Poor sleep and impaired self-care: towards a comprehensive model linking sleep, cognition, and heart failure outcomes

Depressive Symptoms and Sleep Quality Mediate the Relationship Between Race and Quality of Life Among Patients With Heart Failure: A Serial Multiple Mediator Model

BACKGROUND

Black patients with heart failure (HF) report worse quality of life (QoL) than White patients. Few investigators have examined mediators of the association between race and QoL, but depressive symptoms and sleep quality are associated with QoL.

OBJECTIVE

The aim of this study was to determine whether depressive symptoms and sleep quality are mediators of the relationship between race and QoL among patients with HF.

METHODS

This was a cross-sectional study. We included 271 outpatients with HF. Self-reported race (White/Black), depressive symptoms (Patient Health Questionnaire), sleep quality (Pittsburgh Sleep Quality Index), and QoL (Kansas City Cardiomyopathy Questionnaire) were collected at baseline. A serial multiple mediator analysis was conducted using the PROCESS macro for SPSS.

RESULTS

Ninety-six patients (35.4%) were Black. Black participants reported higher levels of depressive symptoms and poorer sleep quality than White participants. Race was not directly associated with QoL but indirectly associated with QoL through depressive symptoms and poorer sleep quality. Because of higher levels of depressive symptoms and poorer sleep quality, Black participants reported poorer QoL than White participants.

CONCLUSIONS

Depressive symptoms and sleep quality together mediated the relationship between race and QoL. These findings suggest that screening for depressive symptoms and sleep quality could identify patients at risk for poor QoL, especially in Black patients.

Daily worry, rumination, and sleep in late life

OBJECTIVE

Perseverative thinking (e.g., worry/rumination) is a common response to stress, and can be detrimental to well-being. Sleep may represent an important mechanism by which perseverative thinking is disrupted or amplified from day to day. This study examined the associations between older adults' everyday worry, rumination, and sleep.

METHODS

Older adults (N = 270) aged 65-89 completed a baseline interview and morning and evening assessments each day for 5-6 days. Every morning, they indicated their worry toward the day and their sleep duration and disturbances the prior night. Every evening, they rated worry and rumination experienced that day.

RESULTS

Multilevel models showed that perseverative thinking predicted worse sleep (i.e., fewer hours of sleep) at the between-person level (B = -0.29, p = .004) but better sleep (i.e., fewer sleep disturbances) at the within-person level (Bs < -0.18, ps < .003). At the within-person level, more hours of sleep (B = -0.06, p = .04) and fewer sleep disturbances (B = 0.10, p < .001) predicted less worry the next morning. Prior night's worry predicted greater next morning's worry, but this association was significant only when older adults reported fewer-than-usual hours of sleep (B = 0.24, p < .001), not when they reported more-than-usual hours of sleep (B = 0.04, p = .61).

CONCLUSION

Findings suggest that worry and rumination are intimately linked with sleep and highlight the protective role that better sleep may play in reducing older adults' everyday perseverative thinking.

Healthy couple, better sleep: Exploring connections and changes in couple relationship education participants

Considerable evidence suggests couple relationship education (CRE) programs are effective in improving couples' relationship functioning, yet few studies have examined the implications of CRE programs on indicators of physical health despite substantial research supporting links between relational and physical health. This study utilized a sample of 308 couples randomly assigned to a CRE curriculum to explore the dyadic links between conflict management and self-care skills (emphasized in CRE), stress, and sleep dysfunction concurrently. We prospectively tested whether changes in skills drove changes in sleep dysfunction or vice versa, for both self and partner. Results from a series of structural equation models indicated indirect links for men and women between conflict management and self-care skills and sleep dysfunction through lower stress level at program start. Dyadically, men's and women's better conflict management skills were associated with partners' lower stress, which was in turn associated with partners' lower sleep dysfunction. Men's better self-care skills were linked with partners' lower stress levels, which were linked with partners' lower sleep dysfunction. Tests of dyadic prospective cross-lagged effects among changes in sleep and changes in skills indicated that initial improvements in both partners' sleep predicted improvements in their own conflict management skills 1 year later. Initial improvements in women's conflict management skills predicted reduced sleep dysfunction for themselves. Additionally, for both partners, early changes in self-care predicted later reductions in sleep dysfunction. Dyadically, immediate improvements in men's self-care predicted reduced sleep dysfunction for their partner a year later. Implications for research and practice are discussed.

Sleep and Circadian Rhythm Disturbances in Diabetes: A Narrative Review

Sleep and circadian rhythm disturbances are less-known risk factors for the development and suboptimal outcomes of diabetes. The goal of this narrative review is to highlight the importance of sleep and circadian rhythm disturbances in the development and outcomes of type 1 diabetes (T1D) and type 2 diabetes (T2D), assess current treatment options and the possible mediating mechanisms. We performed a literature search using PubMed and selected relevant English and Dutch papers. Disturbances of sleep and circadian rhythm are common in people with diabetes. They are associated with an increased risk of developing T2D as well as with suboptimal diabetes outcomes (including higher HbA1c levels and reduced quality of life) for T1D and T2D. Preliminary data suggest that treatment of sleep and circadian rhythm disturbances could improve diabetes outcomes in people with T1D and T2D. Finally, the association with medical parameters appears to be mediated by disturbance in hormones, and by suboptimal self-care including forgetting or postponing glucose monitoring or medication use as well as higher consumption of high fat/high sugary foods. Diabetes may also disturb sleep, for example through nocturnal hypoglycemia and nocturia. We concluded that sleep and circadian rhythm disturbances are closely linked with diabetes. More attention to sleep in regular diabetes care is warranted, while further research is needed on treatment of sleep and circadian rhythm disturbances in the prevention of diabetes and its suboptimal outcomes.

The Association Between Self-reported Sleep Quality and Self-care in Adults With Heart Failure

BACKGROUND

Sleep disturbance is one of the most common symptoms among patients with heart failure (HF), and it may affect the ability of patients to perform self-care. There is a lack of evidence on the association between sleep quality and its components and self-care in adults with HF.

OBJECTIVE

The aim of this study was to evaluate the association between sleep quality and its components and self-care in adults with HF.

METHODS

This study is a secondary analysis of baseline data from the MOTIVATE-HF study, a randomized controlled trial on patients with HF and their caregivers. Only patients' data were analyzed in this study (n = 498). Sleep quality and self-care were evaluated with the Pittsburgh Sleep Quality Index and the Self-Care of Heart Failure Index v6.2, respectively.

RESULTS

A habitual sleep efficiency of 75% to 84% was associated with lower self-care maintenance compared with a habitual sleep efficiency of 85% or greater ( P = .031), as was taking sleep medications once or twice a week compared with less than once a week ( P = .001). A frequency of daytime dysfunction less than once a week was associated with lower self-care management compared with a frequency of daytime dysfunction of 3 or more times a week ( P = .025). Taking sleep medications less than once a week was associated with lower self-care confidence compared with taking sleep medications 3 or more times a week ( P = .018).

