title: Double jeopardy: the influence of excessive daytime sleepiness and impaired cognition on health-related quality of life in adults with heart failure.
abstract: OBJECTIVE
  To determine how excessive daytime sleepiness (EDS) and impaired cognition contribute to health-related quality of life (HRQL) in heart failure (HF).
  
  
  RESULTS
  Adults with chronic HF were enrolled into a prospective cohort study. Data were obtained from 280 subjects enrolled from three sites in the northeastern USA; 242 completed the 6-month study. At baseline, cohorts with and without EDS were identified using the Epworth Sleepiness Scale. Each EDS group was further subdivided into those with and without impaired cognition using a battery of five neuropsychological tests. Two disease-specific measures, the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the Functional Outcomes of Sleep Questionnaire (FOSQ), were used to measure HRQL. General linear modelling of square-transformed variables was used to test the hypothesis that cohort membership was a significant predictor of HRQL. At 6 months the remaining sample was 62.5 [standard deviation (SD) 12] years old, mostly male (63%), white (65%), and functionally compromised [72% New York Heart Association (NYHA) class III/IV]. The cohort with both EDS and impaired cognition had the lowest KCCQ overall summary score (60.5 ± 22.5) compared with the cohort without EDS or impaired cognition (74.6 ± 17.4, P ≤ 0.001). A similar effect was seen on the FOSQ (16.0 ± 2.8 vs. 18.5 ± 2.2, P < 0.001).
  
  
  CONCLUSIONS
  Impaired cognition alone did not explain poor HRQL, but the addition of EDS poses a significant risk for poor HRQL. Interventions designed to influence EDS may improve HRQL in this population.
authors.affiliation: University of Pennsylvania School of Nursing, Philadelphia, PA 19104-4217, USA. briegel@nursing.upenn.edu
authors.forename: Barbara
authors.initials: B
authors.lastname: Riegel
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Ratcliffe
authors.forename: William S
authors.initials: WS
authors.lastname: Weintraub
authors.forename: Steven L
authors.initials: SL
authors.lastname: Sayers
authors.forename: Lee R
authors.initials: LR
authors.lastname: Goldberg
authors.forename: Sheryl
authors.initials: S
authors.lastname: Potashnik
authors.forename: Terri E
authors.initials: TE
authors.lastname: Weaver
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Pressler
mesh_terms: D000368:Aged; D003072:Cognition Disorders / Q000523:psychology*; D016001:Confidence Intervals; D006970:Disorders of Excessive Somnolence / Q000209:etiology / Q000523:psychology*; D005260:Female; D006305:Health Status Indicators; D006333:Heart Failure / Q000523:psychology*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011594:Psychometrics; D011788:Quality of Life / Q000523:psychology*; D012372:ROC Curve; D012893:Sleep Wake Disorders / Q000150:complications* / Q000523:psychology; D013223:Statistics as Topic; D011795:Surveys and Questionnaires