1
|
Shang H, Chen D, Deng Q, Ma Z. Influencing factors of delay in seeking medical attention of patients with obstructive sleep apnea based on the Model of Pathways to Treatment in China: a qualitative analysis. Sleep Breath 2024; 28:2311-2321. [PMID: 38888793 PMCID: PMC11450029 DOI: 10.1007/s11325-024-03078-1] [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: 01/30/2024] [Revised: 04/05/2024] [Accepted: 06/07/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND There is the highest estimated number of patients with obstructive sleep apnea (OSA) in China. Early treatment could lead to fewer complications associated with OSA. This study aimed to analyze the factors influencing help-seeking from the first symptom discovery to treatment in OSA. METHODS Semi-structured interview outline was designed to conduct face-to-face interview based on the analyses of a great number of related literatures on the delay in seeking medical attention of patients with OSA. 15 patients diagnosed were interviewed between June 2021 to September 2022 in general hospital of Shenyang, Northeastern of China. Qualitative data was analyzed by content analysis using the Model of Pathways to Treatment. RESULTS Analyses identified factors contributing to elapsed time from first symptom discovery to received treatment that are linked to disease characteristic, patients, health system organization. Appraisal interval is most obvious for patients with OSA, but it is difficult to pinpoint precisely because the patients didn't remember exactly when the first symptom was detected. CONCLUSIONS Patients diagnosed with OSA didn't initially interpret the snore as a warning sign and even thought it was a blessing. The findings provided guidance or avenues for reducing elapsed time between the first symptom and received treatment.
Collapse
Affiliation(s)
- Hongyan Shang
- Department of Thoracic Oncology, Hefei Cancer Hospital, Chinese Academy of Sciences, Hefei, 230088, Anhui Province, China
| | - Dandan Chen
- Department of Nursing, Hefei Cancer Hospital, Chinese Academy of Sciences, Hefei, 230088, Anhui Province, China
| | - Qingmei Deng
- Department of Laboratory, Hefei Cancer Hospital, Chinese Academy of Sciences, Hefei, 230088, Anhui Province, China
| | - Zuchang Ma
- Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, 230031, Anhui Province, China.
| |
Collapse
|
2
|
Zarhin D. Sleep as a familial and communal matter: a qualitative study of social norms around sleep health in Israel. BMC Public Health 2023; 23:2080. [PMID: 37875859 PMCID: PMC10598894 DOI: 10.1186/s12889-023-17003-w] [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: 06/16/2022] [Accepted: 10/16/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND A growing body of research has clarified that sleep is influenced not only by biological factors but also by social factors. While studies have shown that social norms can affect sleep behavior and sleeping arrangements, including when, where, how, and with whom people sleep, researchers still know relatively little about how social norms affect sleep health, especially among adults. The current study explores the association between social norms and sleep health in the Israeli context. METHODS Data were drawn from semi-structured, in-depth interviews with 66 Israelis-including women and men, Arabs and Jews, and religious and non-religious persons-conducted between February 2020 and February 2022. This article focuses on responses to a set of questions about the comments people make or hear from others about their sleep. Exploring how people comment on the sleep of others highlights prevalent social norms around sleep. RESULTS Findings indicate that how sleep is "done" is policed by family and community members who react to norm violations by commenting on what is perceived as "inappropriate" sleep behavior. Comments were made in jest or earnest in response to breaches of social norms regarding sleep timing, duration, continuity, and alertness/sleepiness, indicating that social norms and expectations shape each of these sleep health dimensions. CONCLUSIONS This article expands the scholarly understanding of the social determinants of sleep health. The study concludes that since individuals may opt to conform to current social norms, which are enforced by members of the family and community, interventions aimed at promoting sleep health should target not only individuals but also the family and community.
Collapse
Affiliation(s)
- Dana Zarhin
- Department of Sociology, University of Haifa, Social Science Building, Mt. Carmel, Haifa, 3190501, Israel.
