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Gabrovska M, Herpeux A, Bruyneel AV, Bruyneel M. Pulmonary rehabilitation improves sleep efficiency measured by actigraphy in poorly sleeping COPD patients. Sci Rep 2023; 13:11333. [PMID: 37443292 PMCID: PMC10345113 DOI: 10.1038/s41598-023-38546-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 07/10/2023] [Indexed: 07/15/2023] Open
Abstract
Chronic insomnia is reported by up to 50% of chronic obstructive pulmonary disease (COPD) patients. This may be attributable to several factors including nocturnal dyspnea, reduced physical activity, and less time outside. Pulmonary rehabilitation (PR) is recommended in COPD to improve both physical and psychological conditioning. The aim of this study was to assess the effect of PR on sleep efficiency (SE, measured by actigraphy) in COPD patients. COPD eligible for PR were prospectively included. Baseline and post PR (30 sessions) assessments included incremental and maximal exercise testing, 6-min walking distance test (6MWT), actigraphy, and questionnaires [Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety Depression scale, St George Respiratory, and modified Medical Research Council dyspnea scale]. Sixty-one patients were included, and 31 patients completed the study protocol (68% of males, age 63 ± 9 y, FEV1 44.2 ± 12.3%). After PR, SE remained unchanged, p = 0.07, as well as PSQI score (p = 0.22), despite improvements in exercise capacity (incremental exercise test, 6MWT) and dyspnea. However, SE improved significantly in the poor sleeper subgroup (SE < 85%, n = 24, p = 0.02), whereas the PSQI remained unchanged. The present study shows, in COPD patients included in a PR program, that improvement in exercise capacity was disappointingly not associated with a better SE assessed by actigraphy. Subjective sleep quality was also unchanged at the end of PR program. However, SE improved significantly in the poor sleeper subgroup (SE < 85%). Further studies are required to better characterize the origin of sleep disturbances in COPD and the potential benefit of some (non-)pharmacologic interventions.
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Affiliation(s)
- Maria Gabrovska
- Department of Pulmonary Medicine, CHU Saint-Pierre, Rue Haute, 322, 1000, Brussels, Belgium
- Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Audrey Herpeux
- Department of Pulmonary Medicine, CHU Saint-Pierre, Rue Haute, 322, 1000, Brussels, Belgium
- Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Anne-Violette Bruyneel
- Geneva School of Health Sciences, HES-SO School of University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
| | - Marie Bruyneel
- Department of Pulmonary Medicine, CHU Saint-Pierre, Rue Haute, 322, 1000, Brussels, Belgium.
- Université Libre de Bruxelles (ULB), Brussels, Belgium.
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Iannetta D, Rouleau CR, Chirico D, Fontana FY, Hauer T, Wilton SB, Aggarwal S, Austford LD, Arena R, Murias JM. An evaluation of the role of the exercise training dose for changes in exercise capacity following a standard cardiac rehabilitation program. Int J Cardiol 2023; 379:104-110. [PMID: 36934989 DOI: 10.1016/j.ijcard.2023.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/21/2023] [Accepted: 03/16/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND To retrospectively characterize and compare the dose of exercise training (ET) within a large cohort of patients demonstrating different levels of improvement in exercise capacity following a cardiac rehabilitation (CR) program. METHODS A total of 2310 patients who completed a 12-week, center-based, guidelines-informed CR program between January 2018 and December 2019 were included in the analysis. Peak metabolic equivalents (METpeak) were determined pre- and post-CR during which total duration (ET time) and intensity [percent of heart rate peak (%HRpeak)] of supervised ET were also obtained. Training responsiveness was quantified on the basis of changes in METpeak from pre- to post-CR. A cluster analysis was performed to identity clusters demonstrating discrete levels of responsiveness (i.e., negative, low, moderate, high, and very-high). These were compared for several baseline and ET-derived variables which were also included in a multivariable linear regression model. RESULTS At pre-CR, baseline METpeak was progressively lower with greater training responsiveness (F(4,2305) = 44.2, P < 0.01, η2p = 0.71). Likewise, average training duration (F(4,2305) = 10.7 P < 0.01, η2p = 0.02) and %HRpeak (F(4,2305) = 25.1 P < 0.01, η2p = 0.042) quantified during onsite ET sessions were progressively greater with greater training responsiveness. The multivariable linear regression model confirmed that baseline METpeak, training duration and intensity during ET, BMI, and age (P < 0.001) were significant predictors of METpeak post-CR. CONCLUSIONS Along with baseline METpeak, delta BMI, and age, the dose of ET (i.e., training duration and intensity) predicts METpeak at the conclusion of CR. A re-evaluation of current approaches for exercise intensity prescription is recommended to extend the benefits of completing CR to all patients.
