The impact of sleep quality and daytime sleepiness on global quality of life in community-dwelling patients with heart failure

Unveiling the Potential: Remote Monitoring and Telemedicine in Shaping the Future of Heart Failure Management

Heart failure (HF) remains a significant burden on global healthcare systems, necessitating innovative approaches for its management. This manuscript critically evaluates the role of remote monitoring and telemedicine in revolutionizing HF care delivery. Drawing upon a synthesis of current literature and clinical practices, it delineates the pivotal benefits, challenges, and personalized strategies associated with these technologies in HF management. The analysis highlights the potential of remote monitoring and telemedicine in facilitating timely interventions, enhancing patient engagement, and optimizing treatment adherence, thereby ameliorating clinical outcomes. However, technical intricacies, regulatory frameworks, and socioeconomic factors pose formidable hurdles to widespread adoption. The manuscript emphasizes the imperative of tailored interventions, leveraging advancements in artificial intelligence and machine learning, to address individual patient needs effectively. Looking forward, sustained innovation, interdisciplinary collaboration, and strategic investment are advocated to realize the transformative potential of remote monitoring and telemedicine in HF management, thereby advancing patient-centric care paradigms and optimizing healthcare resource allocation.

Automated Stress Recognition Using Supervised Learning Classifiers by Interactive Virtual Reality Scenes

Virtual reality (VR) technology offers a great opportunity to explore stress disorder therapies. We created a VR stress training system, which incorporates three highly interactive stressful scenes to elicit stress, and demonstrate the concurrent variations between physiological data (heart rate, electrodermal activity and eye-blink rate) and self-reported stress ratings through a self-designed customized perceived stress questionnaire (SSAI) and wearable devices. Several supervised learning models were rigorously applied to automate stress recognition. Our findings include the evaluations of the VR system by computing Cronbach's alpha ( α = 0.72 ) and Kaiser-Meyer-Olkin (KMO) coefficient ( η = 0.78 ) through a retrospective survey, which were subsequently confirmed as reliable on four aspects (sense of presence, sense of space, sense of immersion and sense of reality) via factor analysis. Additionally, we demonstrate the effectiveness of physiology-based stress level classification (no stress, low stress and high stress) and continuous SSAI score prediction, with accuracy reaching 0.742 by bagging ensemble learning model and goodness-of-fit reaching 0.44 via multivariate stepwise regression. This study provides detailed insight regarding the effect of objective physiological measures on the validation of subjective self-ratings under a novel complex VR stress training system, which stimulates the further investigations of stress disorder recognition and treatment.

Association between sleep and quality of life in heart failure patient-caregiver dyads and mediation of fatigue: An actor-partner interdependence mediation model

AIMS

Quality of life is essential to heart failure patients and their family caregivers. This study aimed to examine the mediating role of fatigue in the association between sleep and quality of life in heart failure patient-caregiver dyads.

DESIGN

A cross-sectional descriptive study was conducted from November 2017 to August 2018.

METHODS

A total of 269 heart failure patient-caregiver dyads at two hospitals in China were included. The Chinese version of the Pittsburgh Sleep Quality Index, the Chalder Fatigue Scale and the 12-item Short-Form Health Survey were used to collect data on heart failure patients and their family caregivers. The structural equation model was employed in the dyadic analysis based on the actor-partner interdependence mediation model.

RESULTS

Regarding the actor effects, poor sleep was negatively associated with physical and mental quality of life in heart failure patients and their family caregivers, respectively, and the relationship was mediated by their fatigue. Regarding the partner effects, caregivers' fatigue was positively associated with patients' physical quality of life and mediated the association between caregivers' sleep and patients' physical quality of life.

CONCLUSIONS

Heart failure patients and their family caregivers experience reduced quality of life when they have poor sleep and fatigue, and caregivers' fatigue is related to patients' improved physical quality of life. Hence, dyadic interventions targeting to improving sleep and fatigue may be beneficial to their quality of life.

