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Summary: Hippocampal atrophy is a prominent neurodegenerative feature of Alzheimer's disease and related dementias. Alterations in circadian rhythms can exacerbate cognitive aging and neurodegeneration. This study aimed to examine how dim light melatonin onset and melatonin levels are associated with hippocampal volume in cognitively healthy individuals. We studied data from 52 later‐life adults (mean age ± SD = 70.0 ± 6.3 years). T1‐weighted anatomical images from 3.0 T magnetic resonance imaging data were collected and processed using the BRAINSTools toolbox. Dim light melatonin onset was used to assess circadian timing. The area under the curve was calculated to quantify melatonin concentration levels 6 hr before bedtime, and 14‐day wrist actigraphy data were used to assess habitual bedtime. Multiple linear regression modelling with hippocampal volume as the dependent variable was used to analyse the data adjusting for age and sex. The average dim light melatonin onset was 19:45 hours (SD = 84 min), and area under the curve of melatonin levels 6 hr before habitual bedtime was 38.4 pg ml−1 × hr (SD = 29.3). We found that later dim light melatonin onset time (b = 0.16, p = 0.005) and greater area under the curve of melatonin levels 6 hr before habitual bedtime (b = 0.05, p = 0.046) were associated with greater adjusted hippocampal volume. The time between dim light melatonin onset and the midpoint of sleep timing was not associated with hippocampal volume. The findings suggest that earlier circadian timing (dim light melatonin onset) and reduced melatonin may be associated with reduced hippocampal volume in older adults. Future research will help researchers utilize circadian rhythm information to delay brain aging. [ABSTRACT FROM AUTHOR]

Ageing and chronic stress have been linked to reduced telomere length (TL) in mixed‐age groups. Whether stress response components are linked to TL during the midlife‐to‐late adulthood transition remains unclear. Our study aimed to synthesise evidence on the relationship between psychological and biological components of stress response on TL in middle‐aged and older adults. We conducted a systematic review of studies obtained from six databases (PubMed, CINAHL, EMBASE, PsycINFO, Web of Science, and Scopus) and evaluated by two independent reviewers. Original research measuring psychological and biological components of stress response and TL in human individuals were included. From an initial pool of 614 studies, 15 were included (n = 9446 participants). Synthesis of evidence showed that higher psychological components of the stress response (i.e., global perceived stress or within a specific life domain and cognitive appraisal to social‐evaluative stressors) were linked to shorter TL, specifically in women or under major life stressors. For the biological stress response, cortisol, dehydroepiandrosterone sulphate and IGF‐1/cortisol imbalance, IL‐6, MCP‐1, blood pressure, and heart rate presented a significant association with TL, but this relationship depended on major life stressors and the stress context (manipulated vs. non‐manipulated conditions). This comprehensive review showed that psychological and biological components of the stress response are linked to shorter TL, but mainly in women or those under a major life stressor and stress‐induced conditions. The interaction between stressor attributes and psychological and biological reactions in the transition from middle to late adulthood still needs to be fully understood, and examining it is a critical step to expanding our understanding of stress's impact on ageing trajectories. [ABSTRACT FROM AUTHOR]

Summary: Sleep behaviour is an important contributing factor in healthy human ageing and cognitive function. Previous studies have linked sleep deficiency with cognitive decline in older adults. However, there is need for more prospective investigations that focus on specific domains of cognitive function. The present study analysed cross‐sectional and prospective associations between self‐reported sleep and cognitive function in the Midlife in the United States (MIDUS) study. Weekday and weekend sleep duration and habitual sleep quality were obtained via questionnaire data. Brief Test of Adult Cognition by Telephone was conducted to assess overall cognitive function, as well as episodic memory and executive function. We found significant trend for both long weekday and weekend sleep (>8 hr) and lower episodic memory scores in the overall sample. Sex‐specific cross‐sectional analysis demonstrated men with longer weekend sleep duration have lower overall cognitive function scores, and a negative association between weekend sleep and episodic memory scores. Women demonstrated a positive association between weekend sleep duration and executive function scores. There was no prospective significance for overall or sex‐specific analysis. Our present results suggest that sleep duration may contribute to cognitive function, and future studies should include objective sleep measurements and focus on the potential cognitive benefits of improving sleep to further elucidate this association. [ABSTRACT FROM AUTHOR]

