraints, lack of awareness, and insufficient integration into routine medical history-taking⁸. Yet, sleep disorders frequently precede or exacerbate metabolic dysfunction long before overt disease appears⁹

Biological Pathways Linking Sleep and Cardiometabolic Disease

Multiple interrelated mechanisms explain how disrupted sleep contributes to cardiovascular and metabolic pathology¹⁰. Sleep fragmentation, intermittent hypoxia, and circadian misalignment elevate sympathetic nervous system activity, producing sustained increases in blood pressure and heart rate even during daytime¹¹. Poor sleep alters metabolic hormone balance by reducing insulin sensitivity, increasing glucose intolerance, and disrupting appetite-regulating hormones such as ghrelin and leptin¹². These changes promote visceral adiposity, weight gain, and insulin resistance, driving the development of metabolic syndrome¹³. Furthermore, sleep disorders elevate inflammatory cytokines including IL-6, TNF-α, and CRP, creating a persistent low-grade inflammatory state that accelerates endothelial injury and atherogenesis¹⁴. Intermittent hypoxia associated with obstructive sleep apnea increases oxidative stress and impairs nitric oxide production, resulting in endothelial dysfunction¹⁵. These changes collectively disturb cardiac autonomic regulation, reducing heart rate variability and predisposing patients to arrhythmias, sudden cardiac events, and overall heightened cardiovascular risk¹².

Why Sleep Disorders Cannot Be Ignored in Clinical Practice

Ignoring sleep disorders leads to significant diagnostic and therapeutic gaps¹⁵. Many patients with resistant hypertension fail to respond to multiple antihypertensive agents simply because underlying obstructive sleep apnea has not been recognized¹¹. Similarly, patients with diabetes may struggle with glycemic control despite optimal pharmacotherapy because untreated sleep problems worsen insulin resistance¹³. Obesity becomes more difficult to manage when hormonal disturbances caused by poor sleep perpetuate increased appetite and reduced energy expenditure⁵. Sleep disorders also increase the rate of myocardial infarction, stroke, and heart failure, making early recognition essential⁸. Clinically, identifying sleep disturbances is far easier and more cost-effective than managing long-term complications of cardiometabolic disease⁹, yet sleep remains an overlooked dimension¹⁰.

Integrating Sleep Into Routine Clinical Evaluation

There is a pressing need to embed sleep assessment as a core component of clinical evaluation¹⁴. A few focused questions regarding snoring, breathing pauses during sleep, excessive daytime sleepiness, morning headaches, insomnia symptoms, and sleep patterns can significantly improve early detection¹². Diagnostic pathways such as polysomnography, overnight oximetry, and actigraphy should be integrated into care protocols for high-risk patients, particularly those presenting with resistant hypertension, obesity, or metabolic syndrome¹⁵. Screening instruments such as the STOP-BANG questionnaire or the Epworth Sleepiness Scale provide rapid and clinically meaningful insights⁶. Incorporating sleep considerations into cardiometabolic risk stratification tools will improve diagnostic accuracy and allow clinicians to initiate earlier interventions¹³.

Therapeutic Importance of Addressing Sleep Disorders

Treating sleep disorders can yield profound metabolic and cardiovascular benefits¹¹. Continuous positive airway pressure (CPAP) therapy in obstructive sleep apnea reduces blood pressure, improves insulin sensitivity, enhances endothelial function, and lowers cardiovascular risk¹⁵. Non-pharmacological methods such as sleep hygiene training, cognitive behavioral therapy for insomnia, structured weight reduction programs, and circadian alignment strategies create long-term health improvements¹². Addressing sleep problems in shift-workers, who represent a growing population in urban South Asia, can dramatically improve metabolic parameters and reduce cardiovascular strain¹⁰. Integrating sleep into multidisciplinary cardiometabolic management alongside exercise, diet, and pharmacotherapy provides a more complete and biologically aligned therapeutic approach¹⁴.

CONCLUSION

Sleep disorders represent a rapidly emerging and clinically significant cardiometabolic risk factor¹³. The evidence linking sleep with cardiovascular and metabolic disease has become unequivocal, yet clinical practice remains slow to adapt¹⁵. A paradigm shift is urgently needed⁹. Clinicians must treat sleep as a measurable and modifiable vital sign, deserving the same attention as blood pressure, glucose levels, and lipid panels¹¹. Early recognition, structured screening, and targeted therapy for sleep disorders can substantially reduce the burden of cardiometabolic diseases and improve patient outcomes¹⁴. The challenge now is not a lack of evidence, but the need for clinicians to translate this evidence into everyday practice¹⁵. Only by taking sleep seriously can we meaningfully advance cardiometabolic health and long-term disease prevention¹.