IMPACT

This study highlights the importance of routinely measuring and managing sleep and fatigue for heart failure patients and their family caregivers. Effective dyadic-based interventions that maintain equal attention to family caregivers should be considered by healthcare providers to maximize the improvement of patients' quality of life.

Diagnostic accuracy and suitability of instruments that screen for obstructive sleep apnoea, insomnia and sleep quality in cardiac patients: a meta-analysis

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.

Assessment of chronic disease self-management in patients with chronic heart failure based on the MCID of patient-reported outcomes by the multilevel model

Purpose

The minimal clinically important difference (MCID) of a patient-reported outcome (PRO) represents the threshold value of the change in the score for that PRO. It is deemed to have an important implication in clinical management. This study was performed to evaluate the clinical significance of chronic disease self-management (CDSM) for patients with chronic heart failure based on the MCID of the chronic heart failure—PRO measure (CHF-PROM).

Methods

A multicenter, prospective cohort study of 555 patients with heart failure were enrolled from July 2018. Advice of CDSM was provided in written form at discharge to all patients. Information regarding CHF-PROM and CDSM were collected during follow-up. Multilevel models were applied to dynamically evaluate the effects of CDSM for CHF-PROM scores, as well as its physical and psychological domains. MCID changes of the PRO were introduced and compared with β values of CDSM obtained from the multi-level models to further evaluate the clinical significance. The STROBE checklist is shown in Additional file 1.

Results

Scores for CHF-PROM improved significantly after discharge. The multilevel models showed that a regular schedule, avoidance of over-eating, a low-sodium diet and exercise increased scores on CHF-PROM. Compared with the MCID, avoidance of over-eating (12.39 vs. 9.75) and maintenance of a regular schedule often (10.98 vs. 9.75), and exercise almost every day (11.36 vs. 9.75) reached clinical significance for the overall summary. Avoidance of over-eating (5.88 vs. 4.79) and a regular schedule almost every day (4.96 vs. 4.79) reached clinical significance for the physical scores. Avoidance of over-eating half of the time (5.26 vs. 4.87) and a regular schedule almost every day (5.84 vs. 4.87) demonstrated clinical significance for the psychological scores.

Conclusions

This study observed an association of avoidance of over-eating and maintenance of a regular schedule with the improvement of CHF-PROM. It provides further evidence for management of heart failure.

Trial Registration: Current Prospective Trials NCT02878811; registered August 25, 2016; https://clinicaltrials.gov/ct2/show/NCT02878811?term=NCT02878811&draw=2&rank=1.

Factors associated with quality of life and work ability among Finnish municipal employees: a cross-sectional study

OBJECTIVES

Quality of life (QoL) and work ability are elementary parts in defining the well-being of an employed person. The aim of this study was to demonstrate factors associated with QoL and self-reported work ability among public sector employees, while taking into account several confounding factors, including sleep quality, occupational stress and psychological symptoms.

METHODS

A cross-sectional study was conducted in Finland among 710 employees (89% women, mean age 49 (SD=10) years) from 10 municipal work units in 2015. Information about the participants was collected by physical examination, self-administered questionnaire and from medical history. QoL was assessed with the EUROHIS-Quality of Life 8-item index and work ability with the Work Ability Score (WAS).

RESULTS

The EUROHIS-QOL mean score among all participants was 4.07 (95% CI 4.03 to 4.11). QoL was positively associated with good sleep quality, cohabiting, university-level education and lower body mass index (BMI), and negatively associated with occupational stress, depression and/or anxiety and disease burden. Work ability was reported good or excellent by 80% of the participants and the WAS mean score among all participants was 8.31 (95% CI 8.21 to 8.41). Work ability was positively associated with good sleep quality, younger age, lower BMI and university-level education, and negatively associated with occupational stress and disease burden.