CONCLUSION

Poor sleep quality is frequently reported by patients with HF. Sleep efficiency, sleep medications, and daytime dysfunction may influence self-care more than the other sleep quality components.

Predictors of Effective Self-care Interventions Among Jordanians With Heart Failure

Jordan has dramatic increases in the prevalence of risk factors for heart failure. However, there are few studies addressing heart failure self-care in Jordan. Identifying predictors of heart failure self-care among Jordanian patients is crucial in providing comprehensive care including addressing risk factors. The study aimed to identify predictors of self-care behaviors among Jordanians with heart failure. A cross sectional study with a convenience sample of 300 Jordanian patients was performed in an educational hospital in the north of Jordan. Differences in the level of self-care between selected sociodemographic and clinical variables were identified using univariate statistics, and multiple regression was used to adjust estimates for covariates. The predictors of self-care were insomnia (p ≤ .001) and marital status (p = .018). Identifying factors influencing self-care can assist with addressing the causes of insomnia to ensure effective treatment, providing patients with social support, and eventually promoting heart failure self-care.

Sleep Characteristics, Mood, Somatic Symptoms, and Self-Care Among People With Heart Failure and Insomnia

BACKGROUND

Almost 50% of people with heart failure (HF) experience chronic insomnia and must perform self-care to manage their day-to-day healthcare needs. Understanding multifactorial influences on self-care, including demographic, clinical, and sleep characteristics, and mood and somatic symptoms will help identify people at highest risk for poor self-care. However, past research focused only on the associations of single symptoms and self-care. Multivariate approaches are needed to account for the synergistic associations of self-care with sleep, mood, and somatic symptoms among people with HF.

OBJECTIVES

The aims of the study were to (a) evaluate the levels of self-care maintenance and self-care confidence among people with stable HF and chronic insomnia; (b) identify the clinical and demographic correlates of self-care maintenance and confidence among people with stable HF and chronic insomnia; and (c) identify the associations between sleep characteristics, mood and somatic symptoms, and self-care maintenance and confidence among people with stable HF and chronic insomnia.

METHODS

We utilized a cross-sectional design with 195 adult participants who had chronic HF and insomnia. We assessed for symptoms of anxiety; depression; dyspnea; fatigue; stress; insomnia severity; and sleep disturbance, impairment, and quality. Self-care was measured using the Self-Care for Heart Failure Index v6.2. We used generalized linear models to test the associations between the demographic and clinical factors and self-care maintenance and confidence; exploratory and confirmatory factor analysis to identify the factor structure underlying the symptoms; and structural equation modeling to test the combined associations of the demographic and clinical factors and latent factors with self-care maintenance and confidence.

RESULTS

Self-care maintenance, confidence, and management were inadequate in most participants. We identified three latent factors among the nine symptoms: "sleep characteristics," "mood," and "somatic symptoms." In the structural equation model, "sleep characteristics," White race, and having a left ventricular ejection fraction of <45 were associated with self-care maintenance. Age was negatively associated with self-care confidence.

DISCUSSION

Poor sleep characteristics negatively influence the ability of people with HF and insomnia to perform self-care behaviors. Knowledge of the associations among age, left ventricular ejection fraction, and race with self-care will help clinicians and future researchers identify those at risk for poor self-care.

Sleep quality and glycaemic variability in a real-life setting in adults with type 1 diabetes

AIMS/HYPOTHESIS

Suboptimal subjective sleep quality is very common in adults with type 1 diabetes. Reducing glycaemic variability is a key objective in this population. To date, no prior studies have examined the associations between objectively measured sleep quality and overnight glycaemic variability in adults with type 1 diabetes. We aimed to test the hypothesis that poor sleep quality would be associated with greater overnight glycaemic variability.

METHODS

Data were collected in the home setting from 20 adults (ten male and ten female participants) with type 1 diabetes who were current insulin pump users. Simultaneous assessments of objective sleep quality (Zmachine Insight+) and continuous glucose monitoring (CGM) were performed over multiple nights (up to 15 nights) in each participant. Due to the real-life nature of this study, the participants kept their usual CGM alerts for out-of-range glucose values. Sleep quality was categorised as 'good' or 'poor' using a composite of objective sleep features (i.e. sleep efficiency, wake after sleep onset and number of awakenings) based on the National Sleep Foundation's consensus criteria. Glycaemic variability was quantified using SD and CV of overnight glucose values based on overnight CGM profiles.

RESULTS

A total of 170 nights were analysed. Overall, 86 (51%) nights were categorised as good sleep quality, and 84 (49%) nights were categorised as poor sleep quality. Using linear mixed-effects models, poor sleep quality was significantly associated with greater glycaemic variability as quantified by SD (coefficient: 0.39 [95% CI 0.10, 0.67], p = 0.009) and CV (coefficient: 4.35 [95% CI 0.8, 7.9], p = 0.02) of overnight glucose values, after accounting for age, sex, BMI and overnight insulin dose. There was large inter- and intra-individual variability in sleep and glycaemic characteristics. Both pooled and individual-level data revealed that the nights with poor sleep quality had larger SDs and CVs, and, conversely, the nights with good sleep quality had smaller SDs and CVs. No associations were found between sleep quality and time spent in the target glucose range, or above or below the target glucose range, where CGM alarms are most likely to occur.

CONCLUSIONS/INTERPRETATION

Objectively measured sleep quality is associated with overnight glycaemic variability in adults with type 1 diabetes. These findings highlight an important role of sleep quality in overnight glycaemic control in type 1 diabetes. They also provide a strong incentive to both patients and healthcare providers for considering sleep quality in personalised type 1 diabetes glycaemic management plans. Future studies should investigate the mechanisms linking sleep quality to glycaemic variability.

The association between sleep quality, health status and disability due to breathlessness in chronic obstructive pulmonary disease patients

BACKGROUND

Chronic obstructive pulmonary disease (COPD) increases susceptibility to sleep disturbances. This study aimed to evaluate the association between COPD severity criteria with sleep quality.

METHODS

One hundred fifty-eight patients in Rasul Akram Hospital of Iran University of Medical Sciences, Tehran, Iran, from April 2019 to March 2021 diagnosed with COPD were examined using the Pittsburgh Sleep Quality Index (PSQI), COPD Assessment Test (CAT), modified Medical Research Council (mMRC) dyspnoea scale, spirometry and pulse oximetry.

