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.
- Literature search
- 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)?
- 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.
- 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.
- 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.
- 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).
- 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.
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