Xiaoyue Liu

Abstract

Aim: Heart failure is a leading cause of hospitalisation and often coexists with seven comorbid conditions on average. This study aimed to examine the gender differences in disease burden, symptom burden, and quality of life among older adults with heart failure and multimorbidity. Design: Cross-sectional study. Methods: This study utilised a baseline survey from an ongoing cohort study in 2022–2023. Adults aged ≥ 50 years with heart failure and more than one chronic condition were recruited from a university-affiliated hospital using an electronic patient portal. Disease burden was measured using a modified Disease Burden Impact Scale. The Edmonton Symptom Assessment Scale and EuroQoL-5D-5L assessed symptom burden and quality of life. Gender differences in baseline outcomes were examined using Pearson's Chi-square tests, Welch's t-tests, and multiple linear regressions. Results: Among 353 participants who completed the baseline survey, the mean (±SD) age was 70 (±9.5) years, and 50.1% were women (mean age: 67 ± 9 vs. men: 72 ± 10). In adjusted models, women had 4.9 points higher disease burden (p = 0.003) and reported higher symptom scores of pain (p = 0.018), tiredness (p = 0.021), nausea (p = 0.007), and loss of appetite compared to men (p = 0.036). Women had significantly more moderate/severe problems in usual activities and pain/discomfort and 0.07 points lower EuroQoL index than men (p = 0.010). Conclusions: There were gender differences in disease/symptom burdens and quality of life. Women living with heart failure and multimorbidity had higher burdens but lower quality of life. Impact: Identifying gender differences among people with heart failure and multimorbidity can be the first step to explaining health disparities. Research should take more inclusive and equitable approaches to address these differences. Healthcare providers, including nurses, should implement targeted strategies for effective multimorbidity management by considering these differences and disparities in clinical settings. Reporting Method: STROBE checklist, cross-sectional. Patient or Public Contribution: No patient or public contribution.

Abstract

Background: A tendency to obstruct the upper airway is markedly increased in supine sleep. Positional obstructive sleep apnea (OSA) (POSA) occurs predominantly in the supine position. The implication of POSA in terms of future cardiovascular (CV) risk is unknown. We hypothesized that patients with POSA have decreased future CV risks compared to OSA patients without POSA (non-POSA). Methods: This single-center study included patients who underwent clinically indicated polysomnography. POSA was defined as an apnea-hypopnea index (AHI) ≥ 5 events/hour and supine AHI at least twice as high as non-supine AHI (nsAHI). Exclusive POSA (ePOSA) includes the additional requirement that the nsAHI normalizes to an AHI of < 5/hour. A Cox proportional hazard model was used to assess the future risk of new CV events in patients with POSA compared to non-POSA (reference group). Results: There were 3,779 patients (mean age 51, female 59.7%), consisting of 35.9% POSA, 38.4% non-POSA, and 25.7% no OSA. Using the ePOSA definition, 17.3% had ePOSA, 57.1% had non-ePOSA, and 25.7% had no OSA. Over a median 8.4 years, there were 1,297 composite events. Patients with POSA had a lower risk of CV events compared to non-POSA (HR 0.85, CI:0.74–0.96; p = 0.010). There was a non-significant trend towards lower risk of CV events in patients with ePOSA compared to non-ePOSA (HR 0.86, CI:0.73–1.01; p = 0.061). Conclusions: POSA is associated with lower CV risk than non-POSA. Future studies should consider POSA as a distinct subtype when studying OSA and CV outcomes.

Abstract

Obstructive sleep apnea (OSA), a condition with high prevalence, is characterized by reduced dilatory function of pharyngeal muscles, which can be influenced by upper airway narrowing, dilator muscle dysfunction, respiratory dysfunction, and genetics. Three of the most clinically important phenotypes of OSA include disturbed sleep, excessive sleepiness, and minimal symptoms, with varying implications for management and morbidity. This article reviews current perspectives on these OSA phenotypes, as well as the process of confirming a diagnosis of OSA. Lastly, this article delineates various current and future OSA therapy approaches through review and analysis of the existing literature with discussion on the outlook for OSA treatment.

