Physical functioning and risk for sleep disorders in US adults: results from the National Health and Nutrition Examination Survey 2005–2014

Resilience, Anger, and Insomnia in Nurses after the End of the Pandemic Crisis

INTRODUCTION

Nurses seem to be persistently experiencing intense psychological repercussions, even after the official conclusion of the COVID-19 pandemic. In this cross-sectional study conducted after the end of the pandemic crisis, from 1 June 2023 to 30 June 2023, we evaluated the levels and explored the associations between anger, insomnia, and resilience among Greek nurses.

METHODS

A total of 441 nurses participated in an online survey and were invited to state their work experience, gender, and age and to complete the self-report measures of the Dimensions of Anger Reactions-5 (DAR-5), the Athens Insomnia Scale (AIS), and the Brief Resilience Scale (BRS).

RESULTS

Overall, 62.1% of the participants presented with positive scores on the AIS, and 41.5% displayed positive values on the DAR-5 scale, whereas 24.9% demonstrated scores indicative of low resilience on the BRS. A regression analysis revealed that 23.5% of the variance in the AIS scores can be attributed to the DAR-5 scores and 3% to the BRS scores. A mediation analysis confirmed the protective role of resilience, contributing as a negative mediator in the DAR-5 and AIS relationship.

CONCLUSIONS

Screening for insomnia symptoms and anger issues among nurses after the end of the pandemic and implementing appropriate interventions is considered imperative to avoid long-term health consequences.

The Clinical Relevance of Autonomic Dysfunction, Cerebral Hemodynamics, and Sleep Interactions in Individuals Living With SCI

A myriad of physiological impairments is seen in individuals after a spinal cord injury (SCI). These include altered autonomic function, cerebral hemodynamics, and sleep. These physiological systems are interconnected and likely insidiously interact leading to secondary complications. These impairments negatively influence quality of life. A comprehensive review of these systems, and their interplay, may improve clinical treatment and the rehabilitation plan of individuals living with SCI. Thus, these physiological measures should receive more clinical consideration. This special communication introduces the under investigated autonomic dysfunction, cerebral hemodynamics, and sleep disorders in people with SCI to stakeholders involved in SCI rehabilitation. We also discuss the linkage between autonomic dysfunction, cerebral hemodynamics, and sleep disorders and some secondary outcomes are discussed. Recent evidence is synthesized to make clinical recommendations on the assessment and potential management of important autonomic, cerebral hemodynamics, and sleep-related dysfunction in people with SCI. Finally, a few recommendations for clinicians and researchers are provided.

The relationships between physical function, nutrition, cognitive function, depression, and sleep quality for facility-dwelling older adults with dynapenia

BACKGROUND

The growing population of older adults worldwide is associated with an extended life expectancy and an increasing proportion of older adults with dynapenia. Most research on dynapenia has involved only populations of older adults living in the community; little research has examined the effects of risk factors on sleep quality among older adults with dynapenia residing in assisted living facilities.

AIM

This study examined the relationships among physical function, nutrition, cognitive function, depression, and sleep quality among older adults with dynapenia residing in assisted living facilities.

METHODS

In this cross-sectional study, data on physical function, nutrition, cognitive function, depression, and sleep quality was collected from 178 older adults with dynapenia residing in assisted living facilities, who were selected using purposive sampling. Descriptive statistical analysis, independent-sample t tests, chi-squared tests, and logistic regression analysis were performed using SPSS 25.0.

