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1.
Sleep Health ; 10(3): 335-341, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38704352

RESUMO

OBJECTIVES: To investigate the association between comorbid obstructive sleep apnea and insomnia and major adverse cardiovascular events, including myocardial infarction, unstable angina, congestive heart failure, and stroke, in adults with suspected sleep disorders who underwent sleep apnea testing. METHODS: We conducted a retrospective analysis of electronic medical records data from patients with clinical encounters at sleep medicine centers to identify patients with comorbid obstructive sleep apnea and insomnia, obstructive sleep apnea only, insomnia only, and patients without a diagnosis of obstructive sleep apnea or insomnia (i.e., controls). Obstructive sleep apnea, insomnia, comorbidities, and new-onset major adverse cardiovascular events were ascertained by ICD-9-CM and ICD-10-CM codes. Multivariable adjusted Cox proportional regression models evaluated the risk of major adverse cardiovascular events over a 10-year follow-up period. RESULTS: A total of 3951 patients, 226 controls, 2107 with obstructive sleep apnea only, 276 with insomnia only, and 1342 with comorbid obstructive sleep apnea and insomnia, were included in the analysis. Compared to controls, comorbid obstructive sleep apnea and insomnia were associated with a significantly higher risk of developing major adverse cardiovascular events (hazard ratio 3.60, 95 CI%: 2.33-5.91) in unadjusted analyses. The relationship between comorbid obstructive sleep apnea and insomnia and major adverse cardiovascular events remained after adjustment for demographic and behavioral factors, but not after further adjustment for comorbidities. The greatest risk of major adverse cardiovascular events was found among younger adults with comorbid obstructive sleep apnea and insomnia. Obstructive sleep apnea only was associated with greater risk of major adverse cardiovascular events in unadjusted analyses only (hazard ratio 2.77, 95% CI: 1.80-4.54). Insomnia only was not significantly associated with increased risk of major adverse cardiovascular events. CONCLUSIONS: Comorbid obstructive sleep apnea and insomnia may be a high-risk group for major adverse cardiovascular events, particularly younger adults. Further research is needed to better understand the association between comorbid obstructive sleep apnea and insomnia and major adverse cardiovascular events risk.


Assuntos
Doenças Cardiovasculares , Comorbidade , Apneia Obstrutiva do Sono , Distúrbios do Início e da Manutenção do Sono , Humanos , Masculino , Feminino , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Apneia Obstrutiva do Sono/epidemiologia , Estudos Retrospectivos , Pessoa de Meia-Idade , Doenças Cardiovasculares/epidemiologia , Adulto , Idoso , Fatores de Risco
2.
J Prim Care Community Health ; 15: 21501319241246992, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38628054

RESUMO

OBJECTIVES: Study objectives were to: (1) better understand sleep experiences and unhealthy alcohol use among Veterans with long COVID and (2) explore providers' perceptions of barriers and facilitators to delivering evidence-based care for sleep problems and unhealthy alcohol use in patients with long COVID. METHODS: VA electronic health records were used to conduct chart reviews (n = 57) of patients evaluated in a VA COVID-19 Recovery Clinic during 1 calendar year; semi-structured interviews were completed with Veterans (n = 5) and clinicians (n = 7) recruited from the clinic. Veteran participants also completed quantitative, self-report measures assessing sleep- and alcohol-related experiences and behaviors. RESULTS: Data from chart reviews and interviews suggested that Veterans with long COVID often had pre-existing sleep problems that were exacerbated during long COVID. Patients and providers agreed that sleep interventions would be beneficial and acceptable in the COVID-19 Recovery clinic. Conversely, few Veterans with long COVID had a pre-existing alcohol use disorder (AUD) diagnosis; alcohol use occurred less frequently and was less often discussed between patients and providers. Providers had mixed viewpoints on delivering alcohol-related care in the clinic; some were highly amenable, others were unsure whether patients would be receptive. CONCLUSIONS: This study is among the first to take a mixed-method approach to understanding experiences of sleep-wake behaviors and unhealthy alcohol use in Veterans with long COVID. Characterizing sleep and alcohol-related experiences, examining associations with functioning, and exploring perspectives on treatment approaches is critical to support efforts to refine, personalize, and optimize evidence-based sleep and alcohol care for Veterans living with long COVID.


