Jean E. Davis

Immune mediators in allergic rhinitis and sleep

OBJECTIVE: Our study goal was to examine polysomnography, indices of sleep and allergy, and serum and nasal cytokines in allergic and nonallergic subjects. STUDY DESIGN AND SETTING: In this descriptive, exploratory study, 4 allergic and 4 nonallergic subjects underwent 2 nights of polysomnographic recording with serial measurements of cytokines and completed measures of sleep quality and allergic symptoms. RESULTS: Three serum cytokines (interleukin (IL)-1β, IL-4, and IL-10) were higher in allergic subjects and were termed proallergic. Three serum cytokines (IL-1ra, IL-2, and IL-12) were higher in nonallergic subjects and were termed allergy inhibitory. Proallergic serum cytokines correlated with increased latency to rapid eye movement sleep, decreased time in rapid eye movement sleep, and decreased latency to sleep onset. Low levels of allergy-inhibitory serum cytokines were associated with increased allergic symptoms. CONCLUSIONS: Differences in serum cytokines between allergic and nonallergic individuals are associated with variations in polysomnography and allergic symptoms. SIGNIFICANCE: Understanding these mechanisms may suggest novel approaches to alleviating drowsiness and other symptoms in allergic patients.

Developing and sustaining community-academic partnerships: lessons from Downstate New York Healthy Start.

Partnering with communities is a critical aspect of contemporary health promotion. Linkages between universities and communities are particularly significant, given the prominence of academic institutions in channeling grants. This article describes the collaboration between a school of public health and several community-based organizations on a maternal and infant health grant project. The partnership serves as a model for ways in which a university and community organizations can interrelate and interact. Central lessons include the significance of sharing values and goals, the benefit of drawing on the different strengths of each partner, the gap created by the universitys institutional focus on research rather than service and advocacy, and the strains created by power inequities and distribution of funds. A key element of the partnerships success is the emphasis on capacity building and colearning. The project demonstrates the potential of employing community—academic partnerships as a valuable mechanism for implementing community-based health promotion programs.

Fatigue and Disrupted Sleep-Wake Patterns in Patients With Cancer: A Shared Mechanism

The strong and potentially reciprocal relationship between cancer-related fatigue (CRF) and disrupted sleep-wake patterns suggests a possible shared physiologic pathway. A growing body of evidence supports this and shows that abnormalities in the 24-hour rhythm of stress-related hormones may be related to chronic fatigue and sleep disturbances. Aberrations in the hypothalamic-pituitary-adrenal (HPA) axis, the primary neuroendocrine interface responding to stress, induce important biologic and behavioral consequences. HPA aberrations have long been associated with chronic fatigue syndrome. Many overlapping symptoms exist between chronic fatigue syndrome and CRF, including sleep disruption. Therefore, in the absence of knowledge about CRF mechanisms, emerging biologic models from chronic fatigue syndrome may assist in understanding the cause of CRF. Cancer-associated stressors also may alter the circadian functions of HPA-associated neuroendocrine activities, which result in the symptoms of fatigue and disrupted sleep-wake patterns in patients with cancer. Exploring promising physiologic models furthers the knowledge about CRF and disrupted sleep and may foster hypothesis-based studies of mechanisms that underlie apparent overlapping symptoms, providing the basis for new management to improve sleep and lessen fatigue.

Obesity in Urban Women: Associations with Sleep and Sleepiness, Fatigue and Activity

BACKGROUND African-American women (AAW) have the highest prevalence of obesity and therefore are at greater risk for obesity-related symptoms and diseases. Obese individuals frequently report poorer sleep quality, more daytime sleepiness, more severe fatigue, and higher physical inactivity than normal weight individuals. The relationships among these variables have not been well-characterized in obese, urban-dwelling, AAW. METHODS This descriptive, correlational study examined the relationships among sleep quality, daytime sleepiness, fatigue, level of physical activity, and body mass index (BMI) in AAW living in an urban setting. A convenience sample of 69 young adult women with a BMI of greater than 30 kg/m(2) completed measures of sleep quality, sleepiness, fatigue severity, sense of community, and physical activity. Further analysis was done to determine if any of the study variables predicted level of physical activity. FINDINGS There was a strong and significant correlation between BMI and overall fatigue severity and a significant, negative correlation between BMI and physical activity performance. BMI was significantly correlated with sleep latency but not global sleep quality. There were significant relationships between fatigue severity and poorer global sleep quality and daytime sleepiness. Multiple regression analysis showed BMI and age accounted for a significant amount of the variance in physical activity. CONCLUSIONS Higher BMI was associated with significant fatigue. Fatigue severity was associated with poorer global sleep quality, daytime sleepiness, and a sense of community. Higher BMI may be a barrier to having an active lifestyle.

