Long-COVID Prevalence and Its Association with Health Outcomes in the Post-Vaccine and Antiviral-Availability Era.

Background and Objectives: After recovering from COVID-19, patients may experience persistent symptoms, known as post-COVID-19 syndrome or long COVID, which include a range of continuing health problems. This research explores the prevalence, associated factors, and overall health outcomes of long COVID during a period of extensive vaccination and antiviral treatment availability in Thailand. Materials and Methods: This observational study involved 390 adult patients with COVID-19 between January and March 2022. Beginning three months after their diagnosis, these patients were interviewed via telephone every three months for a period of one year. The data collection process included gathering demographic information and administering a standardized questionnaire that addressed the patients' physical condition following COVID-19, their mental health, sleep disturbances, and overall quality of life. Results: The cohort consisted of 390 participants, with an average age of 31.8 ± 13.6. Among them, 96.7% (n = 377) were vaccinated, and 98.2% (n = 383) underwent antiviral treatment. Long-COVID prevalence was observed at 77.7%, with the most frequently reported symptoms being fatigue (64.1%) and cough (43.9%). Regarding mental health, depression was reported by 8.2% of the participants, anxiety by 4.1%, and poor sleep quality by 33.3%. Advanced statistical analysis using multivariable logistic regression showed significant links between long-COVID symptoms and patients aged below 60 (p = 0.042), as well as the initial symptom of cough (p = 0.045). In the subset of long-COVID sufferers, there was a notable correlation in females with symptoms such as headaches (p = 0.001), dizziness (p = 0.007), and brain fog (p = 0.013). Conclusions: Despite the extensive distribution of vaccines and antiviral therapies, the prevalence of long COVID remains high, being associated particularly with individuals under 60 and those exhibiting a cough as an early symptom. The study further reveals that mental health issues related to long COVID are profound, going beyond the scope of physical symptomatology.

Factors influencing resilience in patients with advanced cancer: A cross-sectional study.

Background: Advanced cancer and its treatments lead to various detrimental impacts on patients. Resilience is an important ability to adapt to such adversity, but there is limited information about its influencing factors, specifically in patients with advanced cancer. Objective: This study aimed to examine the influence of social support, depression, anxiety, hope, optimism, spiritual well-being, religious belief, and hardiness on resilience among adults with advanced cancer. Methods: This cross-sectional research used multi-stage sampling to select 288 participants from a university hospital and three tertiary hospitals in northern Thailand. Data were collected using a demographic data collection form, the Hospital Anxiety and Depression Scale (HADS), the Thai version of the Social Support Questionnaire (SSQ), the Herth Hope Index (HHI), Life Orientation Test-Revised (LOT-R), Buddhist Belief Questionnaire, Health-Related Hardiness Scale (HRHS), and Connor-Davidson Resilience Scale (CD-RISC), from February 2021 to February 2022. Data were analyzed using descriptive statistics, Pearson correlation, and regression analysis. Results: Depression (r = -0.47, p <0.01) and anxiety (r = -0.39, p <0.01) had a significant negative relationship with resilience. Spiritual well-being (r = 0.74, p <0.01), hope (r = 0.67, p <0.01), religious belief (r = 0.53, p <0.01), optimism (r = 0.40, p <0.01), social support (r = 0.33, p <0.01), and hardiness (r = 0.21, p <0.01) had significant positive relationships with resilience. Only hope (ß = 0.29, p <0.01) and spiritual well-being (ß = 0.59, p <0.01) together influenced resilience by 64.70%. Conclusion: Spiritual well-being and hope are crucial to resilience in patients with advanced cancer. Nurses should provide spiritual support to strengthen patients' ability to adapt successfully to life with advanced cancer.

Effectiveness of behavioral and psychosocial interventions for continuous positive airway pressure adherence among patients with obstructive sleep apnea: A systematic review and meta-analysis.