Assuntos
COVID-19 , Transtornos do Sono-Vigília , Veteranos , Estados Unidos/epidemiologia , Humanos , Síndrome de COVID-19 Pós-Aguda , United States Department of Veterans Affairs , COVID-19/epidemiologia , Etanol , Transtornos do Sono-Vigília/epidemiologia , Pesquisa Qualitativa
3.
Sleep Health ; 9(6): 984-990, 2023 12.
Artigo em Inglês | MEDLINE | ID: mdl-37821259

RESUMO

INTRODUCTION: In adults at risk for obstructive sleep apnea, it is unclear what patient-level factors and symptoms may influence communication with healthcare providers regarding sleep difficulties. This analysis examined associations between sociodemographic characteristics, comorbidities, and obstructive sleep apnea-related symptoms and whether adults at high risk for obstructive sleep apnea reported trouble sleeping to an healthcare provider. METHODS: The sample included participants from the 2015-2018 National Health and Nutrition Examination Survey determined by a modified STOP-Bang to be at high risk for obstructive sleep apnea (n = 2009). Participants were asked if they had ever reported trouble sleeping to an healthcare provider. Self-reported comorbidities and obstructive sleep apnea-related symptoms (ie, snoring, snorting, gasping, or breathing cessation during sleep, daytime sleepiness, fatigue, insomnia, and nocturia) were assessed. RESULTS: Half of the sample (50.8%) never reported trouble sleeping to an healthcare provider. Factors associated with an increased likelihood of reporting trouble sleeping included female sex, former smoker, and prediabetes or diabetes, obstructive lung disease, daytime sleepiness, insomnia, nocturia, and symptoms of snorting, gasping, and/or breathing cessation during sleep. Factors associated with a decreased likelihood of reporting trouble sleeping included Mexican American background or Asian race and having less than a high school education. CONCLUSION: Differences in sex, race, education, comorbidities, and obstructive sleep apnea-related symptoms exist between adults at high risk for obstructive sleep apnea who have and have not reported trouble sleeping to an healthcare provider. It is important for healthcare providers to ask all adults about sleep problems, recognizing that men, minorities, and persons with lower educational attainment may be less likely to report trouble sleeping.


Assuntos
Distúrbios do Sono por Sonolência Excessiva , Noctúria , Apneia Obstrutiva do Sono , Distúrbios do Início e da Manutenção do Sono , Transtornos do Sono-Vigília , Masculino , Adulto , Humanos , Feminino , Autorrelato , Inquéritos Nutricionais , Distúrbios do Início e da Manutenção do Sono/complicações , Noctúria/complicações , Apneia Obstrutiva do Sono/complicações , Distúrbios do Sono por Sonolência Excessiva/complicações , Transtornos do Sono-Vigília/complicações , Pessoal de Saúde
4.
J Nurs Adm ; 53(10): 515-519, 2023 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-37747174

RESUMO

A comprehensive, evidence-based onboarding program benefits healthcare workers and institutions. Many institutions do not have onboarding programs for new nurse practitioners (NPs). In this quality improvement initiative, a standardized onboarding program was developed. The impact on NP satisfaction and retention was evaluated. Lead NPs were identified as program managers. Program components included role introduction, competency validation, review of administrative essentials, ongoing progress logs, and program evaluations. The program resulted in increased NP satisfaction and retention.


