Comparison of Swiss and European risk algorithms for cardiovascular prevention in Switzerland.

BACKGROUND: In Switzerland, two distinct algorithms are recommended for cardiovascular prevention: (a) Arbeitsgruppe Lipide und Atherosklerose (AGLA); and (b) European Society of Cardiology (ESC). We validated and determined which algorithm better predicts incident atherosclerotic cardiovascular disease and assessed statin eligibility in Switzerland. DESIGN: A prospective population-based cohort. METHODS: We employed longitudinal data of the CoLaus study involving 6733 individuals, aged 35-75 years, with a 10-year follow-up. Using discrimination and calibration, we evaluated the predictive performance of the AGLA and ESC algorithms for the prediction of atherosclerotic cardiovascular disease. RESULTS: From the 6733 initial participants, 5529 were analysed with complete baseline and follow-up data. Mean age (SD) was 52.4 (10.6) years and 54% were women. During an average follow-up (SD) of 10.2 years (1.7), 370 (6.7%) participants developed an incident atherosclerotic cardiovascular disease. The sensitivity of AGLA and ESC algorithms to predict atherosclerotic cardiovascular disease was 51.6% (95% confidence interval (CI) 46.4-56.8) and 58.6% (53.4-63.7), respectively. Discrimination and calibration were similar between the AGLA and ESC algorithms, with area under the receiver operating characteristic curve values of 0.78 (95% CI 0.76-0.80) and 0.79 (0.76-0.81), and Brier scores of 0.059 and 0.041, respectively. Among 370 individuals developing incident atherosclerotic cardiovascular disease, only 278 (75%) were eligible for statin therapy at baseline, including 210 (57%) according to both algorithms, 4 (1%) to AGLA only and 64 (17%) to ESC only. CONCLUSION: AGLA and ESC algorithms presented similar accuracy to predict atherosclerotic cardiovascular disease in Switzerland. A quarter of adults developing atherosclerotic cardiovascular disease were not identified by preventive algorithms to be eligible for statin therapy.

Association between actigraphy-based sleep duration variability and cardiovascular risk factors - Results of a population-based study.

BACKGROUND: Although a few studies suggest an adverse effect of sleep duration variability on cardiovascular risk factor, others did not and this association remains controversial. Moreover, most studies were non-representative of the general population, used different sleep duration variability measures, and relied on self-reported sleep duration. We aimed to assess the association between different, actigraphy-based sleep duration variability measures and cardiovascular risk factors in a population-based sample. METHODS: In a middle-aged population-based cohort, 2598 subjects had data on sleep duration variability measured by actigraph over 14 days. Multivariable logistic regressions were performed to assess the relationship between different sleep duration variability measures [ie, night-to-night variability (NNV), range between shortest and longest sleep duration (RSL), range between average weekday and weekend sleep duration (RWW)] and cardiovascular risk factors including obesity, diabetes and hypertension. RESULTS: Subjects with highest sleep duration variability - measured as NNV, RSL and RWW, were more likely to be obese. These associations robust in most but not all sensitivity analyses, and no associations between sleep duration variability measures and diabetes or hypertension were found. CONCLUSION: There is a possible association between high sleep duration variability and obesity, although results were not robust in all sensitivity analyses. Further, no associations between sleep duration variability and other cardiovascular risk factor such as diabetes or hypertension were found.

Association of napping with incident cardiovascular events in a prospective cohort study.

OBJECTIVE: There is controversy regarding the effect of napping on cardiovascular disease (CVD), with most studies failing to consider napping frequency. We aimed to assess the relationship of napping frequency and average nap duration with fatal and non-fatal CVD events. METHODS: 3462 subjects of a Swiss population based cohort with no previous history of CVD reported their nap frequency and daily nap duration over a week, and were followed over 5.3 years. Fatal and non-fatal CVD events were adjudicated. Cox regressions were performed to obtain HRs adjusted for major cardiovascular risk factors and excessive daytime sleepiness or obstructive sleep apnoea. RESULTS: 155 fatal and non-fatal events occurred. We observed a significantly lower risk for subjects napping 1-2 times weekly for developing a CVD event (HR 0.52, 95% CI 0.28 to 0.95) compared with non-napping subjects, in unadjusted as well as adjusted models. The increased HR (1.67, 95% CI 1.10 to 2.55) for subjects napping 6-7 times weekly disappeared in adjusted models (HR 0.89, 95% CI 0.58 to 1.38). Neither obstructive sleep apnoea nor excessive daytime sleepiness modified this lower risk. No association was found between nap duration and CVD events. CONCLUSION: Subjects who nap once or twice per week have a lower risk of incident CVD events, while no association was found for more frequent napping or napping duration. Nap frequency may help explain the discrepant findings regarding the association between napping and CVD events.

