Sleep is Essential for Cardiovascular Health: An Analytic Review of the Relationship Between Sleep and Cardiovascular Mortality.

The American Heart Association recently included sleep health as one of eight factors that define cardiovascular health. Restorative sleep is a pillar of lifestyle medicine influenced by sleep duration, quality, and disorders. Short and long sleep duration are associated with greater risk of cardiovascular disease. Short sleep appears causally related to cardiovascular risk. Long sleep is more strongly predictive of cardiovascular risk, which may be due to comorbidities and other risk factors. Good-quality sleep appears to protect against the increased risk and is independently associated with risk of cardiovascular disease (CVD). Insomnia, particularly difficulty falling asleep and non-restorative sleep, is associated with an increase in cardiac events. Obstructive sleep apnea (OSA) is associated with cardiac risk and outcomes, which is typically observed in the context of contributing comorbidities. However, treating OSA with continuous positive airway pressure (CPAP) may not improve prognosis. Further research is needed to understand the causal mechanisms connecting sleep health with CVD and whether modifying sleep can improve outcomes. Sleep health should be considered as part of a holistic approach to improving cardiovascular health, as reflected in the scoring of LE8 and as one of the interrelated components of lifestyle medicine.

Sleep Apnea Among Gulf War Veterans: An Examination of VA Utilization Rates, Treatment Initiation, and Health Outcomes.

OBJECTIVES: Obstructive sleep apnea (OSA) among veterans is frequently underdiagnosed and undertreated. The present study sought to: 1) characterize the prevalence and rate of treatment of OSA among VA users and non-users and 2) examine the associations between diagnosed or probable OSA and key physical and mental health outcomes. METHODS: Gulf-War I-era Veterans were recruited as part of a national survey assessing mental and physical health concerns, healthcare needs, and healthcare utilization. OSA diagnoses were self-reported while sleep apnea risk was assessed via the STOP-Bang. Veterans also completed questionnaires assessing overall health, pain, depression, PTSD, and psychosocial functioning. RESULTS: 1,153 veterans were included in the present analyses (Mean age = 58.81; 21.84% female). Compared to non-VA healthcare users, veterans receiving care at the VA were more likely to have been diagnosed with OSA (p < .001) and report receiving treatment for OSA (p = .005). Compared to veterans at low risk for OSA, veterans at elevated risk reported higher levels of pain (p = .001), depression (p = .02), and poorer psychosocial functioning (p < .001). CONCLUSIONS: OSA diagnoses appear to be more common among VA healthcare users. Findings suggest that OSA remains underdiagnosed and associated with important physical and mental health consequences. Additional screening for OSA, especially among non-VA clinics, is warranted.

Disentangling the Longitudinal Relationship between Loneliness and Depressive Symptoms in U.S. Adults Over 50.

OBJECTIVES: A seminal study on loneliness and depression suggested that loneliness influences depression more than the reverse. However, the study's analytic method has since been criticized for failing to account for the trait-like nature of variables. This study aimed to examine the longitudinal relationship between loneliness and depressive symptoms while accounting for the trait-like nature of both variables. METHODS: Data (n = 16,478) came from the Health and Retirement Study (2006-2016). Measures included the Hughes Loneliness Scale and a modified Center for Epidemiologic Studies Depression scale (loneliness item omitted). Analyses consisted of random intercepts cross-lagged panel models (three time-points evenly spaced across eight years). RESULTS: There was evidence that loneliness and depressive symptoms are trait-like and these trait-like components are strongly associated. There was not evidence of cross-lagged effects between loneliness and depressive symptoms. CONCLUSIONS: A tendency toward loneliness corresponded with a tendency toward depressive symptoms. However, deviations in one's typical level of loneliness did not predict deviations in one's typical level of depressive symptoms or vice-versa. These findings do not support past assertions that loneliness shapes subsequent depression more than the reverse. CLINICAL IMPLICATIONS: By middle to late adulthood, loneliness and depressive symptoms are trait-like phenomena that are strongly associated.

Complementary/integrative healthcare utilization in US Gulf-War era veterans: Descriptive analyses based on deployment history, combat exposure, and Gulf War Illness.

