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Medscape
a minute ago
- Medscape
More Than a Number: Sleep Quality Next Target for CV Health
From the Dalai Lama's claim that it is the 'best meditation' to Benjamin Franklin's insistence that it makes a person 'healthy, wealthy, and wise,' a good night's sleep has long been touted as the secret to a healthy life. And the American Heart Association (AHA) agrees. In 2022, the AHA added sleep duration to Life's Simple 8, their checklist for optimal heart health. This was on the basis of strong evidence from epidemiologic studies linking sleep duration to poor cardiometabolic outcomes, such as obesity, type 2 diabetes, and stroke. But emerging research suggests that it's time for cardiologists to consider more than just sleep duration. 'Lack of sleep has been long known to be associated with coronary heart disease,' said Martha Gulati, MD, the director of Preventive Cardiology in the Smidt Heart Institute at Cedars-Sinai, in Los Angeles. Gulati emphasized that achieving adequate sleep (between 7 and 9 hours) has also been associated with healthy traits, such as better blood pressure, better cholesterol control, and healthy weight. Martha Gulati, MD However, the number of hours a person sleeps each night just scratches the surface she said. Research has shown that consistency and preferred timing of sleep, known as sleep chronotype, are important as well. In a 2023 UK-based study, middle-aged adults who considered themselves night owls — the evening sleep chronotype — had signs of potentially detrimental cardiac remodeling on cardiac magnetic resonance imaging compared with morning folks. And the damage may start early. In a recent study in adolescents, shorter sleep duration was associated with adverse markers of left ventricular wall remodeling and liver fat accumulation suggesting a cumulative effect on health, according to the authors. The MESA Sleep Ancillary study found that people with greater irregularity in sleep patterns — such as falling asleep at different times each night — had a higher coronary artery calcium burden than those with more regular sleep patterns. Because sleep is associated with a range of cardiometabolic diseases, Julie Marcus, MD, a cardiologist at Weill Cornell Medicine/New York Presbyterian Hospital, New York City, said addressing poor sleep has become an important but underappreciated aspect of maintaining a healthy heart. Julie Marcus, MD She added that patients also need to be aware that poor sleep can affect their health and what the various components of healthy sleep are. 'Beyond saying do you snore [or] stop breathing at night and do you sleep between 7 and 9 hours, there's so much more to sleep that is important,' Marcus said. Expanding the Definition of Sleep Health Early this year, the AHA published an updated scientific statement that addresses multidimensional sleep health. This includes duration, timing, regularity, sleep-related daytime functioning, satisfaction, continuity — the ability to initiate and maintain sleep — and sleep architecture, or the amount and timing of the various sleep stages. Marie-Pierre St-Onge, PhD, a sleep health researcher and lead author of the AHA statement, explained that it was developed to promote the breadth of new research. 'We want to let people know that sleep is more than just how long you sleep at night,' said St-Onge, who is the director of the Center of Excellence for Sleep and Circadian Research at Columbia University, New York City. Marie-Pierre St-Onge, PhD For example, she explained excessive daytime sleepiness has been associated with cardiovascular disease, coronary heart disease, stroke, and all-cause mortality. Similarly, sleep disturbances have been linked to hypertension, arterial stiffness, and coronary heart disease. Understanding Poor Sleep's Mechanism of Action St-Onge emphasized that new research has also increased understanding around the associations between poor sleep and worsening cardiometabolic outcomes. Her research has shown that sleep restriction increases oxidative stress in the lining of the arteries that could lead to endothelial dysfunction. Short sleep also impairs the body's ability to counteract this oxidative stress. 'We see immune suppression from poor sleep duration and poor sleep quality,' St-Onge said. In addition, we have found links between sleep regularity and eating patterns, St-Onge noted. Gulati believes that the AHA statement represents an opportunity to raise awareness among patients, cardiologists, and clinical researchers about the importance of better understanding these causal effects of poor multidimensional sleep health. 'I think it is also a call to action to improve the assessment of sleep, particularly in research so we can rigorously assess these components,' Gulati said. 'We need to know what interventions can improve components of sleep as well, and their effect on cardiovascular health. Those knowledge gaps need to be closed.' Talking About Sleep Health Those knowledge gaps are why the statement did not offer guidance for clinical approaches, but St-Onge emphasized the importance of educating and discussing this topic with patients now. She recommended asking an open-ended question: 'How's your sleep?' 'That opens up a conversation for people to express exactly what's bothering them with their sleep.' For example, she said, 'It may be they get plenty of hours of sleep, but they lie there awake for way too long, or they're having a hard time falling asleep, or they get a lot of sleep, but they still wake up not feeling refreshed during the day.' Starting the conversation — and documenting it in clinical notes — will be the first step to helping patients with poor sleep health, she said. Marcus agreed that cardiologists should make time to discuss sleep health with patients, even though it can be more complicated than addressing cholesterol or blood pressure because 'sleep is not a number.' Still, she said that understanding a patient's poor sleep health can also provide physicians with new modifiable risk factors for improving their cardiovascular health. 'Sleep is the next target,' Marcus said. 'We know it impacts health, and it's just a matter of how do we screen for it.' Gulati reported financial relationships with Boehringer Ingelheim Pharmaceuticals, Medtronic, Merck & Co., New Amsterdam, and Zoll.
Forbes
2 minutes ago
- Forbes
Tackling The Nation's Nursing Shortage By Reducing Risk For All
Family nurse practicioner Julie Klaker gives a sports physical to Brian Aguirre, 16, at the Spanish ... More Peaks Outreach Clinic where hospitals and clinics are scarce. The nation's nursing shortage often disproportionately hurts clinics in rural areas. (Photo by) The shortage of nurses is straining our hospitals and increasing health-care costs—and yet there are also big barriers in place for students interested in entering the profession where they are sorely needed. But with some creative collaboration, a scalable solution that addresses the needs of all stakeholders—students, schools, and hospitals—may now be in sight. The clinical staffing shortage isn't a small problem. In 2024, nearly half of hospitals had nursing vacancy rates higher than 10 percent, with the average time to fill a Registered Nurse (RN) position taking anywhere from 59 to 109 days. Nationwide the shortage of RNs is roughly 350,000. States like California had a shortage of over 100,000 nurses and Georgia had over 34,000. Our country's inability to solve this crisis has led not just to a shortage of trained professionals to the detriment of patient care—but also a steadily increasing set of costs in the form of rural hospital closings, signing bonuses, poaching, contract labor, and expensive internationally educated nurses. The challenge is threefold: not enough individuals completing nursing school; not enough capacity in existing nursing schools; and the friction associated with traditional tuition assistance programs. What these three challenges have in common is a desire to avoid risk. Prospective students can be reticent to take on the high cost of education—an average yearly cost of $30,884 for a Bachelor of Science in Nursing according to the National Center for Education Statistics. That cost comes on top of the opportunity cost from not working and lack of security that students will find jobs at the local employers where they want to work. There's also the risk of failure. Yes, many programs boast high graduation and licensure pass rates. And given the shortage of nurses, most graduates can then find a job. But the education to employment path has bumps—which means that at least four out of ten students are likely to fall through one of these cracks at some point in their journey. Most nursing schools are also trying to minimize risk. Although affordable, online programs do operate at scale, most students still enroll in local colleges. And those schools are cautious about over-expanding and having to slash costs once the nursing shortage passes, as it has done in past—albeit more short-lived—episodes. What's more, nursing programs often have difficulty finding sufficient faculty and are dependent on hospitals for clinical slots as part of students' hands-on practicum requirement. Together, that has created limited nursing school capacity. In 2021, nursing schools turned away over 91,000 qualified applicants. Even though hospitals could alleviate some of the shortage by funding the cost of a nurse's education to solve their challenge, they have been understandably reticent to take on the cost and risk of training people who might simply pick up and leave for a better salary at a different hospital. There's good news on the horizon. New, scalable programs are emerging to help students enter the