Sleep-related disorders in patients with precapillary pulmonary hypertension.

Precapillary pulmonary hypertension (PcPH) is associated with the development of sleep-related disorders and impairment of sleep quality. With growing recognition of the clinical relevance of sleep-related conditions in PcPH, this narrative review seeks to discuss the spectrum of disorders encountered in clinical practice, pathophysiological mechanisms linking PcPH with sleep-related disorders, and potential therapeutic considerations. Current evidence demonstrates a higher prevalence of impaired sleep quality, sleep-disordered breathing, sleep-related hypoxia, and restless leg syndrome in patients with PcPH. These sleep-related disorders could further lead to impairment of quality of life in a patient population with already a high symptom burden. Recent data suggest that sleep-related hypoxia is strongly linked to worse right ventricular function and higher risk of transplantation or death. However, limited studies have investigated the role of oxygen therapy or positive airway pressure therapy improving symptoms or outcomes. Abnormal iron homeostasis is highly prevalent in PcPH and may contribute to the development of restless legs syndrome/periodic limb movement of sleep. To improve sleep management in PcPH, we highlight future research agenda and advocate close collaboration between pulmonary hypertension specialists and sleep physicians.

Ethical Challenges of Nonreading Older Adult Women's Autonomy in Receiving Percutaneous Coronary Intervention Under Familial Paternalism in Taiwan.

In the context of familial paternalism in Taiwan, nonreading older adult women (NOAWs) may passively disengage from treatment and submit to the decisions of their families. The purposes of this case study were to examine the ethical conflicts regarding the autonomy of hospitalized NOAWs receiving percutaneous coronary intervention in a cultural environment of familial paternalism and to propose a theoretical framework based on a literature review to resolve the ethical challenges specific to this cultural context. The proposed framework "Nursing advocacy model for engaging NOAWs with their medical treatment" was established on the basis of relational ethics, nursing advocacy, and shared decision making. Our argument does not question traditional Chinese cultural values. Instead, we advocate for NOAWs to engage with their treatment, express their preferences, and communicate with their families in a decision-making process that incorporates mutual respect and understanding within the context of Chinese culture.

Mediating effect of social support on the relationship between illness concealment and depression symptoms in patients with pulmonary arterial hypertension.

BACKGROUND: Depression symptoms are common in patients with pulmonary arterial hypertension (PAH). Social support may mediate the effect of illness concealment on depression symptoms. OBJECTIVE: To examine the relationships between illness concealment, dimensions of social support, and depression symptoms and the mediating effect of the dimensions of social support on depression symptoms in PAH patients. METHODS: A cross-sectional design and convenience sampling were applied. Data were collected with three questionnaires and analyzed with hierarchical regression and the PROCESS macro. RESULTS: Ninety-seven participants were enrolled (mean age 50 ± 14 years). In total, 8% had a Patient Health Questionnaire (PHQ)-9 score ≥15. Hierarchical regression analysis showed that education level (ß = 0.28, p < 0.05), illness concealment (ß = 0.21, p < 0.05), and emotional support (ß = 0.29, p < 0.01) were determinants of depression symptoms. Emotional support mediated the relationship between illness concealment and depression symptoms. CONCLUSIONS: Emotional support can help patients reduce the effect of illness concealment on depression symptoms.