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Aim: Insomnia is associated with cardiovascular disease (CVD), particularly the phenotype with objective short sleep duration and associated physiological arousal. However, what objective sleep and arousal characteristics among patients with insomnia are related to markers of cardiovascular structure and function remains unknown. The present study examined the association of objective sleep metrics and self-reported arousability with arterial stiffness, endothelial function, and left ventricular function among patients with insomnia disorder. Methods: Sixteen young, healthy adults (age: M [ SD ]=30[7]; 56.3% women) meeting diagnostic criteria for insomnia disorder and reporting no history of CVD, underwent fasting vascular testing including carotid-femoral pulse wave velocity (cfPWV) to assess arterial stiffness (SphymocorXCEL TM ), brachial-artery flow mediated dilation (FMD) to assess endothelial function, and 2D echocardiography to assess left ventricular function (Terason uSmart 3300 TM ). Left ventricular function was assessed by ejection fraction (EF), global longitudinal strain (GLS), mitral valve E/e’ (MVE/e’), and lateral e’ using standardized methods. Ten participants wore a portable sleep monitor for 1 night (WatchPat200, Itamar Medical) and an actigraph for 8 nights (Actiwatch Spectrum Plus, Philips Respironics). All participants completed the Pre Sleep Arousal Scale (PSAS; somatic & cognitive subscales), and the Arousal Predisposition Scale (APS). Bivariate correlations and curvilinear regressions (total sleep time [TST] only) were conducted for the associations between actigraphy-assessed TST and WatchPat (WP) TST, actigraphy-assessed mean bedtime, and PSAS and APS scores with cardiovascular markers. Each set of one sleep metric with all six cardiovascular markers were Bonferroni corrected (α level: p Results: On average, participants obtained 7h,9min of TST (range: 6h,26min - 8h,41min) and went to bed at 23:40 (range:21:47-2:13) via actigraphy, and slept 6h,51min via WP. Mean PSAS Somatic, PSAS Cognitive, and APS scores were 13.7(SD=4.5), 24.5(SD=7.5), and 27.9(SD=7.6), respectively. cfPWV (range:4.6-8.0), EF% (range:55.0-70.9), GLS% (range:-25- -19), and MVE/e’ (range:3.6-13.3) were all within age and sex normative ranges. Mean FMD was 7.8% (SD=2.6, range:4.4-14.6), and lateral e’ was 15 cm/s (SD=4.5, range:9-22). Correlations indicated that greater PSAS cognitive scores were related to worsening (less negative) GLS% ( r =0.77, p =0.001), later bedtimes were associated with lower lateral e’ ( r =-0.84, p =0.004), and shorter WPTST was associated with lower EF% (r=0.84, p=0 . 002). Conclusion: Among young adults with insomnia disorder, greater cognitive arousal, later bedtimes, and shorter objective total sleep time were associated with subclinical worsening of left ventricular strain, diastolic and systolic function.

Aim: Few studies have examined the association between objective sleep metrics and arterial and echocardiographic (left ventricular systolic/diastolic function) markers of sub-clinical cardiovascular disease (CVD). The present study examined the association of wrist actigraphy-assessed sleep metrics with arterial stiffness, endothelial dysfunction, and left ventricular systolic/diastolic function. Methods: Fifteen young, healthy adults (21-39y; 60% women) with no history of CVD, and no current sleep-disordered breathing (WatchPat200, Itamar Medical) or sleep complaints wore Actiwatch Spectrum Plus actigraphs for eight nights (Philips Respironics, Bend OR) with accompanying sleep logs. Participants underwent fasting vascular testing including central augmented aortic pressure (AP), carotid-femoral pulse wave velocity (cfPWV) to assess arterial stiffness (SphymocorXCEL TM ), brachial artery flow mediated dilation (FMD) to assess endothelial function, and 2D echocardiography to assess left ventricular function (Terason uSmart 3300 TM ). Left ventricular function was assessed by ejection fraction (EF%), left atrial volume index (LAVI), deceleration time (DT), and mitral valve E/e’ ratio (MVE/e’) using standardized methods. Bivariate correlations investigating the association between mean total sleep time (TST), sleep efficiency % (SE), sleep-onset latency (SOL), and wake after sleep time (WASO) with cardiovascular indices were conducted. Curvilinear regression models examining quadratic relationships between TST and the cardiovascular indices were conducted. Results: On average, participants obtained 6 hrs 44 min of TST (SD=29.1), with 86.0% SE (SD=3.1), 10.6 min SOL (SD=8.5), and 37.0 min WASO (SD=11.6). cfPWV (range: 4.8-7.5), EF% (range: 60.0-72.0), LAVI (range: 15.0-26.7 mL/m 2 ), and MVE/e’ (range: 3.2-7.8) were all within normal ranges according to age and sex normative standards. Mean FMD was 9.2% (SD=4.62, range: 4.3-19.8). Correlations indicated that greater SOL was associated with greater cfPWV (r=.63, p=0.01), and AP (r=.57, p=0.03). Lower SE (r= -.70, p=0.003) and higher WASO (r=.71, p=0.003) were associated with higher MVE/e’. WASO was associated with higher DT (r=.57, p=0.04). Curvilinear regression models revealed a quadratic relationship between TST and cfPWV (F[2,11]=9.78, p=0.004) such that shorter and longer TST were associated with greater cfPWV. No sleep metrics were associated with FMD, EF%, or LAVI. Conclusions: Among normal sleeping, apparently healthy young adults, with no history of CVD, lower levels of objective sleep quality and both shorter and longer sleep duration were associated with greater arterial stiffness, whereas only lower levels of objective sleep quality were related to worsening left ventricular diastolic dysfunction. These data may have implications for CVD risk reduction in young, healthy adults.

