Factors associated with sleeping difficulties in patients with heart failure

Abstract Background Sleeping difficulties is prevalent in heart failure (HF) and a predictor of cardiac events in patients with HF. Purpose To describes the prevalence of sleeping difficulties in patients with HF and factors associated. Method This study used data of a multicentre RCT entitled Tele-Yoga study (clincialtrials.gov:NCT03703609). Patients were included in the analysis when they were diagnosed with HF and completed a questionnaire on sleeping difficulties. Sleeping difficulties were measured with the Minimal Insomnia Symptom Scale (MISS), patients with a score a 6 or higher patients were characterised as having sleeping difficulties. Through a literature search we identified factors that could be associated with sleeping difficulties. Demographic and clinical background variables (age, sex, BMI, marital status, working status, having atrial fibrillation and/or diabetes), anxiety and depressive symptoms (Hospital Anxiety and Depression scale) and Health related Quality of Life (EQ-5D index score) were considered. Logistic regression was performed with backwards elimination of the factors considered associated with having or not having sleeping difficulties. Results In total 244 patients were included (mean age 67±10, 28% women), whereas 27% had sleeping difficulties (n = 68, a score a 6 or higher on the MISS); 28% had moderate till very severe difficulties initiating sleep (n=77), 53% had moderate till very severe problems by waking up at night (n=130), 38% had moderate till very severe problems by not feeling refreshed by sleep (n=92). The logistic regression showed that patients with sleeping difficulties were significantly more often single (27% vs. 18%, OR 0.336 P-value=0.023), more often not working (72% vs. 69%, OR 2.524, P-value=0.047) more often experienced symptoms of anxiety (45% vs. 10%, OR 4.882, P-value<001) and had a lower quality of life, (0.637±0.261 vs. 0.786±0.203, OR 0.042 P-Value=0.001) compared to patients with no sleeping difficulties. Conclusion Patients having symptom of anxiety were at five times greater risk of experiencing sleeping difficulties. Being in a relationship and being employed were associated with less sleeping difficulties. Additionally, patients with sleeping problems reported lower quality of life.