RESULTS

Of 158 subjects, 125 patients were male (79%), and 33 were female (21%). The mean subject's age and FEV1/FVC ratio were 62.6 ± 11.5 and 65.6 ± 14.9%, respectively. The mean CAT scoring and Spo2 saturation reported 16.2 ± 7 and 91.5 ± 10.8%, respectively. The mean PSQI score was 8.2 ± 3.8. The association between PSQI score with FEV1 and FEV1/FVC ratio was not statistically significant (p = 0.64 and 0.58, respectively), whereas the association between PSQI scores with CAT score (p ˂ 0.0001, r²  = 0.51) and dyspnoea severity (p ˂ 0.0001, r²  = 0.29) were statistically significant. The patients with higher CAT score demonstrated poor sleep quality, particularly in longer sleep latency (p = 0.001, r²  = 0.056), bad subjective sleep quality (p ˂ 0.0001, r²  = 0.286), lower sleep efficiency (p = 0.002, r²  = 0.077), higher sleep disturbance (p ˂ 0.0001, r²  = 0.225), daytime dysfunction (p ˂ 0.0001, r²  = 0.259) and sleep medication intake times a week (p = 0.01, r²  = 0.069). Dyspnoea severity was attributed to bad subjective sleep quality (p ˂ 0.0001, r²  = 0.069), higher sleep disturbances (p = 0.005, r²  = 0.08), and daytime dysfunction (p ˂ 0.0001, r²  = 0.108).

CONCLUSION

The PSQI has a significant association with the CAT and mMRC for COPD patients and is linked to the disease's severity.

The Long-Term Public Health Impact of Social Distancing on Brain Health: Topical Review

Social distancing has been a critical public health measure for the COVID-19 pandemic, yet a long history of research strongly suggests that loneliness and social isolation play a major role in several cognitive health issues. What is the true severity and extent of risks involved and what are potential approaches to balance these competing risks? This review aimed to summarize the neurological context of social isolation and loneliness in population health and the long-term effects of social distancing as it relates to neurocognitive aging, health, and Alzheimer’s disease and related dementias. The full scope of the underlying causal mechanisms of social isolation and loneliness in humans remains unclear partly because its study is not amenable to randomized controlled trials; however, there are many detailed experimental and observational studies that may provide a hypothesis-generating theoretical framework to better understand the pathophysiology and underlying neurobiology. To address these challenges and inform future studies, we conducted a topical review of extant literature investigating associations of social isolation and loneliness with relevant biological, cognitive, and psychosocial outcomes, and provide recommendations on how to approach the need to fill key knowledge gaps in this important area of research.

Sleep disturbance in heart failure: A concept analysis

AIM

This concept analysis aims to analyze the concept of sleep disturbance (SD) in the context of heart failure (HF) to guide the development of a clearly defined definition.

BACKGROUND

The term "sleep disturbance" has been used in the literature to describe sleep problems and sleep disorders among individuals with HF. Environmental, physical, psychological, behavioral, and developmental factors complicate the phenomenon of SD in HF.

DESIGN

Walker and Avant's method was used for this concept analysis.

DATA SOURCE

Published literature from 2000 to 2020 was identified from electronic health profession-related databases. The current definition and usages of SD were abstracted from empirical work and electronic databases.

REVIEW METHODS

A focused review of abstracts and full text relating to SD in HF was performed. Studies featuring original data and peer-reviewed articles written in English were included to investigate the multifactorial contextual meaning of the concept.

RESULTS

SD in HF can be described as a condition in which individuals experience difficulty initiating and maintaining sleep, and difficulty continuing or resuming sleep due to frequent nocturnal arousals due to HF symptoms, sleep-disordered breathing, insomnia, and psychological burdens.

CONCLUSIONS

To evaluate SD in HF, clinicians must examine the underlying causes to provide the contextual meaning of the concept. A clearly defined and distinguishable concept of SD in HF provides a possibility for accurate measurements of sleep quality, exploring interventions, and evaluating outcomes.

A comparison of diabetes self-care behavior in people with type 2 diabetes with and without insomnia symptoms

AIMS

Individuals with type 2 diabetes (T2DM) are advised to undertake diabetes self-care behavior (DSCB) in order to avoid complications of T2DM. However, comorbidities, such as insomnia symptoms which are commonly reported in people with T2DM, may limit the ability to engage in DSCB. Insomnia and the common sequelae accompanying insomnia such as pain, depression, and anxiety may negatively influence the performance of DSCB. Therefore, this study aimed to compare the DSCB of people with T2DM with and without insomnia symptoms.

METHODS

Sixty participants with T2DM were divided into two groups based on the presence of insomnia symptoms: T2DM-only group and T2DM+ insomnia group. Insomnia symptoms were identified using the Insomnia Severity Index (ISI). DSCB was assessed using the Diabetic Care Profile (DCP). A standardized composite score was established to account for all of the DCP domains. Chi-square and independent sample t tests were used to assess between-group differences in categorical and continuous variables, respectively. Stepwise linear regression analysis used the ISI score to predict standardized DCP composite score, while controlling for covariates.

RESULTS

Significant between-group differences were found in age, symptoms of pain, depression, and anxiety. The total DCP composite score was significantly lower in the T2DM+ insomnia group compared to the T2DM-only group (- 0.30 ± 0.46 vs. 0.36 ± 0.48, respectively, p < 0.001) with large effect size (g = 1.40). Stepwise linear regression results showed that a 1-point increase in ISI score significantly predicted a .03-point decrease in standardized DCP composite score, after controlling for age, symptoms of pain, depression, and anxiety (β = - 0.03, p = 0.04).

CONCLUSIONS

The data suggest that people with T2DM and insomnia symptoms had worse scores on the majority of the DSCB domains and a worse DCP composite score compared to people with T2DM only. The data suggest a negative association between insomnia severity and DSCB among people with T2DM. Further research using a larger sample size and more rigorous research design is required to examine the causal relationship between insomnia symptoms and DSCB.

Sweet dreams or bitter nightmare: a narrative review of 25 years of research on the role of sleep in diabetes and the contributions of behavioural science

The aim of this review was to provide an overview of developments, clinical implications and gaps in knowledge regarding the relationship between diabetes and sleep over the past 25 years, with special focus on contributions from the behavioural sciences. Multiple prospective observational and experimental studies have shown a link between suboptimal sleep and impaired glucose tolerance, decreased insulin sensitivity and the development of type 2 diabetes. While prevalence rates of suboptimal sleep vary widely according to definition, assessment and sample, suboptimal subjective sleep quality appears to be a common reality for one-third of people with type 1 diabetes and over half of people with type 2 diabetes. Both physiological and psychosocial factors may impair sleep in these groups. In turn, suboptimal sleep can negatively affect glycaemic outcomes directly or indirectly via suboptimal daytime functioning (energy, mood, cognition) and self-care behaviours. Technological devices supporting diabetes self-care may have both negative and positive effects. Diabetes and its treatment also affect the sleep of significant others. Research on the merits of interventions aimed at improving sleep for people with diabetes is in its infancy. Diabetes and sleep appear to be reciprocally related. Discussion of sleep deserves a central place in regular diabetes care. Multi-day, multi-method studies may shed more light on the complex relationship between sleep and diabetes at an individual level. Intervention studies are warranted to examine the potential of sleep interventions in improving outcomes for people with diabetes.