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Affiliation(s)
- Danilo Iannetta
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Codie R Rouleau
- Department of Psychology, University of Calgary, Calgary, Canada; TotalCardiology™ Research Network, Calgary, Canada
| | - Daniele Chirico
- Faculty of Kinesiology, University of Calgary, Calgary, Canada; TotalCardiology™ Research Network, Calgary, Canada
| | - Federico Y Fontana
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Trina Hauer
- TotalCardiology™ Rehabilitation, Calgary, Canada; TotalCardiology™ Research Network, Calgary, Canada
| | - Stephen B Wilton
- TotalCardiology™ Research Network, Calgary, Canada; Libin Cardiovascular Institute, University of Calgary, Calgary, Canada
| | - Sandeep Aggarwal
- TotalCardiology™ Research Network, Calgary, Canada; Department of Cardiac Science, University of Calgary, Calgary, Canada
| | | | - Ross Arena
- TotalCardiology™ Research Network, Calgary, Canada; Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Juan M Murias
- Faculty of Kinesiology, University of Calgary, Calgary, Canada.
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Saffaran P, Oh P, Reitav J. Evaluating the Feasibility and Efficacy of A Novel CBTi/SMT Treatment Protocol for Cardiac Rehab Patients: A Non-Randomized Pilot Trial. Behav Sleep Med 2022; 20:716-731. [PMID: 34672904 DOI: 10.1080/15402002.2021.1993227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Cardiac patients and those with chronic medical conditions often suffer from comorbidities such as insomnia and mood disorders. Previous treatment protocols have focused on resolving symptoms of anxiety and depression in this population using Stress Management Training (SMT). However, these treatments have neglected the importance of sleep problems in these patients. This pilot trial sought to address this by examining the feasibility of a novel CBTi/SMT treatment protocol. METHODS 42 participants attending a Cardiac Rehab (CR) exercise program registered in this 7-week non-randomized pilot trial. The primary objective of the pilot trial was to determine the feasibility of the protocol for retention and adherence rates. Secondarily, the authors sought to examine the potential efficacy of the program in terms of treating insomnia, depression, anxiety, emotion dysregulation, and arousal. RESULTS 29 participants attended at least 1 class, with 21 participants completing the program. The average attendance for the program completers was 6 out of 7 classes (SD = 0.8) with four days of practice each week (SD = 1.6) for 33 minutes daily (SD = 16.8). Moreover, the number of participants meeting clinical threshold for insomnia, anxiety, and/or depression was significantly reduced at post-treatment and follow-up. Similarly, raw scores on the relevant scales were significantly reduced at both timepoints. CONCLUSION This pilot trial provided preliminary evidence for the feasibility and efficacy of targeting sleep improvement with a combined CBTi/SMT protocol. This provides the groundwork for future RCTs to establish the effectiveness of targeting insomnia in a range of medical populations.
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Affiliation(s)
- Pouria Saffaran
- Department of Human Biology, University of Toronto, Toronto, Canada
| | - Paul Oh
- Cardiovascular Prevention and Rehabilitation Program, Toronto, Canada, University Health Network/Toronto Rehabilitation Institute, Toronto, Canada
| | - Jaan Reitav
- Cardiovascular Prevention and Rehabilitation Program, Toronto, Canada, University Health Network/Toronto Rehabilitation Institute, Toronto, Canada
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Tighe CA, Buysse DJ, Weiner DK, Beehler GP, Forman DE. Prevalence, Impact, and Trajectories of Sleep Disturbance in Cardiac Rehabilitation: A NARRATIVE REVIEW AND SUGGESTIONS FOR EVALUATION AND TREATMENT. J Cardiopulm Rehabil Prev 2022; 42:316-323. [PMID: 35522949 PMCID: PMC9437109 DOI: 10.1097/hcr.0000000000000694] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of this review was to summarize literature examining the prevalence, impact, and trajectories of sleep disturbance in cardiac rehabilitation (CR) patients and discuss how CR programs may incorporate targeted evaluation and interventions to promote sleep health. REVIEW METHODS A narrative review of literature allowed for an examination of the prevalence of sleep disturbance in CR patients, the effects of sleep disturbance on CR outcomes, and trajectories of sleep disturbance in CR. SUMMARY Sleep disturbance is prevalent in CR patient populations and is related to clinical and functional outcomes. Sleep may be an important biobehavioral process to target in CR to improve important patient outcomes and achieve secondary prevention goals.