Effects of Exercise on S-IGA and URS in Postmenopausal Women

32 postmenopausal women were randomized to a 16-week home-based walking program or control group. Before and after the intervention, each subject completed a graded maximal treadmill test to establish VO(2)max and resting saliva was collected to determine levels of salivary immunoglobulin A. The 16-week walking program resulted in an increase in VO(2)max (+10.4%; p<0.01). Repeated measures ANOVA revealed a marked increase in the resting secretion rate of salivary immunoglobulin A (+37.4%; p<0.05) in the exercise group following training. Independent of study group, both before and after the intervention, the secretion rate of salivary immunoglobulin A ( - 32.3%) and saliva flow rate (- 29.3%) were reduced following acute maximal exercise (p<0.05). Weekly upper respiratory symptomatology logs revealed that the number of incidences of upper respiratory symptoms throughout the intervention period were the same and the duration per incidence (control: 5.3±1.5 days; exercise: 6.3±2.2 days) were similar between study groups. These findings in postmenopausal women support that the secretion rate of salivary immunoglobulin A and saliva flow rate are reduced immediately following maximal exercise. Moreover, a 16-week moderate intense walking program can increase the secretion of salivary immunoglobulin A without affecting upper respiratory symptomatology.

A Pilot Study of the Feasibility and Outcomes of Yoga for Lung Cancer Survivors

PURPOSE/OBJECTIVES To determine the feasibility of a standardized yoga intervention for survivors of non-small cell lung cancer (NSCLC) and, effects on sleep, mood, salivary cortisol levels, and quality of life (QOL). DESIGN This 14-week, one-group, repeated-measures study included a three-week preintervention phase, eight weeks of yoga classes (40 minutes once per week) and home practice, and a three-week postintervention phase. Follow-up occurred at three and six months poststudy. SETTING A community-based cancer support center in the midwestern United States. SAMPLE 7 adults who had completed initial treatment for stages I-IIIa NSCLC. METHODS A standardized yoga protocol was developed prior to the study by experts in the field. Breathing ease was monitored before, during, and after classes to assess feasibility of movement without compromising respiratory status while doing yoga. Data analysis included descriptive statistics, repeated-measures analysis of variance, and salivary cortisol analysis. MAIN RESEARCH VARIABLES Sleep quality, mood, salivary cortisol, and QOL were assessed using the Pittsburgh Sleep Quality Index, Profile of Mood States-Brief, a cortisol measurement, and the Medical Outcomes Survey SF-36®, respectively. Breathing ease was assessed using a dyspnea numeric rating scale as well as observation of participants. FINDINGS Participants with varying stages of disease and length of survivorship were able to perform yoga without respiratory distress. Class attendance exceeded 95%, and all practiced at home. Mood, sleep efficiency, and QOL significantly improved; salivary cortisol levels decreased over time. CONCLUSIONS Yoga was feasible for NSCLC survivors without further compromising breathing with movement. Potential benefits were identified, supporting the need for future clinical trials with larger samples stratified by cancer stage, treatment, and length of survivorship. IMPLICATIONS FOR NURSING Nurses and healthcare providers should consider yoga as a mind-body practice to manage stress, improve mood and sleep, and potentially enhance QOL for NSCLC survivors.

Assessing sleep in adolescents through a better understanding of sleep physiology.

OverviewAdolescents need about nine hours of sleep per night, yet most teens get far less. Inadequate sleep has consequences not only for academic performance but also for mental and physical health; it has been linked to lowered resilience and an increased risk of cardiovascular and metabolic diseases. Its imperative that assessment of sleep become a routine part of adolescent health care. An understanding of sleep physiology is essential to helping nurses better assess and manage sleep deprivation in this population. Sleep assessment involves evaluating the three main aspects of sleep: amount, quality, and architecture. The authors provide an overview of sleep physiology, describe sleep changes that occur during adolescence, and discuss the influence of these changes on adolescent health. They also provide simple questions that nurses can use to assess sleep and risk factors for disrupted sleep, and discuss patient education and other interventions.