Objectives: Alzheimer's disease (AD) and related dementias contribute to one in three senior deaths. Lifestyle factors, including sleep, may contribute to AD risk and mortality; however, current evidence on sleep and AD mortality is mixed. Methods: We used data from the NIH-AARP Diet and Health Study. Sleep duration and napping were self-reported and AD death were ascertained via linkage to the National Death Index. Results: Long sleep and napping were both associated with increased AD mortality. Specifically, 9+ hr of sleep was associated with 50% increase (hazard ratio = 1.50, 95% CI = [1.17, 1.92]) in AD mortality when compared 7 to 8 hr, while napping for 1+ hr was associated with 29% increase (1.29 [1.08, 1.55]) when compared with no napping. Results appeared to be stronger in men and remained after removing AD deaths within first 5 years after baseline. Discussion: Long sleep and napping may predict higher AD mortality in the older population. [ABSTRACT FROM AUTHOR]

The purpose of this investigation is to examine differences in rest-activity patterns and sleep characteristics in older adults with heart failure (HF) and healthy older adults. The sample included older adults with HF (n = 20) and a reference group of healthy older adults (n = 20). Traditional cosinor analysis was used to assess three parameters of rest–activity from wrist actigraphy data: amplitude (range of activity), mesor (mean activity), and acrophase (time of peak activity). Traditional sleep characteristics were also determined from actigraphy data: total sleep time (TST), sleep latency (SL), sleep efficiency (SE), and wake after sleep onset (WASO). The HF group demonstrated significantly lower mesor and amplitude than the reference group (p < .01). The HF group had significantly greater TST (p < .01), but the groups had similar SE, SL, and WASO. Despite similar sleep characteristics to healthy older adults, overall rest–activity patterns were significantly dampened in those with HF. [ABSTRACT FROM AUTHOR]

Before completing a nursing PhD program, doctoral students are encouraged to seek out and apply for a position in one of many, often highly competitive postdoctoral programs. These programs include the more traditional National Institutes of Health (NIH) funded experiences, such as the T32, as well as the nontraditional institution funded positions, including the associate faculty role. Graduates often need guidance on which postdoctoral programs are available, the resources each program offers to promote development of the applicant's program of research, the disadvantages of each program, and what each program uses as benchmarks for success. This article summarizes both traditional and nontraditional postdoctoral positions including the T32, F32, F99/K00, T90/R90, research supplements, associate faculty, research associate, and hospital-affiliated postdoctoral positions. This article updates previous papers describing postdoctoral opportunities and offers a starting place to aide PhD students planning their postgraduate activities in seeking and evaluating these positions. [ABSTRACT FROM AUTHOR]

Purpose of the study: Individuals with heart failure (HF) have a high frequency of sleep problems. Patients with HF present with structural brain changes different from normal aging including reductions in brain volume, increases in white matter hyperintensity (WMH) and reduced cerebral blood flow. These structural changes in the brain may explain the pathophysiology of sleep and daytime problems. The objective of this study was to determine whether multimodal imaging data are related to self-reported sleep problems and daytime sleepiness in older adults with HF. Methods: Participants in this study underwent magnetic resonance imaging scans on the General Electric 3.0 T Discovery MR750 to acquire WMH, cerebral blood flow and brain volume. Data on 37 stable HF patients (mean age = 68; SD = 5.75) were included. Results: In this sample, WMH was associated with daytime sleepiness (p = 0.025). However, gray and white matter volume and cerebral blood flow were not associated with daytime sleepiness, sleep quality or insomnia. Conclusion: Although further studies are needed to determine the relationship between WMH and sleep and daytime problems, the findings preliminarily support that increases in WMH from ischemic changes could explain increases in daytime sleepiness among people with HF. [ABSTRACT FROM AUTHOR]