CONCLUSIONS

Occupational stress and self-reported sleep quality were strongly associated with both QoL and work ability among Finnish public sector employees. These findings highlight the need for screening and handling of work stress and sleep problems in occupational and primary healthcare.

Sleep – the yet underappreciated player in cardiovascular diseases: A clinical review from the German Cardiac Society Working Group on Sleep Disordered Breathing

Patients with a wide variety of cardiovascular diseases, including arterial and pulmonary hypertension, arrhythmia, coronary artery disease and heart failure, are more likely to report impaired sleep with reduced sleep duration and quality, and also, sometimes, sleep interruptions because of paroxysmal nocturnal dyspnoea or arrhythmias. Overall, objective short sleep and bad sleep quality (non-restorative sleep) and subjective long sleep duration are clearly associated with major cardiovascular diseases and fatal cardiovascular outcomes. Sleep apnoea, either obstructive or central in origin, represents the most prevalent, but only one, of many sleep-related disorders in cardiovascular patients. However, observations suggest a bidirectional relationship between sleep and cardiovascular diseases that may go beyond what can be explained based on concomitant sleep-related disorders as confounding factors. This makes sleep itself a modifiable treatment target. Therefore, this article reviews the available literature on the association of sleep with cardiovascular diseases, and discusses potential pathophysiological mechanisms. In addition, important limitations of the current assessment, quantification and interpretation of sleep in patients with cardiovascular disease, along with a discussion of suitable study designs to address future research questions and clinical implications are highlighted. There are only a few randomised controlled interventional outcome trials in this field, and some of the largest studies have failed to demonstrate improved survival with treatment (with worse outcomes in some cases). In contrast, some recent pilot studies have shown a benefit of treatment in selected patients with underlying cardiovascular diseases.

Ideal cardiovascular health and quality of life among Finnish municipal employees

Ideal cardiovascular health has been defined by the American Heart Association as the absence of clinically manifest cardiovascular disease together with the presence of favorable levels of cardiovascular health metrics. The ideal metrics are hard to achieve and the aim of this study was to assess the association between favorable cardiovascular health and perceived overall quality of life (QoL). A cross-sectional study was conducted in Finland among 836 employees in 2014 (732 women, 104 men, mean age 48 (SD 10) years) from ten municipal work units. The ideal metrics were evaluated with a physical examination, laboratory tests, medical history and self-administered questionnaires. The cardiovascular health was categorized into three groups by achievement of the ideal metrics. QoL was assessed with the EUROHIS-QOL 8-item index. The prevalence of having 5-7 of the ideal metrics was 25.1% (210), of having 3-4 it was 53.6% (448) and for 0-2 it was 21.3% (178). The EUROHIS-QOL mean score among all participants was 3.92 (SD 0.54). The EUROHIS-QOL mean score had a positive association with the sum of ideal metrics, and was 3.72, 3.91 and 4.10 among subjects with 0-2, 3-4 and 5-7 ideal metrics, respectively. Furthermore, poor sleep quality and disease burden had a significant negative association with QoL. A favorable cardiovascular health status together with good sleep quality seems to have a clear association with overall quality of life among employees in municipal work units.

Chemotherapy effect on daytime sleepiness and contributing factors in older adults with cancer

OBJECTIVES

The objective of this study was to determine the prevalence of excessive daytime sleepiness (EDS) among older Iranian patients with cancer and to analyze the effect of chemotherapy treatment on patients' sleep problems. The relationship between sleep disturbances and physical activity, psychological factors, and demographic data, are also explored.

METHODS

This cross-sectional study consisted of interviews with 83 patients, >60 years old with a solid tumor, carried out in Cancer Institute of Iran once prior to receiving chemotherapy and the second time after the first cycles of chemotherapy. Questionnaires consisted of demographic data, Epworth Sleepiness Scale (ESS), Hospital Anxiety and Depression Scales (HADS), Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), and Eastern Cooperative Oncology Group performance status (ECOG PS). Medical data were also gathered from hospital records. Logistic regression was used to identify predictors of excessive daytime sleepiness after chemotherapy.

