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Storer B, Holden M, Kershaw KA, Braund TA, Chakouch C, Coleshill MJ, Haffar S, Harvey S, Sicouri G, Newby J, Murphy M. The prevalence of anxiety in respiratory and sleep diseases: A systematic review and meta-analysis. Respir Med 2024; 230:107677. [PMID: 38823565 DOI: 10.1016/j.rmed.2024.107677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/07/2024] [Accepted: 05/22/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Anxiety is common in those with chronic physical health conditions and can have significant impacts on both quality of life and physical health outcomes. Despite this, there are limited studies comprehensively investigating the prevalence of anxiety in respiratory and sleep medicine settings. This systematic review and meta-analysis aims to provide insight into the global prevalence of anxiety symptoms/disorders in respiratory and sleep medicine outpatients. METHODS PubMed, Embase, Cochrane, PsycINFO and Google Scholar databases were searched from database inception to January 23, 2023 for studies assessing the prevalence of anxiety in adult (≥16 years) respiratory and sleep medicine outpatients. Data was screened and extracted independently by two investigators. Anxiety was measured using various self-report questionnaires, structured interviews, and/or patient records. Using CMA software for the meta-analysis, a random-effects model was used for pooled estimates, and subgroup analysis was conducted on relevant models using a mixed-effects model. RESULTS 116 studies were included, featuring 36,340 participants across 40 countries. The pooled prevalence of anxiety was 30.3 % (95%CI 27.9-32.9 %, 10,679/36,340). Subgroup analysis found a significant difference across type of condition, with pulmonary tuberculosis the highest at 43.1 % and COVID-19 outpatients the lowest at 23.4 %. No significant difference was found across anxiety types, country or age. Female sex and the use of self-report measures was associated with significantly higher anxiety estimates. CONCLUSIONS Anxiety is a common experience amongst patients in respiratory and sleep medicine outpatient settings. Thus, it is crucial that anxiety identification and management is considered by physicians in the field. REGISTRATION The protocol is registered in PROSPERO (CRD42021282416).
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Affiliation(s)
- Ben Storer
- Clinical Research Department, The Black Dog Institute, Sydney, Australia
| | - Monique Holden
- Clinical Research Department, The Black Dog Institute, Sydney, Australia
| | - Kelly Ann Kershaw
- Clinical Research Department, The Black Dog Institute, Sydney, Australia
| | - Taylor A Braund
- Clinical Research Department, The Black Dog Institute, Sydney, Australia; School of Clinical Medicine, Faculty of Medicine and Health, UNSW, Sydney, Australia
| | - Cassandra Chakouch
- Clinical Research Department, The Black Dog Institute, Sydney, Australia
| | | | - Sam Haffar
- Clinical Research Department, The Black Dog Institute, Sydney, Australia
| | - Samuel Harvey
- Clinical Research Department, The Black Dog Institute, Sydney, Australia; School of Clinical Medicine, Faculty of Medicine and Health, UNSW, Sydney, Australia
| | - Gemma Sicouri
- Clinical Research Department, The Black Dog Institute, Sydney, Australia; School of Psychology, Faculty of Science, UNSW, Sydney, Australia
| | - Jill Newby
- Clinical Research Department, The Black Dog Institute, Sydney, Australia; School of Psychology, Faculty of Science, UNSW, Sydney, Australia
| | - Michael Murphy
- Clinical Research Department, The Black Dog Institute, Sydney, Australia; School of Clinical Medicine, Faculty of Medicine and Health, UNSW, Sydney, Australia.