Abstract: Background and purpose: Sleep‐disordered breathing is common in individuals with heart failure and may contribute to changes in the brain and decreased cognition. However, limited research has explored how the apnea‐hypopnea index contributes to brain structure and cognition in this population. The aims of this study were to explore how the apnea‐hypopnea index is associated with brain volume and cognition in heart failure patients. Methods: Data of 28 heart failure patients (mean age = 67.93; SD = 5.78) were analyzed for this cross‐sectional observational study. We evaluated the apnea‐hypopnea index using a portable multichannel sleep‐monitoring device. All participants were scanned using 3.0 Tesla magnetic resonance imaging and neuropsychological tests. Brain volume was evaluated using a voxel‐based morphometry method with T1‐weighted images. We used multiple regressions to analyze how the apnea‐hypopnea index is associated with brain volume and cognition. Results: We found an inverse association between apnea‐hypopnea index scores and white matter volume (β = −0.002, p = 0.026), but not in gray matter volume (β = −0.001, p = 0.237). Higher apnea‐hypopnea index was associated with reduced regional gray and white matter volume (p < 0.001, uncorrected). Cognitive scores were not associated with the apnea‐hypopnea index (p‐values were >0.05). Conclusion: Findings from this study provide exploratory evidence that higher apnea‐hypopnea index may be associated with greater brain volume reduction in heart failure patients. Future studies are needed to establish the relationship between sleep‐disordered breathing, brain volume, and cognition in heart failure samples. [ABSTRACT FROM AUTHOR]

Background: Cognitive decline associated with aging is a growing public health concern as individuals are living longer with chronic medical conditions. Rest activity rhythm (RAR) describes the pattern of physical activity and sleep period in 24 hours. Compared with younger people, older adults are more likely to maintain a sedentary lifestyle with altered RAR. Although there is no doubt that physical activity plays a vital role in health outcomes, little is known about how RAR is linked to cognitive functioning in late life. This study investigated the association between RAR and cognitive performance among older adults. Method: Sixty community dwelling older adults aged 70±7.3 years (mean ± standard deviation) wore Phillips actigraphy spectrum plus 2 for two weeks. RAR parameters were analyzed using cosinor approach, such as amplitude (difference between the peak and lowest activity levels), mesor (mean activity level), pseudo‐F‐statistic (the robustness of RAR), and acrophase (peak activity time). A comprehensive neuropsychological battery was used to assess cognition (i.e., Brief Visuospatial Memory Test – Revised (BVMT‐R), California Verbal Learning Test – II, Boston Naming Test, Wechsler Adult Intelligence Scale‐IV Coding, and Trail Making Test A and B). Multiple linear regression models were built to explore associations between different RAR measures and each cognitive task adjusting for age, gender, and years of education. Result: We found positive associations between RAR amplitude (p = 0.01), mesor (p = 0.008), acrophase (p = 0.006), pseudo F‐statistic (p = 0.002) and visual memory (BVMT‐R). Similarly, positive associations were found between amplitude (p = 0.006), mesor (p = 0.005), acrophase (p = 0.005), pseudo F‐statistic (p = 0.002) and psychomotor processing speed (Coding). Greater pseudo‐F statistics were associated with stronger performance on naming (BNT); p = 0.03). No association was found between RAR and other cognitive tasks. Conclusions: Our findings provide evidence that some RAR characteristics are associated with cognitive performance among older adults, particularly visual memory, psychomotor processing speed, and naming ability. Further research should be undertaken using a large and diverse sample, prospective design, and inclusion of potentially confounding variables to confirm those associations. [ABSTRACT FROM AUTHOR]