The objective of the study is to examine the 90-day readmission rate and identify the predictors for 90-day readmissions at a geriatric ward in a tertiary hospital in Singapore. A secondary analysis of case–control data was performed. Data of patients discharged from a geriatric ward between January 2015 and January 2016 were retrieved from an existing data set. Out of 564 index admissions involving older adults, the 90-day geriatric readmission rate was 10.1%. Activities of daily living dependency (odds ratio [OR]: 0.988, 95% confidence interval [CI]: [0.978, 0.999]) and living with the spouse (OR: 2.988, 95% CI: [1.388, 6.432]) were identified as significant predictors of 90-day geriatric readmissions. The study suggests that rehabilitation to restore the geriatric patient’s ability to perform daily activities and adequate caregiver training for the spouse are essential in reducing geriatric readmissions. Also, postdischarge follow-up with both the patient and caregiver can greatly reduce the risk of readmission in geriatric patients.

Introduction Insomnia is a novel and modifiable risk factor for incident cardiovascular disease (CVD). However, identification of early markers of subclinical CVD in diagnosed insomnia is understudied. Our aim for this ongoing study is to contrast markers of cardiovascular structure and function between people with insomnia and good-sleeping controls. Methods Persons with insomnia (met ICSD-III criteria) and good sleeping controls ( Results AP (range:-5,10mmHg), cfPWV (range: 4.8-7.6m/s), EF% (range:55.0-72.0%), LVGLS (range:-26,-19%) LAVI (range:14.1-26.7mL/m2), E/e’ (range:3.2-7.8), and lateral e’ (range:0.09-0.22cm/sec) were all within normal ranges according to age and sex normative standards. Mean FMD was 8.8% (SD=4.3, range:4.3-19.8%). Age adjusted ANCOVA models indicated that the insomnia group had significantly worse cardiovascular function than good sleeping controls on cfPWV (M=6.8±0.3 vs. M=5.7±0.2; p=0.004), EF% (M=60.0±1.7 vs. M=65.2±1.0; p=0.017), LVGLS (M=-21.6±0.6 vs. M=-24.3±0.4; p=0.001), and lateral e’ (M=0.12±0.01 vs. M=0.18±0.01; p=0.003). No group differences were found for AP, FMD, LAVI, and E/e’. Conclusion Among relatively healthy young adults, people with insomnia had greater arterial stiffness and worse left ventricular systolic and diastolic functioning. Support American Academy of Sleep Medicine Foundation Focused Projects Award for Junior Investigators 179-FP-18

Objective To investigate diet adherence, medication adherence and self-care behaviour among patients with chronic heart failure (CHF) in a multi-ethnic society and identify the significant factors associated with their diet and medication adherence. Methods A cross-sectional descriptive correlational study was conducted with a convenience sample of 107 patients with CHF recruited from two cardiology wards of a public tertiary hospital in Singapore. Study variables were measured using the Dietary Sodium Restriction Questionnaire, the Medication Adherence Rating Scale-5 items and the European Heart Failure Self-care Behaviour Scale-12 items. Results Our sample reported positive attitudes towards diet adherence, poor self-care behaviour, and good medication adherence. The multiple linear regression results indicated that lower income, Chinese ethnicity, diabetic complications, current smoking, lower New York Heart Association classification I and II, and poorer self-care behaviour predicted poorer diet adherence. In addition, absence of hypertension, having non-myocardial infarction as a cause of CHF, and moderately diminished ejection fraction were identified as significant predictors of poorer medication adherence. Conclusion The findings from this study have established the need to improve current education and rehabilitation programmes for patients with CHF by addressing those factors significantly influencing their adherence to diet and medication.

To review the evidence and determine the effectiveness of smartphone-based self-management interventions on self-efficacy, self-care activities, health-related quality of life, glycated hemoglobin, body mass index (BMI), and blood pressure (BP) levels of adults with type 2 diabetes mellitus .A systematic search of five databases (PubMed, Embase, Cochrane, CINAHL and Scopus) was conducted. Studies published in English from January 2007 to January 2018 were considered. Only randomized controlled trials (RCTs) of smartphone-based self-management interventions for patients with type 2 diabetes mellitus that reported any of the study outcomes were included. Two reviewers independently screened the studies, extracted data and assessed the quality of the studies. Meta-analyses were conducted for the different study outcomes.A total of 26 articles, consisting of 22 studies with 2645 participants, were included in the review. The results from meta-analysis on the studies revealed that as compared to control group, participants received smartphone-based self-management intervention had better self-efficacy with large effect size of 0.98 (P 0.001), self-care activities with effect size of 0.90 (P 0.001), health related quality of life with effect size of 0.26 (p=0.01), and lower glycated hemoglobin (pooled MD=-0.55; p0.001). Subgroup analyses were also conducted for self-efficacy as significant heterogeneity was present among the studies. The effects on BMI and BP were not statistically significant.Smartphone-based self-management interventions appear to have beneficial effects on self-efficacy, self-care activities and health-relevant outcomes for patients with type 2 diabetes mellitus. However, more research with good study design is needed to evaluate the effectiveness of smartphone-based self-care interventions for T2DM.

Background Besides physical and mental changes from childbirth, first-time mothers are also confronted with challenges associated with the demands of adapting to their roles as new parents. While positive effects of home-based psychoeducation intervention for mothers have been demonstrated, limited studies have developed and examined more accessible and cost-effective web-based psychoeducational interventions for mothers. Objective To examine the effectiveness of web-based and home-based postnatal psychoeducational interventions for first-time mothers during the early postpartum period. Methods A randomized controlled three-group pre-test and post-tests experimental design was adopted. Data were collected over five months, from October 2016 to August 2017, in a public tertiary hospital in Singapore from 204 primiparas who were randomly allocated to the web-based psychoeducation group, the home-based psychoeducation group, or the control group. The measured outcomes included maternal parental self-efficacy, social support, psychological well-being, satisfaction with postnatal care, and cost-effectiveness evaluation. Data were collected at four time points: the baseline, and three post-tests at one month, three and six months post-delivery. Results When compared to the control group, the web-based intervention improved self-efficacy at post-test 1 (mean difference = 2.68, p = 0.028) and reduced postnatal depression at post-test 3 (mean difference = −1.82, p = 0.044), while the home-based intervention did not show significant effect on these two outcomes at all post-tests. Both web-based and home-based interventions helped mothers to get better social support at all post-tests than those in the control group. Mothers in both web-based and home-based intervention groups were more satisfied with the postnatal care than those in the control group at all post-test time points (except for web-based group at post-test 1). There were no differences in anxiety scores among the three groups. When compared to the home-based intervention, the web-based intervention showed noninferior effect on all outcomes at all post-tests. Conclusion The web-based intervention had better effects on improving self-efficacy, social support, and postnatal depression, which should be introduced to first-time mothers for better postnatal care.

Background: In addition to recuperating from the physical and emotional demands of childbirth, first-time mothers are met with demands of adapting to their social roles while picking up new skills to take care of their newborn. Mothers may not feel adequately prepared for parenthood if they are situated in an unsupported environment. Postnatal psychoeducational interventions have been shown to be useful and can offer a cost-effective solution for improving maternal outcomes. Objective: The objective of this study was to examine the effectiveness and cost-effectiveness of Web-based and home-based postnatal psychoeducational programs for first-time mothers on maternal outcomes. Methods: A randomized controlled three-group pre- and posttests experimental design is proposed. This study plans to recruit 204 first-time mothers on their day of discharge from a public tertiary hospital in Singapore. Eligible first-time mothers will be randomly allocated to either a Web-based psychoeducation group, a home-based psychoeducation group, or a control group receiving standard care. The outcomes include maternal parental self-efficacy, social support, psychological well-being (anxiety and postnatal depression), and cost evaluation. Data will be collected at baseline, 1 month, 3 months, and 6 months post-delivery. Results: The recruitment (n=204) commenced in October 2016 and was completed in February 2017, with 68 mothers in each group. The 6-month follow-up data collection was completed in August 2017. Conclusions: This study may identify an effective and cost-effective Web-based postnatal psychoeducational program to improve first-time mothers’ health outcomes. The provision of a widely-accessed Web-based postnatal psychoeducational program will eventually lead to more positive postnatal experiences for first-time mothers and positively influence their future birth plans. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 45202278; http://www.isrctn.com/ISRCTN45202278 (Archived by WebCite at http://www.webcitation.org/6whx0pQ2F).