Assuntos
Pessoal de Saúde , Profissionais de Enfermagem , Humanos , Avaliação de Programas e Projetos de Saúde , Melhoria de Qualidade , Atenção à Saúde
5.
Int J Nurs Stud ; 138: 104395, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36481596

RESUMO

BACKGROUND: Extended work hours and shift work can result in mistimed sleep, excessive sleepiness, and fatigue, which affects concentration and cognition. Impaired concentration and cognition negatively affect employee safety. OBJECTIVE: To examine the evidence of the impact of shift work organization, specifically work hours and scheduling, on nurse injuries including needlestick and sharps injuries, drowsy driving and motor vehicle crashes, and work-related accidents causing a near miss or actual injury to the nurse. METHODS: A scoping review was conducted using search results from five bibliographic databases. RESULTS: Through database searching, 7788 articles were identified. During the title and abstract screening, 5475 articles were excluded. Full text screening eliminated 1971 articles. During the data extraction phase, 206 articles were excluded leaving 34 articles from 14 countries in the scoping review. The results of the review suggest a strong association in nurses between long work hours and overtime and an increased risk for needlestick and sharps injuries, drowsy driving and motor vehicle crashes, and other work-related accidents. Rotating shifts increase the risk for needlestick and sharps injuries and other work-related accidents while night and rotating shifts increase the risk for drowsy driving and motor vehicle crashes. CONCLUSIONS: Proper management of work hours and scheduling is essential to maximize recovery time and reduce or prevent nurse injuries. Nurse leaders, administrators, and managers, have a responsibility to create a culture of safety. This begins with safe scheduling practices, closely monitoring for near miss and actual nurse injuries, and implementing evidence-based practice strategies to reduce these occurrences.


Assuntos
Condução de Veículo , Ferimentos Penetrantes Produzidos por Agulha , Jornada de Trabalho em Turnos , Humanos , Acidentes de Trânsito/prevenção & controle , Sono , Tolerância ao Trabalho Programado
6.
Sleep Med Rev ; 67: 101712, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36442290

RESUMO

Obstructive sleep apnea (OSA) is unrecognized in as high as 80% of patients before surgery. When untreated, OSA increases a surgical patient's propensity for airway collapse and sleep deprivation lending to a higher risk for emergent re-intubation, prolonged recovery time, escalation of care, hospital readmission, and longer length of stay. We have reviewed the evidence regarding diagnostic performance of OSA screening methods and the impact of perioperative management strategies on postoperative complications among patients with diagnosed or suspected OSA who are undergoing orthopedic surgery. We then integrated the data and recommendations from professional society guidelines to develop an evidence-based clinical care pathway to optimize the perioperative management of this surgical population. Successful management of patients with diagnosed or suspected OSA encompass five facets of care: screening, education, airway management, medications, and monitoring. This narrative review revealed two gaps in the evidence to inform management of patients undergoing orthopedic surgery 1) during the perioperative setting to include evidence-based interventions that reduce postoperative complications and 2) after discharge to an unmonitored environment. The clinical care pathway as well as perspectives for future research are discussed.


Assuntos
Procedimentos Clínicos , Apneia Obstrutiva do Sono , Humanos , Complicações Pós-Operatórias/etiologia , Apneia Obstrutiva do Sono/cirurgia , Apneia Obstrutiva do Sono/complicações
7.
Sleep Breath ; 27(5): 1695-1702, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-36571709

RESUMO

STUDY OBJECTIVES: To determine the sensitivity of the Multivariable Apnea Prediction (MAP) index for obstructive sleep apnea (OSA) in pre- and post-menopausal women with the goal of developing a tailored scoring classification approach. METHODS: Data from two studies (N = 386); the diabetes sleep treatment trial (N = 236) and EMPOWER (N = 150) were used to assess the sensitivity and specificity of the MAP index by comparing men (n = 129) to women (n = 257), and premenopausal (n = 100) to post-menopausal women (n = 136). We evaluated participants at two cut points, apnea-hypopnea index (AHI) values of ≥ 5 and ≥ 10, using 0.5 as a predicted probability cut point to establish baseline sensitivity and specificity. Contingency tables and receiver operating characteristic (ROC) analysis were conducted to evaluate the accuracy of the MAP index in predicting OSA in men versus women, and in pre-versus post-menopausal women. To select optimal predicted probabilities for classification by sex and menopausal status, Youden's J statistic was generated from ROC coordinates. RESULTS: The MAP index was more sensitive to women in the AHI ≥ 5 group (76%) compared to AHI ≥ 10 group (30%). Among post-menopausal women with AHI ≥ 5, sensitivity was similar to men (98%), but less than men when AHI ≥ 10 (32%). Suggested probability cut points for women with an AHI ≥ 10 are 0.24 overall; 0.15 for premenopausal, and 0.38 for postmenopausal women. CONCLUSIONS: Because women's risk for OSA (AHI ≥ 10) was underestimated by the MAP index, we suggest the use of tailored cut points based on sex and menopausal status or assessing for OSA risk with an AHI of ≥ 5.