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Affiliation(s)
- Caitlan A. Tighe
- VISN 4 Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System
| | - Daniel J. Buysse
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Debra K. Weiner
- Department of Psychiatry, University of Pittsburgh School of Medicine
- Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System
- Department of Medicine, University of Pittsburgh School of Medicine
- Department of Anesthesiology, University of Pittsburgh School of Medicine
- Clinical and Translational Science Institute, University of Pittsburgh School of Medicine
| | - Gregory P. Beehler
- VA Center for Integrated Healthcare
- Community Health and Health Behavior, School of Public Health and Health Professions, University of Buffalo
| | - Daniel E. Forman
- Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System
- Department of Medicine, University of Pittsburgh School of Medicine
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Tan LH, Chen PS, Chiang HY, King E, Yeh HC, Hsiao YL, Chang DR, Chen SH, Wu MY, Kuo CC. Insomnia and Poor Sleep in CKD: A Systematic Review and Meta-analysis. Kidney Med 2022; 4:100458. [PMID: 35518837 PMCID: PMC9065912 DOI: 10.1016/j.xkme.2022.100458] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Rationale & Objective Poor sleep quality and insomnia are pervasive among patients with advanced chronic kidney disease (CKD); however, these health issues have not been systematically evaluated. Study Design Systematic review and meta-analysis. Setting & Study Populations Adult patients with CKD not receiving kidney replacement therapy (KRT), as well as adults receiving KRT, including hemodialysis, peritoneal dialysis, and kidney transplantation. Selection Criteria for Studies A systematic literature search using PubMed, Embase, and PsycNET, was conducted for articles published between January 1, 1990, and September 28, 2018. Data Extraction Data on the prevalences of poor sleep quality and insomnia in patients with CKD, including those receiving and not receiving KRT, were extracted. Analytical Approach Pooled prevalences were estimated using a random-effects meta-analysis and were stratified according to age, CKD stage, World Health Organization region, risk of bias, Pittsburgh Sleep Quality Index score, and the different criteria for insomnia that were used at diagnosis. Results Of 3,708 articles, 93 were selected, and significant methodological heterogeneity was present. The pooled prevalences of poor sleep quality for CKD without KRT, hemodialysis, peritoneal dialysis, and kidney transplantation were 59% (95% CI, 44%-73%), 68% (95% CI, 64%-73%), 67% (95% CI, 44%-86%), and 46% (95% CI, 34%-59%), respectively. The corresponding prevalences of insomnia were 48% (95% CI, 30%-67%), 46% (95% CI, 39%-54%), 61% (95% CI, 41%-79%), and 26% (95% CI, 9%-49%), respectively. Insomnia was significantly more prevalent among patients aged 51-60 years and those aged >60 years than among those aged <50 years. The prevalence of insomnia in the European region was the lowest of all World Health Organization regions. Limitations High interstudy heterogeneity. Conclusions Approximately half of the patients with advanced CKD had poor sleep quality or insomnia, and the prevalence was even higher among those who received KRT. Kidney transplantation may reduce the burden of poor sleep quality and insomnia.
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Affiliation(s)
- Lek-Hong Tan
- Department of Urology, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Pei-Shan Chen
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Hsiu-Yin Chiang
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Emily King
- Department of Medical Media Design and Application, Saint Bear Incorporated, Taichung, Taiwan
| | - Hung-Chieh Yeh
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Ya-Luan Hsiao
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - David Ray Chang
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Sheng-Hsuan Chen
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Min-Yen Wu
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Chin-Chi Kuo
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
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Tsiptsios D, Leontidou E, Fountoulakis PN, Ouranidis A, Matziridis A, Manolis A, Triantafyllis AS, Tsamakis K, Serdari A, Terzoudi A, Dragioti E, Steiropoulos P, Tripsianis G. Association between sleep insufficiency and dyslipidemia: a cross-sectional study among Greek adults in the primary care setting. Sleep Sci 2022; 15:49-58. [PMID: 35273747 PMCID: PMC8889970 DOI: 10.5935/1984-0063.20200124] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/08/2021] [Indexed: 11/20/2022] Open
Abstract
Objective To investigate the potential association between sleep insufficiency and dyslipidemia (DL) in the primary care setting using self-reported questionnaires. Material and Methods 957 adults aged between 19 and 86 years old from the rural area of Thrace, Greece were enrolled in this cross-sectional study. Multistage stratifed cluster sampling was used and the subjects were classifed into three groups according to sleep duration [short (<6h), normal (6-8h), and long (>8h) sleep duration]. DL was defined by a positive response to the question "Have you ever been told by a doctor or health professional that your blood cholesterol or triglyceride levels were high?", or if they were currently taking antilipidemic agents. Sleep quality, utilizing Epworth sleepiness scale, Athens insomnia scale, Pittsburgh sleep quality index and Berlin questionnaire, was also examined. Results DL prevalence was significantly associated with short sleep duration (aOR=2.18, p<0.001) and insomnia (aOR=1.43, p=0.050), while its relation with poor sleep quality (aOR=1.31, p=0.094) and risk for obstructive sleep apnea (aOR=1.32, p=0.097) were of marginal statistical significance. Concerning insomnia subtypes, DL was significantly associated with difficulties maintaining sleep (aOR=2.99, p<0.001) and early morning awakenings (aOR=1.38, p=0.050), but not difficulties initiating sleep (aOR=1.18, p=0.328). Conclusion This study reveals an association between sleep pathology and DL. Thus, early pharmacological and cognitive or behavioral interventions that improve sleep are deemed necessary in order to decrease DL burden.