Relationship between sleep and cognitive function in patients with heart failure: A systematic review

OBJECTIVE

The aim of this systematic review is to synthesize relevant evidence and illustrate the relationship between sleep and cognitive function in patients with heart failure.

METHODS

A literature search was conducted on Embase, PubMed, Web of Science, CINAHL, PsychINFO, Cochrane Library, China National Knowledge Infrastructure (CNKI) and Wan Fang to identify relevant studies.

RESULTS

Seven studies, which enrolled a total of 1218 heart failure patients, were included in this review. These articles investigating the relationship between sleep and cognitive performance in patients with heart failure had inconsistent results. Five studies confirmed that sleep quality and insomnia were significantly associated with cognitive function, including global cognition, attention, and executive function, whereas the other two studies indicated no statistically significant relationship between sleep and cognitive function.

CONCLUSION

Although limited evidence restricts the overall conclusions, this review might provide new opportunities to identify patients with heart failure that are at high risk for cognitive decline. Further studies across a longer period are needed to confirm the relationship between sleep and cognitive function in patients with heart failure.

Self-care in People with Type 2 Diabetes Mellitus Research Protocol of a Multicenter Mixed Methods Study (SCUDO)

About 11% of the adult global populations is estimated to be living with type 2 diabetes mellitus (T2DM) by 2040. T2DM requires people to make decisions regarding complex therapeutic regimes, to maintain their well-being and quality of life, to manage symptoms and to reduce disease complications. All these behaviours, requiring knowledge, motivation, experience, and skills, have been referred to the concept of self-care. The intricacy and multidimensionality of T2DM self-care requires a complex approach to its overall comprehension. This Embedded Mixed Method study aims to investigate the experience of self-care in Type 2 Diabetes Mellitus adult patients. It comprises a prospective observational design, and an interpretive description. Quantitative data will be collected with validated questionnaires from 300 patients at baseline and once a year for two years on: diabetes self-care, quality of life, diabetes related distress, and sleep quality. Socio-demographic and clinical data will be collected from medical records. Qualitative data will be collected using semi-structured interviews on circa 10-20 patients, at baseline and once a year for two years, analysed according to interpretive description. Quantitative and qualitative data will be analysed separately and then merged and interpreted. This study will expand our understanding of self-care in people with T2DM. The expected outcome will be a better understanding of the effect of self-care on glycaemic control and therefore clinical outcomes and costs.

The effect of an educational program based on Roy's adaptation model on the quality of life of patients suffering from heart failure: A clinical trial study

AIM

Heart failure is a progressive, debilitating disease with exacerbated physical and psychological symptoms that reduces the quality of life of patients. Nursing intervention based on nursing theories could help in the adaptation of patients to the disease and improving quality of life. The aim of this study was to determine the effect of an educational program based on Roy's adaptation model on the quality of life of patients with heart failure.

METHODS AND MATERIAL

In this randomized controlled trial, 76 patients with heart failure were allocated to either the intervention or control group through a blocked randomization method. The data were collected between May and October 2017. The intervention group received oral and written educational programs for 4 weeks. Minnesota quality-of-life questionnaire and Roy's adaptation model-based evaluation form was completed at the beginning of the trial, and 1 month after the completion of the study.

RESULTS

Intervention patients showed statistically significantly improved scores on the physiologic, role function, independence-interdependence dimensions and the total score of Roy's adaptation model over time compared with control patients (p < .05). The mean score of all of the three quality-of-life dimensions and total score of quality of life increased significantly (p < .05).

CONCLUSION

The study results help nursing staff detect the stimuli and the behaviors of patients with heart failure. Roy's adaptation model can be used as a standard practice to increase adaptation to the disease and improving quality of life.

Impaired Sleep Quality in COPD Is Associated With Exacerbations: The CanCOLD Cohort Study

BACKGROUND

COPD increases susceptibility to sleep disturbances, which may in turn predispose to increased respiratory symptoms. The objective of this study was to evaluate, in a population-based sample, the relationship between subjective sleep quality and risk of COPD exacerbations.

METHODS

Data were obtained from the Canadian Cohort Obstructive Lung Disease (CanCOLD) study. Participants with COPD who had completed 18 months of follow-up were included. Sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI) and a three-factor analysis. Symptom-based (dyspnea or sputum change ≥ 48 h) and event-based (symptoms plus medication or unscheduled health services use) exacerbations were assessed. Association of PSQI with exacerbation rate was assessed by using negative binomial regression. Exacerbation-free survival was also assessed.

RESULTS

A total of 480 participants with COPD were studied, including 185 with one or more exacerbations during follow-up and 203 with poor baseline sleep quality (PSQI score > 5). Participants with subsequent symptom-based exacerbations had higher median baseline PSQI scores than those without (6.0 [interquartile range, 3.0-8.0] vs 5.0 [interquartile range, 2.0-7.0]; P = .01), and they were more likely to have baseline PSQI scores > 5 (50.3% vs 37.3%; P = .01). Higher PSQI scores were associated with increased symptom-based exacerbation risk (adjusted rate ratio, 1.09; 95% CI, 1.01-1.18; P = .02) and event-based exacerbation risk (adjusted rate ratio, 1.10; 95% CI, 1.00-1.21; P = .048). The association occurred mainly in those with undiagnosed COPD. Strongest associations were with Factor 3 (sleep disturbances and daytime dysfunction). Time to symptom-based exacerbation was shorter in participants with poor sleep quality (adjusted hazard ratio, 1.49; 95% CI, 1.09-2.03).

CONCLUSIONS

Higher baseline PSQI scores were associated with increased risk of COPD exacerbation over 18 months' prospective follow-up.

Non-pharmacological interventions for sleep and quality of life: a randomized pilot study

OBJECTIVE

to estimate the effects of non-pharmacological interventions to improve the quality of sleep and quality of life of patients with heart failure.

METHOD

pilot study of a randomized controlled trial with 32 individuals assigned to four groups. Sleep was assessed using the Pittsburgh Sleep Quality Inventory, while health-related quality of life was assessed using the Minnesota Living with Heart Failure Questionnaire, at the baseline and at the 12th and 24th weeks. The means of the outcomes according to intervention groups were compared using analysis of covariance; effect sizes were calculated per group.

RESULTS

all groups experienced improved quality of sleep and health-related quality of life at the end of the intervention (week 12) and at follow-up (week 24), though differences were not statistically significant (p between 0.22 and 0.40). The effects of the interventions at the 12th week ranged between -2.1 and -3.8 for the quality of sleep and between -0.8 and -1.7 for quality of life, with similar values at the 24th week.

CONCLUSION

the effects found in this study provide information for sample size calculations and statistical power for confirmatory studies. Brazilian Clinical Trials Registry - RBR 7jd2mm.

