Relationship between daytime sleepiness and blood pressure in healthy older adults

BACKGROUND: Some sleep disorders have been linked to hypertension, but few studies have examined the relationship between daytime sleepiness and blood pressure (BP). This study attempted to determine whether scores on a short questionnaire assessing daytime sleepiness (Epworth Sleepiness Scale [ESS]) were associated with BP and could be used to predict hypertension after 5 years in healthy older adults who had not previously been diagnosed with hypertension. METHODS: A group of 157 healthy men and women 55 to 80 years of age completed an extensive medical examination, a series of psychosocial tests, and two 24-h ambulatory BP sessions. After 5 years the procedures were repeated in 133 (85%) of the subjects. Psychosocial variables and BP were compared in subjects scoring high (score of > or = 10) and low (< 10) on the ESS. RESULTS: Compared to individuals with low ESS sores, those scoring high had increased casual and sleep BP as well as higher systolic BP levels and diastolic BP variability during waking hours, and reported higher levels of anger, depression, anxiety, and intensity of psychological symptoms as well as lower defensiveness. Individuals with high ESS scores were more likely to be diagnosed with hypertension 5 years later. Groups with high and low ESS scores did not differ significantly on any other variables. CONCLUSIONS: The ESS, a simple measure of daytime sleepiness, identified individuals at risk for hypertension. Future studies should investigate the possibility that diagnosis and treatment of daytime sleepiness could aid in BP reduction and ultimately in decreased morbidity and mortality from cardiovascular disorders.     

A comparison of health-related quality of life between older adults with heart failure and healthy older adults

BACKGROUND: Health-related quality of life (HRQOL) in older adults with heart failure may be affected by a variety of variables including aging. It is important to determine the unique impact of heart failure to more effectively improve HRQOL in this population. OBJECTIVE: The purpose of this study was to compare HRQOL and physical, psychologic, clinical, and sociodemographic status in older adults with and without heart failure. METHODS: The HRQOL of 90 older adults with heart failure and 116 healthy older adults was compared. The factors best associated with HRQOL in each group were determined using multiple regression model. RESULTS: HRQOL was substantially worse among older adults with heart failure than among healthy older adults. Older adults with heart failure had more severe physical and emotional symptoms, poorer functional status, and worse health perceptions. Physical symptom status was the strongest predictor of HRQOL in both groups. In addition, in older adults with heart failure, physical symptom status, age, and anxiety were related to HRQOL. CONCLUSION: The poor HRQOL seen in patients with heart failure is not just a reflection of aging. Comprehensive interventions targeted toward the factors that specifically negatively impact HRQOL are essential in older adults with heart failure.     

Relationship between caregiver burden and health-related quality of life

This study tested the cross-sectional relationship between caregiver burden and health-related quality of life (HRQOL) among 1,594 caregivers of veterans identified to qualify for formal home care. A two-stage model found that familial relationship, coresidence, and low income predicted objective burden. Coresidence also predicted subjective burden, whereas being African American was protective. In the full model, spousal relationship, low income, and burden were associated with poor HRQOL scores. Total variance explained in HRQOL ranged from 14% to 29%, with objective burden contributing more than subjective burden. These findings suggest a direct effect of objective burden on caregiver HRQOL, indicating a need among caregivers for assistance in caring for disabled family members.     

Relationship between patient and disease characteristics,and health-related quality of life in adults with asthma