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Affiliation(s)
- Dimitrios Tsiptsios
- South Tyneside & Sunderland NHS Foundation Trust, Department of Clinical Neurophysiology - Sunderland - Tyne & Wear - United Kingdom
| | - Eleni Leontidou
- Democritus University of Thrace, Laboratory of Medical Statistics - Alexandroupolis - Thrace - Greece
| | | | - Andreas Ouranidis
- Aristotle University of Thessaloniki, Department of Pharmaceutics - Thessaloniki - Central Macedonia - Greece
| | - Anestis Matziridis
- Democritus University of Thrace, Laboratory of Medical Statistics - Alexandroupolis - Thrace - Greece
| | - Apostolos Manolis
- Democritus University of Thrace, Laboratory of Medical Statistics - Alexandroupolis - Thrace - Greece
| | | | - Konstantinos Tsamakis
- King’s College, Institute of Psychiatry, Psychology and Neuroscience - London - London - United Kingdom
| | - Aspasia Serdari
- Democritus University of Thrace, Department of Child and Adolescent Psychiatry - Alexandroupolis - Thrace - Greece
| | - Aikaterini Terzoudi
- Democritus University of Thrace, Neurology Department - Alexandroupolis - Thrace - Greece
| | - Elena Dragioti
- Linköping University, Department of Health, Medicine and Caring Sciences - Linköping - Linköping - Sweden
| | - Paschalis Steiropoulos
- Democritus University of Thrace, Department of Pneumonology - Alexandroupolis - Thrace - Greece
| | - Gregory Tripsianis
- Democritus University of Thrace, Laboratory of Medical Statistics - Alexandroupolis - Thrace - Greece
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Zhang Y, Jiang X, Liu J, Lang Y, Liu Y. The association between insomnia and the risk of metabolic syndrome: A systematic review and meta-analysis. J Clin Neurosci 2021; 89:430-436. [PMID: 34074598 DOI: 10.1016/j.jocn.2021.05.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/19/2021] [Accepted: 05/20/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to perform a systematic review and meta-analysis on the association between insomnia and the risk of developing into metabolic syndrome (including hypertension, hyperglycemia, hyperlipidemia and obesity). METHOD We conducted our research according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta Analyses). After the search term was determined, we searched Pubmed and Embase databases until December 1, 2020 for the observational studies. We used random effects models to aggregate risk estimates for individual studies and the odds ratio (OR) as well as 95% confidence intervals (CI) were calculated for pooled data. Heterogeneity in this study was assessed by using I2 statistic. RESULTS 12 studies were eventually included in this meta-analysis which contained metabolic syndrome related symptoms (hypertension, hyperglycemia, hyperlipidemia and obesity). The combined OR value and 95% CI of the hypertension group was 1.41 (1.19-1.67). The hyperglycemia group was 1.29 (1.11-1.50). The hyperlipidemia group was 1.12 (0.92-1.37) and the obesity group was 1.31 (1.03-1.67). CONCLUSION The risk of insomnia patients suffering from hypertension, hyperglycemia, hyperlipidemia and obesity in metabolic syndrome was 1.41 times, 1.29 times and 1.31 times than people without insomnia respectively.
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Affiliation(s)
- Yuanfeng Zhang
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, PR China
| | - Xiaojiang Jiang
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, PR China
| | - Juan Liu
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, PR China
| | - Ying Lang
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, PR China
| | - Yazhen Liu
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, PR China.
