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Zheng T. Sleep disturbance in heart failure: A concept analysis. Nurs Forum 2021; 56:710-716. [PMID: 33665809 DOI: 10.1111/nuf.12566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/18/2021] [Accepted: 02/21/2021] [Indexed: 11/28/2022]
Abstract
AIM This concept analysis aims to analyze the concept of sleep disturbance (SD) in the context of heart failure (HF) to guide the development of a clearly defined definition. BACKGROUND The term "sleep disturbance" has been used in the literature to describe sleep problems and sleep disorders among individuals with HF. Environmental, physical, psychological, behavioral, and developmental factors complicate the phenomenon of SD in HF. DESIGN Walker and Avant's method was used for this concept analysis. DATA SOURCE Published literature from 2000 to 2020 was identified from electronic health profession-related databases. The current definition and usages of SD were abstracted from empirical work and electronic databases. REVIEW METHODS A focused review of abstracts and full text relating to SD in HF was performed. Studies featuring original data and peer-reviewed articles written in English were included to investigate the multifactorial contextual meaning of the concept. RESULTS SD in HF can be described as a condition in which individuals experience difficulty initiating and maintaining sleep, and difficulty continuing or resuming sleep due to frequent nocturnal arousals due to HF symptoms, sleep-disordered breathing, insomnia, and psychological burdens. CONCLUSIONS To evaluate SD in HF, clinicians must examine the underlying causes to provide the contextual meaning of the concept. A clearly defined and distinguishable concept of SD in HF provides a possibility for accurate measurements of sleep quality, exploring interventions, and evaluating outcomes.
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Affiliation(s)
- Tao Zheng
- Pre-doctoral Fellow, Omics and Symptom Science Training Program, University of Washington School of Nursing, Registered Nurse, University of Washington Medical Center, Seattle, Washington, USA
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Alonderis A, Raskauskiene N, Gelziniene V, Zaliunaite V, Brozaitiene J. Undiagnosed sleep apnoea in cardiac rehabilitation: Age-dependent effect on diastolic function in coronary artery disease patients with preserved ejection fraction. Eur J Cardiovasc Nurs 2021; 20:202–211. [PMID: 33611367 DOI: 10.1177/1474515120941373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 04/03/2020] [Accepted: 06/22/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Focusing on detection of sleep apnoea early in the cardiac rehabilitation process may improve the recovery process and reduce recurrence of cardiovascular events. Patients who continue to be undiagnosed may experience a significantly worse outcome during their cardiac rehabilitation and recovery. Diastolic dysfunction has both diagnostic and prognostic importance in the management of coronary artery disease. We hypothesise that undiagnosed/untreated sleep apnoea in middle-aged coronary artery disease patients with preserved left ventricular ejection fraction changes the pattern of diastolic filling close to that in elderly patients without sleep apnoea. METHODS AND RESULTS This cross-sectional study included the 450 coronary artery disease patients with undiagnosed sleep apnoea who had left ventricular ejection fraction ⩾50% and were referred consecutively to the Clinic of Cardiovascular Rehabilitation within two weeks after treatment for acute coronary syndrome. Polysomnographic and echocardiographic measurements were analysed. Mild to severe sleep apnoea was defined as the apnoea-hypopnea index ⩾5. Age was dichotomised into under the age of 60 years and age 60 years or over. Up to 35% of coronary artery disease patients were likely to have undiagnosed sleep apnoea. There was a statistically significant interaction between the effect of sleep apnoea and age group on diastolic function defined as the ratio peak flow velocity in early diastole/peak flow velocity in atrial contraction ratio (p=0.036). This ratio was significantly (p=0.029) lower in the mild-severe sleep apnoea group (0.97, 95% confidence interval 0.88-1.06) than in the non-sleep apnoea group (1.09, 95% confidence interval 1.03-1.15) among middle aged (<60 years) coronary artery disease patients. Therefore, filling patterns in the middle aged (<60 years) patients with sleep apnoea resemble those observed in the elderly (⩾60 years) patients without sleep apnoea. The effect of sleep apnoea on left ventricular filling pattern in elderly was not observed. CONCLUSIONS Age modifies the effect of sleep apnoea on cardiovascular outcomes. The findings that undiagnosed sleep apnoea impairs diastolic function in a middle-aged coronary artery disease patient underscore the importance of early diagnosis and treatment of sleep apnoea. It is recommended to train and educate cardiac rehabilitation staff on the importance of sleep disorders in this population.
