Faith S. Luyster

Sleep: a health imperative.

Chronic sleep deficiency, defined as a state of inadequate or mistimed sleep, is a growing and underappreciated determinant of health status. Sleep deprivation contributes to a number of molecular, immune, and neural changes that play a role in disease development, independent of primary sleep disorders. These changes in biological processes in response to chronic sleep deficiency may serve as etiological factors for the development and exacerbation of cardiovascular and metabolic diseases and, ultimately, a shortened lifespan. Sleep deprivation also results in significant impairments in cognitive and motor performance which increase the risk of motor vehicle crashes and work-related injuries and fatal accidents. The American Academy of Sleep Medicine and the Sleep Research Society have developed this statement to communicate to national health stakeholders the current knowledge which ties sufficient sleep and circadian alignment in adults to health.

Body mass index and neuropsychological function in healthy children and adolescents

Elevated body mass index (BMI) is associated with adverse neurocognitive outcome in adults, including reduced neuropsychological test performance. It is unknown whether this relationship also exists in children and adolescents. A total of 478 children and adolescents (age 6-19) without significant medical or psychiatric history provided demographic information and completed a computerized cognitive test battery. Participants were categorized using clinical criteria into underweight, normal weight, at risk for overweight and overweight groups based on age and gender. Partial correlation and MANCOVA analyses adjusting for age and intellectual function found no relationship between BMI and cognitive test performance in the full sample. However, analyses performed separately by gender showed that underweight females exhibited poorer memory performance than other female BMI groups. These findings suggest that elevated BMI is not associated with cognitive function in healthy children and adolescents, though underweight might be a risk factor for reduced memory performance in females. Further work is needed to clarify the inconsistent findings between adults and minors.

Depression and anxiety symptoms are associated with reduced dietary adherence in heart failure patients treated with an implantable cardioverter defibrillator.

Background: Heart failure (HF) patients treated with an implantable cardioverter defibrillator (ICD) are a growing patient population for whom the general treatment guidelines for HF still apply. Dietary recommendations, sodium and fluid restriction and daily weight monitoring, are a critical component of HF self-management. However, HF patients often report poor adherence to these recommendations. Studies that have investigated factors associated with poor diet adherence have focused on knowledge and beliefs. The current study extends previous research by examining the impact of psychosocial factors (depression, anxiety, and social support) on adherence to dietary recommendations in this growing subgroup of HF patients. Methods: Eighty-eight HF patients, with a mean age of 70 years, treated with an ICD (77% male) completed questionnaires assessing depression and anxiety symptoms, social support, and dietary adherence. Results: Most patients reported following dietary recommendations in the past week most of the time (63%), whereas only 16% of patients reported following dietary recommendations all of the time. Greater depression and anxiety symptoms were associated with poorer dietary adherence, whereas social support did not predict reported dietary adherence. Conclusions: Findings suggest that many HF patients treated with an ICD do not comply with dietary recommendations. Depression and anxiety symptoms were found to be associated with worse dietary adherence, whereas social support was not related to adherence. Further research is needed to understand the role of social support in dietary adherence in HF patients.

Sleep Quality and Quality of Life in Adults With Type 2 Diabetes

Purpose The purpose of this study was to examine the relationship between sleep quality and health-related and diabetes-related quality of life in adults with type 2 diabetes. Methods Three hundred individuals with type 2 diabetes (mean age 63.9 years) completed questionnaires assessing sleep quality, health-related quality of life, diabetes-related quality of life, comorbidities, and depressive symptoms. Results More than half of the participants (55%) were “poor sleepers” according to the Pittsburgh Sleep Quality Index. After controlling for covariates, poor sleep quality was found to be a significant predictor of lower health-related quality of life as indicated by lower scores on both the physical and mental component scores of the Medical Outcomes Study 36-item Short Form health survey (SF-36). Poor sleep quality was also associated with worse diabetes-related quality of life, in particular lower scores on the Diabetes Quality of Life measure total score and the Satisfaction With Treatment and Diabetes Impact subscale scores. Conclusions These results suggest that poor sleep is common in type 2 diabetes and may adversely impact quality of life. Interventions to improve sleep hygiene can be suggested to patients by diabetes educators as part of diabetes self-management education programs.

Sleep quality and asthma control and quality of life in non-severe and severe asthma.

PurposeThe effect of sleep quality on asthma control independent from common comorbidities like gastroesophageal reflux disease (GERD) and obstructive sleep apnea (OSA) is unknown. This study examined the association between sleep quality and asthma control and quality of life after accounting for OSA and GERD in non-severe (NSA) and severe (SA) asthma.MethodsCross-sectional data from 60 normal controls, 143 with NSA, and 79 with SA participating in the Severe Asthma Research Program was examined. Those who reported using positive airway pressure therapy or were at high risk for OSA were excluded.ResultsBoth SA and NSA had poorer sleep quality than controls, with SA reporting the worst sleep quality. All asthmatics with GERD and 92% of those without GERD had poor sleep quality (p = 0.02). The majority (88–100%) of NSA and SA participants who did not report nighttime asthma disturbances still reported having poor sleep quality. In both NSA and SA, poor sleep quality was associated with worse asthma control and quality of life after controlling for GERD and other covariates.ConclusionsThese results suggest that poor sleep quality is associated with poor asthma control and quality of life among asthmatics and cannot be explained by comorbid GERD and nighttime asthma disturbances.