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Semenova NV, Madaeva IM, Bairova TA, Kolesnikova LI. [Deletion polymorphism of GSTT1 gene and lipid peroxidation hyperactivation in menopausal insomnia]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:93-97. [PMID: 33834724 DOI: 10.17116/jnevro202112103193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE A comparative analysis of the parameters of lipid peroxidation - antioxidant defense system in menopausal women with- and without insomnia, depending on the GSTT1 polymorphism. MATERIAL AND METHODS The study included 181 menopausal Caucasian women (ethnic group - Russians), who according to the results of the clinical-anamnestic examinations were divided into insomnia group (n=120, age 53.68±4.61 years, body mass index 26.47±3.73 kg/m2) and control group (n=61, age 52.64±4.91 years, body mass index 27.69±3.11 kg/m2). The insomnia group was formed according to the clinical guidelines for the diagnosis and treatment of chronic insomnia in adults, and scores of the Insomnia Severity Index. The study of the GSTT1 gene polymorphism was carried out using polymerase chain reaction. The lipid peroxidation - antioxidant system parameters were determined by spectrofluorophotometric methods. RESULTS In the insomnia group, carriers of the normal GSTT1 genotype had higher diene conjugates with lower glutathione peroxidase activity as compared to controls. When comparing groups of women with the deletion in GSTT1, an increase in the content of substrates and lipid peroxidation products was observed at all stages of lipid peroxidation, oxidized glutathione, glutathione S-transferase activity with a decrease in the content of reduced glutathione and retinol in the insomnia group as compared to controls. In the insomnia group, carriers of the deletion genotype had a higher content of ketodienes/conjugated trienes and active products of thiobarbituric acid, a lower content of retinol and α-tocopherol as compared to the patients with normal GSTT1 genotype. Conclusions. Insomnia in the menopausal women is accompanied with the intensification of lipid peroxidation only in the carriers of the GSTT1 deletion genotype.
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Affiliation(s)
- N V Semenova
- Scientific Centre for Family Health and Human Reproduction Problems, Irkutsk, Russia
| | - I M Madaeva
- Scientific Centre for Family Health and Human Reproduction Problems, Irkutsk, Russia
| | - T A Bairova
- Scientific Centre for Family Health and Human Reproduction Problems, Irkutsk, Russia
| | - L I Kolesnikova
- Scientific Centre for Family Health and Human Reproduction Problems, Irkutsk, Russia
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Le Grande MR, Jackson AC, Beauchamp A, Kerr D, Driscoll A. Diagnostic accuracy and suitability of instruments that screen for obstructive sleep apnoea, insomnia and sleep quality in cardiac patients: a meta-analysis. Sleep Med 2021; 86:135-160. [PMID: 33674192 DOI: 10.1016/j.sleep.2021.02.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/29/2021] [Accepted: 02/08/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND A number of clinical guidelines recommend that all cardiac rehabilitation patients should be screened for potential sleep disorders with a validated screening instrument. There is currently no consensus on what specific tools should be used. OBJECTIVE To identify tools that are practical to use in the clinical environment and have high diagnostic accuracy. METHODS We systematically searched online databases to identify patient reported outcome instruments that have been used in published research studies to assess the likelihood of obstructive sleep apnoea (OSA) in cardiac patients. In studies that provided diagnostic data, these data were extracted and verified via an evidence-based diagnostic calculator. Where sufficient numbers of studies were available, a meta-analysis was conducted to determine pooled estimates of specificity, sensitivity and diagnostic odds ratios. Selected papers were qualitatively assessed using the Standards for Reporting Diagnostic accuracy studies (STARD). RESULTS Of the 21 instruments identified, six detected likelihood of OSA, two assessed daytime sleepiness, five assessed insomnia and eight examined sleep quality. A meta-analysis of 14 studies that assessed diagnostic accuracy of moderate OSA, revealed moderate sensitivity for the Berlin Questionnaire, Sens = 0.49 (95% CI 0.45-0.52) and good sensitivity for the Stop-BANG, Sens = 0.93 (95% CI 0.87-0.96) but poor specificity at standard cut-off criteria. CONCLUSION There are promising practical tools available to screen patients with OSA and other sleep disorders in cardiac rehabilitation settings, but specificity could be improved. Additional assessment of sleep quality may enhance prognostic ability with both OSA and insomnia screening.
