Nicholas A Giordano, Madelyn C Houser, Jordan Pelkmans, Francisco J Pasquel, Victoria Pak, Ann E Rogers, Katherine A Yeager, Susan Mucha, Matthew Schmitt, Andrew H Miller
{"title":"Longitudinal Fatigue Symptoms and Inflammatory Markers in African American Adults With Hypertension and Obstructive Sleep Apnea.","authors":"Nicholas A Giordano, Madelyn C Houser, Jordan Pelkmans, Francisco J Pasquel, Victoria Pak, Ann E Rogers, Katherine A Yeager, Susan Mucha, Matthew Schmitt, Andrew H Miller","doi":"10.1097/NNR.0000000000000779","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>There is a dearth of research inclusive of African American adults living with obstructive sleep apnea (OSA) despite differences in symptom presentations compared to non-Hispanic White patient populations. Less is known regarding the potential effect of comorbidities, including hypertension, on commonly reported symptoms, such as fatigue, and their association with inflammatory biomarkers.</p><p><strong>Objective: </strong>This longitudinal pilot study aimed to characterize fatigue symptom presentations among African American adults newly diagnosed with OSA and discern peripheral blood analytes linked to symptoms while accounting for co-occurring hypertension.</p><p><strong>Methods: </strong>African American adults newly diagnosed with OSA with and without co-occurring hypertension were approached by study staff and recruited following their diagnostic visit with sleep medicine clinicians at two health systems and followed over 6 months after commencing continuous positive airway pressure treatment. Patient-Reported Outcomes Measurement Information System Fatigue surveys and plasma were collected every 3 months from 29 participants. Mixed-effects models examined changes in fatigue symptom presentations over time while accounting for plasma-based analytes and hypertension status.</p><p><strong>Results: </strong>Despite higher fatigue symptom severity upon diagnosis, participants with co-occurring hypertension reported greater improvements in fatigue scores after commencing continuous positive airway pressure treatment for up to 6 months than those without hypertension. Inverse correlations were observed between fatigue scores, C-reactive protein, matrix metalloproteinase-8, and osteoprotegerin analyte levels among participants with/without hypertension. Across all participants, changes in interleukin-6 were associated with changes in fatigue scores in the first 3 months after diagnosis.</p><p><strong>Discussion: </strong>Findings indicate that hypertension is linked to increased fatigue upon diagnosis of OSA in this sample of African American adults. Fatigue in persons with hypertension improved after treatment in this sample. These hypothesis-generating findings can inform future interventional studies aimed at improving fatigue among persons with OSA while leveraging markers linked to fatigue symptom severity as potential objective markers of improvements. Further research on the role of inflammatory markers, such as IL-6, on fatigue symptom presentations is warranted in persons with OSA.</p>","PeriodicalId":49723,"journal":{"name":"Nursing Research","volume":" ","pages":"9-19"},"PeriodicalIF":2.2000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11637946/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Nursing Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/NNR.0000000000000779","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/9/27 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"NURSING","Score":null,"Total":0}
引用次数: 0
Abstract
Background: There is a dearth of research inclusive of African American adults living with obstructive sleep apnea (OSA) despite differences in symptom presentations compared to non-Hispanic White patient populations. Less is known regarding the potential effect of comorbidities, including hypertension, on commonly reported symptoms, such as fatigue, and their association with inflammatory biomarkers.
Objective: This longitudinal pilot study aimed to characterize fatigue symptom presentations among African American adults newly diagnosed with OSA and discern peripheral blood analytes linked to symptoms while accounting for co-occurring hypertension.
Methods: African American adults newly diagnosed with OSA with and without co-occurring hypertension were approached by study staff and recruited following their diagnostic visit with sleep medicine clinicians at two health systems and followed over 6 months after commencing continuous positive airway pressure treatment. Patient-Reported Outcomes Measurement Information System Fatigue surveys and plasma were collected every 3 months from 29 participants. Mixed-effects models examined changes in fatigue symptom presentations over time while accounting for plasma-based analytes and hypertension status.
Results: Despite higher fatigue symptom severity upon diagnosis, participants with co-occurring hypertension reported greater improvements in fatigue scores after commencing continuous positive airway pressure treatment for up to 6 months than those without hypertension. Inverse correlations were observed between fatigue scores, C-reactive protein, matrix metalloproteinase-8, and osteoprotegerin analyte levels among participants with/without hypertension. Across all participants, changes in interleukin-6 were associated with changes in fatigue scores in the first 3 months after diagnosis.
Discussion: Findings indicate that hypertension is linked to increased fatigue upon diagnosis of OSA in this sample of African American adults. Fatigue in persons with hypertension improved after treatment in this sample. These hypothesis-generating findings can inform future interventional studies aimed at improving fatigue among persons with OSA while leveraging markers linked to fatigue symptom severity as potential objective markers of improvements. Further research on the role of inflammatory markers, such as IL-6, on fatigue symptom presentations is warranted in persons with OSA.
背景:尽管与非西班牙裔白人患者相比,非裔美国人患有阻塞性睡眠呼吸暂停(OSA)的症状表现存在差异,但有关非裔美国人的研究却十分匮乏。人们对高血压等合并症对疲劳等常见症状的潜在影响及其与炎症生物标志物的关系知之甚少:这项纵向试点研究旨在描述新诊断为OSA的非裔美国人的疲劳症状表现,并在考虑并发高血压的情况下鉴别与症状相关的外周血分析物:研究人员与新诊断出患有或未合并高血压的 OSA 的成年非裔美国人进行了接触,并在两个医疗系统的睡眠医学临床医生对他们进行诊断后招募了他们,在开始持续气道正压治疗后对他们进行了 6 个月的随访。患者报告结果测量信息系统每 3 个月收集一次 29 名参与者的疲劳调查和血浆。混合效应模型检验了疲劳症状随时间的变化,同时考虑了血浆分析物和高血压状态:结果:尽管确诊时的疲劳症状严重程度较高,但与无高血压者相比,合并高血压的参与者在开始长达 6 个月的持续气道正压治疗后,疲劳评分有了更大的改善。在患有/未患有高血压的参与者中,疲劳评分、C反应蛋白、基质金属蛋白酶-8和骨保护蛋白分析物水平之间存在反向相关性。在所有参与者中,白细胞介素-6的变化与确诊后头三个月疲劳评分的变化相关:讨论:研究结果表明,在非裔美国人样本中,高血压与确诊 OSA 后的疲劳增加有关。高血压患者的疲劳感在治疗后有所改善。这些假设性研究结果可为今后旨在改善 OSA 患者疲劳状况的干预性研究提供参考,同时利用与疲劳症状严重程度相关的标记物作为改善的潜在客观标记物。无论是否患有高血压,都有必要进一步研究炎症标志物(如 IL-6)对 OSA 患者疲劳症状表现的作用。
期刊介绍:
Nursing Research is a peer-reviewed journal celebrating over 60 years as the most sought-after nursing resource; it offers more depth, more detail, and more of what today''s nurses demand. Nursing Research covers key issues, including health promotion, human responses to illness, acute care nursing research, symptom management, cost-effectiveness, vulnerable populations, health services, and community-based nursing studies. Each issue highlights the latest research techniques, quantitative and qualitative studies, and new state-of-the-art methodological strategies, including information not yet found in textbooks. Expert commentaries and briefs are also included. In addition to 6 issues per year, Nursing Research from time to time publishes supplemental content not found anywhere else.