Multimodal brain imaging investigation of self-reported sleep quality and daytime sleepiness in older adults with heart failure

PURPOSE OF THE STUDY

Individuals with heart failure (HF) have a high frequency of sleep problems. Patients with HF present with structural brain changes different from normal aging including reductions in brain volume, increases in white matter hyperintensity (WMH) and reduced cerebral blood flow. These structural changes in the brain may explain the pathophysiology of sleep and daytime problems. The objective of this study was to determine whether multimodal imaging data are related to self-reported sleep problems and daytime sleepiness in older adults with HF.

METHODS

Participants in this study underwent magnetic resonance imaging scans on the General Electric 3.0 T Discovery MR750 to acquire WMH, cerebral blood flow and brain volume. Data on 37 stable HF patients (mean age = 68; SD = 5.75) were included.

RESULTS

In this sample, WMH was associated with daytime sleepiness (p = 0.025). However, gray and white matter volume and cerebral blood flow were not associated with daytime sleepiness, sleep quality or insomnia.

CONCLUSION

Although further studies are needed to determine the relationship between WMH and sleep and daytime problems, the findings preliminarily support that increases in WMH from ischemic changes could explain increases in daytime sleepiness among people with HF.

Sleep quality and daytime sleepiness are not associated with cognition in heart failure

BACKGROUND

Individuals with heart failure (HF) exhibit comorbid impairments in both sleep and cognitive performance. Sleep quality has been associated with impaired cognitive performance in HF patients, but reports are inconsistent. In this study, we examined associations between sleep quality, daytime sleepiness, and cognitive function in HF.

METHODS AND RESULTS

Participants were 267 (age = 69.1 ± 9.3) mostly Caucasian (74.9%), male (59.6%) stable HF patients recruited from outpatient settings. This cross-sectional study was a secondary analysis of a prospective observational study. Cognitive function domains assessed included: global cognitive function, attention, memory, and executive function. Sleep quality and daytime sleepiness were assessed using the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS), respectively. Separate multiple hierarchical linear regressions were conducted to determine associations between cognitive function and sleep quality and daytime sleepiness, after controlling for sex, New York Heart Association (NYHA) class, education, depressive symptoms, and medical comorbidities. Cognitive function was not associated with sleep quality or daytime sleepiness after alpha inflation corrections were applied.

CONCLUSIONS

Cognitive function in HF is not associated with sleep quality or daytime sleepiness; other factors may exert greater influence on cognitive performance.

Relationship between sleep disturbance and self-care in adults with type 2 diabetes

AIMS

Type 2 diabetes (T2D) is a metabolic disorder requiring intensive self-care to maintain optimal glycemic control. Sleep disturbance is common in T2D patients and likely impairs glycemic control. Our aim was to examine the relationship between sleep disturbance and self-care in adults with T2D.

METHODS

This study used a correlational design. Sixty-four adults with T2D were recruited. Validated instruments were used to measure self-care, subjective sleep disturbance, and covariates (e.g., diabetes distress, self-efficacy, fatigue, and daytime sleepiness). Over an 8-day period, the ActiGraph-wGT3X was used to measure objective sleep outcomes (e.g., total sleep time and number of awakenings). Bivariate correlation and multiple linear regression analyses were conducted.

RESULTS

The mean age of the participants was 60.6 (SD 6.8) years (range 50-78), and 51.6% were women. Controlling for covariates, subjective sleep disturbance (β = - 0.26), diabetes distress (β = - 0.39), and daytime sleepiness (β = - 0.21) were strong predictors of diabetes self-care (R² = 0.51, p < 0.001). When objective sleep parameters were used, the number of awakenings (β = - 0.23) also predicted self-care along with diabetes distress, fatigue, and daytime sleepiness (R² = 0.57, p < 0.001).

CONCLUSIONS

Subjective sleep disturbance and frequent nocturnal awakenings are associated with worse diabetes self-care in adults with T2D. Healthcare providers are recommended to include comprehensive sleep assessment at every clinical visit. Diabetes educators may consider including sleep-related education in their diabetes self-management classes and/or counseling sessions.

Social and structural barriers for adherence to methadone maintenance treatment among Vietnamese opioid dependence patients

Introduction

Methadone maintenance treatment (MMT) services may reduce the risk of HIV transmission if patients completely adhere to the treatment. Identifying adherence patterns and potential related factors is vital for the sustainability of MMT program in Vietnam. This study examined social and structural factors associated with adherence to MMT among patients in different service delivery models.

Materials and methods

A total of 510 patients at three MMT clinics in Hanoi were interviewed. Measures of self-reported adherence included the number of missed doses in the past 7 days and the level of adherence in the past 30 days using a visual analog scale (VAS) scoring from 0 (non-adherence) to 100 (perfect adherence). Multivariate regressions were employed to identify factors associated with non-adherence to MMT.

Results

A total of 17.7% of participants reported incomplete MMT adherence in the last 30 days and 8.3% reported missing a dose in the last seven days, respectively. Living with HIV/AIDS, poor self-care and usual activities, and disclosure of health issues to spouses or intimate partners were associated with non-adherence. Those patients with pain or depression were more likely to report better adherence. Disclosing health status to spouse/partner increased the risk of incomplete adherence, while disclosing to friends reduced the number of missed dose in the last seven days. Patients attending clinics with comprehensive services had a lower VAS score of adherence compared to those enrolling in clinics with only MMT and general health care.

Conclusions

Sustaining the compliance of patients to MMT is principal in the rapid expansion of this service in Vietnam. It is necessary to address the complexity of health care demands of drug users, their difficulties to be rehabilitated into workforce and society, and the stigmatization to maximize the outcomes of MMT program.

Sleep disturbance in people with diabetes: A concept analysis

AIMS AND OBJECTIVES

To clarify the meaning of sleep disturbance in people with diabetes and examine its antecedents, attributes and consequences through concept analysis.

BACKGROUND

Sleep is crucial for health, and people with diabetes are frequently beset with disturbances in their sleep. The concept of sleep disturbance in people with diabetes has not been clearly defined. The inconsistent use of sleep disturbance has created confusion and impeded our understanding of the sleep in people with diabetes. This analysis will provide a conceptual foundation of sleep disturbance in diabetes, thereby facilitating more effective means for assessment and treatment.

DESIGN

Concept analysis.

METHODS

A systematic search without time restriction on the publication year was carried out using PubMed, CINAHL, PsycINFO, Web of Science and ProQuest Dissertations and Theses. Rodgers's method of evolutionary concept analysis guided the analysis. Inductive thematic analysis was conducted to identify the attributes, antecedents and consequences.

RESULTS

Based on the 26 eligible studies, two major attributes are that sleep disturbance is a symptom and is characterised by impaired sleep quality and/or abnormal sleep duration. Two antecedents are diabetes-related physiological change and psychological well-being. Sleep disturbance can result in impaired daytime functioning, glucose regulation and quality of life.

