Sex differences in the effectiveness and affecting factors to adherence of continuous positive airway pressure therapy.

Although sex differences in clinical backgrounds of patients with obstructive sleep apnea (OSA) are well known, studies of sex differences about the influencing factors on adherence to continuous positive airway pressure (CPAP) are very sparse. Our aim was to investigate the effects of CPAP use affecting therapeutic adherence in sex differences. We retrospectively assessed demographic data, clinical characteristics, OSA-related symptoms, and effects and adherence of CPAP use in 348 patients (264 males, median age 58 years) who continued CPAP for at least 1 year. Poor adherence was defined as CPAP dropout within 1 year after starting CPAP or the average cumulative CPAP use less than four hours/night. We also studied the predictors or influencing factors of CPAP adherence by multivariate logistic regression analyses. Age was higher and the severity of OSA was lower in female patients. Although the adherence level itself was not significantly different between both sexes, influencing factors were different. OSA severity, such as apnea-hypopnea index and sleepiness, and many effects from CPAP use (respiratory difficulty, difficult adaptation to CPAP use, improved awakening, reduced nocturia, and easy adaptation to CPAP) influenced adherence only in men. Common factors of poor adherence in both sexes were lower age, insomnia by CPAP use, and improved daytime sleepiness. No other specific factors predicted poor adherence in women. We found that there were sex differences in influencing factors on CPAP adherence not only in clinical characteristics of OSA, but also in effectiveness and side effects of CPAP use.

Impact of Workplace on the Risk of Severe COVID-19.

Indiscriminate regional lockdowns aim to prevent the coronavirus disease 2019 (COVID-19) infection by restricting the movement of people; however, this comes with psychological, social, and economic costs. Measures are needed that complement lockdowns and reduce adverse effects. Epidemiological studies, to date, have identified high-risk populations, but not workplaces appropriate for closure. This study was conducted to provide evidence-based measures that used exact and reliable follow-up data of the PCR-positive COVID-19 cases to complement lockdowns. The data are not subjected to selection or follow-up biases, since the Japanese government, by law, must register and follow all the PCR-positive cases until either recovery or death. Direct customer exposure may affect the quantity of viral inoculum received, which, in turn, may affect the risk of the severity of disease at infection. Therefore, the professions of the cases were grouped according to their frequency of direct customer exposure (FDCE) based on subjective observations, which resulted in five workplaces; hospital, school, food service, outdoor service, and indoor office being identified. Analyzing the follow-up data, we obtained precise estimates for the risk of severe disease, defined as intensive care unit (ICU) hospitalization or death, for the workplaces adjusted for age, sex, family status, and comorbidity. Major findings are as follows: hospital and school are the lowest risk, food and outdoor services are, despite higher FDCE, safer than indoor office. Unemployed and unclear are the highest risk, despite low FDCE. These results suggest the following workplace-specific measures complementing the lockdown: school should not be closed and indiscriminate closing of food and outdoor service industries should be avoided, since it would be more effective to reinforce their efforts to promote adherence to public health guidelines among students and customers. These actions would also reduce the adverse effects of the lockdown. This study is the first to address the causality between the workplaces and severe disease. We introduce FDCE and adherence to public health guidelines (APHGs) to associate the workplace characteristics with the risk of COVID-19 severity, which provided the basis for the measures complementing lockdowns.

Elaborate evaluation of serial changes in electrocardiograms of atrial septal defects after transcatheter closure for a better understanding of the recovery process.

Serial changes of electrocardiograms (ECG) could be used to assess their clinical features in atrial septal defects (ASD) after transcatheter closure together with other clinical parameters. We retrospectively studied 100 ASD patients who underwent transcatheter closure. Complications of persistent atrial fibrillation occurred in five ASD patients, and they were excluded. We divided the other 95 patients according to PQ intervals before closure (normal: < 200 ms, n = 51; prolonged: ≥ 200 ms, n = 44) to evaluate their clinical characteristics and parameters such as echocardiography, chest X-rays, and brain natriuretic protein (BNP) levels. Individuals in the prolonged PQ group were significantly older, had higher incidences of paroxysmal atrial fibrillation (PAF) and heart failure (HF) treated with more ß-blockers and diuretics, and with a higher tendency of NYHA functional classification and BNP levels than the normal PQ group. The prolonged PQ group also had a significantly higher incidence of complete right bundle branch block, wider QRS intervals, and larger cardiothoracic ratios in chest X-rays accompanied by larger right atrial-areas and larger left atrial dimensions in echocardiograms. Furthermore, the prolonged PQ intervals with less PQ interval shortening after transcatheter closure revealed that the patients were the oldest at the time of closures and showed less structural normalization of the right heart and left atrium after ASD closure. PAF and HF also occurred more frequently in this subgroup. These results suggested that the ASD patients with prolonged PQ intervals with less PQ shortening were accompanied by more advanced clinical conditions. Together with other clinical parameters, detailed analyses of ECG and their changes after closure could elucidate the clinical characteristics and status of ASD patients with transcatheter closure and were useful for predicting structural normalization after transcatheter closure.

