Link Between Sleep Deprivation/Apnea and Cardiovascular Diseases

1.     
Introduction

            The focus of this essay is to critique
two research papers acquired through a systematic literature search evaluating
the link between sleep deprivation or apnea and cardiovascular diseases. The critique
will include one quantitative and one qualitative research paper on the
influence of sleep disturbance on cardiovascular health. Articles will be
retrieved from PsychINFO, MEDLINE, and CINAHL databases. The critique will
follow Holland and Rees (2010) frameworks for both qualitative and quantitative
articles. The contribution to theory and practice and the strengths and
weaknesses of both articles will be used to inform the discussion critique. A
conclusion on the overall process will be made to determine the success rate.

1.  Literature search
2. Literature Research Question

            The literature research question
will follow the PEO structure. According to Butler, Hall and Copnell (2016),
this structure includes a population (P) of the research targets to
investigate. The adult population is most affected by cardiovascular diseases.
Besides, they are prone to busy schedules and psychological disorders that may
expose them to sleep apnea or deprivation. Therefore, the adult population will
be investigated to determine whether sleep apnea increases or reduces the
chances of contracting cardiovascular diseases as Mukherjee et al. (2015)
opines. Exposure (E), on the other hand, displays the cause of the condition
under study. In this case, the exposure is sleep apnea or deprivation which
affects the cardiovascular functioning. The outcome (O) of the exposure for the
target population, in this case, is the cardiovascular diseases. Therefore, the
literature search question is framed as follows:

Among adults
(P), is there a connection between sleep apnea/deprivation (E) and
cardiovascular diseases (O)?

1. Databases

            PsychINFO, MEDLINE and CINAHL are
the databases used to conduct the research. PsychINFO is a psychology database rich
in mental illness information. The site gives access to various articles
relating to mental disorders and their impact on overall health and other
related diseases. These databases also enable access to peer-reviewed articles
with reliable information for medical research. MEDLINE, on the other hand, is
a medical-related database. Articles stored in the database include all health
conditions, their causes, effects, preventive and treatment measures.
Therefore, MEDLINE will enable the researcher to retrieve information on the
relationship between sleep apnea/deprivation and cardiovascular diseases from a
general perspective. CINAHL database is a definitive tool for medical, clinical
and healthcare research. It provides full access to top journals in a more convenient
and easier way. MEDLINE and CINAHL specialize in allied health and nursing,
while PsycINFO offers social, behavioral, and social sciences content. The
content found in these databases is updated constantly to ensure there is a
pool of resources to use in research and that studies are based on the latest
emerging trends in healthcare (Makaza 2012).
Finally, it is possible to access the databases from the university library
portal, which makes the research efficient and cost-effective.

1. Key Search Terms

            Key search terms for the literature
include sleep apnea/deprivation, cardiovascular diseases, physical exercise,
and trials or RCTs. Sleep apnea, which is the exposure mechanism, was used in
the research as one of the key terms. Cardiovascular diseases, on the other
hand, is the expected outcome of the exposure. The two terms must be used in
the research to ensure the results retrieved are valid and relevant to the
topic of study. The boolean operator, AND is used between the two terms to
combine the keywords to obtain productive and focused results. Physical
exercises appear in the search terms as a solution to sleep apnea/deprivation,
and hence reduction of cardiovascular disease prevalence. The boolean operator,
AND is also used in both cases to combine physical exercises with the two key
words already employed. Inclusion of RCTs OR trials, on the other hand, shows
exclusion. This implies that the result can be either a clinical trial or RCT.
Question mark (?) truncation was used while keying in the research question to
indicate that the search aims at informing or rather retrieving a solution to
the content under study.

1. Literature Search Results

            Table 1 below shows various search
words and filters used to retrieve up to date and valid information for the
literature search. Filters were employed to ensure the literature falls within
5 years and their full-text presentations can be accessed to facilitate
information gathering. The search results are as shown below.

Table 1

Keywords: PsychINFO MEDLNE CINAHL (sleep apnea/deprivation AND cardiovascular diseases AND physical exercises) 411,000,000

AND importance 112,000

AND reduce 101,000

AND RCTs OR trials 59,100

Filters: 2015-2020 18,000

Filters: full text

• Literature Selection

            The selection of the two papers for
analysis is based on content, date of release, and type of study (Jimeno Yepes and Verspoor 2014). On the basis of
content, one of the papers covers the connection between sleep deficiency and
cardiovascular diseases, while the other includes the link between sleep apnea
and cardiovascular diseases. This implies that all the areas of interest are
covered by selecting the two articles. The date of release is also important as
causes of cardiovascular diseases are ever-changing, and thus it’s important to
use the most recent literature to uphold the study’s validity and relevance.