| |
Collapse
|
3
|
Toh ZA, Cheng LJ, Wu XV, De Silva DA, Oh HX, Ng SX, He HG, Pikkarainen M. Positive airway pressure therapy for post-stroke sleep disordered breathing: a systematic review, meta-analysis and meta-regression. Eur Respir Rev 2023; 32:32/167/220169. [PMID: 36889784 PMCID: PMC10032615 DOI: 10.1183/16000617.0169-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/24/2022] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Sleep disordered breathing (SDB) is an under-recognised independent risk factor and a potential consequence of stroke. We systematically reviewed and meta-analysed the effectiveness of positive airway pressure (PAP) therapy in improving post-stroke outcomes. METHODS We searched CENTRAL, Embase, PubMed, CINAHL, PsycINFO, Scopus, ProQuest, Web of Science and CNKI (China National Knowledge Infrastructure) for randomised controlled trials comparing PAP therapy against a control or placebo group. We evaluated the pooled effects of PAP therapy on recurrent vascular events, neurological deficit, cognition, functional independence, daytime sleepiness and depression using random effects meta-analyses. RESULTS We identified 24 studies. Our meta-analyses showed that PAP therapy reduced recurrent vascular events (risk ratio 0.47, 95% CI 0.28-0.78), and showed significant beneficial effects on neurological deficit (Hedges' g= -0.79, 95% CI -1.19- -0.39), cognition (g=0.85, 95% CI 0.04-1.65), functional independence (g=0.45, 95% CI 0.01-0.88) and daytime sleepiness (g= -0.96, 95% CI -1.56- -0.37). However, there was insignificant reduction in depression (g= -0.56, 95% CI -2.15-1.02). No publication bias was detected. CONCLUSIONS Post-stroke patients with SDB benefited from PAP therapy. Prospective trials are needed to determine the ideal initiation period and the minimum effective therapeutic dose.
Collapse
Affiliation(s)
- Zheng An Toh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Nursing, National University Hospital, Singapore
- National University Health System, Singapore
| | - Ling Jie Cheng
- National University Health System, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Xi Vivien Wu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- National University Health System, Singapore
| | - Deidre Anne De Silva
- Department of Neurology, Singapore General Hospital Campus, National Neuroscience Institute, Singapore
| | - Hui Xian Oh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Nursing, National University Hospital, Singapore
- National University Health System, Singapore
| | - Si Xian Ng
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Nursing, National University Hospital, Singapore
- National University Health System, Singapore
| | - Hong-Gu He
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- National University Health System, Singapore
| | - Minna Pikkarainen
- Department of Occupational Therapy, Prosthetics and Orthoptics, Faculty of Health Sciences and Department of Product Design, Faculty of Technology, Art and Design, Oslo Metropolitan University, Oslo, Norway
- Martti Ahtisaari Institute, University of Oulu, Oulu, Finland
| |
Collapse
|
4
|
Zarhin D. How religion affects sleep health: exploring the perspectives of religious Muslims and Jews in Israel. J Sleep Res 2022:e13809. [PMID: 36560913 DOI: 10.1111/jsr.13809] [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: 10/04/2022] [Revised: 11/30/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
Few empirical studies have explored the links between sleep and religion and no research has examined how religious individuals view these links. This article contributes to the literature by drawing on in-depth interviews with 31 midlife Israeli Muslims and Jews who describe themselves as religious or very religious. Findings indicate that respondents shared the view that sleep is important for health and wellbeing, as well as for religious practice and the proper worship of God. Their accounts clarified that religious observance entails a set of social rules and prescriptions as well as beliefs that may affect sleep behaviour and sleep outcomes. Traditional prayer times affected sleep duration for observant Muslims and Jews because respondents woke up early for prayer but could not always retire early enough so as to obtain a sufficient amount of sleep. Religion also dictated a preferred sleep position, to which participants became accustomed and found to be helpful. Respondents maintained that their deep faith in God and the practice of praying helped reduce stress, which contributed to sleep quality. However, among Muslims, missing prayers could arouse feelings of guilt and unease, thus affecting sleep quality. The article concludes that religion affects the sleep of both Muslims and Jews, but these effects vary by how individuals practice their religion and by how religiosity intersects with other social categories, such as gender. Future studies could enrich understanding of the social determinants of sleep by designing research inspired by lay persons' insights into the association between religion and sleep.
