Fatigue et maladies cardiovasculaires

The relationship between stress and sleep quality: The mediating effect of fatigue and dizziness among patients with cardiovascular disease

Cardiovascular disease is the leading cause of non-noncommunicable disease mortality worldwide. Therefore, this study analyzes the mediating effect of dizziness and fatigue in the relationship between stress and sleep quality in patients with heart disease. This study was conducted on patients with heart disease diagnosed by a cardiologist from December 7, 2021 to August 30, 2022 at the Outpatient Department of Cardiology at Hanyang University Hospital in Guri-si, Gyeonggi-do. To verify the serial multiple mediation effect, serial multiple mediation analysis was performed using SPSS Macro Process Model 6 as the most appropriate verification method for this study. The analysis indicated that the more dizziness a participant experienced, the more severe their physical and psychological fatigue and the poorer their quality of sleep. Also, the more severe the physical fatigue, the worse the psychological fatigue and the worse the quality of sleep. In other words, the more severe the psychological fatigue, the poorer the quality of sleep. In summary, in the relationship in which stress in patients with heart disease affects sleep quality, stress is a variable that directly affects sleep quality, and this means that the stress of patients with heart disease can affect the quality of sleep through the parameters, dizziness and fatigue, sequentially; this research model can thus be considered a partial mediator model. Fatigue in patients with cardiovascular disease had a direct effect on sleep quality, and there was a mediating effect through dizziness and fatigue in the relationship between stress and sleep quality. Therefore, it is necessary to develop a sleep management program that can improve the quality of sleep in patients with cardiovascular disease as well as a nursing intervention plan that can alleviate fatigue and control stress in such patients.

Fatigue Monitoring Through Wearables: A State-of-the-Art Review

The objective measurement of fatigue is of critical relevance in areas such as occupational health and safety as fatigue impairs cognitive and motor performance, thus reducing productivity and increasing the risk of injury. Wearable systems represent highly promising solutions for fatigue monitoring as they enable continuous, long-term monitoring of biomedical signals in unattended settings, with the required comfort and non-intrusiveness. This is a p rerequisite for the development of accurate models for fatigue monitoring in real-time. However, monitoring fatigue through wearable devices imposes unique challenges. To provide an overview of the current state-of-the-art in monitoring variables associated with fatigue via wearables and to detect potential gaps and pitfalls in current knowledge, a systematic review was performed. The Scopus and PubMed databases were searched for articles published in English since 2015, having the terms "fatigue," "drowsiness," "vigilance," or "alertness" in the title, and proposing wearable device-based systems for non-invasive fatigue quantification. Of the 612 retrieved articles, 60 satisfied the inclusion criteria. Included studies were mainly of short duration and conducted in laboratory settings. In general, researchers developed fatigue models based on motion (MOT), electroencephalogram (EEG), photoplethysmogram (PPG), electrocardiogram (ECG), galvanic skin response (GSR), electromyogram (EMG), skin temperature (T_sk), eye movement (EYE), and respiratory (RES) data acquired by wearable devices available in the market. Supervised machine learning models, and more specifically, binary classification models, are predominant among the proposed fatigue quantification approaches. These models were considered to perform very well in detecting fatigue, however, little effort was made to ensure the use of high-quality data during model development. Together, the findings of this review reveal that methodological limitations have hindered the generalizability and real-world applicability of most of the proposed fatigue models. Considerably more work is needed to fully explore the potential of wearables for fatigue quantification as well as to better understand the relationship between fatigue and changes in physiological variables.

Self-reported fatigue following intensive care of chronically critically ill patients: a prospective cohort study

Background

Protracted treatment on intensive care unit (ICU) sets the patients at increased risk for the development of chronic critical illness (CCI). Muscular and cardio-respiratory deconditioning are common long-term sequelae, going along with a state of chronic fatigue. At present, findings regarding the frequency, long-term course, and associated factors of self-reported fatigue following ICU treatment of CCI patients are lacking.

Methods

CCI patients with the diagnosis of critical illness polyneuropathy/myopathy (CIP/CIM) were assessed at three time points. Four weeks following the discharge from ICU at acute care hospital (t1), eligibility for study participation was asserted. Self-reported fatigue was measured using the Multidimensional Fatigue Inventory (MFI-20) via telephone contact at 3 (t2, n = 113) and 6 months (t3, n = 91) following discharge from ICU at acute care hospital.