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Yayla A, Özer N. Effects of early mobilization protocol performed after cardiac surgery on patient care outcomes. Int J Nurs Pract 2019; 25:e12784. [PMID: 31617651 DOI: 10.1111/ijn.12784] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 08/09/2019] [Accepted: 08/10/2019] [Indexed: 12/26/2022]
Abstract
AIM This study aimed to determine the effects of an early mobilization protocol performed in patients who underwent cardiac surgery on post-operative outcomes. BACKGROUND Post-operative complications are common in patients undergoing cardiac surgery. Early mobilization is recommended for patients who undergo cardiac surgery to prevent complications and achieve successful outcomes in post-operative care. DESIGN The study design was quasi-experimental with a control group. METHODS Participants were patients who underwent cardiac surgery between January and October 2015. The study included 102 patients (51 patients each in the experimental and control groups). The introductory characteristics form, the Richards-Campbell Sleep Questionnaire (RCSQ), duration of hospital stay (post-operatively), and development of a post-operative late complications form were used to collect data. RESULTS The study results revealed that patients in the experimental group had better improvement in RCSQ scores, shorter duration of hospitalization, and fewer late complications after surgery than patients in the control group. CONCLUSION Early mobilization is feasible in adult cardiac surgery patients and has significant benefits. More research is recommended into the effectiveness of early mobilization in different patient groups.
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Affiliation(s)
- Ayşegül Yayla
- Department of Surgical Nursing, Faculty of Nursing, Atatürk University, Erzurum, Turkey
| | - Nadiye Özer
- Department of Surgical Nursing, Faculty of Nursing, Atatürk University, Erzurum, Turkey
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Walter FA, Ede D, Hawkins MAW, Dolansky MA, Gunstad J, Josephson R, Moore SM, Hughes JW. Sleep quality and daytime sleepiness are not associated with cognition in heart failure. J Psychosom Res 2018; 113:100-106. [PMID: 30190041 DOI: 10.1016/j.jpsychores.2018.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 08/07/2018] [Accepted: 08/08/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Individuals with heart failure (HF) exhibit comorbid impairments in both sleep and cognitive performance. Sleep quality has been associated with impaired cognitive performance in HF patients, but reports are inconsistent. In this study, we examined associations between sleep quality, daytime sleepiness, and cognitive function in HF. METHODS AND RESULTS Participants were 267 (age = 69.1 ± 9.3) mostly Caucasian (74.9%), male (59.6%) stable HF patients recruited from outpatient settings. This cross-sectional study was a secondary analysis of a prospective observational study. Cognitive function domains assessed included: global cognitive function, attention, memory, and executive function. Sleep quality and daytime sleepiness were assessed using the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS), respectively. Separate multiple hierarchical linear regressions were conducted to determine associations between cognitive function and sleep quality and daytime sleepiness, after controlling for sex, New York Heart Association (NYHA) class, education, depressive symptoms, and medical comorbidities. Cognitive function was not associated with sleep quality or daytime sleepiness after alpha inflation corrections were applied. CONCLUSIONS Cognitive function in HF is not associated with sleep quality or daytime sleepiness; other factors may exert greater influence on cognitive performance.
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Affiliation(s)
- Fawn A Walter
- Kent State University, Department of Psychological Sciences, P.O. Box 5190, Kent, OH 44240, USA
| | - David Ede
- Kent State University, Department of Psychological Sciences, P.O. Box 5190, Kent, OH 44240, USA
| | - Misty A W Hawkins
- Oklahoma State University, Department of Psychology, 116 N. Murray, Stillwater, OK 74078, USA
| | - Mary A Dolansky
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - John Gunstad
- Kent State University, Department of Psychological Sciences, P.O. Box 5190, Kent, OH 44240, USA
| | - Richard Josephson
- Harrington Heart & Vascular Institute, University Hospitals, Cleveland, OH, USA; College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Shirley M Moore
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Joel W Hughes
- Kent State University, Department of Psychological Sciences, P.O. Box 5190, Kent, OH 44240, USA.