RESULTS

The statistical analyses revealed correlations between sleep quality and age (t = 2.37, p < 0.05), level of education (χ2 = 3.85, p < 0.05), grip strength (t = 3.40, p < 0.01), activities of daily living (t = 4.29, p < 0.001), instrumental activities of daily living (t = 2.23, p < 0.001), calf circumference (t = 2.89, p < 0.01), Mini Nutritional Assessment scores (t = 2.29, p < 0.05), Mini Mental State Exam (MMSE) scores (t = 4.50, p < 0.001), and Geriatric Depression Scale (GDS) scores (t = - 4.20, p < 0.001). Calf circumference (OR = 0.8, 95% CI = 0.650.97, p < 0.05), GDS score (OR = 1.42, 95% CI = 1.05-1.92, p < 0.05), and MMSE score (OR = 0.85, 95% CI = 0.73-0.97, p < 0.05) were related to sleep quality among the sample population.

CONCLUSION

Physical function, nutrition, cognitive function, and depression affect the sleep quality of older adults with dynapenia residing in assisted living facilities. Facility nurses must regularly assess these aspects of their patients to ensure that facility-dwelling older adults can maintain their physical function and improve their health to improve the quality of their sleep.

Determinants of Physical Functioning and Health-Related Quality of Life among Sexual and Gender Minority Older Adults with Cognitive Impairment

Objectives: To examine risk and protective factors predicting physical functioning and physical and psychological health-related quality of life (HRQOL) among sexual and gender minority (SGM) older adults with cognitive impairment. Methods: This study analyzed longitudinal data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study with a sub-sample of 855 SGM older adults who reported difficulties in cognitive performance. Results: Physical functioning and HRQOL linearly declined over time, and the decline of physical functioning was steeper for those with low levels of physical and outdoor leisure activities. The overall levels of physical functioning and HRQOL over time were associated with physical and outdoor leisure activities, optimal sleep, and sufficient food intake. HRQOL was negatively associated with lifetime discrimination and victimization, identity stigma, and smaller social network. Discussion: These findings can be used to develop interventions to improve physical functioning and HRQOL of SGM older adults living with cognitive impairment.

Relationships of Low Cognitive Performance and Sleep Disorder With Functional Disabilities Among Older Adults

Objectives

This study examined the relationships of low cognitive performance and sleep disorder with functional disabilities among older adults. Methods: NHANES 2011–2014 data on 3179 individuals [Mage=69.71] were analyzed. Functional domains included: activities of daily living (ADL), instrumental ADL (IADL) and leisure and social activities (LSA). Animal Fluency Test and the Digit Symbol Substitution Test assessed cognitive performance. Participants self-reported having physician-diagnosed sleep disorder. Results: Participants with both low cognitive performance and sleep disorder had 4- to 10-times greater odds for ADL, IADL, and LSA difficulties compared to the participants with no low cognitive performance/sleep disorder. Participants with only low cognitive performance and those with only sleep disorder were two to three times more likely to experience these difficulties. Discussion: Low cognitive performance and sleep disorder together or independently were associated with functional disabilities. Participants with both low cognitive performance and sleep disorder had higher odds of functional disabilities.

Activity limitation and participation restriction in Osteoarthritis and Rheumatoid arthritis: findings based on the National Health and Nutritional Examination Survey

Background

Osteoarthritis (OA) and Rheumatoid arthritis (RA) are the most common joint diseases leading to chronic pain and disability. Given the chronicity and disabling nature of OA and RA, they are likely to influence full participation of individuals in the society. An activity limitation occurs when a person has difficulty executing an activity; a participation restriction is experienced when a person has difficulty participating in a real-life situation. The aim of this study was to examine the associations between OA and RA and the domains of activity limitation and participation restriction.

Methods

A cross-sectional study design comprised 3604 adults from the 2009 to 2018 National Health and Nutrition Examination Survey (NHANES). All participants aged ≥ 20 years with complete data were included. Activity limitation and participation restriction were assessed by reported difficulty in performing 14 tasks selected from Physical Functioning Questionnaire. Data on OA and RA were obtained from Medical Conditions Questionnaire. Weighted logistic regression model was used to examine the associations between OA and RA and the selected tasks.