The purpose of this study was to examine relationships between patient- and disease-related variables and health-related quality of life (HQL). This cross-sectional study surveyed adults with asthma enrolled in a managed care organization (MCO). Data were obtained from a mailed questionnaire and the MCO's patient and claims databases. The Asthma Quality of Life Questionnaire (AQLQ) and the SF-36 instruments were used. The behavioral Model of Health Services Utilization was used to characterize independent variables and their relationships to HQL. Independent variables included predisposing (age, gender, education, race, number of comorbidities, years with asthma, social support, health-belief questions); enabling (income, number of metered dose inhaler (MDI) instructors, perceived inconvenience of accessing the physician); and illness level (perceived and symptom-derived asthma severity). Multivariate linear regression models were developed to examine the relationships between the independent variables and the domain and summary scores of the AQLQ and the SF-36. The survey response rate was 63% (n=603). for the AQLQ, symptom-derived severity perceived severity education level, and the health-belief factor Barriers were significant in all five models. Symptom-derived severity had consistently higher standardized regression coefficients than perceived severity Barriers had the highest coefficient in all but the Symptoms domain model. Number of Comorbidities was significant in all eight domain and two summary score SF-36 models. Symptom-derived and/or perceived severity were also significant in all but the Mental Health domain model. Other frequently significant variables included the health-belief factor Barriers and Yearly Household Income. When assessing HQL of a population, such as this group of patients with asthma, one must consider patient and disease variables that may influence the results.     

Association between obstructive sleep apnea and health-related quality of life in untreated adults: a systematic review

Sleep and Breathing - The objective of this systematic review was to answer the question: “Is there association between obstructive sleep apnea (OSA) and health-related quality of life...     

Measuring health-related quality of life in adults during an acute asthma exacerbation

BACKGROUND: Acute severe asthma can be distressing for patients. It is important to be able to identify the causes of the distress so that these can receive attention in conjunction with the conventional treatment of the airways. STUDY OBJECTIVE: To modify the Asthma Quality of Life Questionnaire (AQLQ) for evaluating patients with acute severe asthma and to test the measurement properties of the Acute Asthma Quality of Life Questionnaire (Acute AQLQ). METHODS: The Acute AQLQ contains the symptom and emotional function items of the AQLQ (n = 11), which are capable of changing over short periods of time. The measurement properties were tested during a clinical trial to compare formoterol and salbutamol in the treatment of acute severe asthma in hospital emergency departments. RESULTS: The 88 patients in the clinical trial provided evidence that the Acute AQLQ has high internal consistency (Cronbach alpha = 0.90) and is very responsive to change in status (p < 0.00001) with a responsiveness index of 2.5. Correlations between the Acute AQLQ and other measures of clinical status provided evidence of the validity of the instrument. CONCLUSION: The Acute AQLQ has strong measurement properties and can be used with confidence to identify the problems that are distressing to patients during an acute asthma exacerbation and to evaluate the effectiveness of interventions.     

Relationship between symptoms and health-related quality of life in chronic lung disease

The authors studied the relationship between patient self-reported symptoms and responses to a general measure of health-related quality of life [Short Form 36 (SF-36)] for 102 patients who had chronic lung disease [forced expiratory volume in one second (FEV₁)<70%]. The primary diagnoses were chronic bronchitis, emphysema, and asthma; the mean age was 62 years, and 46% were women. Based upon Medical Research Council (MRC) symptom scores, the patients’ disease severity was classified as mild (21%), moderate (22%), or severe (57%). The SF-36 scores differed significantly between disease severity groups in domains of health perception, physical functioning, physical role, and energy. The SF-36 physical functioning and Oxygen Cost Diagram scores correlated well (r=0.78). The authors conclude that SF-36 is a useful and valid measure of general health status in patients with chronic lung disorders. Supported in part by educational grants from Glaxo Canada, Inc., and Schering-Phlough Research Institute. This work was completed while Dr. Viramontes was an INCLEN graduate student at McMaster University sponsored by the Rockefeller Foundation.     

Relationship between guideline treatment and health-related quality of life in asthma.

The aim of this study was to compare the health-related quality of life (HRQL) of asthma patients treated according to the 1997 National Institute of Health (NIH) international asthma guideline and that of asthmatics receiving non-guideline treatment. The suitability of 146 asthmatics' medication regimes was determined according to the 1997 NIH asthma guideline. Quality of life was assessed on a seven-point scale using the Asthma Quality of Life questionnaire. Just over half of the patients were not currently using the treatment considered necessary for controlling their asthma. Patients treated according to the guideline (n=72) had a significantly higher overall HRQL than patients with non-guideline treatment (5.7 versus 5.3). The differences were also significant for the subscales measuring symptoms and environmental exposure, but not for activities or emotional function. An association between non-guideline treatment and a poorer health-related quality of life in asthma patients treated in general practice was observed. This study supports the role of evidence-based guidelines in daily practice. Further studies are needed to determine if guideline treatment is responsible for the increase in health-related quality of life observed in this work.     