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2
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Namsrai T, Phillips C, Parkinson A, Gregory D, Kelly E, Cook M, Desborough J. Diagnostic delay of sarcoidosis: an integrated systematic review. Orphanet J Rare Dis 2024; 19:156. [PMID: 38605384 PMCID: PMC11010435 DOI: 10.1186/s13023-024-03152-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 03/28/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Sarcoidosis is a chronic inflammatory granulomatous disease of unknown cause. Delays in diagnosis can result in disease progression and poorer outcomes for patients. Our aim was to review the current literature to determine the overall diagnostic delay of sarcoidosis, factors associated with diagnostic delay, and the experiences of people with sarcoidosis of diagnostic delay. METHODS Three databases (PubMed/Medline, Scopus, and ProQuest) and grey literature sources were searched. Random effects inverse variance meta-analysis was used to pool mean diagnostic delay in all types of sarcoidosis subgroup analysis. Diagnostic delay was defined as the time from reported onset of symptoms to diagnosis of sarcoidosis. RESULTS We identified 374 titles, of which 29 studies were included in the review, with an overall sample of 1531 (694 females, 837 males). The overall mean diagnostic delay in all types of sarcoidosis was 7.93 months (95% CI 1.21 to 14.64 months). Meta-aggregation of factors related to diagnostic delay in the included studies identified three categories: (1) the complex and rare features of sarcoidosis, (2) healthcare factors and (3) patient-centred factors. Meta-aggregation of outcomes reported in case studies revealed that the three most frequent outcomes associated with diagnostic delay were: (1) incorrect diagnosis, (2) incorrect treatment and (3) development of complications/disease progression. There was no significant difference in diagnostic delay between countries with gatekeeper health systems (where consumers are referred from a primary care clinician to specialist care) and countries with non-gatekeeper systems. No qualitative studies examining people's experiences of diagnostic delay were identified. CONCLUSION The mean diagnostic delay for sarcoidosis is almost 8 months, which has objective consequences for patient management. On the other hand, there is a paucity of evidence about the experience of diagnostic delay in sarcoidosis and factors related to this. Gaining an understanding of people's experiences while seeking a diagnosis of sarcoidosis is vital to gain insight into factors that may contribute to delays, and subsequently inform strategies, tools and training activities aimed at increasing clinician and public awareness about this rare condition. TRIAL REGISTRATION PROSPERO Registration number: CRD42022307236.
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Affiliation(s)
- Tergel Namsrai
- National Centre for Epidemiology and Population Health, The Australian National University, 63, Eggleston Road, Acton ACT, Canberra, 2601, Australia
| | - Christine Phillips
- School of Medicine and Psychology, The Australian National University, Canberra, Australia
| | - Anne Parkinson
- National Centre for Epidemiology and Population Health, The Australian National University, 63, Eggleston Road, Acton ACT, Canberra, 2601, Australia
| | - Dianne Gregory
- National Centre for Epidemiology and Population Health, The Australian National University, 63, Eggleston Road, Acton ACT, Canberra, 2601, Australia
- Sarcoidosis Lyme Australia, Camden, Australia
| | - Elaine Kelly
- National Centre for Epidemiology and Population Health, The Australian National University, 63, Eggleston Road, Acton ACT, Canberra, 2601, Australia
- Sarcoidosis Lyme Australia, Camden, Australia
| | - Matthew Cook
- John Curtin School of Medical Research, The Australian National University, Canberra, Australia
| | - Jane Desborough
- National Centre for Epidemiology and Population Health, The Australian National University, 63, Eggleston Road, Acton ACT, Canberra, 2601, Australia.
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Moor CC, Obi ON, Kahlmann V, Buschulte K, Wijsenbeek MS. Quality of life in sarcoidosis. J Autoimmun 2023:103123. [PMID: 37813805 DOI: 10.1016/j.jaut.2023.103123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/04/2023] [Indexed: 10/11/2023]
Abstract
Having sarcoidosis often has a major impact on quality of life of patients and their families. Improving quality of life is prioritized as most important treatment aim by many patients with sarcoidosis, but current evidence and treatment options are limited. In this narrative review, we describe the impact of sarcoidosis on various aspects of daily life, evaluate determinants of health-related quality of life (HRQoL), and provide an overview of the different patient-reported outcome measures to assess HRQoL in sarcoidosis. Moreover, we review the current evidence for pharmacological and non-pharmacological interventions to improve quality of life for people with sarcoidosis.
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Affiliation(s)
- Catharina C Moor
- Department of Respiratory Medicine, Centre of Excellence for Interstitial Lung Diseases and Sarcoidosis, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Ogugua Ndili Obi
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Vivienne Kahlmann
- Department of Respiratory Medicine, Centre of Excellence for Interstitial Lung Diseases and Sarcoidosis, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Katharina Buschulte
- Center for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany
| | - Marlies S Wijsenbeek
- Department of Respiratory Medicine, Centre of Excellence for Interstitial Lung Diseases and Sarcoidosis, Erasmus Medical Center, Rotterdam, the Netherlands.