BACKGROUND: Continuous positive airway pressure (CPAP) therapy is the treatment of choice for Obstructive Sleep Apnea (OSA) syndrome; however, interventions to improve CPAP adherence are still inconclusive. OBJECTIVE: This study aimed to examine the effectiveness of behavioral and psychosocial interventions on CPAP adherence. METHODS: The PRISMA guidelines and JBI approach for Systematic Review and Meta-analysis were used. Participants included 1) newly diagnosed patients with OSA, naive to CPAP treatment; 2) any type of behavioral and/or psychosocial intervention delivered via individual or group level; 3) CPAP adherence as an outcome. Two reviewers independently selected studies, evaluated their methodological quality, and extracted data. RESULTS: Critical appraisal was conducted on 34 of the 1657 studies, with 18 RCTs included in the final review. Telemonitoring increased the mean nightly hour of CPAP use compared to standard care (WMD = 0.76, 95 % CI = 0.31-1.20, p = 0.001, I2 = 0 %, moderate certainty of evidence). Positive results were discovered in Motivational Enhancement Therapy (MET) (WMD = 1.22, 95 % CI = 0.28-2.16, p = 0.011, I2 = 65 %, very low degree of certainty of evidence). The combined effects of cognitive therapy and education on CPAP adherence were inconclusive. Behavioral/supportive interventions improved mean nightly CPAP use in both the short term (WMD = 1.49, 95 % CI = 0.16-2.81, p = 0.029, I2 = 30 %, very low certainty of evidence) and long-term follow-up (WMD = 1.67, 95 % CI = 1.55-1.79, p = 0, I2 = 0 %, very low certainty of evidence). CONCLUSIONS: Telemonitoring improved the mean nightly hour of CPAP utilization compared with standard care. Motivational Enhancement Therapy (MET) had the most significant effect on long-term adherence.

Patterns of Health-Related Quality of Life among Stroke Survivors: A Longitudinal Study.

Six months poststroke is critical for optimizing stroke survivors' recovery and improving their health-related quality of life (HRQoL). Understanding HRQoL profiles in specific domains can provide a more typical plan for stroke survivors. This pilot study aimed to explore the HRQoL patterns among 39 stroke survivors within 6 months following diagnosis. The results revealed that there were four patterns based on HRQoL domains. Pattern 1: energy, family role, mobility, self-care, social role, and work/productivity domains likely to improve; Pattern 2: language and vision domains likely to improve and be stable; Pattern 3: thinking and upper extremity function domains likely to worsen and improve later; and Pattern 4: mood and personality domains likely to worsen and be constant. Health care providers can apply these results by continuing to assess and provide care to stroke survivors focusing on functional status, cognitive status, and depression over time. Further study should explore the factors predicting HRQoL.

Continuous positive airway pressure adherence in people with obstructive sleep apnoea.

OBJECTIVES: This cross-sectional study aimed to identify whether five factors of the health belief model were related to continuous positive airway pressure adherence in Thai people with obstructive sleep apnoea. BACKGROUND: Obstructive sleep apnoea is a disorder impacting health, social wellbeing and the economy. Continuous positive airway pressure is a gold standard of treatment; however, poor adherence to treatment is an important issue that is related to a multiplicity of psychological and behavioural factors. METHODS: The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies was used to report the study. Purposive sampling was used to recruit 94 patients newly diagnosed with sleep apnoea and using CPAP devices from a sleep clinic. Participants completed a demographic record, the Thai versions of the Functional Outcomes of Sleep Questionnaire, the Perceived Barriers Questionnaire and the Self-Efficacy Measure for Sleep Apnea. CPAP adherence was measured by using information downloaded from the smart card of the devices. Data were analysed using descriptive statistics and logistic regression. RESULTS: Only 54.3% of participants adhered to CPAP treatment using standard protocols. Perceived seriousness of their condition was significantly associated with CPAP adherence, whereas perceived susceptibility, benefits, barriers and self-efficacy were not. CONCLUSIONS: We found a low rate of CPAP adherence among participants. The only factor related to CPAP adherence was perceived seriousness. RELEVANCE FOR THE CLINICAL PRACTICE: With a low rate of CPAP adherence, healthcare professionals, especially nurses, should encourage patients to use CPAP regularly by providing them with support and education regarding the severity of the disease if untreated and the benefits of CPAP treatment on the disease. Healthcare professionals should be aware of psychological factors impacting patients' perception of sleep apnoea and CPAP treatment. Interventions dealing with these factors should be developed and implemented in practice.

Feasibility of sleep extension and its effect on cardiometabolic parameters in free-living settings: a systematic review and meta-analysis of experimental studies.

AIMS: Inadequate sleep is a global health issue and has been associated with an increased risk for cardiovascular diseases. As a part of sleep hygiene, intentional lengthening of night-time sleep duration (i.e. sleep extension) might be a behavioural intervention to improve cardiometabolic health. To examine the feasibility of sleep extension and its effects on cardiometabolic parameters in free-living settings. METHODS AND RESULTS: This review was registered in PROSPERO (CRD42019146174). Five databases were searched. Only experimental studies conducted in adults without a diagnosis of sleep disorder were included. The pooled mean difference was calculated by the inverse variance method. Narrative summaries were also used. Thirteen studies from 11 trials were included. The intervention ranged from 3 days to 6 weeks. Sleep extension increased total sleep time by 51 min [95% confidence interval (CI) 39-63]. Overall, sleep extension did not result in significant changes in blood pressure. However, sub-group analysis revealed that when 24 h mean blood pressure was obtained among those with pre-hypertension or Stage 1 hypertension, sleep extension reduced systolic (weighted mean difference = -7.8 mm/Hg; 95% CI -10.6 to -4.9), and diastolic blood pressure (weighted mean difference = -4.2 mm/Hg; 95% CI -6.7 to -1.8). The pooled effects on fasting glucose and insulin resistance were not significant. The effect of sleep extension on other parameters (e.g. heart rate) was not consistent. CONCLUSION: Sleep extension is feasible and could increase sleep in free-living settings. Sleep extension shows promise for reducing 24 h mean blood pressure among those with pre-hypertension or hypertension. More large-scale studies are needed to examine its long-term effects.