Does sleep predict next-day napping or does napping influence same-day nocturnal sleep? Results of a population-based ecological momentary assessment study.

STUDY OBJECTIVES: The temporal relationship between nocturnal sleep and daytime napping has only been assessed in small non-representative samples, and suggests that nocturnal sleep and napping are interdependent, although mixed results exist. In this study, we investigated the temporal relationship between nocturnal sleep and napping (and vice versa). METHODS: A population-based sample of middle-aged adults (N = 683, mean age 60.7 [SD 9.5]) completed seven days of ecological momentary assessment reporting sleep and nap characteristics. Multilevel random-effects models were used to assess the temporal relationship between sleep duration and quality, and nap occurrence and duration (and vice versa). RESULTS: In sum, 64% of the study population took at least one nap over the course of seven days. Poor subjective sleep quality and shorter sleep duration increased the likelihood and duration of next-day napping. No effect of nap occurrence or duration was found on same-day nocturnal sleep duration and quality. However, when considering the timing of nap, afternoon naps, but not morning or evening naps, decreased same-day nocturnal sleep duration. CONCLUSION: Naps seem to compensate for poor subjective sleep quality, and to some extent for short sleep duration. As only afternoon naps reduced same-day nocturnal sleep duration, timing of the daytime nap seems to matter with respect to same-day nocturnal sleep duration.

Cardiovascular health and sleep disturbances in two population-based cohort studies.

OBJECTIVE: We aimed to investigate the association between cardiovascular health (CVH), as defined by the American Heart Association, and several sleep disturbances. METHODS: Two community-based cohorts, the Paris Prospective Study 3 (PPS3, France, n=6441) and the CoLaus study (Switzerland, n=2989) were analysed. CVH includes 7 metrics which all can be classified as poor, intermediate and ideal. Global CVH score was categorised into poor (0-2 ideal metrics), intermediate (3-4 ideal metrics) and ideal (≥5 ideal metrics). Associations between global CVH and self-reported sleep disturbances (proxy of sleep-disordered breathing [SDB], excessive daytime sleepiness, insomnia symptoms and short/long sleep duration) and SDB severity measured by polysomnography (PSG) were investigated. Adjusted OR/relative risk ratio (RRR) and 95% CIs were estimated. Subjects with previous cardiovascular disease were excluded. RESULTS: Compared with poor CVH, subjects with intermediate and ideal global CVH had lower odds of self-reported SDB in both cohorts (ORs 0.55; 95% CI 0.44 to 0.68 and 0.35; 95% CI 0.22 to 0.53, respectively) and had lower SDB severity measured by PSG (RRR 0.07; 95% CI 0.02 to 0.20) in CoLaus. Subjects with intermediate and ideal global CVH had lower odds of excessive daytime sleepiness in PPS3 (ORs 0.82; 0.72 to 0.95 and 0.80; 0.82 to 1.02, respectively). No consistent associations were found between CVH and sleep duration or insomnia symptoms. CONCLUSIONS: Higher levels of CVH are associated with lower odds of SDB and excessive daytime sleepiness. However, causal interpretation cannot be made and associations might be bidirectional.

How Are Sleep Characteristics Related to Cardiovascular Health? Results From the Population-Based HypnoLaus study.

Background Although sleep characteristics have been linked to cardiovascular disease and cardiovascular risk factors, the association between sleep characteristics measured by polysomnography and cardiovascular health ( CVH ) remains unknown. Methods and Results In a population-based sample (n=1826), sleep characteristics were assessed by both sleep questionnaires and polysomnography. Global, behavioral, and biological CVH were defined according to the American Heart Association. Multinomial logistic regressions were performed to estimate relative risk ratios and 95% CI . Strong dose-response associations were found between all oxygen saturation-related variables (oxygen desaturation index, mean oxygen saturation, and percentage of total sleep time spent under 90% oxygen saturation) and obstructive sleep apnea (severity categories and apnea/hypopnea index) and global, behavioral, and biological CVH . Mean oxygen saturation had the strongest positive association (relative risk ratios 1.31 [ CI 1.22-1.41]; 1.78 [ CI 1.55-2.04] for intermediate relative to ideal CVH ), and oxygen desaturation index had the strongest negative association (relative risk ratios 0.71 [ CI 0.65-0.78]; 0.45 [ CI 0.34-0.58] for intermediate relative to ideal CVH ) with global CVH , and these associations were also the most robust in sensitivity analyses. The impacts of sleep architecture and sleep fragmentation were less consistent. Conclusions Mean oxygen saturation, oxygen desaturation index, and apnea/hypopnea index were associated with CVH . Conversely, most variables related to sleep architecture and sleep fragmentation were not consistently related to CVH . Sleep-disordered breathing and the associated oxygen (de)saturation were associated with CVH more strongly than with sleep fragmentation.

