Characteristics of sleep in patients with stable heart failure versus a comparison group

Redeker, Nancy S.; Stein, S.

doi:10.1016/j.hrtlng.2005.10.007

Cited by 82 publications

(118 citation statements)

References 44 publications

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“…This finding is consistent with previous reports that documented an association of daytime sleepiness with the use of medication for congestive heart failure [26] and the occurrence of hypertension [27]. Additionally, it has been suggested that, in patients with heart disease, daytime sleepiness derives from disturbed sleep continuity and poor sleep quality [26].…”

Section: Discussionsupporting

confidence: 92%

Predictors of residual sleepiness in adequately treated obstructive sleep apnoea patients

Koutsourelakis¹,

Perraki²,

Economou³

et al. 2009

Eur Respir J

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Some patients with obstructive sleep apnoea syndrome (OSAS; respiratory distress index (RDI) of .5 events?h -1 ) experience residual excessive daytime subjective sleepiness (Epworth Sleepiness Scale (ESS) score of .10), despite adequate use of continuous positive airway pressure (CPAP) therapy. The aim of the present study was to identify clinical and polysomnographic predictors of this sleepiness.Clinical and polysomnographic variables and ESS score were evaluated in 208 OSAS patients with an ESS score of .10 before (initial assessment) and after o6 months of adequate (o4 h?day -1 ) CPAP use. Following CPAP treatment, 114 (55%) patients showed an abnormal ESS score (.10; CPAP nonresponders), whereas 94 (45%) showed a normal ESS score (,11; CPAP responders). Of the CPAP responders, none had a history of depression, whereas the converse was true for 38.8% of CPAP nonresponders. In addition, multivariate logistic regression analysis revealed that the independent predictors of residual excessive daytime sleepiness following CPAP therapy were a history of diabetes and heart disease, and a higher ESS score and lower RDI on initial assessment.In conclusion, predictors of residual excessive sleepiness in adequately CPAP-treated OSAS were a history of depression, diabetes and heart disease, and a higher ESS score and lower RDI on initial assessment.

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Section: Discussionsupporting

confidence: 92%

Predictors of residual sleepiness in adequately treated obstructive sleep apnoea patients

Koutsourelakis¹,

Perraki²,

Economou³

et al. 2009

Eur Respir J

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“…Only one of the studies focused specifically on HF and observed that HF patients had a lower sleep quality than controls. 2 In our cross-sectional analyses, we did not observe an association between HF and sleep. In clinical studies HF is probably more severe than in our study, which might explain the absence of the association in our crosssectional analyses.…”

Section: Discussioncontrasting

confidence: 50%

“…Several studies have related poor sleep quality to prevalence of cardiovascular disease; however, these studies have not reported repeated sleep assessments. 2,11,12,25 Therefore, any effect of cardiovascular disease upon sleep must be inferred from case-control studies, which have been undertaken in a clinical setting. Only one of the studies focused specifically on HF and observed that HF patients had a lower sleep quality than controls.…”

Section: Discussionmentioning

confidence: 99%

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Associations of Heart Failure with Sleep Quality: The Rotterdam Study

Zuurbier

Luik

Leening

et al. 2015

Journal of Clinical Sleep Medicine

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Study Objectives: The prevalence of sleep disturbances and heart failure increases with age. We aimed to evaluate the associations of incident heart failure and cardiac dysfunction with changes in sleep quality. Methods: This prospective population-based study was conducted in the Rotterdam Study. Of the 3,445 eligible persons (mean age 72.0 ± 7.1 years) available for crosssectional analyses, 8.9% (n = 307) had prevalent clinical heart failure. In longitudinal analyses, 1,989 eligible persons (mean age 70.0 ± 5.8 years) were followed for an average of 6.5 ± 0.4 years, of which 4.6% (n = 91) had prevalent or incident clinical heart failure. Heart failure was assessed according to European Society of Cardiology criteria. To estimate cardiac function, we measured left ventricular fractional shortening, left ventricular systolic function, and E/A ratio by echocardiography. Heart failure and cardiac dysfunction were studied with linear regression in relation to sleep quality, assessed by the Pittsburgh Sleep Quality Index. Results: No associations between clinical heart failure and sleep quality were observed in cross-sectional analyses. Clinical heart failure predicted a reduction of sleep quality (B = 1.00 points on the Pittsburgh Sleep Quality Index; 95% CI 0.40, 1.60) in longitudinal assessment. This association was driven by the sleep onset latency and sleep quality components of the Pittsburgh Sleep Quality Index. Cardiac dysfunction was not related to sleep quality in cross-sectional or longitudinal analyses. Conclusions: Clinical heart failure, but not cardiac dysfunction measured by echocardiography, increases the risk of poor sleep quality in the general population over time. These fi ndings suggest that clinical manifestations of heart failure negatively affect sleep. Keywords: sleep quality, heart failure, echocardiography, population-based, epidemiology Citation: Zuurbier LA, Luik AI, Leening MJ, Hofman A, FreakPoli R, Franco OH, Stricker BH, Tiemeier H. Associations of heart failure with sleep quality: the Rotterdam Study. J Clin Sleep Med 2015;11(2):117-121.pii: jc-00172-14 http://dx.doi.org/10.5664/jcsm.4454 S leep disturbances have been reported in around 60% of patients with heart failure (HF).1,2 Despite improved treatment and an overall decline in mortality after a cardiovascular event, the number of HF patients is increasing among the elderly.3 This is probably due to an aging population and to the improved chances of survival for HF patients. 4 Nevertheless, only 25% to 35% of patients with clinical HF survive up to 5 years after diagnosis, and HF poses a great burden in terms of treatment, hospitalization and quality of life. [5][6][7] HF is related to multiple physical and mental problems, including shortness of breath, depressive symptoms, cognitive impairment, and sleep problems. 8,9 Little is known about the changes in sleep occurring in these patients over time.Previous studies investigating HF and sleep have been mostly cross-sectional and cannot establish a temporal relation. Prospective...