Results

At both 3 and 6 months, nearly every second CCI patient showed clinically relevant fatigue symptoms (t2/t3: n = 53/n = 51, point prevalence rates: 46.9%/45.1%). While total fatigue scores remained stable in the whole sample, female patients showed a decrease from 3 to 6 months. The presence of a coronary heart disease, the perceived fear of dying at acute care ICU, a diagnosis of major depression, and the perceived social support were confirmed as significant correlates of fatigue at 3 months. At 6 months, male gender, the number of medical comorbidities, a diagnosis of major depression, and a prior history of anxiety disorder could be identified. A negative impact of fatigue on the perceived health-related quality of life could be ascertained.

Conclusions

Nearly every second CCI patient showed fatigue symptoms up to 6 months post-ICU. Patients at risk should be informed about fatigue, and appropriate treatment options should be offered to them.

Trial registration

The present study was registered retrospectively at the German Clinical Trials Register (date of registration: 13th of December 2011; registration number: DRKS00003386). Date of enrolment of the first participant to the present trial: 09th of November 2011.

Prolonged fatigue in Ukraine and the United States: Prevalence and risk factors

BACKGROUND

Prolonged, severe, unalleviated fatigue may be disabling whether it occurs on its own or in conjunction with medical or psychiatric conditions. This paper compares the prevalence and correlates of prolonged fatigue in general population samples in Ukraine versus the U.S.

METHODS

Population surveys were conducted in 2002 in both Ukraine (Ukraine World Mental Health [WMH] Survey) and the U.S. (National Comorbidity Survey-Replication; NCS-R). Both surveys administered the Composite International Diagnostic Interview (CIDI 3.0), which contained modules assessing: neurasthenia (prolonged fatigue); mood, anxiety, and alcohol/drug use disorders; chronic medical conditions; and demographic characteristics. Multivariable logistic regression was used to examine risk factors in each country.

RESULTS

The lifetime prevalence of prolonged fatigue was higher in Ukraine (5.2%) than the U.S. (3.7%). In both countries, one-fifth of individuals with prolonged fatigue had no medical or DSM-IV psychiatric condition. Also in both settings, fatigue was significantly associated with sociodemographic characteristics (being female, not working, and married before) as well as early onset and adult episodes of mood/anxiety disorder. Fatigue prevalence in Ukraine increased with age, but decreased in the U.S. at age 70. Unique risk factors for fatigue in Ukraine included lower socio-economic status, Ukrainian vs Russian ethnicity, and cardiovascular disease. Unique risk factors in the U.S. were parental depression/anxiety, adult episodes of alcohol/drugs, pain conditions, and other health problems.

CONCLUSIONS

The lifetime prevalence of prolonged fatigue in Ukraine was 40% higher than that found in U.S. data. In addition, fatigue prevalence increased sharply with age in Ukraine perhaps due to limited social and medical resources and greater comorbidity.

Review on depression and coronary heart disease

The impact of psychological factors on somatic disorders - and vice versa - and the involvement of biological mechanisms in psychic disorders have generated considerable interest in recent years, notably thanks to cutting-edge investigation techniques (immunohistochemistry, functional imaging, genetics, etc.). In the field of psychosomatics, coronary heart disease (CHD) is a frequent co-morbidity of mental disorders, particularly mood disorders. Indeed, there is a bidirectional relationship between CHD and mood disorders, with a strong co-occurrence of the two diseases accompanied by a reciprocal worsening of the prognosis for the two conditions. Various epidemiological studies have shown that depression is a psychic risk factor for CHD and that CHD is present in almost 30% of patients with affective disorders. In this review of the literature, we tackle the crucial question of the diagnosis of depression during myocardial infarction. This clinical approach is essential given the underevaluation of this psychic problem. Then, various psychological, biological and genetic arguments are presented in support of the hypothesis that various aetiological mechanisms of the two disorders are partly shared. We finally deal with the treatment of depression in the context of CHD with its pharmacological and psychological specificities. In conclusion, this review reiterates the need for a multidisciplinary approach, which is necessary to understand, diagnose and then treat this frequent co-morbid condition of heart disease and depression.