Results

Over 36% of participants had limitations. Both OA (OR = 2.11) and RA (OR = 2.36) were positively associated with activity limitation and participation restriction (p < 0.001). Poor or fair health was associated with difficulty in physical functioning, with highest odds observed in leisure activities (OR = 2.05), followed by difficulty in attending social events (OR = 1.99), walking for a quarter mile (OR = 1.97), preparing meals (OR = 1.93) and walking up ten steps (OR = 1.92).

Conclusion

Adults with OA and RA had nearly similar odds of having activity limitations and participation restrictions. Difficulty in executing most activities of daily living (ADLs) has significant association with poor or fair health. Holistic interdisciplinary care to individuals with OA or RA focusing on ADLs and environmental factors may improve health status.

Is Sleep Disordered Breathing Confounding Rehabilitation Outcomes in Spinal Cord Injury Research?

The purpose of this article is to highlight the importance of considering sleep-disordered breathing (SDB) as a potential confounder to rehabilitation research interventions in spinal cord injury (SCI). SDB is highly prevalent in SCI, with increased prevalence in individuals with higher and more severe lesions, and the criterion standard treatment with continuous positive airway pressure remains problematic. Despite its high prevalence, SDB is often untested and untreated in individuals with SCI. In individuals without SCI, SDB is known to negatively affect physical function and many of the physiological systems that negatively affect physical rehabilitation in SCI. Thus, owing to the high prevalence, under testing, low treatment adherence, and known negative effect on the physical function, it is contended that underdiagnosed SDB in SCI may be confounding physical rehabilitation research studies in individuals with SCI. Studies investigating the effect of treating SDB and its effect on physical rehabilitation in SCI were unable to be located. Thus, studies investigating the likely integrated relationship among physical rehabilitation, SDB, and proper treatment of SDB in SCI are needed. Owing to rapid growth in both sleep medicine and physical rehabilitation intervention research in SCI, the authors contend it is the appropriate time to begin the conversations and collaborations between these fields. We discuss a general overview of SDB and physical training modalities, as well as how SDB could be affecting these studies.

Association between sleep quality and physical functioning in adults with down syndrome: A brief report

BACKGROUND

Sleep quality is associated with physical functioning in adults, but this has not been examined in those with Down syndrome (DS). High body mass index (BMI) and accelerated aging, both common in adults with DS, may alter the relationship between sleep quality and physical functioning in this population.

OBJECTIVE

To examine sleep quality indicators and its association with physical functioning in adults with DS, and whether associations are altered by BMI and age.

METHODS

Participants were 15 adults with DS (8 women; age 29 ± 14 years). We evaluated sleep quality over seven days with wrist-worn accelerometers and physical functioning with the timed-up-and-go (TUG) and 6-min walk (6 MW) tests. We examined the associations between sleep quality and physical functioning variables using Spearman's rho.

RESULTS

Sleep quality indicators were: total sleep time 407 ± 54 min; latency 26.8 ± 21 min; efficiency 73.9 ± 12 %; wake after sleep onset 122.8 ± 65.2 min; number of awakenings 21.0 ± 6.2; and average length of awakenings 6.1 ± 3 min. Total sleep time and average length of awakenings were significantly associated with 6 MW distances (rho = 0.58 and -0.69; p < 0.05, respectively). After controlling for age and BMI, 6 MW distance was significantly associated with total sleep time, latency, efficiency, and average length of awakenings (rho = 0.56, -0.73, 0.60, and -0.87; p < 0.05, respectively). TUG was significantly associated with total time in bed (rho = 0.71); p < 0.05).

CONCLUSIONS

Sleep quality indicators are associated with walking performance in adults with DS. Age and BMI strengthen the relationship between sleep quality and physical functioning.

Use of item response theory to investigate disability-related questions in the National Health and Nutrition Examination Survey

OBJECTIVES

Accurately measuring disability is critical toward policy development, economic analyses, and determining individual-level effects of health interventions. Nationally representative population surveys such as the National Health and Nutrition Examination Survey provide key opportunities to measure disability constructs such as activity limitations. However, only very limited work has previously evaluated the item response properties of questions pertaining to limitations in National Health and Nutrition Examination Survey.

