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Background/Objective: Insomnia and insomnia symptoms are highly prevalent in persons with heart failure (HF), and they are associated with several untoward outcomes. The purpose of this integrative review is to describe the correlates, predictors, and outcomes of insomnia and insomnia symptoms in persons with HF. Methods: Using integrative review methods, an extensive electronic search of 5 databases was conducted for the period of 2000-2019. Sixteen studies were identified that met the inclusion criteria for review and investigated insomnia or insomnia symptoms in HF. Results: Various sociodemographic factors, chronic comorbidities, clinical factors, and cognitive-behavioral factors are correlates and predictors of insomnia and insomnia symptoms in persons with HF. Depression, fatigue, daytime sleepiness, poor self-reported physical functioning, decreased exercise capacity, cardiac events, and poor health-related quality of life are significant outcomes of insomnia and insomnia symptoms in persons with HF. The associations of insomnia and insomnia symptoms with age, sex, sleep-disordered breathing, and cognition were not consistent across all studies. Conclusion: Larger studies with diverse age and race groups as well as longitudinal studies and designs that test mediation effects are needed to disentangle complex relationships between insomnia and insomnia symptoms and several of their potential predictors and correlates in HF.

Although cognitive impairment is common among persons with heart failure and negatively impacts self-care, hospitalization, and mortality, the associations between cognitive impairment and insomnia symptoms are not clearly understood. The purpose of this study was to explore these associations and examine if they are maintained after adjusting for relevant sociodemographic, clinical, and lifestyle factors. Guided by the Neurocognitive model of insomnia and sleep and the self-care conceptual model, a cross-sectional data analysis using parametric testing was conducted on the Health and Retirement Study wave 2016. Difficulty initiating sleep and early morning awakening, but not difficulty maintaining sleep were significantly associated with poorer cognitive performance in the bivariate and multivariate analysis. Our results are suggestive of different phenotypes of insomnia symptoms that may have different associations with cognition in persons with heart failure. Further research using objective measurements of insomnia symptoms and detailed neuropsychiatric testing of cognition is needed to confirm this conclusion.

Insomnia symptoms are very common in persons with heart failure (HF). However, many of the correlates and predictors of insomnia symptoms in this population remain unclear. The purpose of this study is to investigate the associations of sociodemographic, clinical, and lifestyle factors with insomnia symptoms in persons with HF. A theoretical framework was adapted from the neurocognitive model of chronic insomnia to guide the study. Data from the health and retirement study were used for the analysis. Parametric and nonparametric bivariate and multivariate analyses were conducted to investigate these associations. Age, depressive symptoms, comorbidity, dyspnea, pain, and smoking had significant bivariate associations with all insomnia symptoms. Race, Hispanic ethnicity, marital status, household income, poverty, and physical activity were associated with difficulty initiating sleep (DIS) and early morning awakening (EMA). Female sex, education, and alcohol consumption had a significant bivariate association with DIS. Sleep-disordered breathing and body mass index were significantly associated with EMA. Multivariate analysis suggested that depressive symptoms, comorbidity, dyspnea, and pain had independent associations with each insomnia symptom. Age explained DIS and difficulty maintaining sleep, and significant interaction effects between age and physical activity on DIS and EMA were revealed. Results suggest that insomnia symptoms are associated with several sociodemographic, clinical, and lifestyle factors. Age below 70 years, depressive symptoms, comorbidity, dyspnea, and pain might be considered as a phenotype to identify persons with HF who are at increased risk for insomnia symptoms.

Background: Heart failure (HF) is accompanied with several untoward outcomes including insomnia symptoms. Many factors including comorbidities, experienced symptoms, and psychosocial characteristics associated with HF were attributed to the high prevalence of insomnia symptoms in persons with HF. However, it is not yet clear if HF itself contributes to insomnia symptoms regardless of these associated factors. Purpose: The purpose of this analysis was to investigate the association of HF with insomnia symptoms in adjusted models for sociodemographic, clinical, and lifestyle factors. Methods: A secondary data analysis guided by the neurocognitive model of insomnia was conducted on data from the health and retirement study using multiple logistic regression. The total sample size included 17,910 subjects of which 1,189 were identified to have HF. Results: The results showed that those with HF were approximately two times more likely to have insomnia symptoms (OR:1.95, p <0.001) in the unadjusted model. After adjusting for age, sex, race, ethnicity, education, marital status, income, poverty level, sleep-disordered breathing, obesity, depression symptoms, comorbid diseases, smoking, alcohol consumption, and physical activity using block-wise selection, HF maintained a significant association with insomnia symptoms (OR:1.15, p<0.05). When looking at each insomnia symptom separately, HF significantly predicted difficulty initiating sleep (OR: 1.23, p < 0.01) in the fully adjusted model, but maintained a trend with difficulty maintaining sleep and early morning awakening. Conclusion: These results are suggestive of an alerting effect in HF which could be attributed to its pathophysiology. Specifically, the neurohormonal compensatory mechanism and the increased sympathetic stimulation in heart failure may exert an alerting effect during the day and contribute to a hyper-arousal state and difficulty initiating sleep before it partially wears off after sleep. Further studies are needed to investigate this hypothesis.