Three nights leg thermal therapy could improve sleep quality in patients with chronic heart failure.

Sleep quality is often impaired in patients with chronic heart failure (HF), which may worsen their quality of life and even prognosis. Leg thermal therapy (LTT), topical leg warming, has been shown to improve endothelial function, oxidative stress, and cardiac function in patients with HF. However, its short-term influence to sleep quality has not been evaluated in HF patients. Eighteen of 23 patients with stable HF received LTT (15 min of warming at 45 °C and 30 min of insulation) at bedtime for 3 consecutive nights and 5 patients served as control. Subjective sleep quality was evaluated by St. Mary's Hospital Sleep Questionnaire, Oguri-Shirakawa-Azumi Sleep Inventory, and Epworth sleepiness scale, and also objectively evaluated by polysomnography. LTT significantly improved subjective sleep quality indicated by depth of sleep (p < 0.01), sleep duration (p < 0.05), number of awaking (p < 0.01), nap duration (p < 0.01), sleep quality (p < 0.05), and sleep satisfaction (p < 0.05). It was also objectively affirmed by a slight but significant decrease of sleep stage N1 (p < 0.01), and increase in sleep stage N2 (p < 0.05). No significant changes occurred in the controls. Hence, the short-term LTT could improve subjective and objective sleep quality in patients with HF. LTT can be a complimentary therapy to improve sleep quality in these patients.

Left Ventricular Ejection Fraction Predicts Severity of Posttraumatic Stress Disorder in Patients With Implantable Cardioverter-Defibrillators.

BACKGROUND: Implantable cardioverter-defibrillators (ICD) have provided effective therapy for fatal arrhythmia. However, ICD patients are known to develop psychological problems, such as posttraumatic stress disorder (PTSD), if they have experienced potentially fatal arrhythmia and ICD shocks. Little is known about the factors influencing PTSD in ICD patients. HYPOTHESIS: Echocardiographic cardiac-function parameters might relate to psychological problems, especially PTSD, in ICD patients. METHODS: A total of 128 outpatients with ICD implantation completed the Impact of Event Scale Revised (IES-R) questionnaire as a measurement of PTSD. Demographic and clinical characteristic data were collected from medical records. RESULTS: The mean age of the ICD patients was 59 ± 16 years; 103 were male; and the mean left ventricular ejection fraction (LVEF) by echocardiography was 52.4% ± 18.3%. In the ICD patients, female sex and impaired LVEF were related to lower IES-R scores or led to PTSD (P = 0.01 and P = 0.03, respectively). Impaired LVEF also worsened 2 symptoms of PTSD, intrusion (P = 0.02) and hyperarousal (P = 0.03). In patients with LVEF <35%, there was a significant negative correlation between LVEF level and IES-R score (P = 0.045). CONCLUSIONS: This study showed that LVEF was related to the severity of PTSD, especially in the ICD patients with LVEF of <35%. We should pay more attention to ICD patients with severely impaired left ventricular function to prevent psychological problems.

Influence of primary and secondary prevention indications on anxiety about the implantable cardioverter-defibrillator.