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Broström A, Wahlin Å, Alehagen U, Ulander M, Johansson P. Sex-specific associations between self-reported sleep duration, depression, anxiety, fatigue and daytime sleepiness in an older community-dwelling population. Scand J Caring Sci 2017; 32:290-298. [DOI: 10.1111/scs.12461] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 02/27/2017] [Indexed: 02/03/2023]
Affiliation(s)
- Anders Broström
- Department of Clinical Neurophysiology; University Hospital; Linköping Sweden
- Department of Nursing; School of Health and Welfare; Jönköping University; Jönköping Sweden
| | - Åke Wahlin
- Institute of Gerontology; School of Health and Welfare; Jönköping University; Jönköping Sweden
| | - Urban Alehagen
- Department of Cardiology and Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - Martin Ulander
- Department of Clinical Neurophysiology; University Hospital; Linköping Sweden
| | - Peter Johansson
- Department of Cardiology and Department of Medical and Health Sciences; Linköping University; Linköping Sweden
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Moon C, Yoon JY, Bratzke LC. The Role of Heart Failure, Daytime Sleepiness, and Disturbed Sleep on Cognition. West J Nurs Res 2016; 39:473-491. [PMID: 27784834 DOI: 10.1177/0193945916675587] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Disturbed sleep and daytime sleepiness may interfere with possible direct relationships between heart failure (HF) and cognition, yet there is limited research investigating this relationship. We aimed to investigate possible mediating roles of disturbed sleep and daytime sleepiness on the relationship between HF and selected cognitive domains among individuals with and without HF. In a cross-sectional design study, we examined the data of 841 older adults with and without HF from the Aging, Demographics, and Memory Study (ADAMS). We found individuals with HF were likely to have a higher degree of disturbed sleep and daytime sleepiness. Both disturbed sleep and daytime sleepiness were significant predictors of cognition. We found that only daytime sleepiness mediated the relationship between the presence of HF and cognitive domains, such as in attention, memory, and executive function after controlling for covariates. Interventions to improve daytime sleepiness among individuals with HF may also help improving cognition.
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Affiliation(s)
- Chooza Moon
- 1 University of Wisconsin-Madison, Madison, WI, USA
| | - Ju Young Yoon
- 2 College of Nursing and Research Institute of Nursing Science, Seoul National University, Seoul, South Korea
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Al-Rawashdeh SY, Lennie TA, Chung ML. The Association of Sleep Disturbances With Quality of Life in Heart Failure Patient–Caregiver Dyads. West J Nurs Res 2016; 39:492-506. [DOI: 10.1177/0193945916672647] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sleep disturbance is common in patients with heart failure and their family caregivers. The purpose of this study was to determine whether sleep disturbances of patients and their spousal caregivers predicted their own and their partners’ quality of life (QoL) in 78 heart failure patient–spousal caregiver dyads. Sleep disturbance was assessed using a composite score of four common sleep complaints. QoL was assessed by the physical and mental well-being subscales of the Short-Form 12 Health Survey. The multilevel dyadic actor–partner interdependence model analysis was used to determine the association between sleep disturbance and QoL. Each individual’s sleep disturbance predicted their own poor physical and mental well-being while spousal caregivers’ sleep disturbance predicted their partners’ mental well-being. Results indicated that patients’ mental well-being is sensitive to their spouses’ sleep disturbance. Interventions targeting improving sleep and QoL may have to include both patients and spousal caregivers.
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Tailored educational supportive care programme on sleep quality and psychological distress in patients with heart failure: A randomised controlled trial. Int J Nurs Stud 2016; 61:219-29. [PMID: 27400028 DOI: 10.1016/j.ijnurstu.2016.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 06/30/2016] [Accepted: 07/01/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Up to 74% of patients with heart failure report poor sleep in Taiwan. Poor symptom management or sleep hygiene may affect patients' sleep quality. An effective educational programme was important to improve patients' sleep quality and psychological distress. However, research related to sleep disturbance in patients with heart failure is limited in Taiwan. OBJECTIVES To examine the effects of a tailored educational supportive care programme on sleep disturbance and psychological distress in patients with heart failure. DESIGN randomised controlled trial. PARTICIPANTS AND SETTING Eighty-four patients with heart failure were recruited from an outpatient department of a medical centre in Taipei, Taiwan. Patients were randomly assigned to the intervention group (n=43) or the control group (n=41). METHODS Patients in the intervention group received a 12-week tailored educational supportive care programme including individualised education on sleep hygiene, self-care, emotional support through a monthly nursing visit at home, and telephone follow-up counselling every 2 weeks. The control group received routine nursing care. Data were collected at baseline, the 4th, 8th, and 12th weeks after patients' enrollment. Outcome measures included sleep quality, daytime sleepiness, anxiety, and depression. RESULTS The intervention group exhibited significant improvement in the level of sleep quality and daytime sleepiness after 12 weeks of the supportive nursing care programme, whereas the control group exhibited no significant differences. Anxiety and depression scores were increased significantly in the control group at the 12th week (p<.001). However, anxiety and depression scores in the intervention group remained unchanged after 12 weeks of the supportive nursing care programme (p>.05). Compared with the control group, the intervention group had significantly greater improvement in sleep quality (β=-2.22, p<.001), daytime sleepiness (β=-4.23, p<.001), anxiety (β=-1.94, p<.001), and depression (β=-3.05, p<.001) after 12 weeks of the intervention. CONCLUSION This study confirmed that a supportive nursing care programme could effectively improve sleep quality and psychological distress in patients with heart failure. We suggested that this supportive nursing care programme should be applied to clinical practice in cardiovascular nursing.