Assuntos
Apneia Obstrutiva do Sono , Feminino , Humanos , Masculino , Menopausa , Polissonografia , Medição de Risco , Sensibilidade e Especificidade , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia , Ensaios Clínicos como Assunto
8.
J Clin Sleep Med ; 18(6): 1491-1501, 2022 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-35040430

RESUMO

STUDY OBJECTIVES: The impact of sleep problems (ie, sleep duration and presence of sleep disorders) on cardiovascular morbidity and all-cause mortality in adults with asthma-chronic obstructive pulmonary disease overlap (ACO) is unknown. METHODS: Using the National Health and Nutrition Examination Survey database (2007-2012 cycles) and National Death Index data, we identified 398 persons with ACO. Data on self-reported physician-diagnosed sleep disorders and cardiovascular disease were collected. Sleep duration in hours was categorized as short (≤ 5 hours), normal (6-8 hours), and long (≥ 9 hours). Associations between sleep duration and presence of sleep disorders and cardiovascular disease and all-cause mortality were analyzed in regression models adjusted for age, sex, race, smoking status, and body mass index. RESULTS: Presence of sleep disorders was more commonly reported in the ACO group (24.7%) compared to all other groups. The ACO group had a higher proportion of short sleepers (27.6%) compared to controls (11.7%) and chronic obstructive pulmonary disease (19.2%) and a higher proportion of long sleepers (6.9%) compared to chronic obstructive pulmonary disease (5.5%). Presence of sleep disorders was associated with increased risk for cardiovascular disease (odds ratio = 2.48; 95% confidence interval, 1.65-3.73) and death (hazard ratio = 1.44; 95% confidence interval, 1.03-2.02); risk did not vary between groups. A stronger association existed between sleep duration and increased risk for cardiovascular and all-cause mortality in ACO compared to chronic obstructive pulmonary disease and controls. CONCLUSIONS: These results suggest that persons with ACO may represent a high-risk group that should be targeted for more aggressive intervention for sleep problems, a modifiable risk factor. CITATION: Baniak LM, Scott PW, Chasens ER, et al. Sleep problems and associations with cardiovascular disease and all-cause mortality in asthma-chronic obstructive pulmonary disease overlap: analysis of the National Health and Nutrition Examination Survey (2007-2012). J Clin Sleep Med. 2022;18(6):1491-1501.


Assuntos
Asma , Doenças Cardiovasculares , Doença Pulmonar Obstrutiva Crônica , Transtornos do Sono-Vigília , Adulto , Asma/complicações , Asma/epidemiologia , Doenças Cardiovasculares/complicações , Humanos , Inquéritos Nutricionais , Doença Pulmonar Obstrutiva Crônica/complicações , Transtornos do Sono-Vigília/complicações , Transtornos do Sono-Vigília/epidemiologia
9.
Nurs Outlook ; 70(2): 347-354, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34895736

RESUMO

BACKGROUND: Little is known about nursing faculty and nursing student's confidence or potential hesitancy to receive the Covid-19 vaccine once it was available. METHODS: An anonymous electronic survey of nursing students and faculty was conducted at a large academic center in the eastern U.S. FINDINGS: Both students and faculty reported they were fairly or completely confident that the vaccine was safe (n = 235, 89.4%) and that it would effectively mitigate their risk (n = 230, 87.5%). There was a 52.6% decrease in vaccine hesitancy from 6 months prior (p <.01); 22% (n = 58) of those currently willing to receive the vaccine reported moderate to high concern about its side-effects and/or long-term efficacy. Access to vaccine research, vaccine education, and watching others be inoculated, had mitigated their concerns from the previous six months. DISCUSSION: While both nursing students and faculty reported having high confidence in the efficacy and safety of the Covid-19 vaccine, concerns remained.