METHODS

This was a cross-sectional study. We included participants ⩾20 years old for the 2013-2018 National Health and Nutrition Examination Survey cycles. Activity limitations, and a smaller number of body function impairments or participation restrictions, were determined from interview questions. We performed item response theory models (a two-parameter logistic and a graded response model) to characterize discriminating information along the latent continuum of activity limitation.

RESULTS

We included 17,057 participants. Although each particular limitation was somewhat rare (maximally 13%), 7214 (38%) responded having at least one limitation. We found a high amount of discriminating information at 1-2 standard deviations above average limitation, though essentially zero discrimination below that range. Items had substantial overlap in the range at which they provided information distinguishing individuals. The ordinal graded response model including 20 limitations provided greater information than the dichotomous two-parameter logistic model, though further omitting items from the graded response model led to loss of information.

CONCLUSION

National Health and Nutrition Examination Survey disability-related questions, mostly specifically activity limitations, provided a high degree of information distinguishing individuals with higher than average limitations on the latent continuum, but essentially zero resolution to distinguish individuals with low or average limitations. Future work may focus on developing items which better distinguish individuals at the "lower" end of the limitation spectrum.

Herrick J. Energy cost of walking and functional aerobic capacity during moderate intensity exercise in adults with obstructive sleep apnea: a cross-sectional study

Background

Autonomic dysregulation associated with obstructive sleep apnea (OSA) may limit cardiopulmonary responses to exercise, which, in turn, may impair functional aerobic capacity (FAC) and walking economy. We aimed to characterize walking economy and FAC in OSA patients compared with healthy adults (non-OSA) and examine their relationship with OSA severity (apnea-hypopnea index [AHI]).

Methods

A total of 26 adults (OSA, n = 13; non-OSA, n = 13) participated in this cross-sectional study. In this study, the participants with OSA were between the ages of 25 and 60 years, with a body mass index of 25 kg/m2 to 39 kg/m2, and who had undergone a recent third-party sleep study with an AHI of 5 or greater. Participants completed a maximal integrated cardiopulmonary exercise test, three separate exercise bouts of constant work rate (CWR) treadmill test at 85% of anaerobic threshold (AT), and a 10-min walk test (10MWT). Multiple linear regression analysis corrected for weight, age, and BMI were performed to examine the associations.

Results

There were significant differences between OSA and non-OSA participants in VO2peak (29.7 ± 5.6 mL/kg/min vs. 37.5 ± 6.5 mL/kg/min, p = 0.03) and Net VO2 during CWR (12.7 ± 5 vs.19 ± 6 mL/kg/min, p = 0.02). The 10MWT speed and distance were significantly lower in the OSA group (all p < 0.001). The energy cost of walking during submaximal exercise and 10-min walk test was higher among patients with OSA (all p < 0.001). The AHI scores were associated with 10MWT distance (R2 = 0.85, p < 0.001), energy cost of walking (R2 = 87, p < 0.001), and VO2 at anaerobic threshold (R2 = 0.92, p < 0.001).

Conclusions

The findings of this study show that patients with OSA have reduced FAC and a higher energy cost of walking. AHI explained 87% of variance in the energy cost of walking during the 10MWT. The results suggest that individuals with more severe obstructive sleep apnea experience greater impairment in functional performance.

Sleep and functional capacity in adults: Cross-sectional associations among self-report and objective assessments

OBJECTIVES

This study examined the relationship between self-reported and objectively measured sleep and functional capacity in adults.

DESIGN

Cross-sectional.

PARTICIPANTS

Data were from the Midlife in the United States study. The sample consisted of men and women (n = 664) aged 25-83 who completed telephone interviews, questionnaires, and an overnight clinic stay.