CONCLUSIONS

Defining the concept of sleep disturbance in people with diabetes facilitates consistent use and effective communication in both practice and research. Sleep disturbance in people with diabetes is a complex symptom that includes impaired sleep quality and/or abnormal sleep duration. This paper contributes to the current knowledge of sleep in people with diabetes. Future research on antecedents and consequences of sleep disturbance is necessary for further clarifications.

RELEVANCE TO CLINICAL PRACTICE

Findings from this paper underscore the need for nursing education, clinical assessment and effective management of sleep disturbance in people with diabetes.

Sleep quality and duration in relation to memory in the elderly: Initial results from the Hellenic Longitudinal Investigation of Aging and Diet

BACKGROUND

Sleep is crucial for cognition, particularly for memory, given its complex association with neurodegenerative processes. The aim of the present study was to examine the association between sleep quality as well as sleep duration and memory performance in a Greek elderly population.

SETTING

Cross-sectional design in the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD), a population representative study of Greek elderly (65years or older).

METHODS

Data from 1589 participants free of sleep medication were included. Sleep quality was estimated by using the Sleep Scale from the Medical Outcomes Study. An extensive neuropsychological assessment examining memory was administered to each participant. Linear regression analyses were used to examine whether sleep quality (higher score, poor quality) and/or sleep duration were associated with memory expressed in the form of a z-score. Age, sex, education, and body mass index were included as covariates. The main analyses were conducted first on the total sample, then with the exclusion of demented participants, and finally with the exclusion of both demented and participants with Mild Cognitive Impairment (MCI). We then conducted further analyses on the non-demented, non-MCI group, initially stratified by Apolipoprotein E-ε4 gene. We further examined the role of co-morbidities, as well as the association between sleep duration groups and memory. We also explored any interaction effect between sex and sleep quality/duration on memory. We then examined the associations between components of sleep measures and memory scores. Lastly, we examined the associations between sleep quality/duration and verbal/non-verbal memory separately.

RESULTS

In the total sample, we noted significant associations between sleep duration and memory (B=-0.001, p≤0.0001), but not for sleep quality and memory (B=-0.038, p=0.121). After excluding the demented participants, the associations were significant for: sleep quality and memory (B=-0.054, p=0.023), and sleep duration and memory (B=-0.001, p≤0.0001). After excluding both the MCI and the demented subjects, the associations between sleep quality and memory (B=-0.065, p=0.006), and sleep duration and memory (B=-0.001, p=0.003) were still significant. The association between the sleep duration groups and memory function was also significant, such that poor memory performance was associated with the longer sleep duration group. The results remained significant even after controlling for the co-morbidities, as well as after adding in the model anxiety and depression as covariates. Associations between sleep quality and memory, and sleep duration and memory were present in the ApoE-ε4 non-carriers. The individual sleep questions that were probably shown to be driving the associations between sleep and memory were: time to fall asleep, sleep not quiet, getting enough sleep to feel rested upon waking in the morning, and getting the amount of sleep needed. Sleep duration was associated with both verbal and non-verbal memory, while sleep quality was only associated with verbal memory.

CONCLUSION

Poor sleep quality and longer sleep duration were linked to low memory performance, independent of demographic and clinical factors, in a large sample of cognitively healthy older Greek adults. Other parameters than sleep and memory measurements could play an important role on the association. Levels of melatonin, or circadian rhythms dysregulation might play a crucial role in the above associations.

The Role of Heart Failure, Daytime Sleepiness, and Disturbed Sleep on Cognition

Disturbed sleep and daytime sleepiness may interfere with possible direct relationships between heart failure (HF) and cognition, yet there is limited research investigating this relationship. We aimed to investigate possible mediating roles of disturbed sleep and daytime sleepiness on the relationship between HF and selected cognitive domains among individuals with and without HF. In a cross-sectional design study, we examined the data of 841 older adults with and without HF from the Aging, Demographics, and Memory Study (ADAMS). We found individuals with HF were likely to have a higher degree of disturbed sleep and daytime sleepiness. Both disturbed sleep and daytime sleepiness were significant predictors of cognition. We found that only daytime sleepiness mediated the relationship between the presence of HF and cognitive domains, such as in attention, memory, and executive function after controlling for covariates. Interventions to improve daytime sleepiness among individuals with HF may also help improving cognition.

The Association of Sleep Disturbances With Quality of Life in Heart Failure Patient–Caregiver Dyads

Sleep disturbance is common in patients with heart failure and their family caregivers. The purpose of this study was to determine whether sleep disturbances of patients and their spousal caregivers predicted their own and their partners’ quality of life (QoL) in 78 heart failure patient–spousal caregiver dyads. Sleep disturbance was assessed using a composite score of four common sleep complaints. QoL was assessed by the physical and mental well-being subscales of the Short-Form 12 Health Survey. The multilevel dyadic actor–partner interdependence model analysis was used to determine the association between sleep disturbance and QoL. Each individual’s sleep disturbance predicted their own poor physical and mental well-being while spousal caregivers’ sleep disturbance predicted their partners’ mental well-being. Results indicated that patients’ mental well-being is sensitive to their spouses’ sleep disturbance. Interventions targeting improving sleep and QoL may have to include both patients and spousal caregivers.

Symptom-Hemodynamic Mismatch and Heart Failure Event Risk

BACKGROUND

Heart failure (HF) is a heterogeneous condition of both symptoms and hemodynamics.

OBJECTIVE

The goals of this study were to identify distinct profiles among integrated data on physical and psychological symptoms and hemodynamics and quantify differences in 180-day event risk among observed profiles.

METHODS

A secondary analysis of data collected during 2 prospective cohort studies by a single group of investigators was performed. Latent class mixture modeling was used to identify distinct symptom-hemodynamic profiles. Cox proportional hazards modeling was used to quantify difference in event risk (HF emergency visit, hospitalization, or death) among profiles.

RESULTS

The mean age (n = 291) was 57 ± 13 years, 38% were female, and 61% had class III/IV HF. Three distinct symptom-hemodynamic profiles were identified: 17.9% of patients had concordant symptoms and hemodynamics (ie, moderate physical and psychological symptoms matched the comparatively good hemodynamic profile), 17.9% had severe symptoms and average hemodynamics, and 64.2% had poor hemodynamics and mild symptoms. Compared with those in the concordant profile, both profiles of symptom-hemodynamic mismatch were associated with a markedly increased event risk (severe symptoms hazards ratio, 3.38; P = .033; poor hemodynamics hazards ratio, 3.48; P = .016).

CONCLUSIONS

A minority of adults with HF have concordant symptoms and hemodynamics. Either profile of symptom-hemodynamic mismatch in HF is associated with a greater risk of healthcare utilization for HF or death.

Is sleep quality related to cognition in individuals with heart failure?

OBJECTIVE

To examine how self-reported sleep quality and daytime symptoms are associated with selected domains of cognitive function among individuals with heart failure (HF).