Assuntos
COVID-19 , Estudantes de Enfermagem , Vacinas , Centros Médicos Acadêmicos , COVID-19/prevenção & controle , Vacinas contra COVID-19 , Docentes de Enfermagem , Humanos , SARS-CoV-2 , Vacinação
10.
Vaccines (Basel) ; 9(8)2021 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-34451983

RESUMO

Even with the availability of COVID-19 vaccines, factors associated with vaccine hesitancy and uptake among nurses are unknown. This study evaluated COVID-19 vaccine hesitancy and uptake of nursing staff during one of the first COVID-19 vaccine rollouts in the United States. A cross-sectional survey was conducted during February 2021 among nursing staff working in a large medical center in central United States. There were 276 respondents; 81.9% of participants were willing to receive the vaccine during the initial rollout, 11.2% were hesitant, and only 5.1% were unwilling. The hesitant group was likely to report having inadequate information to make an informed decision about whether to receive the vaccine (45.2%) and about vaccine expectations (32.3%). The majority (83.3%) received at least one dose of the vaccine. Having greater than 10 years' work experience (OR 3.0, 95% CI 1.16-7.9) and confidence in vaccine safety (OR 7.78, 95% CI 4.49-13.5) were significantly associated with vaccine uptake. While our study indicates higher vaccine uptake among nursing staff during an active vaccine rollout, there remains sustained hesitancy and unwillingness to uptake. For those hesitant to receive the COVID-19 vaccine, public health efforts to provide more data on side effects and efficacy may help increase vaccine uptake.

11.
J Gerontol Nurs ; 46(11): 28-36, 2020 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-33095890

RESUMO

The current study examined the prevalence of insomnia and its relationship with daily function in older adults with asthma. Data on 278 older adults with asthma (aged ≥60 years) from the 2005-2008 National Health and Nutrition Examination Survey were analyzed. Insomnia was present in 40% of the study sample and was associated with a greater number of activities of daily living (ADL) and instrumental ADL (IADL) limitations. In multivariate analyses accounting for covariates including depressive symptoms, insomnia was not associated with having at least two ADL/IADL limitations. However, those with co-occurring insomnia and depressive symptoms were more likely to have at least two ADL/IADL limitations compared to those with either condition singly. Insomnia in the presence of depressive symptoms may impede one's ability to perform ADL/IADL. Current findings suggest that assessment and treatment of insomnia and depression in older adults with asthma may be important for maintaining active, independent living. [Journal of Gerontological Nursing, 46(11), 28-36.].


Assuntos
Atividades Cotidianas , Asma , Distúrbios do Início e da Manutenção do Sono , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Vida Independente , Masculino , Inquéritos Nutricionais
12.
Ann Allergy Asthma Immunol ; 125(3): 319-324, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32389780