Background: Physical activity is a modifiable behavioral factor that could delay the development of Alzheimer's disease. Although metabolites detected in the brain correspond to neuronal integrity and neurodegenerative pathologies, we do not clearly understand the effect of physical activity interventions on brain metabolites. The purpose of this systematic review and meta‐analysis was to assess the effect of physical activity on brain metabolites measured by magnetic resonance spectroscopy (MRS). Methods: A systematic search was performed in PubMed, Embase, Web of Science and CINAHL from database inception to November 2022. Eight studies were integrated into the final systematic review and meta‐analysis. Results: Among included studies, 5 of the studies were randomized control designs, 1 study was an observational longitudinal study, 1 study was an observational cross‐sectional design, and 1 study was a case‐control design study. These studies involved 312 participants with mean age from 23 to 72. Physical activity interventions included cycling, running, and yoga. We found multiple metabolites are associated with physical activity including Myo‐inositol, choline (Cho), N‐acetyl aspartate (NAA), creatine, glutamate, and glutamine. The brain areas studied in reviewed articles included the hippocampus, frontal, occipital, or thalamus. From the quantitative synthesis, NAA/ Cho was higher in the physical activity group (effect size (ES) = ‐0.30, p = 0.03) than in the control group. However, for NAA (ES = ‐0.22, p = 0.08) and NNA/Cr (ES = 0.03, p = 0.07), the difference between the physical activity group and the control group was not statistically significant. Conclusion: Evidence shows that there have been attempts to understand the relationship between physical activity and metabolites. The meta‐analysis demonstrates physical activity may affect changes in NAA/Cho. However, caution needs to be accompanied when interpreting the direct association between physical activity and different brain metabolites due to insufficient data, publication bias, and heterogeneity. [ABSTRACT FROM AUTHOR]

Background: Hippocampal atrophy is one of the prominent neurodegenerative features of Alzheimer's disease and related dementias. Alterations in circadian rhythms and 24‐hour rest activity rhythms can exacerbate cognitive aging and neurodegeneration. The aim of this study was to examine how 24‐hour rest activity rhythms and circadian rhythms are associated with hippocampal volume. Method: We studied 61 older adults' data (mean age±SD = 70.0±7.2). T1‐weighted anatomical images from 3T MRI data were collected and processed using the BRAINSTools toolbox. Hippocampal volume was divided by intracranial volume (ICV). Dim light melatonin onset (DLMO) was used to assess circadian timing. Area under the curve (AUC) was calculated based on melatonin levels 6 hours prior to the bedtime. 10‐day actigraphy data assessed 24‐hour rest activity rhythms. Multiple linear regression was used to develop a model for hippocampal volume, controlling for age and sex. Additional covariates (i.e., depressive symptoms, hypertension, coronary artery disease, handedness, and ICV) and moderating effects of age and sex were examined. Result: Acrophase was positively associated with hippocampal volume (b = 0.12, p =.016). Interaction between mesor and age (b = ‐1.22, p =.006) indicated that positive effect of mesor (b = 8.58, p =.007) on hippocampal volume decreased with age. Advanced DLMO time (b = 0.16, p =.005) and greater AUC/10 (b = 0.05, p =.046) were associated with increased hippocampal volume. Amplitude and Pseudo‐F‐Statistics were not associated with hippocampal volume. Conclusion: The findings indicate delayed peak activity time (acrophase), delayed circadian timing (DLMO), and greater mesor and melatonin (AUC) were associated with increased hippocampal volume. The effect of mesor decreased with age. Future studies using larger sample sizes and prospective designs are needed to better understand the relationships. [ABSTRACT FROM AUTHOR]