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4
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Saketkoo LA, Russell AM, Jensen K, Mandizha J, Tavee J, Newton J, Rivera F, Howie M, Reese R, Goodman M, Hart P, Strookappe B, De Vries J, Rosenbach M, Scholand MB, Lammi MR, Elfferich M, Lower E, Baughman RP, Sweiss N, Judson MA, Drent M. Health-Related Quality of Life (HRQoL) in Sarcoidosis: Diagnosis, Management, and Health Outcomes. Diagnostics (Basel) 2021; 11:1089. [PMID: 34203584 PMCID: PMC8232334 DOI: 10.3390/diagnostics11061089] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/30/2021] [Accepted: 06/02/2021] [Indexed: 02/06/2023] Open
Abstract
Health-related quality of life (HRQoL), though rarely considered as a primary endpoint in clinical trials, may be the single outcome reflective of patient priorities when living with a health condition. HRQoL is a multi-dimensional concept that reflects the degree to which a health condition interferes with participation in and fulfillment of important life areas. HRQoL is intended to capture the composite degree of physical, physiologic, psychological, and social impairment resulting from symptom burden, patient-perceived disease severity, and treatment side effects. Diminished HRQoL expectedly correlates to worsening disability and death; but interventions addressing HRQoL are linked to increased survival. Sarcoidosis, being a multi-organ system disease, is associated with a diffuse array of manifestations resulting in multiple symptoms, complications, and medication-related side effects that are linked to reduced HRQoL. Diminished HRQoL in sarcoidosis is related to decreased physical function, pain, significant loss of income, absence from work, and strain on personal relationships. Symptom distress can result clearly from a sarcoidosis manifestation (e.g., ocular pain, breathlessness, cough) but may also be non-specific, such as pain or fatigue. More complex, a single non-specific symptom, e.g., fatigue may be directly sarcoidosis-derived (e.g., inflammatory state, neurologic, hormonal, cardiopulmonary), medication-related (e.g., anemia, sleeplessness, weight gain, sub-clinical infection), or an indirect complication (e.g., sleep apnea, physical deconditioning, depression). Identifying and distinguishing underlying causes of impaired HRQoL provides opportunity for treatment strategies that can greatly impact a patient's function, well-being, and disease outcomes. Herein, we present a reference manual that describes the current state of knowledge in sarcoidosis-related HRQoL and distinguish between diverse causes of symptom distress and other influences on sarcoidosis-related HRQoL. We provide tools to assess, investigate, and diagnose compromised HRQoL and its influencers. Strategies to address modifiable HRQoL factors through palliation of symptoms and methods to improve the sarcoidosis health profile are outlined; as well as a proposed research agenda in sarcoidosis-related HRQoL.
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Affiliation(s)
- Lesley Ann Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA 70112, USA; (K.J.); (M.R.L.)
- Comprehensive Pulmonary Hypertension Center and Interstitial Lung Disease Clinic Programs, University Medical Center, New Orleans, LA 70112, USA
- Section of Pulmonary Medicine, Louisiana State University School of Medicine, New Orleans, LA 70112, USA
- Tulane University School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Anne-Marie Russell
- College of Medicine and Health, University of Exeter, Devon EX1 2LU, UK
- Imperial College Healthcare NHS Foundation Trust, London W2 1NY, UK
| | - Kelly Jensen
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA 70112, USA; (K.J.); (M.R.L.)
- Tulane University School of Medicine, Tulane University, New Orleans, LA 70112, USA
- Department of Internal Medicine, Oregon Health and Science University, Portland, OR 97239, USA
| | - Jessica Mandizha
- Respiratory Medicine, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter EX2 5DW, UK;
| | - Jinny Tavee
- Department of Neurology, National Jewish Health, Denver, CO 80206, USA;
| | - Jacqui Newton
- Sarcoidosis UK, China Works, Black Prince Road, London SE1 7SJ, UK; (J.N.); (M.H.)
| | - Frank Rivera
- Foundation for Sarcoidosis Research, Chicago, IL 60614, USA; (F.R.); (R.R.)