The MacNew Heart Disease Health-Related Quality of Life Questionnaire in patients with angina and patients with ischemic heart failure

OBJECTIVE

Patient-reported outcomes including health-related quality of life are important in clinical care and research studies. The MacNew Heart Disease Health-Related Quality Of Life Questionnaire has been validated in English-speaking patients with myocardial infarction. The aim of this study was to validate the MacNew in English-speaking patients with angina or ischemic heart failure.

METHODS

Canadian and American patients with angina or ischemic heart failure completed the MacNew, the Short Form-36 Health Survey, and the Hospital Anxiety and Depression Scale.

RESULTS

We administered questionnaires to 276 patients with angina (mean age, 65.9 years) and 155 patients with ischemic heart failure (mean age, 70.3 years). The mean ± SD MacNew global score in patients with ischemic heart failure (5.1 ± 1.2) was statistically (P < 0.001), but not clinically, poorer than in patients with angina (5.3 ± 1.1). The three-factor measurement model explained 46.1% of the observed variance in the MacNew in patients with angina and 46.5% in patients with ischemic heart failure. Internal consistency was ≥0.90, and test-retest reliability was ≥0.70 for each MacNew scale and the a priori convergent and discriminative validity hypotheses were confirmed in both diagnoses. The MacNew was highly accepted by patients with little respondent or administrative burden.

CONCLUSIONS

The English version of the MacNew is reliable and valid in patients with angina or ischemic heart failure. This permits health-related quality of life outcome comparisons in patients with angina, ischemic heart failure, and myocardial infarction with the MacNew and provides a better understanding of the full range of health-related quality of life outcomes.

Symptom clusters and health-related quality of life in people with chronic stable angina

AIM

This paper reports findings of a study to examine the independent contribution of chest pain, fatigue and dyspnoea to health-related quality of life in people with chronic stable angina.

BACKGROUND

People with chronic stable angina experience poorer quality of life in multiple areas including physical and emotional health. Emerging evidence suggests the presence of concomitant symptoms yet there are no systematic studies examining the impact of symptom clusters on quality of life in people with chronic angina.

METHOD

Outpatients (n = 134), recruited over a 16-month period in 2000 and 2001, with confirmed coronary heart disease and chronic angina completed reliable and valid questionnaires measuring chest pain frequency, fatigue, dyspnoea and quality of life. The data have contemporary relevance because despite changes in treatment of coronary heart disease, chronic angina remains prevalent worldwide. Hierarchical multiple linear regression was used to examine the symptom cluster of chest pain frequency, fatigue and dyspnoea in predicting quality of life.

RESULTS

The sample was predominantly white (74·6%), men (59·7%) with a mean age of 63·4 (sd 12·12) years. Controlling for age, gender, social status and co-morbidities, the symptom cluster of chest pain frequency, dyspnoea and fatigue accounted for a statistically significant increase in unadjusted R² (F of Δ, P < 0·05) for the models predicting physical limitation (R² Δ 24·1%), disease perception (R² Δ 24·6%), Short Form-36 Physical Component Score (R² Δ 24·3%) and Mental Component Score (R² Δ 07·0%).

CONCLUSION

Symptom assessment and management of people with chronic stable angina should involve multiple symptoms. Greater fatigue predicted poorer quality of life in multiple areas. As a possible indicator of depression, it warrants further assessment and follow-up.

Low-frequency electromyostimulation and chronic heart failure

Low-frequency electromyostimulation (EMS) acts on the skeletal muscle abnormalities that aggravate intolerance to effort in patients with chronic heart failure (CHF). It improves the oxidative capacity of muscles and thus enhances aerobic performance and physical capacity to almost the same degree, as does conventional physical training. No local or hemodynamic intolerance has been reported, even in cases of severe CHF. However, the presence of a pacemaker is one of the relative contra-indications (prior evaluation of tolerance is required), while that of an implanted defibrillator is one of the absolute contra-indications. EMS is an alternative to physical effort training when the latter is impossible due to a high degree of deconditioning or because there is a contra-indication, which may be temporary, due to the risk of acute decompensation and/or rhythm troubles. EMS can also be used in patients waiting for a heart transplant or in CHF patients who are unwilling to engage in physical activities. As EMS is not expensive and easy to set up, its use is likely to develop in the future.