BACKGROUND: Implantable cardioverter-defibrillators (ICDs) have been established for primary and secondary prevention of fatal arrhythmias. However, little is known about the influence of ICD indications on quality of life (QOL) and psychological disturbances. This study aimed to examine whether there were differences in QOL and psychological distress in patients that have an ICD for primary or secondary prevention of fatal arrhythmias. METHODS: A multicenter survey of 179 consecutive outpatients (29.1% primary prevention) with ICD implantations completed the Short Form-8 (SF-8), Beck Depression Inventory (BDI), Impact of Event Scale-Revised (IES-R), State-Trait Anxiety Inventory (STAI), and Worries about ICD (WAICD). RESULTS: Patients with an ICD for primary prevention had a higher trait anxiety score and worries about ICD score than patients with an ICD for secondary prevention (41.7±12.4 vs. 34.7±12.3, p=0.001 and 39.6±18.0 vs. 30.0±18.9, p=0.002, respectively), even after adjusting for demographic and clinical characteristics. In multivariable analysis of variance, primary prevention ICD recipients reported a poorer QOL on the vitality subscale of the SF-8. CONCLUSIONS: In our study population, which mostly consisted of New York Heart Association (NYHA) class I and II subjects, primary prevention ICD recipients were more prone to experience worries about their ICD, anxiety, and a poorer QOL compared to secondary prevention ICD recipients. In clinical practice, primary prevention ICD patients should be closely monitored. If warranted, they should be offered psychological intervention, as anxiety and low QOL were predictors of mortality.

Body Weight Reduction Results in Favorable Changes in Blood Pressure, Serum Lipids, and Blood Sugar in Middle-Aged Japanese Persons: A 5-Year Interval Observational Study of 26,824 Cases.

OBJECTIVE: We investigated the relationships between body weight (BWt) and metabolic syndrome (MS) risk factors to elucidate the effect of BWt (?BWt) change and body mass index (BMI) on these factors in the Japanese population. METHODS: Data were collected on MS-related parameters measured during two annual examinations of 16,640 men (mean age: 41.7±11.6 years) and 10,184 women (mean age: 45.0±12.2 years) without prior treatment of hypertension, diabetes mellitus, or dyslipidemia in 2006 and 2011 in Fukuoka, Japan. The subjects were divided into three groups according to BMI in 2006 (low, middle and high BMI) and into three groups according to change in BMI between 2006 and 2011 (decreased, stable, and increased BMI). Mean values for blood pressure (BP), systolic BP (SBP), diastolic BP (DBP), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), hemoglobin A1c (HbA1c), and fasting blood glucose (FBG) for each group were determined by sex and subjected to statistical analysis for comparison. RESULTS: High BMI (>26) was associated with higher SBP, LDL-C, FBG, and TG in both sexes. An increase≥1.1 BMI units in 5 years was associated with increased DBP, LDL-C, TG, HbA1c, and FBG and decreased HDL-C. In contrast, decreased BMI was associated with decreased BP and LDL-C and increased HDL-C in both sexes, and decreased TG in men and FBG in women. CONCLUSIONS: Maintaining a desirable weight or losing weight may help prevent hypertension and MS, even in non-obese individuals.

Different Physiological and Subjective Responses to the Hyperthermia Between Young and Older Adults: Basic Study for Thermal Therapy in Cardiovascular Diseases.

BACKGROUND: Thermal therapy has been used as adjuvant therapy in patients with cardiovascular disease. However, little is known about responses to thermal stress in older adults. We examined the effects of thermal stress in younger and older healthy Japanese individuals. METHODS: The study included 12 young (mean age, 22 years) and 12 older (mean age, 68 years) healthy adults and was performed under strict temperature and humidity control to minimize confounding. Participants lay supine throughout three consecutive 30-minute phases: Phase I (heating at 70°C in a dome-shaped sauna), Phase II (insulation in the sauna), and Phase III (cool down). Physiological parameters and subjective thermal sensations were compared within and between two age groups. RESULTS: Mean skin temperature increased significantly in both age groups (Phase I) and after the first 10 minutes was higher among older adults (by 6.8°C vs 6.0°C among younger; p < .01). Mean rectal temperature increased by 0.6°C in both groups (Phase II). Mean heart rate increased significantly in both age groups (Phase II) and was higher among younger adults (by 21.4 vs 11.3 beats/min among older adults; p < .05). Both systolic (by 15.1 mmHg) and diastolic (by 10.5 mmHg) blood pressure dropped significantly among older adults (Phase I), returning to baseline in Phase III; no changes were noted among those younger. There was no between-group difference in fluid loss or thermal sensations. CONCLUSIONS: Compared with younger adults, older adults are more likely to drop blood pressure in response to thermal stress but had similar fluid loss and subjective responses.