- National Sarcoidosis Support Group, Stronger than Sarcoidosis, New York, NY 11727, USA
| | - Mike Howie
- Sarcoidosis UK, China Works, Black Prince Road, London SE1 7SJ, UK; (J.N.); (M.H.)
- CGI UK, Space Defense & Intelligence (Cyber Security Operations), London EC3M 3BY, UK
| | - Rodney Reese
- Foundation for Sarcoidosis Research, Chicago, IL 60614, USA; (F.R.); (R.R.)
- National Sarcoidosis Support Group, Stronger than Sarcoidosis, New York, NY 11727, USA
- Sarcoidosis Awareness Foundation of Louisiana, Baton Rouge, LA 70812, USA
| | - Melanie Goodman
- New Orleans Sarcoidosis Support Group, New Orleans, LA 70112, USA;
| | - Patricia Hart
- iHart Wellness Holistic Approach to Sarcoidosis Certified Health & Wellness Coach, International Association of Professionals, New York, NY 11727, USA;
| | - Bert Strookappe
- Department of Physiotherapy, Gelderse Vallei Hospital, 10, 6716 RP Ede, The Netherlands; (B.S.); (M.E.)
- ildcare Foundation Research Team, 6711 NR Ede, The Netherlands; (M.D.)
| | - Jolanda De Vries
- Admiraal de Ruyter Hospital (Adrz), 114, 4462 RA Goes, The Netherlands;
- Department of Medical and Clinical Psychology, Tilburg University, 5037 AB Tilburg, The Netherlands
| | - Misha Rosenbach
- Cutaneous Sarcoidosis Clinic, Department of Dermatology, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Mary Beth Scholand
- Division of Pulmonary Medicine, Interstitial Lung Disease Center, University of Utah, Salt Lake City, UT 84132, USA;
| | - Mathew R. Lammi
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA 70112, USA; (K.J.); (M.R.L.)
- Comprehensive Pulmonary Hypertension Center and Interstitial Lung Disease Clinic Programs, University Medical Center, New Orleans, LA 70112, USA
- Section of Pulmonary Medicine, Louisiana State University School of Medicine, New Orleans, LA 70112, USA
| | - Marjon Elfferich
- Department of Physiotherapy, Gelderse Vallei Hospital, 10, 6716 RP Ede, The Netherlands; (B.S.); (M.E.)
- ildcare Foundation Research Team, 6711 NR Ede, The Netherlands; (M.D.)
| | - Elyse Lower
- Department of Medicine, University of Cincinnati Medical Center, Cincinnati, OH 45267, USA; (E.L.); (R.P.B.)
| | - Robert P. Baughman
- Department of Medicine, University of Cincinnati Medical Center, Cincinnati, OH 45267, USA; (E.L.); (R.P.B.)
| | - Nadera Sweiss
- Division of Rheumatology, Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA;
| | - Marc A. Judson
- Division of Pulmonary Medicine and Critical Care, Albany Medical College, Albany, NY 12208, USA;
| | - Marjolein Drent
- ildcare Foundation Research Team, 6711 NR Ede, The Netherlands; (M.D.)
- Interstitial Lung Diseases (ILD) Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands
- Department of Pharmacology and Toxicology, Faculty of Health and Life Sciences, Maastricht University, 40, 6229 ER Maastricht, The Netherlands
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5
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Voortman M, Stern BJ, Saketkoo LA, Drent M. The Burden of Neurosarcoidosis: Essential Approaches to Early Diagnosis and Treatment. Semin Respir Crit Care Med 2020; 41:641-651. [PMID: 32777849 DOI: 10.1055/s-0040-1710576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Neurosarcoidosis (NS) is an often severe, destructive manifestation with a likely under-reported prevalence of 5 to 15% of sarcoidosis cases, and in its active phase demands timely treatment intervention. Clinical signs and symptoms of NS are variable and wide-ranging, depending on anatomical involvement. Cranial nerve dysfunction, cerebrospinal parenchymal disease, aseptic meningitis, and leptomeningeal disease are the most commonly recognized manifestations. However, non-organ-specific potentially neurologically driven symptoms, such as fatigue, cognitive dysfunction, and small fiber neuropathy, appear frequently.Heterogeneous clinical presentations and absence of any single conclusive test or biomarker render NS, and sarcoidosis itself, a challenging definitive diagnosis. Clinical suspicion of NS warrants a thorough systemic and neurologic evaluation hopefully resulting in supportive extraneural physical exam and/or tissue findings. Treatment targets the severity of the manifestation, with careful discernment of whether NS reflects active potentially reversible inflammatory granulomatous disease versus inactive postinflammatory damage whereby functional impairment is unlikely to be pharmacologically responsive. Non-organ-specific symptoms are poorly understood, challenging in deciphering reversibility and often identified too late to respond to conventional immunosuppressive/pharmacological treatment. Physical therapy, coping strategies, and stress reduction may benefit patients with all disease activity levels of NS.This publication provides an approach to screening, diagnosis, disease activity discernment, and pharmacological as well as nonpharmacological treatment interventions to reduce disability and protect health-related quality of life in NS.