            For the critique, two articles were
selected. The qualitative research article is “Rangaraj and Knutson (2016)
Association between sleep deficiency and cardiometabolic disease: implications
for health disparities”. The article is preferred because it’s based on a
review of literature from experimental and observational studies. The
quantitative research article, on the other hand, is Carroll et al.’s (2015) “Improved
sleep quality in older adults with insomnia reduces biomarkers of disease risk:
pilot results from a randomized controlled comparative efficacy trial” because
it is a randomized clinical trial and its variables can be quantified (Barczak, 2015). Table 2 below shows the selection
process adopted.

Table 2

Keywords: sleep apnea OR sleep deprivation And cardiovascular diseases

AND Causes

AND reduce

AND Importance

AND And trials OR RCTs

• Article Critique
• Qualitative Research Article Critique

The qualitative
article under critique is “Rangaraj, V. and Knutson, K., 2016. Association between
sleep deficiency and cardiometabolic disease: implications for health
disparities. Sleep Medicine, 18,
pp.19-35.”

The major concern of the article is developing an understanding
of the relationship between sleep deficiency and cardiometabolic disease, while
focusing on the implications for the disparities in health. The study is
important for research because, from experiments, sleep deprivation has been found
to cause low insulin sensitivity, appetite regulation and immune system
alterations linked to diabetes, obesity and cardiovascular disease incidents
(Baboli et al. 2015; Cappuccio and Miller 2017; Clark and Landolt 2017).

            To show that the topic is worthwhile
as guided by McIltrot (2018), the researcher highlights that cardiometabolic
diseases such as cardiovascular disease, hypertension, diabetes, and obesity
reduce life expectancy and the quality of life. Also, disparities such as
socioeconomic and ethnic/racial differences have been linked to diseases with
prevalence among Hispanics, African Americans, and individuals of lower
socioeconomic status. The researcher also points out that previous literature
has determined the differences between sleep quality and duration as they reflect
cardiometabolic disease disparities. Possibility of suboptimal sleep mediating
the disparities of cardiometabolic diseases makes the topic more important as
far as personal health is concerned.  As
directed by Mabbott (2013), a thorough review of literature is conducted to
focus on sleep and cardiometabolic diseases. The review is also different for
each condition to ensure it’s more detailed.

            The aim of data collection is stated
as “to review the association between sleep and cardiometabolic disease risk
because of the possibility that suboptimal sleep may partially mediate the
cardiometabolic disease disparities”. The statement is specific and
comprehensive as it summarizes the whole study.

            The methodology used is a broad
qualitative approach as it evaluates both experiments and observations. The
implication is that it accounts for the experiences and feelings of the
patients, the effect of disparities recorded, and the interpretation of the
clinical specialists on the collected data. The methodology matches the aim
statement because it gives the researcher the freedom to ensure research is
conclusive.

            The article utilized document
analysis as the data collection method. The method retrieves documents related
to the topic of study and subjects them to analysis and critique. Their results
are synthesized to check for similarities and differences. The researcher
strives to give actual experimental and observational results from previous
studies. This method worked well for such a comprehensive topic because the collected
data could also be tested for credibility.

            Data analysis and presentation used
include grounded theory, narrative analysis, and content analysis. Grounded
theory is used where the researcher begins by analyzing a single case then
examines similar cases for their contribution. Content analysis, on the other
hand, categorizes behavioral data, such as sleep patterns and verbal data, into
a summary presented in a tabular manner. Narrative analysis is equally employed
to reformulate presented stories, while accounting for disparities of
respondents from the primary data.

            The inclusion criteria are well
stated in the study. The study reviewed literature and existing studies that focused
on impaired sleep quality or restricted sleep duration, while examining
cardiometabolic disease risk biomarkers such as immune function, food intake,
appetite regulation, and insulin sensitivity. Another factor under consideration
is the review of observational studies that explore the relationship between
the quality and quantity of sleep and the risk/prevalence of cardiometabolic
diseases. However, the exclusion criteria were not clearly stated. The
inclusion criteria were reasonable and supported the research question.
Furthermore, the selection criteria are not limited as anyone can suffer sleep
deprivation which poses a risk. Regarding participants selection, random
sampling was used as the sampling technique to select study participants. The method
is appropriate for the research study because it exposes the disparities
clearly and ensures the sample is an actual representation of the general
population. The sample is also unbiased as it retrieves information from a wide
range of sources.

