Impact of implementing sleep hygiene program on self-care behavior of heart failure patients: a randomized clinical trial

Sleep disorder is the common problems among heart failure (HF) patients, which causes cognitive impairment, day-time fatigue and loss of energy to do their daily activities. Moreover, performing daily self-care activities is considered an important factor for reducing disease symptoms and improving heart failure patients’ quality of life. The present study aims to investigate the effect of implementing sleep hygiene program on HF patients’ self-care behavior. In this randomized controlled trial, 74 heart failure patients (NYHA class II–III) from Qaem Hospital, Firoozabad, were randomly allocated (1:1) to intervention ( n = 37) or control ( n = 37) groups using simple randomization by Kitset software. Allocation was concealed using sequentially numbered, opaque, sealed envelopes.. The intervention group received five 90-min sessions of sleep hygiene program on a weekly basis in person and virtually using a sleep hygiene self-declaration booklet. Demographic questionnaire and valid and reliable heart failure self-care behavior scale were used to collect the data. The data were collected in two steps, before and after the intervention. The data were analyzed by SPSS 21.0 using independent t-tests, paired t-tests, their non-parametric equivalents (Wilcoxon and Mann-Whitney tests), and a one-way analysis of covariance (ANCOVA). No significant baseline differences existed between groups. In the intervention group, self-care behavior significantly improved post-intervention (Wilcoxon, p < 0.001), while the control group showed significant worsening (paired t-test, p < 0.001). Between-group comparison (Mann-Whitney, p < 0.001) favored the intervention. ANCOVA, adjusting for baseline scores, confirmed a significant main effect (F (1, 70) = 4.110, p = 0.046, η²=0.055), with a mean difference of –13.51 (95% CI: –15.27 to –11.75, p < 0.001). Most individual self-care items improved significantly except daytime rest and flu vaccination ( p > 0.05). Implementing the sleep hygiene program improved HF patients’ self-care behavior. Therefore, it is suggested that nurses and managers at medical centers use the sleep hygiene program in order to improve HF patients’ self-care. IRCT20231030059902N1- Registration Date: 2024/01/20- https://irct.behdasht.gov.ir