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Affiliation(s)
- Michael R Le Grande
- Australian Centre for Heart Health, 75 Chetwynd Street, North Melbourne, VIC, 3051, Australia; Faculty of Health, Deakin University, Burwood, VIC, 3216, Australia; Melbourne Centre for Behaviour Change, School of Psychological Sciences, The University of Melbourne, Parkville, VIC, 3052, Australia.
| | - Alun C Jackson
- Australian Centre for Heart Health, 75 Chetwynd Street, North Melbourne, VIC, 3051, Australia; Faculty of Health, Deakin University, Burwood, VIC, 3216, Australia; Centre on Behavioural Health, Hong Kong University, Pakfulam, Hong Kong
| | - Alison Beauchamp
- Australian Centre for Heart Health, 75 Chetwynd Street, North Melbourne, VIC, 3051, Australia; Department of Medicine - Western Health, The University of Melbourne, VIC, 3052, Australia; Australian Institute for Musculoskeletal Science (AIMSS), St. Albans, VIC, 3021, Australia; School of Rural Health, Monash University, Newborough, VIC, 3825, Australia
| | - Debra Kerr
- Faculty of Health, Deakin University, Burwood, VIC, 3216, Australia
| | - Andrea Driscoll
- Faculty of Health, Deakin University, Burwood, VIC, 3216, Australia; Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, Geelong, VIC, 3220, Australia
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ADVERSE EFFECT OF INSOMNIA ON BLOOD LIPIDS IN PATIENTS WITH HYPERTENSION. EUREKA: HEALTH SCIENCES 2021. [DOI: 10.21303/2504-5679.2021.001600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Insomnia is a risk factor for the development of arterial hypertension, obesity, type 2 diabetes mellitus, cardiac rhythm disorders, and myocardial infarction. At the same time, insomnia is one of the most frequent non-cardiac complaints in patients with cardiovascular diseases.
The aim of the work was to study the presence of possible relationships between insomnia and the level of blood lipids.
Materials and methods. A cross-sectional study involving 118 patients was conducted. Criteria for inclusion in the study were age over 45 years, the presence of essential hypertension. All patients included the study underwent sampling of 7 ml of venous blood in the morning under fasting conditions. The content of total cholesterol (TCS), triglycerides (TG), high-density lipoprotein cholesterol (HDL CS) was determined by enzymatic method on a biochemical analyser Humalyzer 2000. The patient was interviewed by a pre-trained study doctor.
Results. In the article a relationship between total cholesterol, low-density lipoprotein cholesterol and the presence of insomnia has been established and proved by statistical model. The overall statistical model accuracy is 89.6 % and statistical significance p < 0.005. Accuracy of insomnia prediction is 85.7 % by level of total cholesterol (TCS) and patient interview data. Only one model with best accuracy exists and it was estimated at the article.
Conclusions. Relationship between total cholesterol, low-density lipoprotein cholesterol and the presence of insomnia has been established and proved by statistical model. Accuracy of insomnia prediction is 85.7 % by level of total cholesterol (TCS) and patient interview data.
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State and trait anxiety in islander cardiac patients: associated factors and the impact of perceived social support. ACTA ACUST UNITED AC 2020; 5:e85-e97. [PMID: 32529111 PMCID: PMC7277444 DOI: 10.5114/amsad.2020.95877] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 04/27/2020] [Indexed: 12/20/2022]
Abstract
Introduction Cardiac patients frequently experience elevated levels of anxiety, which may influence clinical outcomes. Perceived social support is a precious resource with which to minimise anxiety. The aim of the study was to explore levels of perceived social support, levels of anxiety (state and trait), and the associated factors as well as the impact of patents’ characteristics and social support on anxiety. Material and methods The study sample consisted of 82 island inhabitant patients with cardiac problems (49 men and 33 women). Data collected by the completion of the State-trait anxiety inventory (STAI) and the Multidimensional scale of perceived social support questionnaire (MSPSS). The statistical significance level was set at p < 0.05. Results Regarding state and trait anxiety, half of the patients scored below 37 and 38, respectively, (medians) while 25% of participants scored more than 50 and 48, respectively. These values indicate moderate levels of anxiety. Regarding social support, at least 50% of patients scored over 27, 27, and 20 (median) on support from significant ones, family, and friends, respectively. In addition, 25% of patients scored above 28, 28, and 26, respectively. These values indicate high levels of social support. The association between anxiety and social support was found to be linearly negative, meaning that the more support a patient felt, the less anxiety they also experienced. Conclusions Enhancing perceived social support may be a key-element in alleviating anxiety among cardiac patients.