nursing field with less debt and more job security—and to help health systems retain new nurses. The idea behind one such program is that students commit to earning their degree and working for three years in local hospitals. Hospitals in turn commit to repay a significant portion students' loan debt through a scholarship fund that it draws down over three years. This eliminates some risk for the student—as they know they can pay for the education and they'll have a job on the other side. By way of example, UNC Health Wayne, a nonprofit hospital affiliate of the UNC Health System and one of the largest private employers in Wayne County, expects to invest in its workforce through the program while recognizing cost savings. If a nurse leaves the hospital for another health system before three years, then the hospital isn't responsible for any more payments—so their risk is also minimized. And the cost of repaying student loans is less than paying for contract labor, signing bonuses and the like. 'Nurses are a vital part of our healthcare system, especially in rural communities like ours,' said Dr. Jessie Tucker, CEO of UNC Health Wayne. 'The UNC Health Wayne Nursing Scholars Program is a powerful tool to help us attract and retain top talent. Through our partnership with Noodle's Scholars Network, we're investing directly in students while building a more stable, sustainable healthcare workforce for our region.' Different states are working to bring schools together with hospitals to reduce risk for everyone. Another bright spot is in New England, where the Scholars Network is working with Providence College to lead a consortium of nursing schools to address the problem and increase capacity. For nursing schools, they get valuable clinical rotation spots in hospitals that they need to expand—with a guarantee for graduating students that they'll have a job, which improves their value proposition. The schools can then bolster capacity without a big investment in infrastructure so they don't create excess capacity. Prior to employment, many Providence College nursing students will complete work through the PC Summer Nursing Academy and have opportunities to work with their potential future employers early in their degree program. Providence College has used this as an opportunity to lead an emerging consortium of healthcare and higher education leaders in Rhode Island to address the shortage. Dr. Kyle McInnis, the founding dean of the School of Nursing and Health Sciences at Providence College said that leveraging partnerships is critical. 'Resolving the nursing workforce crisis requires bold cooperation across sectors,' McInnis said. 'At Providence College, the Scholars Network is supporting creative ways we partner with hospitals—expanding clinical experience opportunities and creating pathways towards exciting career opportunities. The inclusion of tuition incentives makes it a win for students and healthcare systems who recruit the next generation of nurse leaders.' In other regions, the state is also playing a role in advancing this approach. In Pennsylvania, the state helped bring the parties together by funding up to one-third of the reimbursement for the students—and now Gov. Josh Shapiro is including the commitment in the state budget to the tune of just $5 million. This approach is not just relevant to nursing. Solving the shortage in many allied health professions, for example, can happen more quickly and less expensively. Similar high-quality approaches are starting to address shortages in other fields as well, such as teaching. In each of these areas of national need, this model is a small, smart investment that can make a dent in nursing shortages, lower health-care costs, and improve care.
Forbes
2 minutes ago
- Forbes
Cybertruck Regains Some Glory At Mobbed Tesla Diner Opening
Tesla Cybertruck had a big presence on Monday evening at the opening of the Tesla Diner. The Tesla Diner was mobbed Monday evening after opening to the general public. Cybertrucks were prominent. When I arrived at around 7:00 pm, Cybertrucks were out in force, charging in the front parking lot (see video below). Cybertruck sales have hit a rough patch in the last couple of quarters but you would never know that on Monday evening. The line of people snaked from the Diner down N. Orange Ave., which borders the a two-story, circular stainless steel structure on the east side. The queue on N. Orange was several hundred feet long (see photo below). In addition to the people waiting to eat, all of the 80 Superchargers were being used. With Teslas lining up to charge on N. Orange Ave. The lion's share of the 80 Superchargers are in the back lot. And that was also completely waiting to get in diner extended several hundred feet down N. Orange Ave Patrons lining up outside the diner. The line snaked back along N. Orange Ave Tesla Diner back lot was full.