MEASUREMENTS

Sleep was assessed by self-report (Pittsburgh Sleep Quality Index [PSQI]) and by objective measures (sleep latency, duration, wake after sleep onset [WASO], and midpoint/midpoint variability) from 7 consecutive days of actigraphy. Functional capacity was assessed by self-report of limitations and measured gait speed, grip strength, and chair stands.

RESULTS

In linear regression models adjusting for demographic and health factors, better self-reported sleep quality predicted fewer reported limitations, stronger grip, quicker gait, and faster chair stands (all P< .01). Greater WASO predicted more self-report limitations and slower gait speed (P< .05). Long (>8 hours) sleep duration and a more variable sleep schedule predicted lower grip strength (p < .05). Finally, after adjustment for objective sleep measures, PSQI remained a significant predictor of functional measures (P< .05) and explained a significant amount of additional variance (change in R²: 0.01-0.05).

CONCLUSIONS

The present results suggest that subjective and objective sleep measures capture distinct aspects of sleep that are independently related to functional capacity. The variance in functional measures explained by sleep variables, though small, was comparable to other risk factors for functional impairment (eg, obesity), underscoring the importance of associations between sleep and optimal function in adults.

Study Protocol on the Validation of the Quality of Sleep Data from Xiaomi Domestic Wristbands

(1) Background: Sleep disorders are a common problem for public health since they are considered potential triggers and predictors of some mental and physical diseases. Evaluating the sleep quality of a person may be a first step to prevent further health issues that diminish their independence and quality of life. Polysomnography (PSG) is the “gold standard” for sleep studies, but this technique presents some drawbacks. Thus, this study intends to assess the capability of the new Xiaomi Mi Smart Band 5 to be used as a tool for sleep self-assessment. (2) Methods: This study will be an observational and prospective study set at the sleep unit of a hospital in A Coruña, Spain. Forty-three participants who meet the inclusion criteria will be asked to participate. Specific statistical methods will be used to analyze the data collected using the Xiaomi Mi Smart Band 5 and PSG. (3) Discussion: This study offers a promising approach to assess whether the Xiaomi Mi Smart Band 5 correctly records our sleep. Even though these devices are not expected to replace PSG, they may be used as an initial evaluation tool for users to manage their own sleep quality and, if necessary, consult a health professional. Further, the device may help users make simple changes to their habits to improve other health issues as well. Trial registration: NCT04568408 (Registered 23 September 2020).

Prevalence of Disability and Disability Types by Urban-Rural County Classification-U.S., 2016

INTRODUCTION

In the U.S., disability affects approximately 61.4 million (25.7%) adults, with mobility disability being the most prevalent type, affecting about 1 in 7 U.S. adults. However, little is known about the prevalence of disability and functional disability types by urbanization level.

METHODS

Data from the 2016 Behavioral Risk Factor Surveillance System were analyzed. The prevalences of disability, overall and by functional disability type, were estimated among U.S. adults across 6 levels of urban-rural county categories based on the 2013 National Center for Health Statistics Urban-Rural Classification Scheme for Counties. Adjusted prevalence ratios with 95% CIs were estimated by conducting log-linear regression analyses with robust variance estimator while adjusting for study covariates. Data analyses were conducted in 2018.

RESULTS

The prevalences of having any disability, functional disability type, or multiple disabilities were lowest in large metropolitan centers and fringe metropolitan counties and highest in noncore (rural) counties. After controlling for age, sex, race/ethnicity, education, and federal poverty level, adults living in noncore counties were 9% more likely to report having any disability, 24% more likely to report having 3 or more disabilities, and 7% (cognition) to 35% (hearing) more likely to report specific disability types than the adults living in large metropolitan centers.

CONCLUSIONS

Results of this study suggest that significant disparities in the prevalence of disability exist by level of urbanization, with rural U.S. residents having the highest prevalence of disability. Public health interventions to reduce health disparities could include people with disabilities, particularly in rural counties.