title: Associations of heart failure with sleep quality: the Rotterdam Study.
abstract: OBJECTIVE
  The prevalence of sleep disturbances and heart failure increases with age. We aimed to evaluate the associations of incident heart failure and cardiac dysfunction with changes in sleep quality.
  
  
  METHODS
  This prospective population-based study was conducted in the Rotterdam Study. Of the 3445 eligible persons (mean age 72.0±7.1 years) available for cross-sectional analyses, 8.9% (n = 307) had prevalent clinical heart failure. In longitudinal analyses, 1989 eligible persons (mean age 70.0±5.8 years) were followed for an average of 6.5±0.4 years, of which 4.6% (n = 91) had prevalent or incident clinical heart failure. Heart failure was assessed according to European Society of Cardiology criteria. To estimate cardiac function, we measured left ventricular fractional shortening, left ventricular systolic function, and E/A ratio by echocardiography. Heart failure and cardiac dysfunction were studied with linear regression in relation to sleep quality, assessed by the Pittsburgh Sleep Quality Index.
  
  
  RESULTS
  No associations between clinical heart failure and sleep quality were observed in cross-sectional analyses. Clinical heart failure predicted a reduction of sleep quality (B = 1.00 points on the Pittsburgh Sleep Quality Index; 95% CI 0.40, 1.60) in longitudinal assessment. This association was driven by the sleep onset latency and sleep quality components of the Pittsburgh Sleep Quality Index. Cardiac dysfunction was not related to sleep quality in cross-sectional or longitudinal analyses.
  
  
  CONCLUSIONS
  Clinical heart failure, but not cardiac dysfunction measured by echocardiography, increases the risk of poor sleep quality in the general population over time. These findings suggest that clinical manifestations of heart failure negatively affect sleep.
authors.affiliation: Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Lisette A
authors.initials: LA
authors.lastname: Zuurbier
authors.affiliation: Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Annemarie I
authors.initials: AI
authors.lastname: Luik
authors.affiliation: Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands: Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Maarten J G
authors.initials: MJ
authors.lastname: Leening
authors.affiliation: Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Albert
authors.initials: A
authors.lastname: Hofman
authors.affiliation: Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: Rosanne
authors.initials: R
authors.lastname: Freak-Poli
authors.affiliation: Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Oscar H
authors.initials: OH
authors.lastname: Franco
authors.affiliation: Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands: Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands: Inspectorate for Health Care, The Hague, The Netherlands.
authors.forename: Bruno H
authors.initials: BH
authors.lastname: Stricker
authors.affiliation: Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands: Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands: Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Henning
authors.initials: H
authors.lastname: Tiemeier
mesh_terms: D000368:Aged; D015897:Comorbidity; D005260:Female; D006306:Health Surveys / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000453:epidemiology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies; D012893:Sleep Wake Disorders / Q000453:epidemiology*
keywords: Sleep quality; echocardiography; epidemiology; heart failure; population-based