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Peng W, Zhao Y, Wang Y, Wang J, Hao Q, Tu Y, Zhu T. Comparison between acupuncture and cognitive behavioral therapy for primary insomnia: A protocol for systematic review and network meta-analysis. Medicine (Baltimore) 2020; 99:e20453. [PMID: 32481348 PMCID: PMC7249967 DOI: 10.1097/md.0000000000020453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Primary insomnia (PI) is a common disease affecting human health. As the side effects of drug therapy were revealed, people began to seek more safe and effective non-drug therapies. Cognitive behavioral therapy for insomnia (CBT-I) and acupuncture are 2 commonly used non-drug therapies. However, there are few comparative studies on the efficacy of these 2 therapies. Therefore, this study aims to compare the efficacy and safety of the 2 therapies through network meta-analysis. METHODS We will search the following electronic bibliographic databases: PubMed, EMBASE, The Cochrane Library, Web of Science, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, Chongqing VIP database, and Wanfang database. Randomized controlled trials in which the intervention was acupuncture or CBT, and in which the control group was any of the above, western medicine or blank control, would be included. The primary outcome will be the changes of the Pittsburgh Sleep Quality Index, and the additional outcomes will include the changes in Insomnia Severity Index, quality of life, clinical effective rate and adverse events. Two independent authors will screen the literature in the above database, extract data and cross-check. Heterogeneity and inconsistencies are detected before using a network meta-analysis method based on frequency analysis. The risk of bias will be assessed in accordance with the Cochrane risk of bias tool, and the strength of the recommendations will be assessed by the Grading of Recommendations Assessment, Development and Evaluation. ETHICS AND DISSEMINATION This network meta-analysis will provide a reference for clinicians and PI patients to choose a more appropriate non-drug regimen among multiple kinds of acupuncture or CBT-I therapies. This review does not require ethical approval and will be reported in a peer-reviewed journal. TRIAL REGISTRATION NUMBER PROSPERO CRD42020155327.
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Affiliation(s)
| | | | | | - Jun Wang
- Rehabilitation and Health Preservation College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Qinghong Hao
- Rehabilitation and Health Preservation College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yang Tu
- Rehabilitation and Health Preservation College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Tianmin Zhu
- Rehabilitation and Health Preservation College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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Free Radical Oxidation and Sleep Disorders in Andro- and Menopause (Literature Review). ACTA BIOMEDICA SCIENTIFICA 2020. [DOI: 10.29413/abs.2020-5.1.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This review presents data on changes in the physiology of sleep during reproductive aging. It is noted that insomnia and obstructive sleep apnea syndrome (OSAS) are the main sleep disorders. The results of foreign and domestic studies in the field of free radical oxidation during sleep deprivation in animal models are presented, indicating the dependence of processes on the duration of sleep deprivation. The largest number of studies of free radical processes in a person with somnological pathology was carried out in the study of OSAS. Blood, urine, saliva, condensate of exhaled air can be biomaterial for determining the parameters of free radical oxidation. It was shown that the intensity of oxidative stress depends on the severity of OSAS, as evidenced by the positive correlation of the level of active products of thiobarbituric acid, the products of oxidation of proteins and carbonyl groups with the apnea/hypopnea index, determining the development of not only oxidative, but also carbonyl stress in patients with a severe degree OSAS. Biomarkers such as thioredoxin, malondialdehyde, superoxide dismutase, and reduced iron have shown a more stable relationship between increased oxidative stress and OSA. Despite the results obtained, the question of the association of oxidative stress and hypoxia in OSA remains debatable, which is associated with the opposite results of some studies. Insomnia, which occurs mainly in females, is accompanied by a high level of end products of lipid peroxidation with a decrease in the activity of antioxidants such as paraoxonase, an enzymatic component of the glutathione system. Along with this, menopausal women present low levels of uric acid, which correlates with high scores of the Pittsburgh sleep quality index questionnaire. Recent studies have identified an association between the activity of the «lipoperoxidation – antioxidants» system and the Clock 3111T/C gene polymorphism in menopausal Caucasian women, indicating the protective role of the minor allele.
