title: Reduced cerebral blood flow and white matter hyperintensities predict poor sleep in heart failure.
abstract: BACKGROUND
  Poor sleep is common in heart failure (HF), though mechanisms of sleep difficulties are not well understood. Adverse brain changes among regions important for sleep have been demonstrated in patients with HF. Cerebral hypoperfusion, a correlate of sleep quality, is also prevalent in HF and a likely contributor to white matter hyperintensities (WMH). However, no study to date has examined the effects of cerebral blood flow, WMH, and brain volume on sleep quality in HF.
  
  
  METHODS
  Fifty-three HF patients completed the Pittsburgh Sleep Quality Index and underwent brain magnetic resonance imaging to quantify brain and WMH volume. Transcranial Doppler ultrasonography assessed cerebral blood flow velocity of the middle cerebral artery (CBF-V of the MCA).
  
  
  RESULTS
  75.5% of HF patients reported impaired sleep. Regression analyses adjusting for medical and demographic factors showed decreased CBF-V of the MCA and greater WMH volume were associated with poor sleep quality. No such pattern emerged on total brain or regional volume indices.
  
  
  CONCLUSIONS
  Decreased cerebral perfusion and greater WMH may contribute to sleep difficulties in HF. Future studies are needed to confirm these findings and clarify the effects of cerebral blood flow and WMH on sleep in healthy and patient samples.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Alosco
authors.forename: Adam M
authors.initials: AM
authors.lastname: Brickman
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Spitznagel
authors.forename: Erica Y
authors.initials: EY
authors.lastname: Griffith
authors.forename: Atul
authors.initials: A
authors.lastname: Narkhede
authors.forename: Ronald
authors.initials: R
authors.lastname: Cohen
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Sweet
authors.forename: Joel
authors.initials: J
authors.lastname: Hughes
authors.forename: Jim
authors.initials: J
authors.lastname: Rosneck
authors.affiliation: Department of Psychology, Kent State University, Kent, OH, USA. jgunstad@kent.edu.
authors.forename: John
authors.initials: J
authors.lastname: Gunstad
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002560:Cerebrovascular Circulation / Q000502:physiology*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging; D009413:Nerve Fibers, Myelinated / Q000473:pathology* / Q000502:physiology*; D011237:Predictive Value of Tests; D015995:Prevalence; D012044:Regression Analysis; D012893:Sleep Wake Disorders / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology*; D017585:Ultrasonography, Doppler, Transcranial