Background: Alzheimer's disease (AD) is the most common form of dementia afflicting more than 5.8 million older adults in the United States. In AD, cognitive decline and neuropsychiatric symptoms are more pronounced in those who have chronic conditions. These chronic conditions often co‐occur with other chronic conditions, known as multiple chronic conditions (MCCs). This study aimed to examine the longitudinal association between the number of chronic conditions with cognition and neuropsychiatric symptoms by cognitive status. Methods: Participants were 21,219 community dwelling individuals from the longitudinal National Alzheimer's Coordinating Center (NACC, U24 AG072122) database (mean age = 71.8 ± 9.8; 42.8% male). Participants completed a medical history interview, cognitive assessment, and the Neuropsychiatric Inventory (NPI), approximately every two years over a 15‐year period. Number of MCCs was characterized as the sum of clinician‐diagnosed chronic conditions (i.e., cardiovascular, metabolic, sleep, respiratory, and psychological conditions;range 0‐18). The analysis focused on memory (Craft Story 21 recall immediate and delayed), processing speed (Trails A), and executive function (Trails B, Coding, animal naming). We used mixed effect models to test whether the number of MCCs was associated with a change on each cognitive test and number neuropsychiatric symptoms by clinician diagnosed cognitive status (i.e., normal cognition, mild cognitive impairment (MCI) presumed AD etiology, MCI presumed without AD etiology, MCI with AD etiology, dementia with AD etiology, dementia with non‐AD etiology). Results: We found that the mean number of chronic conditions were, 2.2 ± 1.8 in cognitively normal individuals, 2.8 ± 2.0 in MCI with AD etiology, 2.8 ± 2.0 in MCI with non AD etiology, 2.7±1.9 in dementia with AD etiology, 3.0±2.1 in dementia with non‐AD etiology. Compared to cognitively normal adults, individuals with more severe cognitive impairment (i.e., groups with dementia) and a higher number of MCCs demonstrated greater decline in immediate and delayed memory recall, Trails A, animal naming, and coding (p <0.05), as well as the number of neuropsychiatric symptoms (p <0.05) over time accounting for age, sex, and education. Conclusion: The findings suggest that having a higher number of chronic conditions is associated with longitudinal decline in cognition and neuropsychiatric symptoms. [ABSTRACT FROM AUTHOR]

Background: Amyloid β(Aβ) accumulation is a hallmark of the progressive neurodegenerative Alzheimer's Disease (AD). Disruptions in sleep beyond aging are found to be risk factors of developing AD because sleep may involves in Aβ level regulations, neurotoxin clearance, or inflammation process. Sleep disruptions can be defined by shorter sleep duration and lower sleep efficiency. This systematic review examines how sleep duration and efficiency are associated with amyloid deposition in later life adults. Method: We screened 3,122 published articles searched from electronic databases (i.e., PubMed, CINAHL, Embase, and PsycINFO) and used 14 articles for the qualitative synthesis. All articles met the eligibility criteria including published articles that contain sleep duration and efficiency measure, Aβ measure, human studies with cognitively normal older adults who are 50 and above. Result: Studies were conducted in the United States, Italy, South Korea, China, and Australia. Of the 14 studies included, 12 used a cross‐sectional design and 2 used a longitudinal design. Sample sizes ranged from 13 to 4,772. Ages of the samples ranged from 50 to 85. Studies measured Aβ using cerebrospinal fluid, serum, and Positron Emission Tomography (PET) scans with two different tracers: C‐labeled Pittsburgh compound B or fluorine 18–labeled (18F). Sleep duration and efficiency were subjectively measured using interviews and questionnaires, or objective measures, such as polysomnography or actigraphy. Studies accounted for demographic and lifestyle factors in their analyses, such as age, sex, family history, sleep, habitual alcohol consumption, slow wave sleep, apnea hypopnea index, exercise, fasting glucose, and triglycerides. Only 3 of the 14 studies indicated that sleep duration was associated with Aβ accumulation, and 4 of the studies revealed that sleep efficiency was associated with Aβ accumulation. Conclusion: This review suggests that previous studies have provided mixed evidence regarding the relationship between sleep duration and Aβ or the relationship between sleep efficiency and Aβ. Not all studies used a sufficient sample size or a comprehensive measurement of sleep. These results indicate the need for more future studies using a longitudinal design, comprehensive sleep measure, and larger sample sizes to advance understanding the relationship between sleep and Aβ. [ABSTRACT FROM AUTHOR]