The Effect of Excessive Smartphone Use on Mental Wellbeing, Sleep Quality and Active Lifestyle Behaviours

ANNA HAMERLA — 2026-01-30

Introduction: Mobile phone addiction has become a very common phenomenon among young people. It leads to a number of negative consequences for their health, both physical and mental. The aim of this paper is to present the most important consequences of excessive phone use in terms of mental health, such as depression, anxiety and feelings of loneliness. Issues such as the impact of phone addiction on sleep disorders, orthorexia and eating behaviour are also discussed. The paper highlights that excessive use of mobile devices can significantly affect the quality of life of young people, contributing to emotional disturbances and reduced psychological well-being. Conclusions point to the need for further research and educational activities to reduce the negative impact of this phenomenon.

Material and methods: For this work, we conducted a search in the PubMed and Google Scholar databases using the keywords: "phone addiction," " health," " lifestyle," followed by an analysis of the selected materials.

Aim of the study: The aim of this work is to analyse the impact of smartphone addiction on young people's mental health, with a focus on aspects such as depression, anxiety, sleep disorders, orthorexia, social relationships and feelings of loneliness.

Conclusion: Excessive use of mobile devices can have a significant impact on the quality of life of young people, contributing to emotional, sleep and eating disorders. Preventive measures are advisable, including education on sleep hygiene, limiting the time spent in front of screens before bedtime and promoting healthy lifestyles among young people and students.

Augmented Reality Navigation Combined with Fluorescence Imaging for Colorectal Liver Metastases

GUL RUKH — 2026-01-30

Background: Parenchyma-sparing hepatectomy (PSH) is becoming more popular as an option in the treatment of colorectal liver metastases (CRLM). The use of augmented reality navigation (ARN) and indocyanine green fluorescence imaging (FI) has the potential to enhance the accuracy of surgery.

Objective: To compare the perioperative and oncologic outcome of ARN-FI-aided laparoscopic PSH and standard laparoscopic PSH using a synthetic IPTW-modeled cohort (N = 300).

Methods: Artificial cohort of 300 patients (150 ARN-FI, 150 Nonarn-FI), simulated based on published distributions and balanced based on IPTW considerations. Outcomes: EBL, operative time, big-time resection, big-time morbidity, LOS, RFS, OS.

Results: ARN-FI was linked to much less EBL (180 85 mL vs 350 140 mL: p < 0.001), higher R0 rate (94.7% vs 88.0; p = 0.019), shorter operating time (210 45 min vs 175 38 min: p < 0.001), shorter LOS (5.5 1.8 d vs 7.2 2.5 d: p < 0.0 Downward trend of significant morbidity (6.0% vs 11.3%; p = 0.07).

Conclusions: ARN-FI enhances the intraoperative accuracy, lessens blood loss, and amplifies margin negative resections, providing improved RFS with augmented operating time. Potential validation advised.

Data-Driven Evaluation of Metaverse Integration in Healthcare Education: User Adoption Readiness and Impact on Clinical Competency among Healthcare Professionals

KHAIRUNISA SHAIKH — 2026-01-30

Background: One of the new methods of change in healthcare and higher education is the integration of metaverse technologies such as virtual reality, augmented reality and mixed reality. The traditional medical training has been found to have challenges of poor access to clinical practice, patient safety issues, ethical issues and health practitioners’ shortage.

Objective: To assess the applicability of metaverse technologies in medical education assessing both the willingness of medical workers to implement immersive learning devices and the effects of training with the help of metaverse on clinical performance results.

Methodology: This quantitative study was carried out at Healthcare Institution in Sind, Pakistan from 1^st January 2024 to 30^th June 2025. Adoption element entailed 383 recruited healthcare professionals and students who were recruited through stratified sampling. The perceptions, behavioral intention, and determinants of adoption were measured using a structured questionnaire which was prepared according to Unified Theory of Acceptance and Use of Technology 2 (UTAUT2). The quasi-experimental design with clinical effectiveness assessment was performed with regard to an experimental group (metaverse based training, n= 26) and a control group (traditional training, n= 30).

