title: The association between sleep disturbance, depressive symptoms, and health-related quality of life among cardiac rehabilitation participants.
abstract: OBJECTIVE
  Recent guidelines from the Canadian Association of Cardiac Rehabilitation highlight the importance of addressing sleep disturbance among participants of cardiac rehabilitation (CR) programs. The primary objective of this study was to examine the relationship between depressive symptoms, health-related quality of life, and sleep disturbance in CR participants. The secondary objective was to estimate the prevalence of sleep disturbance among CR participants with and without depressive symptoms and explore demographic, medical, and psychological predictors of poor sleep quality.
  
  
  METHODS
  Cardiac rehabilitation participants (N = 259) were included in this study. Participants completed a standardized questionnaire package including demographic, health-related, and psychosocial measures. Physiologic and anthropometric measurements were taken at baseline. Descriptive statistics were calculated for all variables, and data were analyzed using multivariate logistic regression.
  
  
  RESULTS
  Poor sleep quality was reported by 52% of participants in the sample, and 47% of participants in the sample reported experiencing at least mild depressive symptoms. Poor sleep occurred more often in individuals with depressive symptoms, and after adjustment for medical factors and health-related quality of life, participants with symptoms of depression were still more likely to experience sleep disturbance than those without depressive symptoms (OR = 2.80; 95% CI, 1.37-5.77). An important gender difference emerged in the relationship between symptoms of depression and sleep disturbance.
  
  
  CONCLUSIONS
  Among participants of a CR program, disturbed sleep was strongly associated with depressive symptoms and decreased health-related quality of life. Results demonstrate the importance of sleep evaluation in CR programs.
authors.affiliation: Departments of Epidemiology, Biostatistics, and Occupational Health (Ms Banack) and Medicine (Drs Lowensteyn, Grover, and Da Costa), McGill University, Montreal, Quebec, Canada; McGill Cardiovascular Health Improvement Program, Montreal, Quebec, Canada (Drs Holly, Lowensteyn, Marchand, Grover, and Da Costa and Ms Masse); and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (Dr Holly).
authors.forename: Hailey R
authors.initials: HR
authors.lastname: Banack
authors.forename: Crystal D
authors.initials: CD
authors.lastname: Holly
authors.forename: Ilka
authors.initials: I
authors.lastname: Lowensteyn
authors.forename: Lisa
authors.initials: L
authors.lastname: Masse
authors.forename: Sylvie
authors.initials: S
authors.lastname: Marchand
authors.forename: Steven A
authors.initials: SA
authors.lastname: Grover
authors.forename: Deborah
authors.initials: D
authors.lastname: Da Costa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000072038:Cardiac Rehabilitation; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011788:Quality of Life; D012737:Sex Factors; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D055815:Young Adult