RESUMO

BACKGROUND: Asthma contributes to considerable morbidity and health care utilization in adults. Insufficient and excessive sleep duration have known adverse effects on health. Little is known regarding the effect of sleep duration on health outcomes in adults with asthma. OBJECTIVE: To examine associations between sleep duration, patient-reported outcomes, and health care use in adults with asthma from the National Health and Nutrition Examination Survey. METHODS: Cross-sectional data from the 2007 to 2012 National Health and Nutrition Examination Survey were analyzed. Asthma was identified by self-report. Habitual hours of sleep duration were categorized as short (≤5), normal (6-8), and long (≥9). Multivariate regression analyses were used to examine the associations between sleep duration and patient-reported outcomes and health care use. RESULTS: Of the 1389 adults with asthma, 26% reported short sleep duration, 66% reported normal sleep duration, and 8% reported long sleep duration. Those with short sleep duration had increased asthma attacks (adjusted odds ratio [aOR] 1.58; 95% confidence interval [CI] 1.13-2.21), coughing (aOR 1.95; 95% CI 1.32-2.87), and overnight hospitalizations (aOR 2.14; 95% CI 1.37-3.36) compared with those having normal sleep duration. They also reported worse health-related quality of life, including days of poor physical health, mental health, and inactivity because of poor health (P values < .05). Those with long sleep had more activity limitations because of wheezing compared with those with normal sleep (aOR 1.82; 95% CI 1.13-2.91). CONCLUSION: Compared with adults having asthma and normal sleep duration, those having short sleep duration experience more frequent asthma attacks, increased health care use, and worse health-related quality of life, whereas those with long sleep duration experience more frequent activity limitation.


Assuntos
Sono/fisiologia , Adulto , Asma/fisiopatologia , Estudos Transversais , Atenção à Saúde/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Autorrelato
13.
J Aging Health ; 32(1): 42-51, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30270714

RESUMO

Objective: To examine whether sleep duration is correlated with increased frailty risk and investigate the determinants of frailty status. Method: Data on 3,632 participants from the 2011 to 2014 National Health and Nutrition Examination Survey (NHANES, community-dwelling >60 years, 52.1% prefrail, 13.6% frail, 55% women) were used. Frailty status was categorized by Fried Phenotype (robust, prefrail, and frail) with customized criteria for the NHANES data set. Hours of self-reported sleep duration were categorized as short (⩽6), normal (7-9), and long (⩾10). Multinomial regression analysis identified risk factors for each frailty state. Results: Only long sleep duration was associated with increased odds (2.86 [1.09-7.50]) of being characterized as frail but not prefrail. Frail and prefrail states had shared risk factors but also had many distinct to each state. Discussion: Sleep duration is a potential, modifiable therapeutic target for frailty management. Multicomponent interventions should be tailored for frailty status.


Assuntos
Idoso Fragilizado , Fragilidade/epidemiologia , Inquéritos Nutricionais , Sono , Idoso , Idoso de 80 Anos ou mais , Feminino , Avaliação Geriátrica/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Autorrelato , Fatores de Tempo
15.
J Cardiovasc Nurs ; 34(1): E1-E7, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30303893

RESUMO

BACKGROUND: Obstructive sleep apnea (OSA) is a highly prevalent and consequential sleep disorder in older adults. Untreated moderate to severe OSA substantially increases the risk for hypertension and cardiovascular disease (CVD), which can be attributed to the accelerated progression of atherosclerosis and endothelial dysfunction. OBJECTIVE: The aim of this study was to identify factors that can function as correlates of endothelial function in older adults with untreated, moderate to severe OSA and CVD or CVD risk factors. METHODS: A subsample (N = 126) of adults aged 65 years and older from the HeartBEAT study were included in the analyses. Univariate analyses and multiple linear regression models were conducted to establish which demographic and CVD risk factors were the best correlates of endothelial function. RESULTS: In the univariate analyses, sex, employment status, body mass index, waist circumference, hip-to-waist ratio, neck circumference, diastolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, total cholesterol to high-density lipoprotein cholesterol ratio, plasminogen activator inhibitor-1, calcium channel blocker use, and ß-blocker use were associated with endothelial function at a level of P < .10. In the most parsimonious model, male sex (b = -0.305, P < .001), calcium channel blocker use (b = -0.148, P < .019), and body mass index (b = -.014, P < .037) were negatively associated with endothelial function after adjusting for the other covariates. CONCLUSIONS: The authors identified correlates of endothelial function in older adults with untreated OSA and CVD or CVD risk factors, which are different than the correlates in middle-aged adults with the same conditions.