Improvements in Cognitive Function Following Cardiac Rehabilitation for Older Adults With Cardiovascular Disease

ABSTRACT Cognitive impairment is common in persons with cardiovascular disease (CVD). Cardiac rehabilitation (CR) improves many aspects of CVD linked to cognitive impairment. The current study explored whether CR may improve cognitive function. Potential mechanisms for cognitive changes were also examined through exploratory analyses, including changes in cardiovascular fitness and cerebral blood flow. Fifty-one older adults with CVD underwent neuropsychological assessment at baseline and discharge from a 12-week CR program. Cardiovascular fitness (i.e., metabolic equivalents [METs]) was estimated from a symptom-limited volitional stress test. Transcranial doppler quantified mean cerebral blood flow velocity and pulsatility indexes for the middle cerebral artery and anterior cerebral artery (ACA). Repeated measures ANOVA showed improvements in global cognition, attention-executive-psychomotor function, and memory. Exploratory analyses revealed improvement in METs and changes in ACA flow velocity, but only improvement in METs was related to improved verbal recall. CVD patients exhibited improvements in multiple cognitive domains following a 12-week CR program, suggesting that cognitive impairment is modifiable in this population. Although other studies are needed to elucidate underlying mechanisms, exploratory analyses suggest that cognitive improvements may be better explained by physiological processes other than improved cardiovascular fitness and cerebral blood flow.

AGE EFFECTS IN TIME ESTIMATION: RELATIONSHIP TO FRONTAL BRAIN MORPHOMETRY

Compared with many other cognitive functions, relatively little is known about time representation in the brain. Recent work shows disrupted timing and time estimation in older adults, although it is unclear whether these effects are the result of normal aging or disease-related processes. The present study examined time estimation in persons across the adult lifespan who were free from significant medical or psychiatric history. Results showed older adults exhibited greater variability in time estimation, but no evidence for systematic acceleration or slowing emerged. This variability was correlated with performance on a variety of cognitive tests including attention, working memory and executive function. Although no relationship emerged between time estimation and EEG indices from central regions, multiple MRI indices were significantly correlated with time estimation. Stepwise regression showed volume of the supplementary motor area predicted variability in time estimation. These results indicate that healthy aging is associated with altered time estimation and suggest that changes in frontal brain regions mediate these effects.

Accuracy of measures of medication adherence in a cholesterol-lowering regimen.

This study examined the concordance between multiple measures of adherence, as well as sensitivity to detection of poor adherers, specificity, and predictive validity using a daily cholesterol-lowering regimen. Participants (N = 180) aged 24 to 60 years participated in an adherence ancillary study in a clinical trial. Males constituted 53.9% of this well-educated, community sample. Data on adherence were collected over a 6-month period, using electronic monitoring, self-report, specific recall, and pill counts. Electronically monitored (odds ratio [OR] = 5.348) and Shea self-report (OR = 2.678) predicted cholesterol lowering. Days (78.9%) and intervals (84.2%) adherent and the Shea (73.7%) were sensitive to the detection of poor adherers. Moderate associations were found between measures of the same type. Low correlations were found otherwise. The electronic monitor was the most accurate and informative measure. The Shea self-report was the most accurate brief, global estimate of adherence. Other measures were not associated with clinical outcome or sensitive to poor adherence.

Handedness and cognition across the healthy lifespan.

The relationship between handedness and cognitive function varies across studies, perhaps partly due to the many medical and psychiatric conditions with known cognitive impact. This study examined cognitive performance in 643 healthy individuals (age 5–82) who were categorized as strongly right-handed, moderately right-handed, or left/mixed-handed. Cognitive differences emerged, as left/mixed-handed individuals demonstrating superior psychomotor speed and cognitive flexibility, and strongly and moderately right-handed individuals exhibiting better time estimation skills. No interaction-among handedness, sex, and age were found. These findings indicate cognitive differences associated with handedness exist independent of medical and psychiatric confounds. Further work is needed to clarify these findings.

Reduced Executive Functioning Is Associated With Poorer Outcome in Cardiac Rehabilitation

Patients with cardiovascular disease and cognitive impairment show reduced adherence to treatment. No study has examined whether cognitive impairment may also predict reduced benefit from cardiac rehabilitation (CR). It appears that cognitively impaired patients may exhibit poorer adherence to CR and limited gains in cardiovascular fitness and/or quality of life (QOL). Forty-four older adults who enrolled in a CR program and completed measures at enrollment and discharge were included. Cognitive functioning was assessed using the Trail Making Test B. Estimated metabolic equivalents (METs) were derived from a treadmill stress test to provide a measure of cardiovascular fitness. QOL was measured with the Short Form-36 (SF-36) physical and mental component scales (PCS and MCS, respectively). Repeated measures analysis of variance showed improvements in METs [METs; F(1,36)=77.6, P<.001] and physical [SF-36 PCS; F(1,36)=14.14, P=.001)] and mental QOL [SF-36 MCS; F(1,36)=11.55, P=.002)]. Partial correlations indicated that poorer Trail Making Test B performance was associated with lower METs at discharge (r=-0.30, P<.05), but not PCS or MCS. Mini-Mental State Examination scores were not related to outcome variables. Current findings suggest that patients with poorer executive functioning derive reduced benefit from CR. CR programs may consider screening patients at baseline for low cognitive functioning to help identify those patients at greatest risk for poor outcome.