Collapse
Affiliation(s)
- Dana Zarhin
- Department of Sociology, University of Haifa, Haifa, Israel
| |
Collapse
|
5
|
Chen PH, Huang SM, Lai JCY, Lin WL. Determinants of health-seeking behavior toward Chinese or Western medicine in Taiwan: An analysis of biobank research database. Complement Ther Clin Pract 2022; 48:101592. [DOI: 10.1016/j.ctcp.2022.101592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/08/2022] [Accepted: 04/10/2022] [Indexed: 11/30/2022]
|
6
|
Le SM, Copeland LA, Zeber JE, Benge JF, Allen L, Cho J, Liao IC, Rasmussen J. Factors affecting time between symptom onset and emergency department arrival in stroke patients. eNeurologicalSci 2020; 21:100285. [PMID: 33204859 PMCID: PMC7649365 DOI: 10.1016/j.ensci.2020.100285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 08/21/2020] [Accepted: 10/20/2020] [Indexed: 12/15/2022] Open
Abstract
Background and purpose Delays in seeking care compromise diagnosis, treatment options, and outcomes in ischemic strokes. This study identified factors associated with time between stroke symptom onset and emergency department (ED) arrival at a private nonprofit medical center serving a large rural catchment area in central Texas, with the goal of identifying symptomatic, demographic, and historical factors that might influence seeking care. Methods Demographic and clinical data from a large tertiary care center's Get With The Guidelines (GWTG) database were evaluated in 1874 patients presenting to the ED with a diagnosis of transient ischemic attack (TIA), intracranial hemorrhage, subarachnoid hemorrhage, or ischemic stroke. The dependent variable was time between discovery of stroke symptoms and presentation at the hospital (time-to-ED). Factors entered into regression models predicting time-to-ED within 4 h or categorical time-to-ED. Results The average time from symptom onset to presentation was 15.0 h (sd = 23.2), with 43.6% of the sample presenting within 4 h of symptom onset. Results suggested that female gender (Odds Ratio [OR] = 0.70; 95% Confidence Interval [CI] 0.23–0.74), drug abuse (OR = 0.41; CI 0.23–0.74), and diabetes were significantly associated with longer time to presentation. Conclusions A combination of demographics, stroke severity, timing, and health history contributes to delays in presenting for treatment for ischemic stroke. Stroke education concentrating on symptom recognition may benefit from a special focus on high-risk individuals as highlighted in this study. Patients that had stroke symptoms occurring during the daytime were more likely to present within 4h of symptom onset. Females and younger patients were more likely to arrive after 4h of symptom onset. Comorbid conditions such as diabetes and substance abuse were associated with delayed presentation times. Other comorbid conditions such as hypertension or dyslipidemia were not associated with decreased time of presentation.
Collapse
Affiliation(s)
- Scott M Le
- Duke Health, Department of Neurology, Division of Vascular Neurology and Stroke, 40 Duke Medicine, Circle, Durham, NC 27710, United States of America.,Baylor Scott & White Health, Department of Neurology, 2401 S 31 Street, Temple, TX 76508, United States of America.,Texas A&M Health Science Center College of Medicine, 8447 Bryan Rd, Bryan, TX 77807, United States of America
| | - Laurel A Copeland
- VA Central Western Massachusetts, 421 N Main St, Leeds, MA 01053, United States of America.,University of Massachusetts Medical School, Department of Population and Quantitative Health Sciences, 55 N Lake Ave, Worcester, MA 01655, United States of America
| | - John E Zeber
- University of Massachusetts at Amherst, School of Public Health & Health Sciences, Health Policy & Management, 300 Massachusetts Ave, Amherst, MA 01003, United States of America
| | - Jared F Benge
- Baylor Scott & White Health, Department of Neurology, 2401 S 31 Street, Temple, TX 76508, United States of America.,Texas A&M Health Science Center College of Medicine, 8447 Bryan Rd, Bryan, TX 77807, United States of America
| | - Leigh Allen
- Baylor Scott & White Health, Department of Neurology, 2401 S 31 Street, Temple, TX 76508, United States of America.,Ascension Seton, 1201 West 38 St, Austin, TX 78705, United States of America
| | - Jinmyoung Cho
- Baylor Scott & White Health, Center for Applied Health Research, 4236 Lowes Dr., Temple, TX 76502, United States of America
| | - I-Chia Liao
- Baylor Scott & White Health, Center for Applied Health Research, 4236 Lowes Dr., Temple, TX 76502, United States of America
| | - Jennifer Rasmussen
- Baylor Scott & White Health, Department of Neurology, 2401 S 31 Street, Temple, TX 76508, United States of America.,Texas A&M Health Science Center College of Medicine, 8447 Bryan Rd, Bryan, TX 77807, United States of America
| |
Collapse
|
7
|
Zarhin D. "You have to do something": Snoring, sleep interembodiment and the emergence of agency. THE BRITISH JOURNAL OF SOCIOLOGY 2020; 71:1000-1015. [PMID: 32633421 DOI: 10.1111/1468-4446.12774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 03/18/2020] [Accepted: 05/26/2020] [Indexed: 06/11/2023]
Abstract
Although the sociology of sleep is a growing subfield, little is known about agency in the context of sleep. This article contributes to the sociological literature by showing how different types of agency emerge as a result of sleep interembodiment (i.e., experiencing sleep partners' bodies as intertwined). The study draws on qualitative data generated through in-depth interviews with 70 snorers and 20 sleep partners of snorers. Interviews were conducted in Israel and were analysed following constructivist grounded theory principles. Results indicate that two types of agency coexist and, in fact, co-constitute one another: The first type, herein termed material agency, reflects the post-humanist tradition, which conceptualizes agents as entities (whether human or nonhuman) that alter a state of affairs by making a difference in another agent's action. This type of agency exists in both wakefulness and throughout periods of sleep, as the snorer's body acts and interacts with a partner's body in ways that engender significant change in their lives, relationships, and actions. In contrast, the second type, herein termed reflexive agency, reflects the humanist tradition, which regards agency as individuals' creative and assertive capacities motivated by intentionality and reflexivity. This type of agency declines significantly during stages of deep sleep but re-emerges in response to partners' actions. The article adds to the literature by refining the concept of agency and elucidating its relationship to both accountability and interembodiment. In addition, the article provides much-needed empirical evidence showing how "personal responsibility" for health, as required by neoliberal discourses, is invoked within families, specifically with regard to sleep. This study therefore shows how certain macro-level structures of neoliberalism are enacted and reinforced within micro-level interactions.
