Sleep-disordered Breathing in Cardiac Rehabilitation: Prevalence, Predictors, and Influence on the Six-Minute Walk Test.

BACKGROUND: Identification of non-traditional risk factors is an important component of cardiac rehabilitation (CR). However, the prevalence and predictors of sleep-disordered breathing (SDB) and its influence on exercise performance in patients attending CR remain poorly described. METHODS: Patients enrolled in a national CR centre were eligible for a comprehensive SDB screening program. Screening questionnaires for SDB, overnight sleep study, and the 6-minute walk test (6MWT) were conducted. RESULTS: We recruited 332 patients (mean age 62±10 years, 62.4% male) attending CR for primary (29.2%) or secondary (70.8%) prevention, of which 209 successfully completed the overnight sleep study. Sleep-disordered breathing group patients (n=68, 32.5%) were older and had a higher body mass index (BMI) and neck and waist circumferences than the non-SDB group patients. After adjusting for neck and waist circumference, age (OR=1.06; 95% CI 1.02-1.10; p=0.001) and BMI (OR=1.19; 95% CI 1.10-1.30; p<0.001) remained independent predictors of SDB. A high risk of SDB based on the Berlin Questionnaire (43.4% versus 35.5%, p=0.277) or STOP-BANG questionnaire (63.2% versus 53.2%, p=0.170) and excessive daytime sleepiness (Epworth Sleepiness Scale >10, 23.9% versus 17.7%, p=0.297) were similar between the groups. The 6MWT scores were significantly lower in the SDB than non-SDB group (mean difference -32 m; 95% CI -57-7; p=0.013). The relationship was no longer significant after adjusting for age, sex, and waist circumference. CONCLUSION: Sleep-disordered breathing is prevalent in CR patients and is independently predicted by ageing and obesity. The association between SDB and poorer exercise performance may be explained by age, sex, and waist circumference.

Cardiac Rehabilitation After Percutaneous Coronary Intervention in a Multiethnic Asian Country: Enrollment and Barriers.

OBJECTIVE: To determine the enrollment or barriers to cardiac rehabilitation (CR) among Asian patients who have undergone percutaneous coronary intervention (PCI). DESIGN: Prospective observational study. SETTING: Department of cardiology at a university hospital. PARTICIPANTS: Patients (N=795) who underwent PCI between January 2012 and December 2013 at a tertiary medical institution. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Data on enrollment in phase 2 CR and its barriers were collected by dedicated CR nurses. RESULTS: Of 795 patients, 351 patients (44.2%) were ineligible for CR because of residual coronary stenosis, while 30 patients (3.8%) were not screened because of either early discharge or death. Of the remaining 416 patients (90.8% men; mean age, 55 y), 365 (87.7%) declined CR participation and 51 (12.3%) agreed to participate. Of these 51 patients, 20 (39%) did not proceed to enroll and 4 (8%) dropped out, leaving 27 patients (53%) who completed at least 6 sessions of the CR program. The top 3 reasons provided by patients who declined to participate in CR were (1) busy work schedules (37.5%), (2) no specific reason (26.7%), and (3) preference for self-exercise (20.1%). Nonsmokers were more likely to participate in CR (P=.001). CONCLUSIONS: CR participation of Asian patients after PCI was found to be lower than that reported in Western countries. The exclusion criteria used in the institution under study differed from those provided by international associations. A busy work schedule was the most common reason for declining CR after PCI.

Evaluating Structural Models of Cognitive Vulnerabilities: Transdiagnostic and Specific Pathways to Internalizing Symptoms.

The structure of cognitive vulnerabilities to anxiety and depression was examined via a hierarchical approach to examine the usefulness of a bifactor model for identifying a broad transdiagnostic (i.e., common core) factor versus disorder-specific variables (i.e., unique dimensions) in predicting internalizing psychopathology. Several models (i.e., single factor, correlated factor, single hierarchical, and bifactor models) were evaluated in undergraduate (n = 351) and adolescent (n = 385) samples. Across both samples, the bifactor model exhibited comparable good fit as the correlated and single hierarchical models. This model comprised a core transdiagnostic vulnerability factor and six specific factors (i.e., negative cognitive style, dysfunctional attitudes, ruminative style, intolerance of uncertainty, anxiety sensitivity, and fear of negative evaluation). Although the transdiagnostic factor predicted a general internalizing symptom factor, unique fear-related specific-level associations between individual vulnerability and symptom remained significant. Moreover, the transdiagnostic vulnerability factor predicted internalizing symptoms, even after controlling for personality and gender. These findings highlight the importance of advancing an integrative etiologic model of internalizing psychopathology.