Abstract

BACKGROUND: Self-measured blood pressure (SMBP) is an effective strategy for managing and controlling hypertension. However, uncertainty regarding patients' ability to accurately measure their blood pressure (BP) contributes to treatment inertia. Therefore, we compared BP measurements with the Omron HEM-9210T device obtained by nurses and community-dwelling adults after training. METHODS: This cross-sectional study was conducted in a simulated home environment at an academic institution. After a 5-min rest, a trained nurse measured a participant's BP twice at a 1-min interval. The participants then ambulated at their usual pace for 2 min. Next, they were asked to rest for 5 min, during which each individual watched a 3-min video on SMBP. Following the rest, the participants obtained two readings at a 1-min interval. RESULTS: We recruited 102 community-dwelling adults with a mean age of 54 (±14) years; 59% female, 88% Black race, and 63% with a hypertension diagnosis. Half (n=51) had a home BP monitor. Overall, there were no significant differences between nurse-and participant-obtained systolic BP (mean difference [MD]:-1.1; standard deviation [SD]: 8.0; P=0.178) or diastolic BP (MD:-0.9; SD: 5.5; P=0.111). Participants who used an extra-large cuff had higher self-measured diastolic BP (MD:-2.9; SD: 4.5; P=0.010). All participants demonstrated satisfactory SMBP skills after the training. CONCLUSIONS: Community-dwelling adults can accurately measure BP after a 3-min video training. Integrating SMBP training into patient encounters may result in reliable home BP measurements, improving hypertension management and clinical decision making.

Abstract

Purpose of review: Sleep is crucial for human health and life. There is still limited attention to the association between sleep disorders beyond sleep apnea and cardiovascular (CV) health. We investigated the current evidence between non-respiratory sleep disorders and CV health. Recent findings: Current evidence suggests an important association between sleep duration, circadian rhythm, insomnia, disorders of hypersomnolence and CV health. Sleep-related movement disorders exhibit a moderate association with CV health. Further research is needed to explore the effects of each sleep disorder on CV health. Summary: Given the close association between non-respiratory sleep disorders and CV health, it is crucial to recognize and address sleep disorders in patients with a high CV risk.

Abstract

Background: Hypertension and diabetes are major risk factors for cardiovascular diseases, stroke, and chronic kidney disease (CKD). Disparities in hypertension control persist among Black and Hispanic adults and persons living in poverty in the United States. The “LINKED-HEARTS Program” (a Cardiometabolic Health Program LINKED with Community Health WorkErs and Mobile HeAlth TelemonitoRing To reduce Health DisparitieS”), is a multi-level intervention that includes home blood pressure (BP) monitoring (HBPM), blood glucose telemonitoring, and team-based care. This study aims to examine the effect of the LINKED-HEARTS Program intervention in improving BP control compared to enhanced usual care (EUC) and to evaluate the reach, adoption, sustainability, and cost-effectiveness of the program. Methods: Using a hybrid type I effectiveness-implementation design, 428 adults with uncontrolled hypertension (systolic BP ≥ 140 mm Hg) and diabetes or CKD will be recruited from 18 primary care practices, including community health centers, in Maryland. Using a cluster-randomized trial design, practices are randomly assigned to the LINKED-HEARTS intervention arm or EUC arm. Participants in the LINKED-HEARTS intervention arm receive training on HBPM, BP and glucose telemonitoring, and community health worker and pharmacist telehealth visits on lifestyle modification and medication management over 12 months. The primary outcome is the proportion of participants with controlled BP (<140/90 mm Hg) at 12 months. Conclusions: The study tests a multi-level intervention to control multiple chronic diseases. Findings from the study may be leveraged to reduce disparities in the management and control of chronic diseases and make primary care more responsive to the needs of underserved populations. Trial registration: ClinicalTrials.gov. Identifier: NCT05321368.