Collapse
Affiliation(s)
- Dana Zarhin
- Department of Sociology, University of Haifa, Haifa, Israel
- Department of Sociology, Brandeis University, Waltham, USA
| |
Collapse
|
8
|
Waldman LT, Parthasarathy S, Villa KF, Bron M, Bujanover S, Brod M. Understanding the burden of illness of excessive daytime sleepiness associated with obstructive sleep apnea: a qualitative study. Health Qual Life Outcomes 2020; 18:128. [PMID: 32381095 PMCID: PMC7206792 DOI: 10.1186/s12955-020-01382-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 04/28/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is associated with excessive daytime sleepiness (EDS), which may go undiagnosed and can significantly impair a patient's health-related quality of life (HRQOL). This qualitative research examined timing and reasons patients sought medical care for their EDS and OSA symptoms, and the impact of EDS on HRQOL. METHODS Focus groups were conducted in 3 US cities with 42 participants currently experiencing EDS with OSA. Transcripts were coded and analyzed using an adapted grounded theory approach common to qualitative research. RESULTS Over three-fifths of study participants (n = 26, 62%) were currently using a positive airway pressure (PAP) or dental device; one-third (n = 14, 33%) had previously used a positive airway pressure (PAP) or dental device, and the remainder had either used another treatment (n = 1, 2%) or were treatment naïve (n = 1, 2%). Twenty-two participants (52%) reported experiencing OSA symptoms for ≥1 year, with an average duration of 11.4 (median 8.0, range 1-37) years before seeking medical attention. Several (n = 7, 32%) considered their symptoms to be "normal," rather than signaling a serious medical condition. Thirty participants (71%) discussed their reasons for ultimately seeking medical attention, which included: input from spouse/partner, another family member, or friend (n = 20, 67%); their own concern about particular symptoms (n = 7, 23%); and/or falling asleep while driving (n = 5, 17%). For all 42 participants, HRQOL domains impacted by EDS included: physical health and functioning (n = 40, 95%); work productivity (n = 38, 90%); daily life functioning (n = 39, 93%); cognition (n = 38, 90%); social life/relationships (n = 37, 88%); and emotions (n = 30, 71%). CONCLUSIONS Findings suggest that patients may be unaware that their symptoms could indicate OSA requiring evaluation and treatment. Even following diagnosis, EDS associated with OSA can continue to substantially affect HRQOL and daily functioning. Further research is needed to address diagnostic delays and unmet treatment needs for patients with EDS associated with OSA.
Collapse
Affiliation(s)
| | - Sairam Parthasarathy
- University of Arizona Health Sciences Center for Sleep and Circadian Sciences and Division of Pulmonary, Allergy, Critical Care & Sleep Medicine, University of Arizona, Tucson, AZ USA
| | | | | | | | - Meryl Brod
- The Brod Group, 219 Julia Ave, Mill Valley, CA 94941 USA
| |
Collapse
|
9
|
Zarhin D. Conducting Joint Interviews With Couples: Ethical and Methodological Challenges. QUALITATIVE HEALTH RESEARCH 2018; 28:844-854. [PMID: 29303049 DOI: 10.1177/1049732317749196] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Scholars have recently begun to discuss joint interviewing from a methodological perspective, generally presenting a favorable view of this mode of interviewing. In the present article, the author draws on her experiences with interviewing obstructive sleep apnea patients and their partners to shed further light on the methodological and ethical challenges of joint interviews. Specifically, it is shown that joint interviews may become a site in which one partner silences the other and enacts symbolic violence, with the interviewer as unwilling abettor, or alternatively may facilitate passivity. Joint interviewing may therefore prevent researchers from giving an equal voice to both partners, resulting in partial and fragmented data. In addition, the joint approach may generate tension between members of the couple and harm the quality of relationships, thus contravening the researcher's commitment to non-maleficence. The author points to a few possible solutions and suggests interviewing social partners as an alternative to couples.
Collapse
|