Intra-aortic balloon pumping increases myocardial oxygen supply and decreases myocardial oxygen demand by inflation and deflation of the balloon. This leads to increased perfusion of the coronary arteries during diastole. This technology has been used for critically ill cardiac patients for more than 30 years. The literature suggests that preoperative use of an intra-aortic balloon pump can be effective in high-risk coronary artery bypass grafting patients. Preoperative benefits of this technology may yield positive outcomes in terms of hemodynamic effect, decreased length of stay in both the intensive care unit and the hospital, and the reduction of complications. However, the intra-aortic balloon pump must be used with a profound understanding of proper mechanism and function, monitoring, and observation for potential complications. This requires excellent critical care nursing management. [ABSTRACT FROM AUTHOR]

Summary The accurate estimation of circadian phase in the real‐world has a variety of applications, including chronotherapeutic drug delivery, reduction of fatigue, and optimal jet lag or shift work scheduling. Recent work has developed and adapted algorithms to predict time‐consuming and costly laboratory circadian phase measurements using mathematical models with actigraphy or other wearable data. Here, we validate and extend these results in a home‐based cohort of later‐life adults, ranging in age from 58 to 86 years. Analysis of this population serves as a valuable extension to our understanding of phase prediction, since key features of circadian timekeeping (including circadian amplitude, response to light stimuli, and susceptibility to circadian misalignment) may become altered in older populations and when observed in real‐life settings. We assessed the ability of four models to predict ground truth dim light melatonin onset, and found that all the models could generate predictions with mean absolute errors of approximately 1.4 h or below using actigraph activity data. Simulations of the model with activity performed as well or better than the light‐based modelling predictions, validating previous findings in this novel cohort. Interestingly, the models performed comparably to actigraph‐derived sleep metrics, with the higher‐order and nonphotic activity‐based models in particular demonstrating superior performance. This work provides evidence that circadian rhythms can be reasonably estimated in later‐life adults living in home settings through mathematical modelling of data from wearable devices. [ABSTRACT FROM AUTHOR]

Background: Amyloid β (Aβ) is a hallmark of Alzheimer's disease (AD). Insufficient sleep duration and poor sleep quality have been found to be a risk factor of developing AD because sleep may involve regulating Aβ. However, the magnitude of the relationship between sleep duration and Aβ is still unclear. This systematic review examines the relationship between sleep duration and Aβ in later-life adults., Methods: We screened 5,005 published articles searched from relevant electronic databases (i.e., PubMed, CINAHL, Embase, and PsycINFO) and reviewed 14 articles for the qualitative synthesis and 7 articles for the quantitative synthesis., Results: Mean ages of the samples ranged from 63 to 76. Studies measured Aβ using cerebrospinal fluid, serum, and positron emission tomography scans with two tracers: Carbone 11-labeled Pittsburgh compound B or fluorine 18-labeled. Sleep duration was subjectively measured using interviews, questionnaires, or using objective measures such as polysomnography or actigraphy. The studies accounted for demographic and lifestyle factors in their analyses. Five of the 14 studies reported a statistically significant association between sleep duration and Aβ. Using seven eligible articles, our quantitative synthesis demonstrated that the average association between sleep duration and Aβ was not statistically significant (Fisher's Z = -0.006, 95% CI= -0.065 ~ 0.054)., Conclusion: This review suggests that caution should be taken when considering sleep duration as the primary factor for Aβ levels. More studies are needed using a longitudinal design, comprehensive sleep metrics, and larger sample sizes to advance our understanding of the optimal sleep duration and AD prevention., Competing Interests: Competing interests The authors have no potential conflicts of interest to disclose.