Does sleep affect weight gain? Assessing subjective sleep and polysomnography measures in a population-based cohort study (CoLaus/HypnoLaus).

STUDY OBJECTIVES: Although several studies have linked short and long sleep duration to weight gain, mixed results exist. Contrarily, few studies associated objectively measured sleep characteristics with weight gain. We investigated the association between several sleep characteristics measured by questionnaire and polysomnography with prospective weight gain in a population-based, middle-aged cohort. METHODS: Three samples were analyzed: sample 1 (n = 2551, 47.3% men, 56.9 ± 10.3 years) had data for subjective sleep characteristics, sample 2 (n = 1422, 49.4% men, 57.6 ± 10.4 years) had objective sleep assessment (polysomnography), and sample 3 consisting of 1259 subjects included in both samples. Multivariable logistic regressions were performed to assess the relationship between sleep characteristics and ≥5 kg weight gain during a median follow-up of 5.3 years. RESULTS: In both study samples, 12% of the subjects gained ≥5 kg during follow-up. Multivariable analyses showed poor subjective sleep quality (as assessed by Pittsburgh Sleep Quality Index: odds ratio [95% confidence interval] = 1.54 [1.19 to 1.99]), percentage of sleep spent in stage 2 (1.32 [1.10 to 1.58]), and less than 90% oxygen saturation (SpO2 < 90) (1.23 [1.07 to 1.41]); moderate/severe Oxygen Desaturation Index (1.70 [1.01 to 2.85]) and autonomic arousal duration (1.22 [1.02 to 1.45]) were related to ≥5 kg weight gain. Only poor subjective sleep quality was robustly associated with weight gain in all sensitivity analyses, except in female subsamples. CONCLUSIONS: Poor subjective sleep quality, and to some extent moderate to severe oxygen desaturation, but no other sleep characteristics, were robustly associated with weight gain. Future studies should confirm the relationship between sleep quality and weight gain, assess sex differences, and investigate underlying mechanisms.

Effort-Reward Imbalance, Work-Privacy Conflict, and Burnout Among Hospital Employees.

OBJECTIVE: Studies investigating the relative importance of effort-reward imbalance and work-privacy conflict for burnout risk between professional groups in the health care sector are rare and analyses by educational attainment within professional groups are lacking. METHODS: The study population consists of 1422 hospital employees in Switzerland. Multivariate linear regression analyses with standardized coefficients were performed for the overall study population and stratified for professional groups refined for educational attainment. RESULTS: Work-privacy conflict is a strong predictor for burnout and more strongly associated with burnout than effort-reward imbalance in the overall study population and across all professional groups. Effort-reward imbalance only had a minor effect on burnout in tertiary-educated medical professionals. CONCLUSION: Interventions aiming at increasing the compatibility of work and private life may substantially help to decrease burnout risk of professionals working in a health care setting.

Informal caregiving, work-privacy conflict and burnout among health professionals in Switzerland - a cross-sectional study.

INTRODUCTION: Health professionals were found to have an elevated burnout risk compared to the general population. Some studies also reported more emotional exhaustion - a component of burnout - for health professionals with informal caregiving responsibilities for children (double-duty child caregivers) or adults (double-duty adult caregivers) or a combination of both (triple-duty caregivers) compared to health professionals without informal caregiving roles (formal caregivers). However, the potential mediating effect of the work-privacy conflict in this relationship as well as differences between occupational groups have not yet been studied in healthcare settings. AIM: To assess the impact of informal caregiving on burnout risk among health professionals and whether this relationship is mediated by work-privacy conflict or differs between occupational groups. METHODS: Data were collected through an employee survey in six hospitals from German-speaking Switzerland in 2015/2016. Mediation analyses were performed using linear mixed models with fixed effects for caregiving situation and work-privacy conflict as well as random effects for hospitals. RESULTS: Triple-duty caregivers were found to have a significantly higher burnout risk compared to formal caregivers only. Work-privacy conflict did not mediate this relationship, except among the "other health professionals" group. CONCLUSION: Additional and large-scale studies focusing on the combination of formal and informal caregiving roles are needed to better understand its effect on burnout among healthcare professionals and to evaluate the role of work-privacy conflict.