BACKGROUND

HF patients suffer from poor sleep quality and cognitive decline. The relationship between sleep and cognition has not been well documented among individuals with HF.

METHODS

In this descriptive, cross-sectional study, 68 individuals with HF (male: 63%, mean age = 72 years, SD = 11) completed sleep questionnaires and a neuropsychological battery.

RESULTS

Participant had mean Pittsburgh Sleep Quality Index score of 5.04 (SD = 2.8). Regression analyses demonstrated neither sleep quality or excessive daytime sleepiness (EDS) were related to cognitive function, but daytime dysfunction was related to lower letter fluency and attention index.

CONCLUSION

Contrary to some earlier reports, subjective sleep and EDS in this group of individuals was not associated with cognitive decline.

The association between cognitive function and self-care in patients with chronic heart failure

BACKGROUND

Self-care requires that patients learn to care for themselves. Cognitive impairment and depression can decrease the ability and interest in performing self-care. The objectives were to explore the association between cognitive function and self-care in heart failure patients, and to examine if this association was moderated by symptoms of depression.

METHODS

This cross-sectional study included 105 heart failure patients in NYHA II-IV, median age 72 years. Self-care was measured with the European Heart Failure Self-Care Behavior Scale, cognitive function with a neuropsychological battery, and depressive symptoms were measured with the Patient Health Questionnaire. The associations between the study variables were examined with multiple regression analyses.

RESULTS

Psychomotor speed was the only cognitive dimension significantly associated with self-care. The association between psychomotor speed and self-care was not moderated by symptoms of depression.

CONCLUSIONS

Deficits in psychomotor speed have implications for how patients should be educated and supported to perform self-care.

Daytime sleepiness in renal transplant recipients is associated with immunosuppressive non-adherence: a cross-sectional, multi-center study

BACKGROUND

The aims of this study were to determine the prevalence of immunosuppressive non-adherence (NA) in renal transplant patients and describe whether the degree of daytime sleepiness (DS) and depressive symptomatology are associated with immunosuppressive NA.

METHODS

Using a cross-sectional design, 926 home-dwelling renal transplant recipients who were transplanted at one of three Swiss transplant centers provided data by self-report. The Basel Assessment of Adherence Scale for immunosuppressive was used to measure the following: taking, timing, and overall NA to immunosuppressive medication. DS was assessed with the Epworth Sleepiness Scale (ESS) (cut-off ≥6 for DS) and the Swiss Transplant Cohort Study DS item (cut-off ≥4 for DS), and depressive symptomatology was assessed with the Depression, Anxiety, and Stress Scale (cut-off>10). An ordinal logistical regression model was applied for statistical analysis.

RESULTS

The prevalence of the ESS-DS was 51%. NA for taking, timing, and the median overall NA level assessed by 0-100% visual analog scale (VAS) was 16%, 42%, and 0%, respectively. Based on the multivariate analysis, DS was significantly associated (p < 0.001) with taking (1.08 [1.04-1.13]), timing (1.07 [1.03-1.10]), and overall NA (1.09 [1.05-1.13]). Very similar results were found for the Swiss Transplant Cohort Study DS item.

CONCLUSION

DS is associated with immunosuppressive medication NA in renal transplant recipients. Admittedly, the association's strength is limited.

Evaluation of an individual sleep intervention programme in people undergoing peritoneal dialysis treatment

AIMS AND OBJECTIVES

This study aimed to evaluate effects of a non-pharmacological intervention on sleep, activity and fatigue in patients receiving peritoneal dialysis by the use of both actigraphy registration and self-assessed questionnaires.

BACKGROUND

Insomnia is estimated to affect up to 60% of haemo- and peritoneal dialysis patients. It is associated with two common uremic symptoms, pruritus and restless legs syndrome. To our knowledge, no interventions have been evaluated by actigraphy.

DESIGN

A prospective multiple baseline single-case experimental design.

METHODS

Two women and seven men with sleep problems, 48-77 years, treated with PD participated in a 17-week study from January 2009 to February 2011. Two interventions were separately implemented. First, a pressure-relieving mattress and second, a four week individual sleep hygiene and sleep scheduling intervention. The two interventions were evaluated both objectively by actigraphy and subjectively by questionnaires.

RESULTS

A total of 315 sleep-wake cycles from nine individuals were evaluated. Three patients improved clinically significantly in five or more of the nine outcomes, i.e. sleep onset latency, nocturnal sleep duration, numbers and duration of napping, movement and fragmentation index, number of steps, metabolic equivalent unit, sleep efficiency and fatigue. The other six patients also showed improvements but to a lesser degree. Physical activity advice was the intervention that yielded most sleep improvements.

CONCLUSIONS

This study illuminates the need for regular assessment of sleep and tiredness. It also demonstrates how a non-pharmacological treatment and self-management can be applied with renal supportive care to improve sleep quality.

RELEVANCE TO CLINICAL PRACTICE

This study is a clinical example of a non-pharmacological intervention with supportive care and self-management. This model can improve health and reduce the pharmacological burden because hypnotics can be replaced by sleep hygiene self-care activities.

Depressive symptomatology, exercise adherence, and fitness are associated with reduced cognitive performance in heart failure

OBJECTIVE

Depression is common in heart failure (HF) and associated with reduced cognitive function. The current study used structrual equation modeling to examine whether depression adversely impacts cognitive function in HF through its adverse affects on exercise adherence and cardiovascular fitness.

METHOD

158 HF patients completed neuropsychological testing, physical fitness test, Beck depression inventory-II (BDI-II), and measures assessing exercise adherence and physical exertion.

RESULTS

The model demonstrated excellent model fit and increased scores on the BDI-II negatively affected exercise adherence and cardiovascular fitness. There was a strong inverse association between cardiovascular fitness and cognitive function. Sobel test showed a significant indirect pathway between the BDI-II and cognitive function through cardiovascular fitness.

DISCUSSION

This study suggests depression in HF may adversely impact cognitive function through reduced cardiovascular fitness. Prospective studies are needed to determine whether treatment of depression can lead to better lifestyle behaviors and ultimately improve neurocognitive outcomes in HF.

Poorer physical fitness is associated with reduced structural brain integrity in heart failure

OBJECTIVE

Physical fitness is an important correlate of structural and functional integrity of the brain in healthy adults. In heart failure (HF) patients, poor physical fitness may contribute to cognitive dysfunction and we examined the unique contribution of physical fitness to brain structural integrity among patients with HF.

METHODS

Sixty-nine HF patients performed the Modified Mini Mental State examination (3MS) and underwent brain magnetic resonance imaging. All participants completed the 2-minute step test (2MST), a brief measure of physical fitness. We examined the associations between cognitive performance, physical fitness, and three indices of global brain integrity: total cortical gray matter volume, total white matter volume, and whole brain cortical thickness.