Study Objectives: The purpose of this study was to conduct a comprehensive assessment of sleep and circadian rhythms in individuals with and without coronary artery disease (CAD)., Methods: This was a cross-sectional study. Participants were 32 individuals, mean age = 70.9, female 46.9%, 19 with CAD, and 13 without CAD. We assessed sleep quality and 24-hour rest-activity rhythms for 14 days using wrist actigraphy and self-report measures, and circadian rhythm using dim light melatonin onset., Results: Melatonin levels prior to habitual bedtime were significantly lower in individuals with CAD than in those without CAD (median area under the curve = 12.88 vs 26.33 pg/ml × h, P = .049). The median circadian timing measured by dim light melatonin onset was the same for the 2 groups with 20:26 [hours:minutes] for individuals with CAD and 19:53 for the control group ( P = .64, r = .14). Compared to the control group, the CAD group had significantly lower amplitude ( P = .03, r =-.48), and lower overall rhythmicity (pseudo- F -statistic P = .004, r = -.65) in their 24-hour rest-activity rhythms., Conclusions: This is one of the first studies to comprehensively assess both sleep and circadian rhythm in individuals with CAD. Compared to non-CAD controls, individuals with CAD had lower levels of melatonin prior to habitual bedtime and a lower 24-hour rest-activity rhythm amplitude and overall rhythmicity. Future studies using larger sample sizes should further investigate the possibility of suppressed circadian rhythmicity in individuals with CAD., Citation: Moon C, Benson CJ, Albashayreh A, Perkhounkova Y, Burgess HJ. Sleep, circadian rhythm characteristics, and melatonin levels in later life adults with and without coronary artery disease. J Clin Sleep Med . 2023;19(2):283-292., (© 2023 American Academy of Sleep Medicine.)

Disturbed sleep and daytime sleepiness may interfere with possible direct relationships between heart failure (HF) and cognition, yet there is limited research investigating this relationship. We aimed to investigate possible mediating roles of disturbed sleep and daytime sleepiness on the relationship between HF and selected cognitive domains among individuals with and without HF. In a cross-sectional design study, we examined the data of 841 older adults with and without HF from the Aging, Demographics, and Memory Study (ADAMS). We found individuals with HF were likely to have a higher degree of disturbed sleep and daytime sleepiness. Both disturbed sleep and daytime sleepiness were significant predictors of cognition. We found that only daytime sleepiness mediated the relationship between the presence of HF and cognitive domains, such as in attention, memory, and executive function after controlling for covariates. Interventions to improve daytime sleepiness among individuals with HF may also help improving cognition.

Purpose/objectives: Sleep-related breathing disorders (SRBDs), including obstructive sleep apnea and central sleep apnea, are common among patients with cardiovascular disease (CVD), but clinicians often do not pay enough attention to SRBDs. The purpose of this narrative review is to update advanced practice registered nurses on the literature focusing on the relationship between SRBDs and CVD (eg, hypertension, heart failure, coronary artery disease, arrhythmias, and stroke) and on treatments that can improve SRBDs in patients with CVD., Description of the Project: We conducted an electronic search of the literature published between 1980 and 2016 from PubMed, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Academic Search Premier, and related health resource Web sites to address the aims of this study., Outcomes: Fifty-six primary research articles (42 observational studies and 14 experimental and quasi-experimental studies) were selected based on our study aims and inclusion criteria. The studies revealed that individuals with CVD are at a greater risk for SRBDs and that SRBDs can worsen CVD. The findings from the studies also suggest that positive airway treatment could improve both SRBDs and CVD., Conclusions: This review found a close relationship between SRBDs and CVD. Advanced practice registered nurses are in key positions to identify and help patients manage SRBDs. In particular, advanced practice registered nurses can educate staff and establish standards of practice to improve outcomes for patients with CVD.