RESULTS

The results showed a significant association between EDS and receiving chemotherapy. 8.1% were initially experiencing EDS which increased to 21.6% after chemotherapy (P-value < .001). Anxiety before chemotherapy and number of regions of recurrence of cancer, if any, were identified as independent predictors of daytime sleepiness.

CONCLUSIONS

As EDS prevalence increases after chemotherapy, and this can affect patients' quality of life and treatment outcomes; caregivers should bear in mind that senior patient with cancer, especially those suffering from anxiety and cancer recurrence, need special attention before starting treatment in order to manage EDS over the course of chemotherapy.

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

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

Inflammation-sleep interface in brain disease: TNF, insulin, orexin

The depth, pattern, timing and duration of unconsciousness, including sleep, vary greatly in inflammatory disease, and are regarded as reliable indicators of disease severity. Similarly, these indicators are applicable to the encephalopathies of sepsis, malaria, and trypanosomiasis, and to viral diseases such as influenza and AIDS. They are also applicable to sterile neuroinflammatory states, including Alzheimer’s disease, Parkinson’s disease, traumatic brain injury, stroke and type-2 diabetes, as well as in iatrogenic brain states following brain irradiation and chemotherapy. Here we make the case that the cycles of unconsciousness that constitute normal sleep, as well as its aberrations, which range from sickness behavior through daytime sleepiness to the coma of inflammatory disease states, have common origins that involve increased inflammatory cytokines and consequent insulin resistance and loss of appetite due to reduction in orexigenic activity. Orexin reduction has broad implications, which are as yet little appreciated in the chronic inflammatory conditions listed, whether they be infectious or sterile in origin. Not only is reduction in orexin levels characterized by loss of appetite, it is associated with inappropriate and excessive sleep and, when dramatic and chronic, leads to coma. Moreover, such reduction is associated with impaired cognition and a reduction in motor control. We propose that advanced understanding and appreciation of the importance of orexin as a key regulator of pathways involved in the maintenance of normal appetite, sleep patterns, cognition, and motor control may afford novel treatment opportunities.

Daytime sleepiness and sleep duration in long-term cancer survivors and non-cancer controls: results from a registry-based survey study

PURPOSE

Sleep-related complaints are common in cancer survivors. Although daytime sleepiness and sleep duration are associated with poor functional status, quality of life, and mortality in the general population, little is known about these issues in long-term cancer survivors. This study examined differences in daytime sleepiness and sleep duration between long-term cancer survivors and non-cancer controls.

METHODS

Survey data were analyzed from individuals diagnosed with cancer ≥2 years in the past (n = 1,171, mean age = 64.30, 80.8% white, 22.8% male) and spouse/friends controls (n = 250, mean age = 60.78, 88.0% white, 64.8% male). Daytime sleepiness was assessed using the Epworth Sleepiness Scale. Associations between sleep-related variables and history of cancer were estimated with multivariable logistic regression, adjusting for potential confounders. Stratified analyses were conducted to identify subgroups of survivors most at risk for sleep problems.

RESULTS

Cancer survivors were more likely than controls to report excessive daytime sleepiness (OR = 1.64, 95% CI: 1.07, 2.50). A cancer diagnosis was associated with longer sleep duration among males (OR = 1.25, 95% CI: 1.02, 1.53), but not in females (OR = 0.87, 95% CI: 0.37, 1.05). All other associations were similar regardless of cancer site, histology, time since diagnosis, treatment history, and history of multiple cancers.

CONCLUSIONS

Disturbances in daytime sleepiness and sleep duration persist among long-term cancer survivors and should be monitored in routine survivorship care. More research is needed to identify cancer survivors who are at increased risk for daytime sleepiness and disturbed sleep duration, as well as to identify causal mechanisms for, and interventions to mitigate, persistent differences.