Assuntos
Doença da Artéria Coronariana/fisiopatologia , Endotélio Vascular/fisiopatologia , Apneia Obstrutiva do Sono/fisiopatologia , Calcificação Vascular/fisiopatologia , Idoso , Pressão Sanguínea , Doença da Artéria Coronariana/diagnóstico por imagem , Endotélio Vascular/diagnóstico por imagem , Feminino , Humanos , Hipertensão/fisiopatologia , Masculino , Polissonografia , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/diagnóstico , Calcificação Vascular/diagnóstico por imagem
16.
Sleep Breath ; 22(4): 1169-1177, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30324547

RESUMO

PURPOSE: Daytime sleepiness, a frequent symptom of obstructive sleep apnea (OSA), can impact functional status. In patients with coronary artery disease (CAD) and concomitant OSA, the distinction between sleep-related functional impairment from underlying CAD versus OSA is unclear. This study evaluated the impact of OSA on sleep-related functional impairment in patients with CAD and compared the effect of 1-year continuous positive airway pressure (CPAP) use on change in impairment between those with and without excessive daytime sleepiness (EDS) and OSA. We hypothesized that sleep-related functional impairment is impacted by EDS independent of OSA in patients with CAD. METHODS: One hundred five CAD patients without OSA and 105 with moderate-to-severe OSA from the RICCADSA trial were matched on disease severity and included in the current substudy. Of those with OSA, 80 were allocated to CPAP. Functional Outcomes of Sleep Questionnaire (FOSQ) score < 17.9 corresponded to sleep-related functional impairment. RESULTS: Following revascularization, CAD patients with and without OSA frequently report sleep-related functional impairment (35% and 27.3%, respectively; p = .29). Moderate-to-severe OSA was not related to baseline FOSQ scores < 17.9 in regression analyses; EDS was (OR 4.82, 95% CI 2.12-11.0; p < .001). CPAP use significantly improved FOSQ scores from baseline to 1-year follow-up in OSA patients with EDS (17.2 ± 2.0 to 18.15 ± 1.7, p = .002) despite suboptimal adherence. CONCLUSIONS: Sleep-related functional impairment may be reflective of persistent EDS, independent of OSA. Diagnosing OSA and initiating treatment are worthwhile in individuals with CAD and EDS, as both are important to guide appropriate therapy in patients with CAD.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/métodos , Doença da Artéria Coronariana/complicações , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/terapia , Transtornos do Sono-Vigília/etiologia , Adulto , Doença da Artéria Coronariana/terapia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Autorrelato , Apneia Obstrutiva do Sono/complicações , Transtornos do Sono-Vigília/terapia , Resultado do Tratamento
17.
Diabetes Educ ; 44(3): 269-277, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29661088

RESUMO

Purpose The purpose of this study was to examine associations between perceived risk and actual risk of type 2 diabetes by race and/or ethnicity. Methods The study sample included 10 999 adults from the 2011 to 2014 National Health and Nutrition Examination Survey. Sociodemographic, clinical, and behavioral data were collected using interviews and physical examinations. Participants were asked if they felt at risk for diabetes or prediabetes and then asked the reasons why. Data analyses were conducted with SAS to properly analyze complex survey data. Results About 86% of the sample (n = 9496) answered the risk perception question for diabetes, and among those, 28.4% indicated having a high perceived risk. Among this subsample, 38.3% were identified as having an actual risk for prediabetes or diabetes according to the American Diabetes Association guidelines. Across all race groups, the most frequently reported risk factors participants believed to contribute to their risk for diabetes were family history of diabetes, obesity, and poor diet habits. When the percentage of participants with an actual risk factor who correctly perceived it as a risk factor was examined, fewer Asians correctly perceived weight status and physical activity level as a risk for diabetes in contrast to the other racial/ethnic groups. Conclusions Our study showed that when perception was compared to actual risks, associations differed statistically by race. It will be essential to discuss their risk perception to proper screening for diabetes and relevant lifestyle modifications to prevent and delay the onset of diabetes.