Qualitative analysis of therapeutic light effects on global function in Alzheimer's disease.

The occurrence of Alzheimer’s disease (AD) is growing, with 68% of cases occurring in women. Declines in global function exacerbated by reversal of day–night patterns, disturbed sleep–wake rhythms, and excessive daytime sleepiness make managing AD difficult. In this study, the authors examined the effect and duration of effect of therapeutic light on sleep, rest–activity, and global function in women with AD using mixed methods in a two-group experimental design with repeated measures on one factor. Twenty women with AD were randomized to experimental or control conditions. Blue-green or dim red light was delivered via cap visor in the morning. Results of the qualitative analysis of serial interviews with family and facility caregivers regarding perceived effect of light on global function are presented. Themes emerged in both groups with respect to cognition and psychosocial function. Future studies with larger samples using quantitative measures of global function are warranted to verify findings.

Pain in outpatients treated for breast cancer: Prevalence, pharmacological treatment, and impact on quality of life

Background: Cancer pain is an unmitigated clinical phenomenon. Despite available guidelines, variability exists in treating cancer pain. Objective: The objective of this study was to describe prevalence and severity of pain and the pharmacotherapy (opioid, nonopioid, adjuvant analgesics) in outpatients treated for breast cancer. Adequacy of pharmacological pain treatments, the predictors, and impact were also examined. Methods: This descriptive study consisted of 114 chemotherapy outpatients from urban and rural settings. Pain and quality of life were self-reported by patients; treatment-related information was obtained from medical records. Based on the World Health Organization analgesic ladder, adequacy of pharmacological pain management (acceptable or inadequate analgesia) was computed using the Pain Management Index; the most potent analgesic was prescribed relative to the patient’s reported pain. Results: Although patients were commonly treated with traditional analgesics, more than half (52.3%) received inadequate analgesia. Those who received inadequate analgesia reported more pain, greater pain interferences (P = .003), and more symptoms (P = .043). Those who received adjuvant analgesics reported more pain, greater interference (P = .018), more symptoms (P = .032), and lower functioning (P = .029). Nonadvanced disease stages and more comorbidities were strong predictors of inadequate analgesia. Conclusions: There is a lack of congruence between the strength of analgesia and the patient’s pain level. The addition of adjuvant analgesics did not reduce pain severity or improve quality of life. Implications for Practice: The risks and benefits of coadministration of traditional and adjuvant analgesics need to be determined. Other treatment modalities in conjunction with pharmacological treatment are needed, considering negative effects of adjuvant analgesics on pain and quality of life.

An exploratory study of sleep quality, daytime function, and quality of life in patients with mechanical circulatory support.

Purpose: To identify and describe: (1) characteristics of sleep quality, daytime sleepiness, and quality of life (QOL) pre and post implantation of a left ventricular assist device (LVAD); (2) changes in sleep quality, daytime sleepiness, and QOL at baseline and 6 months post implant; and (3) relationships among the sleep quality, daytime sleepiness, and QOL variables. Methods: We employed an exploratory research design. Fifteen patients with continuous/non-pulsatile flow LVAD consented to partake in the study. However, only 12 patients completed the baseline and 6-month post-LVAD implant data. We used the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Minnesota Living with Heart Failure Questionnaire (MLHFQ) to measure study variables. Data were analyzed using IBM SPSS 19.0 software. Results: Patients reported worse sleep quality accompanied by daytime sleepiness particularly at baseline, and persisting up to 6 months post LVAD implant. A significant improvement in QOL was observed at 6 months post implant, but remained at poor levels. Correlations among sleep disturbance and daytime dysfunction components of PSQI and global daytime sleepiness (ESS) with QOL were strong (Pearsons correlations r>.60; p values <.05). Conclusions: We report the first empirical data describing the characteristics and correlations among sleep quality, daytime sleepiness, and QOL in patients with LVADs. Our findings offer beginning evidence about the sleep-QOL connection in this population which warrants attention in clinical practice and research. Further research is required to clearly elucidate these phenomena in patients with mechanical circulatory support and other implantable artificial organs.