title: Poor sleep and impaired self-care: towards a comprehensive model linking sleep, cognition, and heart failure outcomes.
abstract: BACKGROUND
  Persons with heart failure (HF) have significantly lower sleep quantity and quality than persons without HF. The purpose of this article is to propose a conceptual model describing how poor sleep may contribute to inadequate self-care and untoward outcomes in persons with HF.
  
  
  OBJECTIVE
  Our overarching hypothesis is that sleep affects self-care and outcomes through its effects on cognition. Building on the work of others, we outline a conceptual model that illustrates that even transient sleep disruption prevents sleep-related restorative processes and contributes to cognitive dysfunction-especially in the 25-50% of HF patients with existing cognitive impairment. Poor sleep may be sufficient to impair cognition to a level that interferes with higher order functions involved in effective HF self-care practices. Through these mechanisms, inadequate sleep may contribute to poor outcomes such as low health-related quality of life and greater risk of unplanned hospitalization.
  
  
  CONCLUSIONS
  The proposed model (1) bridges physical, neuropsychological and behavioral phenomena, (2) suggests a mechanism by which poor sleep affects daytime behavior, and (3) is empirically testable. Exploring factors that interfere with sleep may improve self-care and outcomes in persons with HF.
authors.affiliation: School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA 19104-6020, USA. briegel@nursing.upenn.edu
authors.forename: Barbara
authors.initials: B
authors.lastname: Riegel
authors.forename: Terri E
authors.initials: TE
authors.lastname: Weaver
mesh_terms: D003072:Cognition Disorders / Q000453:epidemiology*; D015897:Comorbidity; D003657:Decision Making; D003863:Depression / Q000453:epidemiology; D006333:Heart Failure / Q000453:epidemiology*; D006801:Humans; D008962:Models, Theoretical; D011788:Quality of Life; D012307:Risk Factors; D012648:Self Care; D012891:Sleep Apnea Syndromes / Q000453:epidemiology; D012892:Sleep Deprivation / Q000453:epidemiology; D012893:Sleep Wake Disorders / Q000453:epidemiology*
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