            The study has been approved by the
institutional review body of the University of Chicago. The literature review
did not require informed consent since it did not involve face-to-face interviews
with the respondents (Reiss, 2014). However,
consent was obtained during the individual primary data collection for various
articles. The study is based on peer published journals, which implies that the
primary sources are ethically rigorous, and hence the current research. The study
established that sleep deprivation is linked to an increased risk of
cardiometabolic diseases. These findings were checked for accuracy by
supporting institutions and the interpretation of findings was conducted by a
team of researchers. The conclusion answered the research question in a more succinct
and elaborate manner.

            The overall strength of the study is
that it is inclusive and has evaluated a wide range of data sources. It has
also conducted a thorough investigation supported by evidence-based research.
However, the study’s validity is questionable because it may be based on
invalid primary research conducted by other researchers. Additionally, the
limitations of the study are not stated because of their invisibility (Staller, 2014).

            The findings suggest that sleep
deprivation is one of the psychological disorders that incapacitates the
functioning of the entire body. This means that the observation of sleep
patterns in the 24-hour economy should be changed to factor in sleep patterns such
as daytime naps.

1. Quantitative Research Article Critique

The quantitative
article under critique is “Carroll, J., Seeman, T., Olmstead, R., Melendez, G.,
Sadakane, R., Bootzin, R., Nicassio, P. and Irwin, M., 2015. Improved sleep
quality in older adults with insomnia reduces biomarkers of disease risk: Pilot
results from a randomized controlled comparative efficacy trial. Psychoneuroendocrinology, 55,
pp.184-192.”

The topic of concern in this article is the establishment of
improved sleep quality as a factor for reducing risk to disease biomarkers. The
measurable variables are sleep quality and biomarkers of disease risk. The
topic is an important research topic to inform on the connection between sleep
quality and body wellness (Boswell, 2017).

            To ascertain the importance of the topic,
the researcher argues that sleep disturbances are associated with high
mortality and morbidity. However, the influence of improving older insomniac
adults’ sleep quality on the risk of cardiovascular disease was not yet
established. Thus, the study was meant to bridge this research gap (Norris, Plonsky, Ross and Schoonen, 2015). A
literature review about the current knowledge is discussed superficially at the
introduction level. A thorough literature review is missing owing to the
research gap in the area of study. The key variables of sleep quality and cardiovascular
diseases are defined articulately to reflect their measurement scale frequency.

            The objective of the randomized
control trial (RCT) is to determine the comparative efficacy of CBT (Cognitive
behavioral therapy), SS (sleep seminar control), and TCC (tai chi chih) to
reduce multisystem biomarkers of disease risk in older adults with insomnia. The
methodology used an experimental randomized control trial (Engward, 2012). The tool is suitable for the study
being the first of the concept. This will direct future studies in the area and
help predict anticipated results. It will also give accurate results because it
utilizes a small sample that can be managed fully to ensure each participant is
monitored from an individual level (Norris,
Plonsky, Ross and Schoonen, 2015).

            Data analysis and presentation is
conducted using IBM SPSS for windows v.22 (Pallant,
2013). The presentation of results is in the form of flow charts and
bar-graphs. The bar-graph is explained well to elaborate on the percentage of
high risky subjects at 4 and 6 months according to the stratified treatment (Norris, Plonsky, Ross and Schoonen, 2015).

            The total sample consisted of 109
adults or older age suffering primary and chronic insomnia. According to the
inclusion and exclusion criteria outlined by Simpson, Sweetman and Doig (2010),
the sample was comprised of participants aged 55 years and above and free from
sleep apnea and major medical conditions. The participants were also required
to fulfill the statistical and diagnostic manual criteria for sleep disorders
and primary insomnia by undergoing a structured interview. The participants were
also required to register difficulty falling and staying asleep for a period of
not less than one month, and significant daytime impairment and distress.
Random assignment was done in the ratio of 2:2:1 for CBT, TCC, and SS using
permuted block design comprising of between 7 and 10 subjects (Zhao and Weng, 2011). This criterion was
reasonable given that insomnia is more prevalent in this age set. The sample
limits the result application to individuals less than 56 years who may be
suffering from insomnia. This creates bias as according to Gewirtz and Youssef
(2017), the younger population not covered is also susceptible to sleep
deprivation and although lower rates report cases of cardiovascular diseases.

            The study was approved by the UCLA
institutional review board as advised by Koller, Powell and Wolfe (2014).
Besides, the patients underwent an interview where their consent was sought and
were assured of the confidentiality of their information for privacy purposes.
The study can be considered ethically rigorous as the recruitment was widely
advertised and a thorough screening followed to ensure participants meet the
research criteria (Chen, 2018). Research
findings indicated that improving the quality of sleep among insomniac older
adults reduces the risk for chronic diseases such as cardiovascular disease.
The large results that relate to the aim include improvement of biological risk
scores among participants a year after follow-up.

            The
conclusion supported the objective of the trial. The study recommended that
further research should be considered featuring a larger sample of high-risk
participants to develop a treatment plan. It further recommended that treatment
efficacy inform future research.

The study was
pilot research, and according to Whitehead, Cooper, Julious and Pottrill
(2015), perfected in determining the baseline indicators for more comprehensive
studies in the future. It also achieved the objective and formed part of
crucial comprehensive disease prevention and treatment plan. Moreover, it
utilized randomization of participants to conditions of treatment, and included
a thorough assessment of clinical risk biomarkers before, after and a year
following treatment. The study completion rate is also marked as high. However,
the sample population was too small to be representative of the general
population (Boswell, 2017). The study
acknowledged limitations on the selected age of participants and possible
self-report bias (Jerrim and de Vries, 2017).

• Discussion
• Article Comparison

            The correlation between sleep
deprivation and cardiovascular disease is more or less direct. Many patients of
cardiovascular disease have most often than not been tied to a lack of
sufficient sleep (Maeder, 2016). From the articles and supporting literature,
it is clear that sufficient sleep is therapeutic. However, we are living in a
society pervaded with many challenges, and the larger part of the world’s
population experiences sleep deprivation from time to time. Notably, the
consequences of sleep deprivation usually take a toll and have a direct bearing
on the productivity of the affected individuals.

            The qualitative paper reveals the
correlation of statistical data and the techniques used with the research findings
(Bahari, 2010). Importantly, the aim of the
research is valid, and is a testimony that indeed qualitative research must
conform to the reviewed literature. The aspect of data in quantitative research
highlights a critical component of empirical research (Norris, Plonsky, Ross and Schoonen, 2015). The
quantitative paper utilizes raw data to get results, which are analyzed into
findings to support an objective (Guta, 2013).

1. Summary Critique

            From the critique, it is clear that
the research question has a wide scope and can be explored from numerous
perspectives. The critique also provides the research with information required
to reach a valid conclusion (Kumar, 2019).
However, there are gaps in how to improve sleep quality naturally, such as
through physical exercises without the need for psychotherapy. Besides this
aspect, the critique has furnished the research question with a comprehensive
perspective and scope of knowledge.

            The current
nursing practice in the UK benefits from the findings as it will gain access to
information and recommendations to improve sleep patterns as part of nursing
care and hence reduce the cardiovascular diseases significantly.

• Conclusion

      Literature search based on a
well-structured research question retrieves the most desirable results for the
subject of study. During the literature search, credible databases are
important as they give the researcher access to rich and reliable information
sources. Search criteria is also a phenomenon that should be mastered to
identify keywords, truncations, and filters that produce content relevant to
the research. Critique of articles enables the researcher to determine whether
they are suitable for the study or they are lacking in some aspects and would
need to explore other closely related content. Moreover, secondary sources of
both quantitative and qualitative are equally important in research as they ptovide
the researcher with a wide data scope to improve the validity of research and
eliminate potential bias.

References

Baboli, M., Singh, A., Soll, B., Boric-Lubecke, O. and
Lubecke, V., 2015. Good Night: Sleep

Monitoring Using
a Physiological Radar Monitoring System Integrated with a Polysomnography
System. IEEE Microwave Magazine,
16(6), pp.34-41.

Bahari, S., 2010. Qualitative Versus Quantitative Research
Strategies: Contrasting Epistemological

And Ontological
Assumptions. Jurnal Teknologi, 52(1).

Barczak, G., 2015. Publishing Qualitative versus Quantitative
Research. Journal of Product

Innovation Management, 32(5), pp.658-658.

Boswell, A., 2017. Research Methods for Nurses and Midwives. British Journal of Healthcare

Management, 23(3), pp.132-132.

Butler, A., Hall, H. and Copnell, B., 2016. A Guide to
Writing a Qualitative Systematic Review

Protocol to
Enhance Evidence-Based Practice in Nursing and Health Care. Worldviews on Evidence-Based Nursing,
13(3), pp.241-249.

Cappuccio, F. and Miller, M., 2017. Sleep and
Cardio-Metabolic Disease. Current
Cardiology

Reports, 19(11).

Carroll, J., Seeman, T., Olmstead, R., Melendez, G.,
Sadakane, R., Bootzin, R., Nicassio, P.

and Irwin, M.,
2015. Improved sleep quality in older adults with insomnia reduces biomarkers
of disease risk: Pilot results from a randomized controlled comparative
efficacy trial. Psychoneuroendocrinology,
55, pp.184-192.

Chen, C., 2018. Embracing Diversity in Nursing Research
Methods. Journal of Nursing Research,

26(6), p.375.

Clark, I. and Landolt, H., 2017. Coffee, caffeine, and sleep:
A systematic review of epidemiological

studies and
randomized controlled trials. Sleep
Medicine Reviews, 31, pp.70-78.

Engward, H., 2012. Research methodology: a step by step guide
for beginners Ranjit Kumar

Research
methodology: a step by step guide for beginners Sage £26.99 440pp 9781849203012
1849203016. Nurse Researcher, 19(3),
pp.45-45.

Gewirtz, A. and Youssef, A., 2017. Introduction to the
Special Section: Advances in psychological

prevention and
treatment interventions to promote children’s mental health. International Journal of Psychology,
52(2), pp.82-86.

Guta, L., 2013. Quantitative Versus Qualitative Research in
Knowledge Management. SSRN

Electronic Journal,.

Holland, K., & Rees, C. (2010). Nursing: evidence-based practice skills. Oxford, Oxford University

Press.

Jerrim, J. and de Vries, R., 2017. The limitations of
quantitative social science for informing public

policy. Evidence & Policy: A Journal of
Research, Debate and Practice, 13(1), pp.117-133.

Jimeno Yepes, A. and Verspoor, K., 2014. Literature mining of
genetic variants for curation:

quantifying the
importance of supplementary material. Database,
2014(0), pp.bau003-bau003.

Koller, K., Powell, T. and Wolfe, A., 2014. Public health
research: Institutional review board

review or no
institutional review board review?. The
Journal of Pediatrics, 165(2), p.420.

Kumar, D., 2019. Scholarly critiquing: A 12 step guide for
promoting professional life long

learning in
medical academia. Research and
Development in Medical Education, 8(2), pp.65-68.

Mabbott, I., 2013. The Practice of Nursing Research:
Appraisal, Synthesis, and Generation of

Evidence –
Seventh editionThe Practice of Nursing Research: Appraisal, Synthesis, and
Generation of Evidence – Seventh edition. Nursing
Standard, 27(31), pp.30-30.

Maeder, M., Schoch, O. and Rickli, H., 2016. A clinical
approach to obstructive sleep apnea as

 a risk factor
for cardiovascular disease. Vascular
Health and Risk Management, 12, pp.85-103.

Makaza, M., 2012. Nursing: Evidence Based Practice Skills. Nurse Education in Practice, 12(6),

p.e50.

McIltrot, K., 2018. Choosing the Right Topic and Article Type
for Publication. Journal of Pediatric

Surgical Nursing, 7(2), p.35.

Mukherjee, S., Patel, S., Kales, S., Ayas, N., Strohl, K.,
Gozal, D. and Malhotra, A., 2015.

An Official
American Thoracic Society Statement: The Importance of Healthy Sleep.
Recommendations and Future Priorities. American
Journal of Respiratory and Critical Care Medicine, 191(12), pp.1450-1458.

Norris, J., Plonsky, L., Ross, S. and Schoonen, R., 2015.
Guidelines for Reporting Quantitative

Methods and
Results in Primary Research. Language
Learning, 65(2), pp.470-476.

Pallant, J., 2013. SPSS survival manual: a step by step guide
to data analysis using IBM SPSS.

Australian and New Zealand Journal of Public Health, 37(6),
pp.597-598.

Rangaraj, V. and Knutson, K., 2016. Association between sleep
deficiency and cardiometabolic

disease:
implications for health disparities. Sleep
Medicine, 18, pp.19-35.

Reiss, D., 2014. Informed Informed Consent. PsycCRITIQUES, 59(5).

Simpson, F., Sweetman, E. and Doig, G., 2010. A systematic
review of techniques and interventions

for improving
adherence to inclusion and exclusion criteria during enrolment into randomised
controlled trials. Trials, 11(1).

Staller, K., 2014. The invisibility of taken-for-granted limitations
in qualitative inquiry.

Qualitative Social Work: Research and Practice, 13(4),
pp.449-455.

Whitehead, A., Cooper, C., Julious, S. and Pottrill, E.,
2015. Do pilot trials reliably predict

recruitment and
retention rates for full trial? A review of HTA funded trials. Trials, 16(S2).

Zhao, W. and Weng, Y., 2011. A simplified formula for
quantification of the probability of

deterministic
assignments in permuted block randomization. Journal of Statistical Planning and Inference, 141(1), pp.474-478.