Sleep difficulties, daytime sleepiness, and health-related quality of life in patients with chronic heart failure.
BACKGROUND
Normal sleep changes with age in duration, fragmentation, and depth. The prevalence of insomnia is high in the elderly general population. In patients with chronic heart failure (HF) objective sleep assessments have shown disturbances such as a shorter total duration of sleep, frequent arousals, and sleep stage changes.


OBJECTIVE
To describe self-assessed sleep difficulties, daytime sleepiness, and their relation to health-related quality of life (HRQOL) in men and women with HF, as well as to make a comparison to data from a norm population.


METHODS
Cross-sectional design including 223 patients with HF, New York Heart Association classification II-IV, assessed using the Uppsala Sleep Inventory-Chronic Heart Failure, the Epworth Sleepiness Scale, Medical Outcomes Study 36-Item Short Form Health Survey, and Minnesota Living With Heart Failure Questionnaire.


RESULTS
The most commonly reported sleep difficulties were initiating and maintaining sleep. The ratio of habitual sleep to the amount of estimated need for sleep was significantly shorter for women (P < .05), and the number of awakenings per night was significantly increased for men (P < .001). A total of 21% suffered from daytime sleepiness. Patients suffering from difficulties maintaining sleep, initiating sleep, and early morning awakenings reported significantly lower HRQOL in almost all dimensions of the SF-36 (P < .05-P < .001) compared to patients without sleeping difficulties, as well as to the normal population. The disease-specific Minnesota Living With Heart Failure Questionnaire showed significantly reduced (P < .05-P < .001) HRQOL as measured by the total and subscale scores for patients suffering from sleeping difficulties compared to patients without sleeping difficulties.


CONCLUSIONS
Patients with HF have a reduced HRQOL especially if difficulties maintaining sleep, initiating sleep, and early morning awakenings are involved.
Department of Cardiology, Linköping University, Linköping, Sweden. anders.brostrom@imv.liu.se
Anders
A
Broström
Anna
A
Strömberg
Ulf
U
Dahlström
Bengt
B
Fridlund
D000203:Activities of Daily Living; D000368:Aged; D001294:Attitude to Health; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005163:Factor Analysis, Statistical; D005260:Female; D006304:Health Status; D006306:Health Surveys; D006333:Heart Failure / Q000145:classification / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008297:Male; D015404:Nursing Methodology Research; D015995:Prevalence; D011788:Quality of Life; D012720:Severity of Illness Index; D012893:Sleep Wake Disorders / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology*; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology