Hesam Aldin Varpaei

Background and Objectives: Poor sleep quality and gut microbiota dysbiosis are independently associated with cognitive decline, yet their effects on cognition in heart failure (HF) patients remain unexamined. To assess the independent associations of sleep quality and gut microbiota diversity with cognition in patients with HF. Methods: This exploratory/pilot cross-sectional study enrolled adults with chronic stable HF from an outpatient cardiology clinic. Participants completed the Pittsburgh Sleep Quality Index (PSQI) and Montreal Cognitive Assessment (MoCA). Fecal samples were analyzed for gut microbiota composition, including Shannon diversity and Simpson indices. Multivariable linear regression analysis of MoCA scores with sleep quality and alpha diversity (Shannon index) as primary exposures, adjusted for age, sex, and left ventricular ejection fraction (LVEF) was conducted. Results: Of 59 enrolled patients (mean age 73.3 ± 10.8 years; 72.7% male; 86.4% White), 40 provided fecal samples. Analysis of microbiota data revealed a composition dominated by Bacillota (63.7%). In multivariable regressions, poor sleep quality was independently associated with lower MoCA scores (β = −3.01 to −3.88, p < 0.01). Similarly, Shannon diversity was also associated with lower MoCA (β = −3.45, p < 0.05). Beta-diversity analyses showed no consistent association between overall microbial community composition and cognition. No significant interactions between microbiota diversity and sleep variables were identified (all p > 0.20). Conclusions: Sleep quality and gut microbiota alpha diversity are independently associated with cognitive function in HF. Microbial pathways favoring short-chain fatty acid production align with better sleep, while lipopolysaccharide-related pathways associate with poorer sleep and cognition.

Background: SMS text messages have been used as part of health intervention research for over a quarter of a century. Given the ease of reaching people via SMS text message, these interventions are important for all groups, including Hispanic individuals. SMS text messaging interventions continue to show promise for improving health in this population. Several reviews have addressed aspects of designing Hispanic-focused digital health interventions. Emphasis has been placed on the linguistic and cultural relevance of SMS text messages in these studies. However, a gap exists in the literature on how SMS text messages are developed and adapted for use in health interventions with Hispanic communities across the life span. Objective: The objective of this scoping review is to answer the following question: how are bilingual SMS text message databases developed and/or adapted for use in health interventions for the Hispanic population in the United States? Methods: In this scoping review, the framework by Arksey and O’Malley and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines will be used. The review will be conducted in five stages: (1) identifying the research question; (2) identifying relevant studies; (3) study selection; (4) charting the data; and (5) collating, summarizing, and reporting the results. For the inclusion criteria, the population (Hispanic individuals across the life span), concept (development and/or adaptation of bilingual SMS text message databases for health interventions), and context (the United States) framework will be used. There is no age or time limit on the study populations or included articles. In May 2025, we searched 4 databases: PubMed, Embase, Web of Science, and CINAHL. Covidence is being used to collect studies. There are 2 phases, each involving 2 independent reviewers: the title and abstract phase followed by the full-text review phase. One of the authors developed a data extraction tool with 4 sections. These sections include general study information, foundational SMS text message database information, how the development and adaptation of the SMS text message database were informed, and data on cultural and linguistic elements of the database. Each section will be presented in tabular format, with descriptive and numerical summaries. Inductive thematic analysis will be used for the fourth section. Results: This scoping review commenced in May 2025, and titles and abstracts are being reviewed to assess further eligibility. After the full-text review, a determination will be made on which studies to include, and data extraction and results will be documented. We anticipate that this review will be completed by December 2026. Conclusions: This scoping review of the cultural and linguistic elements of SMS text message databases may contribute to the development of more meaningful and concordant databases for use in health interventions among the Hispanic population. International Registered Report Identifier (IRRID): DERR1-10.2196/86032

Study Objectives: Evidence is limited on the role of caffeine intake in the relationship between sleep quality and the incidence of major adverse cardiovascular events (MACE) particularly in patients with sleep breathing disorders. Therefore, this study’s primary aim was to determine the potential confounding effects of total caffeine consumption on the relationship between sleep quality parameters (total sleep time [TST], sleep efficiency [SE], sleep latency [SL], daytime sleepiness, and wakefulness after sleep onset [WASO]) and MACE. Methods: This study is a secondary analysis of data from the Sleep Heart Health Study (SHHS). Sleep assessments (TST, SE, SL, daytime sleepiness, and WASO) were performed objectively using in-home polysomnography. Caffeine was measured using a survey asking about the average number of cups/cans/glasses of tea, soda, and coffee consumed per regular day and during the last night before polysomnography. Results: A final sample of 5628 participants was included in SHHS Visit 1 (78 per cent White/Caucasian; 54 per cent female). Cumulative incidence rates measured over 10.9 ± 2.8 years were 15.1 per cent for MACE and 19.7 per cent for all-cause mortality. In univariate models, all sleep measures except SL were associated with MACE; but after adjustment, only TST remained a significant predictor (odds ratio [OR] = 1.122, p = .011). No confounding effect of caffeine was observed in the associations between sleep measures and MACE. Moderate-high intake attenuated MACE risk among individuals with greater daytime sleepiness (OR = 0.91, p = .011). Conclusions: Caffeine was not a confounding factor in the relationship between sleep measures and MACE. While exploratory analyses suggested potential modification of the association between hypersomnolence and cardiovascular outcomes, these effects were attenuated after statistical adjustment and correction for multiple testing and should be interpreted cautiously.

Post‐operative delirium (POD) is an acute deterioration in cognitive function and highly prevalent after cardiac surgery (CS; up to 55%). Perioperative sleep disorders (PSD) are also commonly noted in surgical patients (up to 60%). The primary aim of our systematic review is to determine the association between PSD and POD in CS patients during their hospital stay. We searched five databases (PubMed, CINAHL, Web of Science, Scopus, and EMBASE) to identify studies evaluating the association between PSD and POD amongst CS (any open‐heart CS) patients, without time and geographic restriction. Original articles that focused on adults undergoing cardiac surgeries and assessed sleep and POD were included. We conducted a meta‐analysis using a random effects model to determine the effect of sleep quality on POD. Thirty‐three studies were included (63% observational designs); most studies originated from China (33%). The most frequently used subjective and objective sleep assessment tools were the Pittsburgh Sleep Quality Index (PSQI) (33%) and polysomnography (18%). After pooling observational data, we identified an incidence of POD ranging from 3.6% to 73%. Increased PSQI scores (standard threshold > 5) were associated with a greater likelihood of POD occurrence (standardised mean difference [SMD] = 0.73, p > 0.05). Lower total sleep time (SMD = −0.68, p < 0.05) was associated with an increased risk of POD. Poor sleep quality, insomnia, and sleep‐disordered breathing are prevalent forms of PSD and are major risk factors for POD following CS. Additional research is warranted to clarify when sleep quality normalises after cardiac surgery and how targeted interventions can accelerate this recovery.

BACKGROUND SMS text messages have been used as part of health intervention research for over a quarter of a century. Given the ease of reaching people via SMS text message, these interventions are important for all groups, including Hispanic individuals. SMS text messaging interventions continue to show promise for improving health in this population. Several reviews have addressed aspects of designing Hispanic-focused digital health interventions. Emphasis has been placed on the linguistic and cultural relevance of SMS text messages in these studies. However, a gap exists in the literature on how SMS text messages are developed and adapted for use in health interventions with Hispanic communities across the life span. OBJECTIVE The objective of this scoping review is to answer the following question: how are bilingual SMS text message databases developed and/or adapted for use in health interventions for the Hispanic population in the United States? METHODS In this scoping review, the framework by Arksey and O’Malley and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines will be used. The review will be conducted in five stages: (1) identifying the research question; (2) identifying relevant studies; (3) study selection; (4) charting the data; and (5) collating, summarizing, and reporting the results. For the inclusion criteria, the population (Hispanic individuals across the life span), concept (development and/or adaptation of bilingual SMS text message databases for health interventions), and context (the United States) framework will be used. There is no age or time limit on the study populations or included articles. In May 2025, we searched 4 databases: PubMed, Embase, Web of Science, and CINAHL. Covidence is being used to collect studies. There are 2 phases, each involving 2 independent reviewers: the title and abstract phase followed by the full-text review phase. One of the authors developed a data extraction tool with 4 sections. These sections include general study information, foundational SMS text message database information, how the development and adaptation of the SMS text message database were informed, and data on cultural and linguistic elements of the database. Each section will be presented in tabular format, with descriptive and numerical summaries. Inductive thematic analysis will be used for the fourth section. RESULTS This scoping review commenced in May 2025, and titles and abstracts are being reviewed to assess further eligibility. After the full-text review, a determination will be made on which studies to include, and data extraction and results will be documented. We anticipate that this review will be completed by December 2026. CONCLUSIONS This scoping review of the cultural and linguistic elements of SMS text message databases may contribute to the development of more meaningful and concordant databases for use in health interventions among the Hispanic population. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/86032

