SSSNAPW Recommendations

Definition:

SSSNAPW is an acronym for lifestyle recommendations aimed at promoting general well-being and managing common chronic conditions, including stress, sleep, smoking, nutrition, alcohol, physical activity, and weight management. These recommendations are designed to improve overall health outcomes, particularly in individuals with cardiovascular risk factors, hypertension, diabetes, or obesity.

Aetiology/Causes:

These lifestyle factors are critical in managing and preventing chronic diseases. Poor nutrition, lack of physical activity, stress, smoking, and excessive alcohol consumption are major contributors to the development of conditions like cardiovascular disease, type 2 diabetes, hypertension, obesity, and mental health disorders.

Pathophysiology:

1. Stress: Chronic stress can lead to elevated cortisol levels, which increase the risk of hypertension, obesity, and cardiovascular diseases.

2. Sleep Deprivation: Poor sleep quality disrupts metabolic processes, increases stress hormones, and can exacerbate conditions like diabetes and heart disease.

3. Smoking: Smoking accelerates the process of atherosclerosis, increasing the risk of cardiovascular diseases, respiratory conditions, and cancers.

4. Nutrition: Poor dietary habits contribute to obesity, diabetes, and cardiovascular disease. A high intake of saturated fats, refined sugars, and salt can increase cholesterol levels, blood pressure, and the risk of heart disease.

5. Alcohol: Excessive alcohol consumption contributes to liver disease, hypertension, heart failure, and mental health issues.

6. Physical Activity: Lack of physical activity leads to weight gain, poor cardiovascular fitness, and increased risks of diabetes and hypertension.

Symptoms:

• Stress: Symptoms include anxiety, irritability, difficulty concentrating, and physical signs such as muscle tension or headaches.

• Sleep: Symptoms of sleep deprivation include fatigue, poor concentration, irritability, and mood swings.

• Smoking: Shortness of breath, cough, and increased susceptibility to infections.

• Nutrition: Poor eating habits manifest as weight gain, high cholesterol, elevated blood pressure, or elevated blood sugar.

• Alcohol: Symptoms of overconsumption include liver damage, high blood pressure, and cognitive decline.

• Physical Inactivity: Weakness, fatigue, and difficulty performing daily activities.

Differential Diagnosis:

• Stress: Anxiety disorders, depression, and other mental health conditions should be considered.

• Sleep Disorders: Conditions like sleep apnea or insomnia may contribute to poor sleep quality.

• Nutrition-related conditions: Should differentiate between metabolic disorders such as hypothyroidism, polycystic ovary syndrome (PCOS), or other causes of weight gain or metabolic syndrome.

• Alcohol-related conditions: Liver diseases like cirrhosis or fatty liver disease may also present with symptoms similar to those of alcohol overuse.

• Physical Inactivity: Musculoskeletal or neurological conditions may also cause weakness or difficulty with movement.

Investigations:

• Stress: Assessment tools like the Perceived Stress Scale (PSS) or referral for cognitive behavioural therapy (CBT).

• Sleep: Sleep studies (e.g., polysomnography) or referral to a sleep specialist for suspected sleep disorders like sleep apnea.

• Smoking: Spirometry for lung function assessment, smoking history, and counseling for smoking cessation.

• Nutrition: Diet assessment tools, weight measurement, waist circumference, and blood tests (e.g., cholesterol, glucose levels).

• Alcohol: Screening for alcohol use disorder (AUDIT-C), liver function tests, and assessment of blood pressure.

• Physical Activity: Physical assessments for fitness levels, strength tests, and cardiovascular fitness evaluation.

Management:

1. Stress:

   • Cognitive Behavioural Therapy (CBT): Refer for CBT to manage stress and anxiety.

   • Sleep Hygiene: Encourage establishing a regular sleep schedule, reducing caffeine intake, and creating a restful environment.

   • Smoking Cessation: Refer to a smoking cessation program and provide nicotine replacement therapy (NRT) or medications like varenicline.

2. Nutrition:

   • Balanced Diet: Encourage a nutritionally balanced, calorie-reduced diet.

     • 5 serves of vegetables, 2 serves of fruits, with a focus on reducing salt (<5g, sodium <2g), and reducing saturated fats.

     • Reduce sugary drinks, including fruit juices, and limit red meat (3-4x per week) while avoiding processed meats.

     • Increase whole grains, lean meats, nuts, and low-fat dairy (milk, yoghurt, cheese).

     • Refer to a dietitian for individual dietary advice if necessary.

3. Alcohol:

   • Limit to <2 standards per day, with no more than 4 on any one occasion.

   • If hypertension (HTN) is present, advise <1 standard drink per day for women.

4. Physical Activity:

   • 30 minutes/day for 5 days a week of moderate-intensity exercise (e.g., brisk walking).

   • 15 minutes/day for 5 days of vigorous-intensity exercise (e.g., jogging).

   • Muscle-strengthening exercises: Perform at least 2 days per week.

   • Minimise prolonged sitting time.

   • Weight loss of 5–10% through healthy eating and increased physical activity.

Complications:

• Stress: Chronic stress can lead to mental health issues, cardiovascular disease, diabetes, and digestive problems.

• Sleep Deprivation: Poor sleep is linked to obesity, cardiovascular disease, and increased risk of accidents.

• Smoking: Leads to lung disease, cardiovascular disease, and several types of cancer.

• Poor Nutrition: Contributes to obesity, diabetes, heart disease, and gastrointestinal disorders.

• Excessive Alcohol: Increases the risk of liver disease, hypertension, stroke, and accidents.

• Inactivity: Leads to muscle weakness, obesity, cardiovascular disease, and metabolic disorders.

Prognosis:

• Stress management: Addressing stress through CBT can significantly improve both mental and physical health outcomes.

• Sleep: Improving sleep hygiene and managing sleep disorders enhances cognitive function and overall health.

• Smoking cessation: Quitting smoking improves life expectancy, reduces the risk of heart disease, and prevents lung cancer.

• Nutrition: A healthy diet promotes weight loss, improves cardiovascular health, and reduces the risk of diabetes.

• Physical activity: Regular exercise improves cardiovascular health, strength, and mobility, and aids in weight management.

NOTES:

• Salt Intake: General recommendation for salt intake is <6g per day, which is equivalent to 2g of sodium. This is particularly important for individuals with heart failure (HF), chronic kidney disease (CKD), and hypertension (HTN).

• These recommendations are applicable to individuals with HF, CKD, and HTN, as well as the general population.