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Affiliation(s)
- Mareye Voortman
- Division of Heart and Lungs, Department of Pulmonology, University Medical Centre Utrecht, The Netherlands.,ILD Care Foundation Research Team, Ede, The Netherlands
| | - Barney J Stern
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland
| | - Lesley Ann Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, Louisiana.,Comprehensive Pulmonary Hypertension Center and Interstitial Lung Disease Clinic Programs, University Medical Center, New Orleans, Louisiana.,Louisiana State University and Tulane University Schools of Medicine, New Orleans, Louisiana
| | - Marjolein Drent
- ILD Care Foundation Research Team, Ede, The Netherlands.,Department of Pharmacology and Toxicology, FHML, Maastricht University, Maastricht, The Netherlands.,Department of Pulmonology, ILD Center of Excellence, St. Antonius Hospital, Nieuwegein, The Netherlands
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6
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Abstract
Health-related quality of life (HRQoL) describes an individual's perception of the impact of health, disease, and treatment on their quality of life (QoL). It is a reflection of how the manifestation of an illness and its treatment is personally experienced. Assessing HRQoL is particularly important in sarcoidosis because the attributable disease mortality is relatively low, and one of the major reasons for initiating treatment is to improve quality of life. HRQoL has been assessed in sarcoidosis using various generic and sarcoid-specific patient-reported outcome measures (PROMs). It is important that both the direct and indirect effects of the disease, as well as potential toxicities of therapy, are captured in the various PROMs used to assess HRQoL in sarcoidosis. This article provides a general overview of HRQoL in patients with sarcoidosis. It describes the various PROMs used to assess HRQoL in sarcoidosis and addresses the various factors that influence HRQoL in sarcoidosis. Specific attention is paid to fatigue, small fiber neuropathy, corticosteroid therapy, and other disease-specific factors that affect HRQoL in sarcoidosis. It also provides an insight into interventions that have been associated with improved HRQoL in sarcoidosis and offers suggestions for future research in this important area.
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Affiliation(s)
- Ogugua Ndili Obi
- Division of Pulmonary, Critical Care and Sleep Medicine, Brody School of Medicine, East Carolina University, Greenville, North Carolina
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7
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Moor CC, Kahlmann V, Culver DA, Wijsenbeek MS. Comprehensive Care for Patients with Sarcoidosis. J Clin Med 2020; 9:E390. [PMID: 32024123 PMCID: PMC7074229 DOI: 10.3390/jcm9020390] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/21/2020] [Accepted: 01/29/2020] [Indexed: 02/07/2023] Open
Abstract
Sarcoidosis is a multisystem granulomatous disease, associated with significant morbidity and impaired quality of life. Treatment is aimed at recovering organ function, reducing symptom burden and improving quality of life. Because of the heterogeneity and variable disease course, a comprehensive, multidisciplinary approach to care is needed. Comprehensive care includes not only pharmacological interventions, but also supportive measures aimed at relieving symptoms and improving quality of life. The purpose of this review is to summarize the most recent knowledge regarding different aspects of care and propose a structured approach to sarcoidosis management.
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Affiliation(s)
- Catharina C. Moor
- Department of Respiratory Medicine, Erasmus Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Vivienne Kahlmann
- Department of Respiratory Medicine, Erasmus Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Daniel A. Culver
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Marlies S. Wijsenbeek
- Department of Respiratory Medicine, Erasmus Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
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