Insomnia and Insomnia Symptoms in Persons With Heart Failure

Abstract

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.

Associations of insomnia symptoms with sociodemographic, clinical, and lifestyle factors in persons with HF: Health and retirement study

“…This analysis was part of a larger secondary data analysis of the health and retirement study (HRS) wave 2016 (Health and retirement study, 2019b). Details of the design and methods of the HRS study and the larger analysis were reported previously (Gharzeddine, 2020; Gharzeddine et al, 2021) and are summarized here for clarity.…”

“…However, these associations were either not investigated or not reported as statistically significant in persons with HF. The lack of a large sample size could be attributed to the nonsignificant associations in these studies, and studies with large samples were deemed necessary (Gharzeddine et al, 2021).…”

“…Many studies investigated sleep quality in HF, but patients with poor sleep quality do not necessarily have insomnia (Sateia, 2014). The associations between insomnia symptoms and insomnia, age, sex, and sleep‐disordered breathing revealed mixed results in a recent review (Gharzeddine et al, 2021). A recent HF study revealed a beneficial effect of physical activity on improving total sleep time and a moderation effect of age on this association (Ash et al, 2021).…”

Associations of Insomnia Symptoms With Cognition in Persons With Heart Failure

“…However, insomnia differs from poor sleep as a person may have poor sleep but not necessarily insomnia or insomnia symptoms (Sateia, 2014). Further, the associations between cognition and insomnia symptoms in persons with HF remains poorly understood since a limited number of studies have investigated these associations and reported mixed results (Gharzeddine et al, 2020). Given the significance of cognition and insomnia symptoms and their impact on clinical outcomes in persons with HF, there is a pressing need to examine these associations in this population.…”

“…We hypothesized that cognitive impairment is associated with insomnia symptoms, and those with insomnia symptoms are more likely to have worse cognition compared to those without. This analysis was part of a larger study (Gharzeddine, 2020) that explored the associations of insomnia symptoms with sociodemographic, clinical, and lifestyle factors including associations with cognition and medication adherence, an essential component of self-care in persons with HF.…”