Results: The respondents showed favorable attitudes toward the adoption of the metaverse, and the following were found to be the major influencing attitude factors, namely, performance expectancy (M=3.86), hedonic motivation (M = 3.83), and personal innovativeness (M=3.77). Compared influence was seen in social influence as well as in perceived privacy. Overall, OSCE scores in the experimental and control groups were significantly higher in all the stations namely; spinal injury transport, treatment of composite injuries, CPR and tracheal intubation, and bronchoscopic lung segment recognition (80.31±11.15 vs. 70.50±10.76; p = 0.002), treatment of composite injuries, CPR and tracheal intubation (87.17±5.74 vs. 77.30±11.45

Conclusion: Immersive learning through metaverse proved to be very acceptable and clearly enhanced clinical competency, compared to conventional approaches to training. These results substantiate the idea of the inclusion in the academic toolset of immersive technologies to optimize clinical skills training and overcome the shortcomings of the traditional health care training systems.

Comparison of Efficacy of Moxifloxacin and Cefotaxime in the Treatment of Spontaneous Bacterial Peritonitis in Cirrhotic Patients

ABDUL SAMAD — 2026-01-30

Background: Spontaneous bacterial peritonitis (SBP) is a life-threatening complication in cirrhotic patients, with high mortality rates if untreated. The study aimed to compare the efficacy of Moxifloxacin and Cefotaxime in the treatment of SBP in cirrhotic patients.

Methodology: This was a randomized, double-blind, controlled clinical trial was conducted at Liaquat University Hospital Hyderabad from 1^st October 2024 to 30^th June 2025. A total of 130 cirrhotic patients diagnosed with SBP, who were randomly assigned to receive Moxifloxacin (400 mg daily) or Cefotaxime (2g every 8 hours) for 7 days were enrolled. The primary outcome was the resolution of infection, and secondary outcomes included clinical improvement, mortality rates, and adverse effects.

Results: The infection resolution rate was 90% in the Moxifloxacin group and 85% in the Cefotaxime group. No significant differences in clinical improvement or mortality rates were observed. Adverse effects were minimal in both groups.

Conclusion: Moxifloxacin appears to be equally effective as Cefotaxime in treating SBP in cirrhotic patients, with no significant differences in clinical outcomes. Further studies are needed to explore long-term outcomes and resistance patterns.

Keywords: Spontaneous bacterial peritonitis, cirrhosis, Moxifloxacin, Cefotaxime, antibiotic treatment, clinical outcomes.

Impact of Psychological Stress on Cortisol Levels and Clinical Characteristics among Breast Cancer Patients

MUHAMMAD UMAR ABBAS — 2026-01-30

Background: Cancer Breast cancer has been one of the most prevalent sources of cancer morbidity and mortality in women around the world especially in Pakistan. Psychological stress has been viewed as a major key factor associated to cancer development through neuroendocrine pathways, especially via cortisol dysregulation. Nevertheless, there are few studies on the association between psychological stress and cortisol level in patients with breast cancer in Pakistan.

Objective: To determine the relationship between psychological stress and cortisol levels in patients with breast cancer in Punjab, Pakistan and to measure the effect of demographic and clinical factors on such results.

Methods: A cross-sectional design study involving treatment breast cancer patients was done at specific tertiary care hospitals within Punjab Pakistan. There were recruited a total of participants via non-probability convenience method of sampling. The validated standardized questionnaire was used to measure psychological stress, and the cortisol level was measured using biological samples in the laboratory. Data summarization was conducted using descriptive statistics and inferential statistical tests, such as t-tests, ANOVA, and correlation analysis were conducted to assess variable associations. The p value was taken to be below 0.05, which was called statistically significant.

Results: The authors discovered that breast cancer patients had high levels of psychological stress scores and cortisol, and the relationship between stress and cortisol levels is significant (p < 0.05). Being younger, unmarried, having lower levels of education, having advanced stage of cancer, and having a positive family history aided significantly in assessing a higher level of stress and cortisol. Cancer stage was also found to be associated with both outcomes (p < 0.001) among clinical variables, which means that the severity of the disease does play a major role in the psychological and physiological stress reactions.

Conclusion: The research proved that the level of cortisol in breast cancer patients is closely related to psychological stress, which also indicates the presence of the psychosocial effect on the cancer treatment. It is possible that by incorporating psychological assessment and stress management interventions into the routine oncology care, the well-being of patients can be enhanced and the course of treatment can be affected. Additional longitudinal research would be suggested to investigate causal-relationships and intervention efficacy.