Update on Research and Practices in Major Sleep Disorders: Part II-Insomnia, Willis-Ekbom Disease (Restless Leg Syndrome), and Narcolepsy.

PURPOSE: This review (Part II of a series on sleep disorders) presents an update of the characteristics, epidemiology, assessment, and latest management of insomnia, restless legs syndrome (Willis-Ekbom disease; RLS/WED), and narcolepsy. Insomnia, the most common sleep disorder and most prevalent of all psychological health disorders, is a problem of difficulty initiating and maintaining sleep and early morning awakenings. RLS/WED is characterized by a crawling sensation or urge to move the legs in the evening and nighttime. Narcolepsy is a sleep disorder that commonly results in chronic daytime sleepiness and cataplexy. Nonpharmacological management, which includes education, cognitive behavioral therapy, and complementary therapy, is used as primary or adjunctive to pharmacotherapy for the treatment of these disorders. METHODS: This narrative review utilized medical databases such as PubMed to identify relevant English-language original and systematic review articles predominantly from peer-reviewed journals from 2012 to 2019. However, as background, findings from classic articles prior to 2012 were also included. CLINICAL RELEVANCE: Assessment of sleep problems, excessive sleepiness, and difficulty performing activities or being productive should be routine in the care of all patients. Utilization of behavioral interventions, including cognitive behavioral therapy, in addition to education and sleep hygiene, can promote sleep quality. Management of insomnia, RLS/WED, and narcolepsy should include helping patients adjust to treatment, managing cataplexy triggers in narcolepsy, and initiating strategies to live with chronic illness to improve quality of life.

Update on Research and Practices in Major Sleep Disorders: Part I. Obstructive Sleep Apnea Syndrome.

PURPOSE: The purpose of this first of two review articles providing an update on sleep disorders was to examine the pathophysiology, epidemiology, and treatment of obstructive sleep apnea (OSA). OSA is a common sleep disorder whose prevalence is similar to asthma. As with other sleep disorders, OSA has a broad impact on individuals, affecting their daily behaviors, cognitive abilities, and performance, and putting them at increased risk for accidents, mood disorders, cancer, cardiovascular disease, and hypertension. Thus, early recognition and management, much of which can be implemented by nurses, can reduce health and accident risks and improve daily functioning. METHODS: This narrative review utilized medical databases such as PubMed to identify relevant English language original and systematic review articles predominantly from peer-reviewed journals from 2012 to 2018. However, as background, findings from classic articles prior to 2012 were also included. CLINICAL RELEVANCE: OSA is a common condition with considerable impact on daily functioning and potential for accidents and serious comorbidities such as hypertension, cardiovascular disease, diabetes, and depressed mood. The impairments and comorbidities associated with OSA can be reduced through early detection, encouraging treatment, providing education about sleep and OSA, and, importantly, promoting adherence to the predominant therapy, positive airway pressure.

Sleep disturbances and related factors among nurses.

The aim of this study was to describe patterns and potential risk factors for sleep disturbances, including that of sleep apnea, among Thai registered nurses. A descriptive, cross-sectional design was implemented. A sample of 233 registered nurses was recruited from 10 nursing departments from a tertiary hospital. Participants completed a one-time, self-report questionnaire and a 1 week-long sleep diary. Descriptive and logistic regression statistics were used for the analysis. Approximately 76% of nurses slept less than 7 h, 12.3% had difficulty initiating sleep, and 5% had difficulty maintaining sleep. Short sleep duration was prevalent, and night shift work schedules that exceeded 10 episodes/month were perceived as contributing to difficulties with initiating sleep. After excluding males from the analysis, the risk for depression related to short sleep duration becomes statistically significant. Organizational policies for registered nurses' shift work should include effective management of night shift assignments, as well as interventional strategies and policy directions, to promote sleep quality and mental health to ensure nurse well-being and patient safety.

Factors associated with sleep quality of Thai intercity bus drivers.