Complementary and integrative health (CIH) approaches have gained empirical support and are increasingly being utilized among veterans to treat a myriad of conditions. A cluster of medically unexplained chronic symptoms including fatigue, headaches, joint pain, indigestion, insomnia, dizziness, respiratory disorders, and memory problems, often referred to as Gulf War Illness (GWI) prominently affect US Gulf War era (GWE) veterans, yet little is known about CIH use within this population. Using data collected as part of a larger study (n = 1153), we examined the influence of demographic characteristics, military experiences, and symptom severity on CIH utilization, and utilization differences between GWE veterans with and without GWI. Over half of the sample (58.5%) used at least one CIH modality in the past six months. Women veterans, white veterans, and veterans with higher levels of education were more likely to use CIH. GWE veterans with a GWI diagnosis and higher GWI symptom severity were more likely to use at least one CIH treatment in the past six months. Over three quarters (82.7%) of veterans who endorsed using CIH to treat GWI symptoms reported that it was helpful for their symptoms. Almost three quarters (71.5%) of veterans indicated that they would use at least one CIH approach if it was available at VA. Results provide a deeper understanding of the likelihood and characteristics of veterans utilizing CIH to treat health and GWI symptoms and may inform expansion of CIH modalities for GWE veterans, particularly those with GWI.

Mental health and demographic correlates of loneliness after left ventricular assist device implantation.

Loneliness is a risk factor for coronary heart disease, stroke, and hospital readmission, yet there are no studies to our knowledge examining loneliness in left ventricular assistance device (LVAD) patients. This study used a cross-sectional survey design on a convenience sample of LVAD patients (n = 73). Logistic regression was used to identify demographic correlates of loneliness; linear regression was used to examine the relationship between loneliness and both stress and depression. Loneliness was measured via the loneliness item from the Center for Epidemiologic Studies Depression (CESD), depression via the CESD (excluding the loneliness item), and stress via the Perceived Stress Scale. In bivariate analyses, older age (OR per year = 0.958, 95%CI = 0.919-0.998) and being partnered (OR = 0.245, 95%CI = 0.083-0.724) were associated with less loneliness. In the multivariate model, there was an interaction effect between age and partnership (p = 0.0212), where older age was protective against loneliness for non-partnered, but not partnered, patients. Higher loneliness was associated with higher stress (ß = 0.484, B = 5.687, 95%CI = 3.195-8.178) and depression (ß = 0.618, B = 7.544, 95%CI = 5.241-9.848). Patients who are not partnered and younger may be at increased risk of loneliness after LVAD. Loneliness in turn is associated with higher stress and depression. Longitudinal research is necessary to speak to direction of effects.

Longitudinal trajectories and risk factors for persistent postconcussion symptom reporting following uncomplicated mild traumatic brain injury in U.S. Military service members.

OBJECTIVE: The purpose of this study was to examine individual postconcussion symptom [PCSx] trajectories following mild traumatic brain injury (MTBI), and to examine risk factors for persistent PCSx reporting. METHOD: Participants were 138 U.S. military service members and veterans (SMVs) prospectively enrolled in the Defense and Veterans Brain Injury Center, 15-Year Longitudinal TBI study. Participants were classified into three groups: uncomplicated MTBI (n = 54), injured controls (IC, n = 26), and non-injured controls (NIC, n = 58). Participants completed the Neurobehavioral Symptom Inventory, PTSD Checklist, and Traumatic Brain Injury Quality of Life at baseline (<8 months post-injury) and at follow-up (2-4 years post-injury). RESULTS: The prevalence of those who met DSM-IV-TR symptom criteria for Postconcussional Disorder (PCD) was high in all three groups (e.g., 44.8-63.0%) and did not significantly change from baseline to follow-up (all ps>.05). However, there was substantial variability in individual symptom trajectories over time. The majority of participants had symptom trajectories classified as either 'persistent' (∼32-55%) or 'asymptomatic' (∼30-36%), with a substantial minority classified as 'improved' (∼7-12%) or 'developed' (∼7-19%). Factors associated with 'persistent' PCD trajectories included cognitive complaints, PTSD, depression, anxiety, pain, and headaches at baseline; but not the presence/absence of MTBI. Factors associated with 'developed' PCD trajectories included PTSD and the number of lifetime exposures to blast. Conclusions: Reporting of 'new' PCSx over time was common in individuals with and without MTBI. It would be erroneous to assume uncritically that PCSx reported many years post-injury reflect only persistent symptomatology, or can be solely attributable to the direct consequences of a brain injury.