Abstract

Objectives: Sleep plays an essential role in well-being. Although U.S. immigrants are considerably growing, few studies have examined sleep in this diverse population, particularly those from Asian backgrounds. It is also unclear how sleep differs by the length of residence across immigrant groups. In this study, we examined the relationships among race/ethnicity, length of residence, and sleep using a nationally representative cohort of U.S. immigrants. Methods: We analyzed data from the 2013-2018 National Health Interview Survey. The sample (N = 27,761; 14% ≥65 years old) included foreign-born adults from the following racial/ethnic backgrounds: non-Hispanic White, non-Hispanic Black, Asian (Chinese, Filipino, Asian Indian), and Hispanic/Latino. Length of residence was categorized as <5, 5-9, 10-14, and ≥15 years. Sleep was assessed with self-reported sleep duration (normal, short, and long) and poor sleep quality (trouble falling asleep, trouble staying asleep, and waking up unrested). Results: Filipino and Hispanic/Latino immigrants reported the highest prevalence of short (41.8%) and long (7.0%) sleep, respectively. Non-Hispanic White immigrants had the highest prevalence rate across all three poor sleep quality measures (range 17.7-41.5%). Length of residence ≥15 years was significantly associated with worse sleep, and it moderated White-Asian differences in sleep quality. Immigrants from different racial/ethnic groups showed variations in sleep patterns as they resided longer in the US. Conclusions: Immigrants exhibited substantial heterogeneities in sleep. Future research should investigate the contributing factors to the variations in their sleep patterns, both between groups and within the same group of immigrants, in order to inform tailored interventions.

Abstract

Obstructive sleep apnea (OSA) and hypertension are two important modifiable risk factors for cardiovascular disease and mortality. Numerous studies have highlighted the interplay between these two conditions. We provide a critical review of the current literature on the role of the OSA as a risk factor for hypertension and its effect on blood pressure (BP). We discuss several key topics: the effect of OSA on nocturnal BP, BP response to continuous positive airway pressure (CPAP) treatment, CPAP effect on BP in refractory hypertension, the role of OSA in BP variability (BPV), and maladaptive cardiac remodeling mediated by OSA’s effect on BP. Finally, we discuss the unique aspects of ethnicity and social determinants of health on OSA with a focus on Asian populations and the disparity in BP control and cardiovascular outcomes.

Abstract

Background: High rates of physical inactivity persist in the United States, with higher rates among non-Hispanic Black adults than among their White peers. However, a comparison of physical activity engagement across nativity among Black adults in the United States has yet to be fully documented. The purpose of this cross-sectional study was to examine physical activity engagement rates among African immigrant and Afro-Caribbean immigrant adults compared with native-born African American adults using data from the 2010 to 2018 National Health Interview Survey. Methods: Using data from the 2010 to 2018 National Health Interview Survey, we used generalized linear models to compare levels of physical activity (meeting the moderate-to-vigorous physical activity [MVPA] recommendations) by ethnic subgroups of Black adults, sequentially adjusting for sociodemographic and health-related risk factors. Results: Data from 38,037 adults (58.8% female, 21% college/graduate degree, and 41.4% with obesity) were included. Only 41.9% of all participants met the MVPA recommendations. In the fully adjusted models across the 9 years, higher levels of MVPA were seen among African Americans (42%) than among African immigrants (38%) and Afro-Caribbean immigrants (41%). Compared with African Americans, African immigrants were less likely to engage in physical activity that met the MVPA guidelines (prevalence ratio: 0.90; 95% confidence interval: 0.85, 0.96), whereas there were no differences in meeting the guidelines between Afro-Caribbean immigrants (prevalence ratio: 0.96; 95% confidence interval:0.90, 1.02) and African Americans. Conclusion: Culturally tailored interventions addressing socioenvironmental barriers and facilitators of physical activity may have important impacts on physical activity promotion and long-term disease burden among Black adults across nativity.