This study aimed to describe sleep quality and explore factors associated with poor sleep quality in Thai intercity bus drivers. A cross-sectional design was employed with a sample of intercity bus drivers from 4 bus transportation companies. The Thai-PSQI was used to identify sleep quality, and the Thai Berlin Questionnaire used to assess sleep apnea risk. Data analysis included descriptive statistics and logistic regression. A total of 338 surveys were analyzed. All bus drivers were male; almost 66% of the bus drivers were defined as poor sleepers, and 18.1% were assessed as being at high risk for obstructive sleep apnea. Working night shifts (OR=20.6), rotating day or night shifts (OR=17.0), alcohol consumption (OR=2.7), being married (OR=3.1), and not exercising (OR=2.3) were related to poor sleep quality. The majority of the Thai intercity bus drivers in our study reported poor sleep quality indicating that action is required at both company and individual levels to encourage the adoption of healthy lifestyles and improvement of working conditions.

Short sleep duration among Thai nurses: Influences on fatigue, daytime sleepiness, and occupational errors.

OBJECTIVES: This study was conducted to: 1) describe sleep duration, fatigue, daytime sleepiness, and occupational errors among Thai nurses and 2) explore the influence of sleep duration on fatigue, daytime sleepiness, and occupational errors. METHODS: A cross-sectional design was implemented. A convenience sample of 233 full-time nurses with at least one year of work experience was recruited to participate in the study. Data were collected using self-reported questionnaires and 1-week sleep diaries. Descriptive and logistic regression statistics were performed using SPSS software. RESULTS: The mean total sleep time was 6.2 hours. Of the total participants, 75.9% (n=167) experienced short sleep duration, 38.2% (n=84) experienced fatigue, and 49.5% (n=109) experienced excessive daytime sleepiness. Occupational errors were reported by 11.7% (n=25). Medication errors, incorrectly performed procedures, and needle stick injuries were reported by 6.5% (n=13), 5.6% (n=12), and 4.7% (n=10), respectively, of participants performing the associated activities. The "Short Sleep Duration" group experienced more fatigue (p=.044) and excessive daytime sleepiness (p=.001) compared with the "Adequate Sleep Duration" group. Although occupational errors were more common in the "Short Sleep Duration" group, the difference between the two groups did not reach the level of statistical significance. Multivariable logistic regression analysis found that short sleep duration was a statistically significant risk factor for excessive daytime sleepiness (OR=2.47, 95% CI=1.18-5.19). CONCLUSIONS: The majority of registered nurses experience short sleep duration. Short sleep duration increased the risk of excessive daytime sleepiness but not fatigue or occupational errors. Adequate night-time sleep is paramount for preventing daytime sleepiness and achieving optimal work performance.

Effectiveness of behavioral and psychosocial interventions for continuous positive airway pressure adherence in obstructive sleep apnea patients: a quantitative systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this review is to assess the effectiveness of behavioral and psychosocial interventions on adherence to continuous positive airway pressure among patients 18 years and over with obstructive sleep apnea.

Effect of continuous positive airway pressure on glucose metabolism in adults with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials.

Obstructive sleep apnea (OSA) has many serious consequences, and one of these may be the exacerbation of type 2 diabetes mellitus (T2DM). Reports on the effect of continuous positive airway pressure (CPAP) on glucose metabolism in people with T2DM and OSA are conflicting. Therefore, the purpose of this review was to examine the effect of CPAP treatment on glucose metabolism by synthesizing findings from randomized controlled trials. The PRISMA review protocol was developed and registered in PROSPERO. A systematic search of PubMed, CINAHL, Embase, Web of Science, PsycInfo, and Cochrane was conducted from inception to March 2017. The Cochrane risk of bias tool was used to assess the study quality. Review Manager (v5.2) was used for the meta-analyses, and the standardized mean difference was calculated. Six studies consisting of 496 participants were included in this review. The meta-analyses indicated that CPAP treatment did not have significant impact on glucose metabolism measured by A1C (mean difference = 0.05, 95% CI - 0.14 to 0.24, P = 0.61), fasting insulin level (mean difference = - 2.34, 95% CI - 8.19 to 3.51, P = 0.43), and fasting glucose (mean difference = - 0.05, 95% CI - 0.52 to 0.42, P = 0.84). As expected, CPAP treatment can improve daytime sleepiness (mean difference = - 2.68, 95% CI - 3.91 to - 1.54, P < 0.001). Findings of this meta-analysis do not substantiate a positive effect of CPAP on glucose metabolism in people with T2DM and coexisting OSA. Future large-scale clinical trials with a longer treatment duration and better CPAP compliance are warranted.