RESULTS

Regression analyses adjusting for demographic characteristics, medical variables (e.g., left ventricular ejection fraction), and intracranial volume revealed reduced performance on the 2MST were associated with decreased gray matter volume and thinner cortex (p<.05). Follow up analyses showed that reduced gray matter volume and decreased cortical thickness were associated with poorer 3MS scores (p<.05).

CONCLUSIONS

Poor physical fitness is common in HF and associated with reduced structural brain integrity. Prospective studies are needed to elucidate underlying mechanisms for the influence of physical fitness on brain health in HF.

Elevated levels of interleukin 6 and C-reactive protein associated with cognitive impairment in heart failure

There is abundant evidence on inflammatory mechanisms in heart failure (HF) that are used for prognostication of the disease; however, data are lacking regarding the association between elevated cytokines, C-reactive protein (CRP), and cognition in HF. A cross-sectional pilot study of 38 patients with HF, aged 62 years (standard deviation± 9 years), predominantly men (68%) and Caucasian (79%) were screened for cognitive function using the Montreal Cognitive Assessment (MoCA). The study aimed to examine cognitive scores on MoCA with cytokines, interleukin 6 [IL-6] and tumor necrosis factor α [TNF-α], and CRP as indicators of early cognitive changes in HF. The result showed no direct correlation between cardiac variables and the MoCA score. The MoCA score, however, was inversely associated with IL-6 (r=-0.53, P=.001) and CRP (r=-0.34, P=.04), with no association to TNF-α. Regression analysis on the MoCA score and log-transformed IL-6 accounted for an additional 11% variation and remained statistically significant (P=.008) after controlling for covariates of education, living arrangements, and loneliness. The large effect size (R(2) =0.87) found in this pilot study provides rationale for a larger exploratory study to examine associations between cognitive function, cytokines, and CRP levels and help design future intervention studies.

Association of sleep quality and dementia among long-lived Chinese older adults

In this study, we examined the existence of relationship between sleep quality and dementia in subjects aged 90 years and above. The sample included 216 men and 444 women. Dementia and sleep quality were measured with 30-item mini-mental state examination (MMSE) and the Pittsburgh sleep quality index, respectively. Subjects with dementia had higher sleep quality score (7.83 ± 2.15 vs. 5.22 ± 2.49; P < 0.0001), longer sleep latency (50.97 ± 21.33 vs. 37.61 ± 12.53; P < 0.0001), and a lower sleep efficiency percentage (73.95 ± 8.783 vs. 81.32 ± 10.21; P < 0.0001) and more likely to report poor sleep quality (25.42 vs.17.13 %; P = 0.035). Subjects with poor sleep quality had significantly lower MMSE scores (P = 0.007) and higher prevalence of dementia (P = 0.042). Multiple logistic regressions were performed by adjusting clinical factors that are thought to be associated with dementia or sleep quality. We found that poor sleep quality was a risk factor for dementia (unadjusted odds ratio (OR) 1.719, 95 % confidence interval (CI) 1.138-2.597; adjusted OR 1.759, 95 % CI 1.012-3.057). There was no significant difference in MMSE scores (11.25 ± 3.40, 16.26 ± 5.14, and 15.43 ± 5.51; P = 0.105) among participants with daily average sleep durations of <5, 5-9, and >9 h, respectively. Among Chinese nonagenarians and centenarians, dementia was correlated with poor sleep quality, longer sleep latency, and lower sleep efficiency percentage.

A brief neuropsychological battery for use in the chronic heart failure population

BACKGROUND

Cognitive impairment is a recognized consequence of heart failure; however, there are no neuropsychological batteries with documented psychometric data in the chronic heart failure population.

AIMS

To document the psychometric properties of a brief neuropsychological battery in a chronic heart failure sample.

METHODS

The Repeatable Battery for the Assessment of Neuropsychological Status, Trail Making Test Part A and Part B, and letter fluency was administered to a sample of individuals with chronic heart failure.

RESULTS

Eighty individuals with stable heart failure participated in this study. Individuals with chronic heart failure scored significantly lower than expected age and education adjusted norms in the domains of attention (p < 0.001), memory (p < 0.001), language (p < 0.001), executive function (p < 0.001), and psychomotor speed (p = 0.02). Scores on the tests of memory and executive function correlated to functional status (r = 0.28, p = 0.02 and r = 0.29, p = 0.03, respectively). Acceptable convergent validity and test-retest reliability were documented for this battery.

CONCLUSION

The neuropsychological battery had adequate reliability and validity in individuals with chronic heart failure.

Disturbed sleep among COPD patients is longitudinally associated with mortality and adverse COPD outcomes

OBJECTIVE

To investigate the cross-sectional association between COPD severity and disturbed sleep and the longitudinal association between disturbed sleep and poor health outcomes.

METHODS

Ninety eight adults with spirometrically-confirmed COPD were recruited through population-based, random-digit telephone dialing. Sleep disturbance was evaluated using a 4-item scale assessing insomnia symptoms as: difficulty falling asleep, nocturnal awakening, morning tiredness, and sleep duration adequacy. COPD severity was quantified by: FEV(1) and COPD Severity Score, which incorporates COPD symptoms, requirement for COPD medications and oxygen, and hospital-based utilization. Subjects were assessed one year after baseline to determine longitudinal COPD exacerbations and emergency utilization and were followed for a median 2.4 years to assess all-cause mortality.

RESULTS

Sleep disturbance was cross-sectionally associated with cough, dyspnea, and COPD Severity Score, but not FEV(1). In multivariable logistic regression, controlling for sociodemographics and body-mass index, sleep disturbance longitudinally predicted both incident COPD exacerbations (OR=4.7; p=0.018) and respiratory-related emergency utilization (OR=11.5; p=0.004). In Cox proportional hazards analysis, controlling for the same covariates, sleep disturbance predicted poorer survival (HR=5.0; p=0.013). For all outcomes, these relationships persisted after also controlling for baseline FEV(1) and COPD Severity Score.

CONCLUSIONS

Disturbed sleep is cross-sectionally associated with worse COPD and is longitudinally predictive of COPD exacerbations, emergency health care utilization, and mortality.

Self-care strategies to facilitate sleep in patients with heart disease--a qualitative study

This study aimed at exploring and describing the self-care management strategies used by patients with coronary artery disease to facilitate sleep. Qualitative interviews in a dialogue manner, in a phenomenographic reference frame analyzed according to manifest and latent principles of qualitative content analysis, were performed. A purposeful sampling technique was used including 11 patients with coronary heart disease in a Heart Medical Unit in a general hospital setting. Two main themes were identified: 'sleep-rhythm' and 'sleep-hygiene' including four descriptive categories. The categories reveal five basic responses including emotions, cognition, physical symptoms (reactions), behaviours and/or the sleep environment, which were related to perceived or actual presence of sleep-wake problems and health that were the underlying reason for the self-care management strategies. Basically, intervention studies that address these five responses for choice of non-pharmacological methods based on cognitive behavioural therapy provided by nurses are needed.