title: Determinants of global perceived health in community-dwelling elderly screened for heart failure and sleep-disordered breathing.
abstract: The relationships between heart failure (HF), sleep-disordered breathing (SDB), insomnia, depressive symptoms, and excessive daytime sleepiness (EDS), as well as their relationship to Global Perceived Health (GPH) in an elderly community-dwelling population, have not been explored. Data from 331 community-dwelling elderly (71-87 years old) were collected by echocardiography, polygraphy, and specific questionnaires. Factor analyses and structural equation modeling were used to explore the relationships between HF, SDB, sleep, psychosocial factors, and GPH. Exploratory and confirmatory factor analyses derived a 5-factor model representing SDB, insomnia, systolic function, breathlessness/physical function, and psychosocial function. Structural equation modeling analyses were used to explore the relationships between the 5 factors and to GPH. Sleep-disordered breathing had a weak effect on systolic function, but no effects on any of the other factors or GPH were found. Psychosocial function and breathlessness/physical function directly affected GPH. Indirect effects on GPH, mediated by psychosocial function, were found for breathlessness/physical function and insomnia. Systolic function also had an indirect effect on GPH. The fact that SDB in the elderly has no obvious negative associations to sleep complaints or GPH does not exclude them from being adequately treated for SDB. However, the present study has shown that SDB, by means of self-rated sleep complaints and health-related quality of life, can be problematic to detect. Psychosocial function was the most important factor for perceived GPH as it had a direct effect, as well as mediated the factors breathlessness/physical function and insomnia effects, on GPH. This study indicates that interventions in clinical practice targeting psychosocial dysfunction, such as depressive symptoms, could help to improve GPH in the elderly with or without HF.
authors.affiliation: Department of Cardiology, Linköping University Hospital, Sweden. peter.johansson@aries.vokby.se
authors.forename: Peter
authors.initials: P
authors.lastname: Johansson
authors.forename: Urban
authors.initials: U
authors.lastname: Alehagen
authors.forename: Erland
authors.initials: E
authors.lastname: Svensson
authors.forename: Eva
authors.initials: E
authors.lastname: Svanborg
authors.forename: Ulf
authors.initials: U
authors.lastname: Dahlström
authors.forename: Anders
authors.initials: A
authors.lastname: Broström
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000453:epidemiology; D004417:Dyspnea / Q000453:epidemiology; D005163:Factor Analysis, Statistical; D005260:Female; D006304:Health Status; D006333:Heart Failure / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008403:Mass Screening; D011788:Quality of Life; D012891:Sleep Apnea Syndromes / Q000453:epidemiology*; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology; D013548:Sweden / Q000453:epidemiology; D013599:Systole