肝硬化患者健康相关生存质量与生存时间的关系

目的研究肝硬化患者健康相关生存质量与生存时间的关系。方法所有受试者回答SF-36 v2(中文版)量表,通过SF-36 v2软件计算出基线:生理功能、生理职能、躯体疼痛、总体健康、活力、社会功能、情感职能、精神健康共8个维度,以及躯体健康总评和精神健康总评评分。同时登记所有受试者入选时的一般资料和临床资料。随访时间为18个月。Cox回归分析和KaplanMeier分析进行生存分析。结果 221例肝硬化患者完成调查。随访期间50例患者死亡。存活组SF-36各维度评分均高于死亡组(P0.05)。存活组躯体健康及精神健康总评评分较死亡组高(P0.001)。Cox回归分析及Kaplan-Meier分析均显示,躯体健康总评和精神健康总评评分越高肝硬化受试者生存时间越长。结论肝硬化患者健康相关生存质量与生存时间密切相关。健康相关生存质量可以用来预测肝硬化患者的生存时间。     

Oral health-related quality of life and loneliness among older adults

Loneliness is a serious concern in aging populations. The key risk factors include poor health, depression, poor material circumstances, and low social participation and social support. Oral disease and tooth loss have a significant negative impact on the quality of life and well-being of older adults. However, there is a lack of studies relating oral health to loneliness. This study investigated the association between oral health-related quality of life (through the use of the oral impact on daily performances—OIDP—measure) and loneliness amongst older adults living in England. Data from respondents aged 50 and older from the third (2006–2007) and fifth (2010–2011) waves of the English Longitudinal Study of Ageing were analyzed. In the cross-sectional logistic regression model that adjusted for socio-demographic, socio-economic, health, and psychosocial factors, the odds of loneliness were 1.48 (1.16–1.88; p < 0.01) higher amongst those who reported at least one oral impact compared to those with no oral impact. Similarly, in the fully adjusted longitudinal model, respondents who reported an incident oral impact were 1.56 times (1.09–2.25; p < 0.05) more likely to become lonely. The association between oral health-related quality of life and loneliness was attenuated after adjusting for depressive symptoms, low social participation, and social support. Oral health-related quality of life was identified as an independent risk factor for loneliness amongst older adults. Maintaining good oral health in older age may be a protective factor against loneliness.     

Relationship between thyroid function and elevated blood pressure in euthyroid adults

Thyroid hormones (THs) have profound effects on cardiovascular functions, suggesting that THs may contribute to the development of elevated blood pressure (BP). Few studies, however, have systematically assessed the relationship between THs and elevated BP. We therefore conducted a cross‐sectional study to examine how serum THs concentrations are related to the prevalence of elevated BP in a euthyroid population. This study (n = 12 487) was performed in Tianjin, China. Serum free triiodothyronine (FT3), free thyroxine (FT4), and thyroid‐stimulating hormone (TSH) levels were measured by chemiluminescence immunoassay. Elevated BP was defined according to the JNC 8 criteria. Analysis of covariance and multiple logistic regression models were used to assess the relationships between FT3, FT4, and TSH quartiles and elevated BP. The multivariable‐adjusted odds ratios (95% confidence interval) of elevated BP for gradual increase in the FT3, FT4, and TSH quartiles, when compared to the lowest quartiles were 1.08 (0.97, 1.21), 1.24 (1.12, 1.39), and 1.32 (1.18, 1.47); 1.18 (1.06, 1.32), 1.18 (1.06, 1.31), and 1.24 (1.11, 1.38); 1.06 (0.96, 1.19), 1.06 (0.95, 1.18), and 1.03 (0.93, 1.15), respectively. Our study demonstrated that FT3 and FT4 are positively related to the prevalence of elevated BP in euthyroid adults, but no significant relationship was found between TSH and elevated BP.     

合并抑郁症状的 COPD 患者与其 BODE指数及生活质量的相关性分析

目的：通过应用流行病学研究中心抑郁自评量表（center for epidemiologic studies depression ,CES‐D）量表调查COPD患者合并抑郁症状的情况,探讨合并抑郁症状的COPD患者与其BODE （body mass index ,degree of air‐flow obstruction ,dyspnea ,exercise capacity）指数及生活质量的相关性。方法74例稳定期COPD患者分别完成CES‐D评估、肺功能检测、BMI检测、改良版M RC呼吸困难指数评估、6分钟步行试验和圣乔治呼吸问卷调查等。结果 C O PD患者中合并抑郁症状的占48.6％（n＝36）。CES‐D评分与FEV1％ pred呈低度负相关（r＝－0.21,P＝0.01）。COPD患者中抑郁症状的患病率与BODE指数分级呈正相关（r＝0.61,P＝0.02）。圣乔治呼吸问卷评分与COPD患者的抑郁症状有相关性（r＝0.58,P＝0.004）。结论 COPD患者中抑郁症状的患病率及抑郁程度与BODE指数、呼吸功能受损程度等均相关。COPD患者的抑郁程度与圣乔治呼吸问卷评分相关。BODE指数对减少COPD患者合并抑郁症状的患病率和改善其生活质量有指导作用。     

Changes of blood pressure and heart rate during sexual activity in healthy adults

OBJECTIVE: This study is to observe the changes of blood pressure (BP), heart rate (HR), double product (DP) and heart rate variability during sexual activity in healthy adults before we cover patients with chronic cardiovascular disease. METHODS: Forty-nine participants grouped by sex, 22 males, aged 40.6+/-7.8 years; 27 females, aged 40.3+/-7.8 years, underwent simultaneous ambulatory monitoring of BP and HR for 24 h. During the monitoring period, sexual activity of the participants with man-on-top in their familiar environment was performed. Participants were requested to measure BP manually at the beginning of each sexual phase and three times after orgasm in every 10-min interval and 60 min after orgasm. For each individual, eight measuring values, respectively, about BP, HR, DP and heart rate variability were obtained from baseline to 1 h after orgasm. The data were statistically analyzed with paired t-test and the significant level was set at P<0.05. RESULTS: In both groups, the peak BP did not appear at orgasm, but at the beginning of plateau and dropped to baseline level at 10 min after orgasm (male 141.41+/-17.13/91.05+/-13.69 vs. 120.14+/-11.07/72.86+/-7.78 mmHg, female 121.67+/-16.61/77.37+/-15.03 vs. 109.37+/-10.54/67.19+/-9.41 mmHg). The peak HR occurred at the beginning of orgasm, and dropped to baseline level 10-20 min after orgasm (male 96.36+/-11.96 vs. 75.41+/-9.02 bpm, female 90.19+/-10.38 vs. 71.44+/-5.68 bpm). DP of both groups elevated at the beginning of plateau and orgasm then decreased to baseline level 10 min after orgasm (male 12964.27+/-2659.17 vs. 9134.09+/-1469.58 mmHg bpm, female 10044.48+/-1777.89 vs. 7841.30+/-1023.79 mmHg bpm). All the results showed that BP, HR and DP have mild to moderate changes during sexual activity in healthy adults. CONCLUSION: Using ambulatory technology to monitor BP and HR helps us to get the real data in participants during sexual activity. BP, HR and DP increase just slightly for a short time and recover to baseline level soon after sexual activity in healthy adults. The physical exhaustion during sexual activity is within the range of the daily-life workload.     

Measurements of base blood pressure during sleep and its clinical significance in hypertensive patients

The intra-arterial blood pressure (BP) was measured during 24 hours on 52 patients with essential hypertension using a portable device. The minimum BP inherent to each subject (base BP) was determined from the systolic and diastolic BP histograms during sleep. In this study the systolic and diastolic BPs were presented as a mean BP (BP) and a base BP, and the average of BPs during waking hours was considered as the sum of the base BP and the additional BP increment. The clinical significance of the base BP and BP increment was examined by comparing them with the results of clinical examinations. The comparison showed that the base BP was closely related with the left ventricular hypertrophy and severity of hypertension, while the BP increment correlated with the baroreflex sensitivity and plasma norepinephrine concentration. In this paper, a new tonometry was developed to indirectly record the BP of the superficial temporal artery. The tonometry correlated well with the intra-arterial BP measurement, and was available for the indirect base BP evaluation at an outpatient-clinic.     