Background: Post-operative cognitive dysfunction (POCD) is a concern for clinicians that often presents post-surgery where generalized anesthesia has been used. Its prevalence ranges from 36.6% in young adults to 42.4% in older individuals. Conceptual clarity for POCD is lacking in the currently body literature. Our two-fold purpose of this concept analysis was to (1) critically appraise the various definitions, while also providing the best definition, of POCD and (2) narratively synthesize the attributes, surrogate or related terms, antecedents (risk factors), and consequences of the concept. Method: The reporting of our review was guided by the PRISMA statement and the 6-step evolutionary approach to concept analysis developed by Rodgers. Three databases, including Medline, CINAHL, and Web of Science, were searched to retrieve relevant literature on the concept of POCD. Two independent reviewers conducted abstract and full-text screening, data extraction, and appraisal. The review process yielded a final set of 86 eligible articles. Result: POCD was defined with varying severities ranging from subtle-to-extensive cognitive changes (1) affecting single or multiple cognitive domains that manifest following major surgery (2), is transient and reversible, and (3) may last for several weeks to years. The consequences of POCD may include impaired quality of life, resulting from withdrawal from the labor force, increased patients’ dependencies, cognitive decline, an elevated risk of dementia, rising healthcare costs, and eventual mortality. Conclusion: This review resulted in a refined definition and comprehensive analysis of POCD that can be useful to both researchers and clinicians. Future research is needed to refine the operational definitions of POCD so that they better represent the defining attributes of the concept.

Postoperative delirium (POD) after cancer surgeries can be a result of chemo brain, anesthesia, surgery duration, and preoperative cognitive impairment. Although older age and preoperative cognitive dysfunction were reported to increase the risk of POD in noncardiac surgery, the role of preoperative cognitive function and age in the development of POD after all types of cancer surgeries is not clear. This study aimed to determine the relationship between preoperative cognitive function and likelihood of POD after cancer surgeries. This study used three main online databases and followed PRISMA guidelines. English language original articles that examined preoperative cognitive function before solid tumor cancer surgery and assessed patients for postoperative delirium were included. We employed the random effect meta‐analysis method. The overall incidence of POD ranged from 8.7% to 50.9%. The confusion assessment method was the most common tool used to assess delirium. Mini‐mental state evaluation (MMSE), Mini‐cog, and Montreal cognitive assessment were the most common tools to assess cognitive function. The pooled (total observation = 4676) random effects SMD was estimated at −0.84 (95% confidence interval [CI]: −1.30 to −0.31), indicating that lower MMSE scores before surgery are associated with a higher risk of POD. The pooled (total observation = 2668) random effects OR was estimated at 5.17 (95% CI: 2.51 to −10.63), indicating preoperative cognitive dysfunction can significantly predict the occurrence of POD after cancer surgeries. In conclusion, preoperative cognitive function is an independent and significant predictor of POD after solid tumor cancer surgeries.

To determine the impact of four maneuvers (Jaw Thrust, Chin Lift, Head Rotation, and Tongue Protrusion) on the degree of airway collapse at different airway levels during drug-induced sleep endoscopy (DISE) compared with natural supine position (regular) DISE and evaluate the association of each maneuver with polysomnographic findings compared with regular DISE without any maneuver. One hundred and nine OSA patients aged 20 to 55 who were candidates for sleep surgery were included. The association of the Apnea Hypopnea Index (AHI) with the degree of obstruction during four maneuvers of DISE and regular DISE was evaluated. AHI is significantly predicted by degree of obstruction at the velum (regular DISE) (β = 10.213), oropharynx (regular DISE) (β = 7.979), velum (jaw thrust DISE) (β = 12.286), oropharynx (jaw thrust DISE) (β = 8.430), velum (head rotation DISE) (β = 10.357), and velum (chin lift DISE) (β = 10.781). In the multivariate model, AHI was predicted by the velum during the jaw thrust maneuver (β = 7.985). Velum obstruction during DISE with jaw thrust, closing, and rotation maneuvers can significantly predict AHI. The degree of velum collapse during the jaw thrust maneuver is the most reliable and independent finding that correlates with the severity of obstructive sleep apnea.