Assuntos
Diabetes Mellitus Tipo 2/etnologia , Autoavaliação Diagnóstica , Etnicidade/psicologia , Estado Pré-Diabético/etnologia , Grupos Raciais/psicologia , Adulto , Diabetes Mellitus Tipo 2/etiologia , Diabetes Mellitus Tipo 2/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Percepção , Estado Pré-Diabético/etiologia , Estado Pré-Diabético/psicologia , Medição de Risco , Fatores de Risco , Adulto Jovem
18.
Geriatr Nurs ; 39(1): 77-83, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28784337

RESUMO

Heart failure in older adults is frequently accompanied by sleep disordered breathing (SDB). Treatment of SDB in persons with heart failure with preserved ejection fraction (HFpEF) is unclear because most data is on heart failure with reduced ejection fraction (HFrEF). The purpose of this paper was to evaluate studies that report on the effects of positive airway pressure on patient outcomes in older adults with HFpEF and comorbid SDB. A search of the literature found six data-based studies (N = 36 to 126). Treatment with positive airway pressure reduced nighttime SDB symptoms and improved daytime functional status in persons with HFPEF and SDB (New York Heart Association Functional Class: effect sizes = -0.67 to -1.60). Limitations (i.e. only two studies were randomized controlled trials, small sample sizes, and women were under-represented) suggest that additional evidence is needed to guide treatment of SDB in older adults with HFpEF.


Assuntos
Insuficiência Cardíaca/complicações , Síndromes da Apneia do Sono/terapia , Volume Sistólico/fisiologia , Pressão Positiva Contínua nas Vias Aéreas/métodos , Insuficiência Cardíaca/terapia , Humanos
19.
Geriatr Nurs ; 39(3): 344-349, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29248354

RESUMO

A large sample (N = 1139) of adults ≥75 years from the 2011-2014 NHANES cohorts was used to examine predictors of high-level health. Analyses were done with SAS to control for sample weights and allow results to be reported as population parameters. The majority of participants described their health as high-level (73.6%). Logistic regression found a longer sleep duration, minority status, decreased income, multiple medications, low physical activity, and late stage memory impairment were significant predictors of low-level health (p < .05) while sex, education level, marital status, body mass index, and depression symptoms were not. The assessment of sleep should be expanded to cover dimensions such as sleep quality and sleep disorders to help maintain wellness in older adults. This study supports that the majority of older adults have high-level health and identifies several modifiable factors to maintain wellness.


Assuntos
Autoavaliação Diagnóstica , Nível de Saúde , Sono/fisiologia , Fatores Socioeconômicos , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Memória , Grupos Minoritários , Inquéritos Nutricionais , Fatores de Tempo
20.
Res Nurs Health ; 39(6): 406-414, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27686225

RESUMO

Prevention of lower extremity fluid pooling (LEFP) is associated with improved sleep quality. Physical activity and compression stockings are non-invasive methods used to manage LEFP, but both are associated with low adherence. Calf muscle pump (CMP) stimulation is an alternative and more convenient approach. Convenience sampling was used to recruit 11 participants between ages 45 and 65 with poor sleep quality. A within-person single-group pre-test-post-test design was used to evaluate changes in sleep quality, daytime sleepiness, and functional outcomes sensitive to impaired sleep as measured by the Pittsburgh Sleep Quality Index (PSQI), Functional Outcomes of Sleep Questionnaire, and Epworth Sleepiness Scale after 4 weeks of CMP stimulation. Statistical analysis included effect size (ES) calculations. After daily use of CMP stimulation, participants demonstrated improvement in overall sleep quality (ES = -.97) and a large reduction in daily disturbance from poor sleep (ES = -1.25). Moderate improvements were observed in daytime sleepiness (ES = -.53) and functional outcomes sensitive to sleepiness (ES = .49). Although causality could not be determined with this study design, these results support further research to determine whether CMP stimulation can improve sleep quality. © 2016 Wiley Periodicals, Inc.


Assuntos
Terapia por Estimulação Elétrica/métodos , Músculo Esquelético/fisiologia , Qualidade de Vida , Transtornos do Sono-Vigília , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Contração Muscular/fisiologia , Transtornos do Sono-Vigília/etiologia , Inquéritos e Questionários
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