Periodic limb movements during sleep are associated with poor health-related quality of life in patients with obstructive sleep apnea

Purpose

The clinical significance of the comorbidity of periodic limb movements during sleep (PLMS) in sleep-disordered breathing remains unclear. This study aimed to determine whether or not the presence of PLMS is related to depressed mood and poor quality of life in subjects with obstructive sleep apnea (OSA).

Methods

We defined PLMS as a periodic leg movement index of?>?15/h. Scores for the Medical Outcomes Study Short Form Health Survey and Beck Depression Inventory were assessed with multiple logistic or linear regression analyses.

Results

Of 1370 subjects with OSA, a prevalence of PLMS was 14.1%. Older age, men, and obesity were positively associated with PLMS. PLMS occurred in 17%, 15%, and 12% of mild, moderate, and severe subjects with OSA, respectively. Severe OSA was less likely to be associated with PLMS than mild OSA. PLMS negatively correlated with physical and mental component summary scores of the health survey but not with Beck Depression Inventory scores after controlling for confounding variables. PLMS were significantly associated with poor sleep architecture on polysomnography. However, the relationship between PLMS and disturbed sleep was no longer significant after adjusting for age.

Conclusions

Health-related quality of life, including physical and mental health but not depressive symptoms, was worse in subjects with OSA and PLMS than in those without PLMS.

     

Oral health-related quality of life and life-space mobility in community-dwelling older adults

OBJECTIVES: To quantify the associations between measures of oral health–related quality of life (OHRQoL) and life‐space mobility (LSM) in community‐dwelling older adults. DESIGN: Cross‐sectional study using a 54‐item OHRQoL questionnaire. SETTING: Five counties in central Alabama: Jefferson and Tuscaloosa (urban), and Bibb, Hale, and Pickens (rural). PARTICIPANTS: The 288 dental study volunteers were recruited from participants in the University of Alabama at Birmingham Study of Aging, a longitudinal study of mobility in community‐dwelling adults aged 65 and older. MEASUREMENTS: Participants completed an in‐home interview about their OHRQoL and LSM. Life‐space was assessed by asking questions about where and how often participants got to areas ranging from the home to beyond town and the degree of independence in getting there. Unadjusted and adjusted regression models were used to quantify associations between OHRQoL and LSM. Other factors examined were age, race, sex, income, education, residence, transportation difficulty, marital status, depressive symptoms, and comorbidity. RESULTS: Unadjusted and adjusted analyses suggested significant associations between OHRQoL and LSM in oral functional limitation, oral pain and discomfort, oral disadvantage, and self‐rated oral health. CONCLUSION: OHRQoL decrements that participants reported were associated with less LSM, suggesting that perceptions of oral well‐being have a significant effect on mobility and the social participation of older adults.     

Socio-economic factors and health-related quality of life in adults living with HIV

This study examined the relationships of income, employment status and other socioeconomic characteristics with dimensions of health-related quality of life (HRQOL) for those living with HIV/AIDS, controlling for clinical characteristics. Demographic (gender, age, education, living with a partner, HIV transmission category), economic (employment status, monthly household income, volunteer experience), clinical (CD4 count, AIDS defining illness, time since diagnosis, number of HIV symptoms, and highly active antiretroviral therapy), and HRQOL measures (five Medical Outcomes Study HIV Health Survey subscales) were obtained from 308 consenting HIV clinic patients in Calgary, Canada. Multiple regression results indicate that the strongest predictor of the five QL subscales is employment status, while income was significant as an independent predictor in two of the models. Other socioeconomic characteristics were not consistently significant predictors of HRQOL subscales. The contribution of employment to HRQOL is important to explore further, and suggest the need for flexibility in income support and return-to-work programmes for those with HIV.