Gender disparities in quality of life and psychological disturbance in patients with implantable cardioverter-defibrillators.

BACKGROUND: Implantable cardioverter-defibrillator (ICD) has improved prognosis in fatal arrhythmia and the number of ICD implantations has increased. ICD-related psychological problems and impaired quality of life (QOL), however, have been observed. This study examined whether gender differences exist in QOL and psychological disturbances in ICD patients. METHODS AND RESULTS: Consecutive outpatients (n=179; mean age, 60.5±15.9 years; 81% male) with ICD implantations completed questionnaires consisting of the Short Form-8 (SF-8), Beck Depression Inventory, Impact of Event Scale-Revised (IES-R), State-Trait Anxiety Inventory, and Worries about ICD. One-way multivariate analysis of variance (MANOVA) showed women to have impaired QOL on the role physical functioning (F15,157=4.57, P<0.05) and bodily pain (F15,157=5.26, P<0.05) subscales of the SF-8. More women reported depression (F15,157=5.37, P<0.05) and worry about ICD than men (F15,157=6.62, P<0.05). Moreover, women also had higher IES-R scores indicating post-traumatic stress disorder (PTSD) than men (F15,157=5.87, P<0.05). CONCLUSIONS: Women reported poorer QOL on 2 subscales: role physical functioning and bodily pain. There was a significant relationship between gender and depression, worry about ICD, and PTSD, but not for anxiety. Female patients need more psychological interventions following ICD implantation.

Bepridil is effective and improves QOL in multidrug-resistant paroxysmal atrial fibrillation.

OBJECTIVE: Efficacy and safety of long-term administration of bepridil as a rhythm and rate controller were comprehensively evaluated in patients with multidrug-resistant paroxysmal atrial fibrillation (PAF). METHODS: A retrospective survey from 1992 to 2006 was conducted on 62 multidrug-resistant PAF patients treated with bepridil from 480 consecutive PAF patients. In addition, a 5-year follow-up study was conducted on 28 of the 62 patients, being continued from 2006 to 2011. The efficacy of bepridil, improvement in symptoms including patients' quality of life (QOL), ECGs, hemodynamics, and its adverse effects were examined. RESULTS: In the retrospective survey, 127 ±â€Š44 mg of bepridil was given for 21 ±â€Š18 months and 40.3% maintained sinus rhythm. Reductions in the frequency and the duration of each episode of PAF and improvement in symptoms were seen in 48.4, 50.0 and 93.5% of the 62 patients, respectively. Reversible torsades de pointes (TdP) occurred in two aged women. Bradycardia and hepatic dysfunction developed in one patient each. In the follow-up study, 100 ±â€Š20 mg of bepridil was given. Sinus rhythm was maintained in 13 patients. Although the occurrences of PAF continued in 14 patients, their symptoms and QOL were improved. No adverse effects were noted in all 28 patients of the follow-up study. CONCLUSIONS: Bepridil was effective in rhythm control in 40% of PAF patients resistant to other antiarrhythmics. Even in those who had failed to maintain sinus rhythm, continued administration of low-dose bepridil improved their symptoms and QOL with few adverse effects. Bepridil is worth returning to use.

Different features of ventricular arrhythmias and the RR-interval dynamics in atrial fibrillation related to the patient's clinical characteristics: an analysis using RR-interval plotting.

The clinical features of ventricular arrhythmia and RR-interval dynamics in AF-patients remain unresolved. We successively plotted points on an X-Y plain as (X, Y) = (RRn, RRn + 1) from the consecutive RR-intervals of Holter ECGs. Eighty of 175 AF-patients were thus diagnosed to have ventricular arrhythmia based on the different plotting patterns between ventricular premature contractions (VPCs) and aberrations. Different characteristics of the RR-interval dynamics before VPCs were observed such as fixed or variable coupling, and a regular or irregular RR-interval sequence. Malignant arrhythmias occurred more frequently in AF-patients with variable coupling VPCs and/or an irregular RR-interval sequence before VPCs than in those with the fixed coupling VPCs and/or the regular RR-interval sequence before VPCs. The RR-interval plotting method enabled us to distinguish different types of VPCs which were related to the clinical characteristics of the AF-patients.