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“…Almost 75% of HF patients report poor sleep. 2,3 Insomnia, characterized by diffi culty initiating and maintaining sleep, early morning awakenings, non-restorative sleep, and daytime dysfunction, occurs in 25% to 56% of HF patients, [2][3][4][5] who report higher rates than "healthy" controls 2 and the general population. Chronic insomnia contributes to incident HF and death.…”

mentioning

confidence: 99%

Feasibility and Efficacy of a Self-Management Intervention for Insomnia in Stable Heart Failure

Redeker

Jeon

Andrews

et al. 2015

Journal of Clinical Sleep Medicine

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Background: Chronic insomnia is common among patients with heart failure (HF) and may contribute to fatigue and poor function. However, to date there have been no randomized controlled trials focused on treatment of insomnia or daytime symptoms in this population. Objective: The purpose of this study was to examine the preliminary effi cacy, feasibility, and acceptability of a selfmanagement intervention (cognitive behavioral therapy [CBT-I]) for insomnia among patients with stable HF. Methods: We conducted a pilot randomized controlled trial (RCT) in which patients with stable Class I-III HF (n = 25/52.1% women; mean age = 59 ± 14.8 years) were randomized in groups to CBT-I (n = 29) or an attention control condition (HF self-management with sleep hygiene; n = 19). Participants completed 2 weeks of wrist actigraphy, the insomnia severity index, and measures of fatigue, depression, sleepiness, and functional performance at baseline and follow-up. We computed the size of the effects on the dependent variables and used MANOVA to evaluate the effects of CBT-I on insomnia and fatigue. Results: CBT-I was feasible and acceptable and had a statistically signifi cant effect on insomnia and fatigue, while controlling for the effects of comorbidity and age. Conclusions: CBT-I has short-term effi cacy as a treatment for chronic insomnia among patients with stable HF. Future studies are needed to address its sustained effects. Keywords: self-management, heart failure, insomnia, cognitive behavioral therapy, sleep, fatigue, depression Citation: Redeker NS, Jeon S, Andrews L, Cline J, Jacoby D, Mohsenin V. Feasibility and effi cacy of a self-management intervention for insomnia in stable heart failure. J Clin Sleep Med 2015;11(10):1109 -1119 .pii: jc-00335-14 http://dx.doi.org/10.5664/jcsm.5082 H eart failure (HF), a disabling chronic condition that affl icts over fi ve million Americans, 1 is associated with excess morbidity and mortality, comorbidity, poor daytime function, and high symptom burden. Almost 75% of HF patients report poor sleep.2,3 Insomnia, characterized by diffi culty initiating and maintaining sleep, early morning awakenings, non-restorative sleep, and daytime dysfunction, occurs in 25% to 56% of HF patients, 2-5 who report higher rates than "healthy" controls 2 and the general population. Chronic insomnia contributes to incident HF and death. 6 It is distressing and associated with symptoms, such as fatigue, nocturnal dyspnea, depression, anxiety, pain, and excessive daytime sleepiness, poor quality of life, and decrements in functional performance. 3,5,[7][8][9][10][11][12][13] Health care providers frequently attribute sleep disturbance, including insomnia symptoms, to the pathophysiology (e.g., fl uid congestion) and symptoms of HF itself (e.g., nocturnal dyspnea, nocturia) or to sleep disordered breathing that occurs in about half the population.14 However, sleep disordered breathing does not consistently explain insomnia, self-reported sleep quality, or fatigue; and insomnia was closely associated with...

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Characteristics of sleep in patients with stable heart failure versus a comparison group

Cited by 82 publications

References 44 publications

Predictors of residual sleepiness in adequately treated obstructive sleep apnoea patients

Predictors of residual sleepiness in adequately treated obstructive sleep apnoea patients

Associations of Heart Failure with Sleep Quality: The Rotterdam Study

Feasibility and Efficacy of a Self-Management Intervention for Insomnia in Stable Heart Failure

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