The association between sleep disturbance, depressive symptoms, and health-related quality of life among cardiac rehabilitation participants.

PURPOSE: Recent guidelines from the Canadian Association of Cardiac Rehabilitation highlight the importance of addressing sleep disturbance among participants of cardiac rehabilitation (CR) programs. The primary objective of this study was to examine the relationship between depressive symptoms, health-related quality of life, and sleep disturbance in CR participants. The secondary objective was to estimate the prevalence of sleep disturbance among CR participants with and without depressive symptoms and explore demographic, medical, and psychological predictors of poor sleep quality. METHODS: Cardiac rehabilitation participants (N = 259) were included in this study. Participants completed a standardized questionnaire package including demographic, health-related, and psychosocial measures. Physiologic and anthropometric measurements were taken at baseline. Descriptive statistics were calculated for all variables, and data were analyzed using multivariate logistic regression. RESULTS: Poor sleep quality was reported by 52% of participants in the sample, and 47% of participants in the sample reported experiencing at least mild depressive symptoms. Poor sleep occurred more often in individuals with depressive symptoms, and after adjustment for medical factors and health-related quality of life, participants with symptoms of depression were still more likely to experience sleep disturbance than those without depressive symptoms (OR = 2.80; 95% CI, 1.37-5.77). An important gender difference emerged in the relationship between symptoms of depression and sleep disturbance. CONCLUSION: Among participants of a CR program, disturbed sleep was strongly associated with depressive symptoms and decreased health-related quality of life. Results demonstrate the importance of sleep evaluation in CR programs.

Fear-related predictors of vasovagal symptoms during blood donation: it's in the blood.

A recent theory proposes that emotional fainting developed from an earlier adaptive characteristic, fainting in response to hemorrhage. Despite potential loss of consciousness, a dramatic decrease in blood pressure improves chances of survival in animals with severe wounds by reducing blood loss and facilitating clotting. Humans may have developed the characteristic of emotional fainting as a response to anticipated blood loss. This idea suggests that people with stronger fears of blood should be especially susceptible to fainting and milder vasovagal symptoms such as dizziness and lightheadedness. Two samples of young adult blood donors (N = 276 and 663) who completed the Medical Fears Survey (MFS) were studied. Items from the MFS related to fears of blood, needles, and mutilation were used to predict self-reported dizziness and nurse-initiated treatment for vasovagal reactions. In both samples, fears of experiencing or seeing blood loss were more closely associated with both subjective and objective measures of vasovagal reactions, despite the fact that other fears (e.g., fears related to needles) were more common overall. Better understanding of the mechanisms of vasovagal reactions has both theoretical and clinical implications, such as improving means of coping with invasive medical procedures.

Relation between perceived blood loss and vasovagal symptoms in blood donors.

UNLABELLED: INTRODUCTION/RESULTS: This study examined whether a belief of significant blood loss may be associated with vasovagal symptoms, irrespective of actual blood loss. Individual differences in vasovagal symptoms among blood donors who had an equivalent amount of blood withdrawn were significantly associated with their rating of perceived blood loss. CONCLUSION: The anticipation or belief of blood loss, and perhaps more remotely associated ideas, may trigger processes similar to those induced by actual hemorrhage though further research is required to address other possibilities such as the inflation of ratings by vasovagal symptoms.

Applied tension and coping with blood donation: a randomized trial.

BACKGROUND: Despite the ongoing need for blood donation, few people give blood. A common reason is concern about vasovagal symptoms. PURPOSE: The aim of this study was to evaluate the effectiveness of applied tension in reducing vasovagal symptoms during blood donation and the mechanisms of action. METHOD: Two hundred eighty-two young adult blood donors were randomly assigned to conditions involving applied tension during the pre-donation wait period, during the blood draw, both, or no applied tension at all. RESULTS: Applied tension was effective in reducing vasovagal symptoms in blood donors, particularly when practiced during the pre-donation wait period (p < 0.001). People who practiced applied tension during the pre-donation wait period required less treatment for vasovagal reactions than people who did not (8% vs. 16%). CONCLUSIONS: The results of this study suggest that the effects of applied tension on vasovagal symptoms are not mediated entirely by exercise-related changes in blood pressure and heart rate. Rather, it may reduce anxiety or physiological consequences of anxiety. Applied tension is a useful treatment which can help people cope during blood donation and other invasive medical interventions.

Applied tension and blood donation symptoms: the importance of anxiety reduction.

OBJECTIVE: Despite being a voluntary activity, many blood donors experience anxiety, and fainting (syncope) is not unusual. The muscle-tensing technique applied tension (AT) has been found to be effective in reducing vasovagal symptoms and syncope. A series of studies was developed to investigate the role of AT on anxiety and fainting. METHODS: The mechanisms of AT were examined in the laboratory and the blood donor clinic. In Study 1, 70 participants were assigned randomly to either a control group or an experimental group who learned AT before watching a video depicting blood draws. In Study 2, 667 volunteer blood donors completed similar questionnaires. RESULTS: In Study 1, a significant Condition × Sex × Needle Fear interaction, F(1, 59) = 4.97, p = .03, indicated that AT reduced vasovagal symptoms in higher-fear women. Study 2 also found a significant Condition × Sex × Needle Fear effect on vasovagal symptoms, F(2, 653) = 3.95, p = .02, indicating that AT reduced symptoms but primarily among women with more pronounced fear of needles. CONCLUSIONS: Analysis of the physiological data and self-reported anxiety supports the conclusion that the reduction in vasovagal symptoms was due more to decreased anxiety rather than exercise-related cardiovascular change. These results suggest that AT may provide a useful means of coping with invasive medical procedures in part by reducing anxiety.

Attitudes and practices of cardiologists and surgeons who manage HLHS.

OBJECTIVE: We conducted a survey to determine which management options pediatric cardiologists and cardiac surgeons in North America discuss and recommend when counseling parents after the diagnosis of hypoplastic left heart syndrome (HLHS). METHODS: Pediatric cardiologists and cardiac surgeons across North America were asked to complete an anonymous, Internet-based survey about their attitudes and practices regarding the management of HLHS. RESULTS: We contacted 1621 pediatric cardiologists and surgeons, of whom 749 (46%) completed the survey. When counseling parents of newborns with HLHS, 99.7% of respondents discussed staged palliative surgery, 67% discussed cardiac transplantation, and 62.2% discussed compassionate care without surgery. Only a minority (14.9%) discussed all of those options. Staged palliative surgery was recommended over cardiac transplantation or compassionate care without surgery by 76.2% of respondents. When counseling parents after prenatal diagnosis of HLHS, 98.8% of respondents discussed continuation of pregnancy with staged palliative surgery after birth, 53.5% discussed continuation of pregnancy with cardiac transplantation after birth, 56.9% discussed continuation of pregnancy with compassionate care after birth, and 74.3% discussed termination of pregnancy. Only 36.5% discussed all of those options. Continuation of pregnancy with staged palliative surgery after birth was recommended over the other options by 56% of respondents. CONCLUSIONS: Virtually all North American pediatric cardiologists and cardiac surgeons surveyed discuss a surgical intervention when counseling parents about the care of their child or fetus with HLHS. However, only a minority discuss all options. Most physicians recommend staged palliative surgery for management of HLHS.