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Experiences and Management of Incidents That Influence Sleep in Patients With Cardiovascular Disease and Insomnia. J Cardiovasc Nurs 2020; 35:364-374. [DOI: 10.1097/jcn.0000000000000626] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Semenova N, Madaeva I, Bairova T, Kolesnikov S, Kolesnikova L. Lipid peroxidation depends on the clock 3111T/C gene polymorphism in menopausal women with Insomnia. Chronobiol Int 2019; 36:1399-1408. [DOI: 10.1080/07420528.2019.1647436] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Natalya Semenova
- Federal State Public Scientific Institution “Scientific Centre for Family Health and Human Reproduction Problems”, Irkutsk, Russian Federation
| | - Irina Madaeva
- Federal State Public Scientific Institution “Scientific Centre for Family Health and Human Reproduction Problems”, Irkutsk, Russian Federation
| | - Tatyana Bairova
- Federal State Public Scientific Institution “Scientific Centre for Family Health and Human Reproduction Problems”, Irkutsk, Russian Federation
| | - Sergey Kolesnikov
- Federal State Public Scientific Institution “Scientific Centre for Family Health and Human Reproduction Problems”, Irkutsk, Russian Federation
| | - Lubov Kolesnikova
- Federal State Public Scientific Institution “Scientific Centre for Family Health and Human Reproduction Problems”, Irkutsk, Russian Federation
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A Systematic Review of the Diagnostic Accuracy of Depression Questionnaires for Cardiac Populations: IMPLICATIONS FOR CARDIAC REHABILITATION. J Cardiopulm Rehabil Prev 2019; 39:354-364. [PMID: 30870244 DOI: 10.1097/hcr.0000000000000408] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Depression is overrepresented in patients with cardiovascular disease and increases risk for future cardiac events. Despite this, depression is not routinely assessed within cardiac rehabilitation. This systematic review sought to examine available depression questionnaires to use within the cardiac population. We assessed each instrument in terms of its capability to accurately identify depressed patients and its sensitivity to detect changes in depression after receiving cardiac rehabilitation. METHODS Citation searching of previous reviews, MEDLINE, PsycInfo, and PubMed was conducted. RESULTS The Beck Depression Inventory-II (BDI-II) and the Hospital Anxiety and Depression Scale (HADS-D) are among the most widely used questionnaires. Screening questionnaires appear to perform better at accurately identifying depression when using cut scores with high sensitivity and specificity for the cardiac population. The BDI-II and the HADS-D showed the best sensitivity and negative predictive values for detecting depression. The BDI-II, the HADS-D, the Center for Epidemiological Studies-Depression Scale, and the 15-item Geriatric Depression Scale best captured depression changes after cardiac rehabilitation delivery. CONCLUSIONS The BDI-II is one of the most validated depression questionnaires within cardiac populations. Health practitioners should consider the BDI-II for depression screening and tracking purposes. In the event of time/cost constraints, a briefer 2-step procedure (the 2-item Patient Health Questionnaire, followed by the BDI-II, if positive) should be adopted. Given the emphasis on cut scores for depression diagnosis and limited available research across cardiac diagnoses, careful interpretation of these results should be done. Thoughtful use of questionnaires can help identify patients in need of referral or further treatment.
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Yang Y, Wang T, Guan J, Wang J, Chen J, Liu X, Qian J, Xu X, Qu W, Huang Z, Zhan C. Oral Delivery of Honokiol Microparticles for Nonrapid Eye Movement Sleep. Mol Pharm 2019; 16:737-743. [PMID: 30652875 DOI: 10.1021/acs.molpharmaceut.8b01016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Honokiol (HNK) is a small-molecule lignin extracted from Magnolia Officinalis, demonstrating high potency in promoting nonrapid eye movement (NREM) sleep by modulating the benzodiazepine site of the GABAA receptor. However, the clinical use of HNK in the treatment of insomnia is restricted by its extremely low oral bioavailability. In the present work, enhanced oral bioavailability of HNK was achieved by loading it into poly lactide-glycolide acid microparticles (HNK-MP). After oral administration, HNK-MP demonstrated 15-fold increase of AUC0-12 h in comparison to free HNK. The maximum blood concentration ( Cmax) of HNK in HNK-MP-treated rats was 3.6 μg/mL at 2 h after oral administration, which was 6.5-fold of that in free HNK-treated rats. Oral administration of HNK-MP (20 mg/kg) efficiently increased NREM sleep by 60% by enhancing the transition from wakefulness to NREM sleep in rats. The biosafety of HNK-MP was assessed in vivo, and no damage occurred in the gastrointestinal tract. The present study provides a promising oral HNK formulation for the treatment of insomnia.
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Affiliation(s)
| | | | | | | | - Junyi Chen
- School of Pharmacy and Key Laboratory of Smart Drug Delivery, Ministry of Education , Fudan University , Shanghai 201203 , China
| | - Xiaoqin Liu
- Department of Pharmaceutical Engineering , Chongqing Chemical Industry Vocational College , Chongqing 401220 , China
| | - Jun Qian
- School of Pharmacy and Key Laboratory of Smart Drug Delivery, Ministry of Education , Fudan University , Shanghai 201203 , China
| | | | - Weimin Qu
- State Key Laboratory of Medical Neurobiology, and Institutes of Brain Science and Collaborative Innovation Center for Brain Science , Fudan University , Shanghai 200032 , China
| | - Zhili Huang
- State Key Laboratory of Medical Neurobiology, and Institutes of Brain Science and Collaborative Innovation Center for Brain Science , Fudan University , Shanghai 200032 , China
| | - Changyou Zhan
- School of Pharmacy and Key Laboratory of Smart Drug Delivery, Ministry of Education , Fudan University , Shanghai 201203 , China
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