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Moon C, Phelan CH, Lauver DR, Bratzke LC. Is sleep quality related to cognition in individuals with heart failure? Heart Lung 2015; 44:212-8. [PMID: 25796476 DOI: 10.1016/j.hrtlng.2015.02.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 01/30/2015] [Accepted: 02/08/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To examine how self-reported sleep quality and daytime symptoms are associated with selected domains of cognitive function among individuals with heart failure (HF). BACKGROUND HF patients suffer from poor sleep quality and cognitive decline. The relationship between sleep and cognition has not been well documented among individuals with HF. METHODS In this descriptive, cross-sectional study, 68 individuals with HF (male: 63%, mean age = 72 years, SD = 11) completed sleep questionnaires and a neuropsychological battery. RESULTS Participant had mean Pittsburgh Sleep Quality Index score of 5.04 (SD = 2.8). Regression analyses demonstrated neither sleep quality or excessive daytime sleepiness (EDS) were related to cognitive function, but daytime dysfunction was related to lower letter fluency and attention index. CONCLUSION Contrary to some earlier reports, subjective sleep and EDS in this group of individuals was not associated with cognitive decline.
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Affiliation(s)
- Chooza Moon
- University of Wisconsin-Madison, School of Nursing, 701 Highland Avenue, Madison, WI 53705, USA.
| | - Cynthia H Phelan
- University of Wisconsin-Madison, School of Nursing, 701 Highland Avenue, Madison, WI 53705, USA; William S. Middleton Memorial Veterans Hospital Geriatrics Research, Education and Clinical Center (GRECC), 2500 Overlook Terrace, Madison, WI 53705, USA
| | - Diane R Lauver
- University of Wisconsin-Madison, School of Nursing, 701 Highland Avenue, Madison, WI 53705, USA
| | - Lisa C Bratzke
- University of Wisconsin-Madison, School of Nursing, 701 Highland Avenue, Madison, WI 53705, USA
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10
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Zambroski CH, Bekelman DB. Palliative symptom management in patients with heart failure. PROGRESS IN PALLIATIVE CARE 2013. [DOI: 10.1179/096992608x346206] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Laugsand LE, Strand LB, Platou C, Vatten LJ, Janszky I. Insomnia and the risk of incident heart failure: a population study. Eur Heart J 2013; 35:1382-93. [PMID: 23462728 DOI: 10.1093/eurheartj/eht019] [Citation(s) in RCA: 147] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
AIMS Insomnia is highly prevalent among heart failure patients, but only a few small studies have investigated insomnia symptoms and risk of heart failure. We aimed to assess the prospective association between self-reported insomnia symptoms and the risk of incident heart failure in a large Norwegian cohort. METHODS AND RESULTS Baseline data on insomnia symptoms, including difficulty initiating sleep, difficulty maintaining sleep and having non-restorative sleep, socio-demographic variables, and health status, including established cardiovascular risk factors, were collected from 54 279 men and women 20-89 years of age who participated in the Nord-Trøndelag Health study (HUNT) between 1995 and 1997 and were free from known heart failure at baseline. The cohort was followed for incident heart failure from baseline through 2008. We used Cox proportional hazard models to assess the association of baseline insomnia symptoms with the risk of heart failure. A total of 1412 cases of heart failure occurred during a mean follow-up of 11.3 years (SD = 2.9 years), either identified at hospitals or by the National Cause of Death Registry. There was a dose-dependent association between the number of insomnia symptoms and risk of heart failure. The multi-adjusted hazard ratios were 0.96 (0.57-1.61), 1.35 (0.72-2.50), and 4.53 (1.99-10.31) for people with one, two, and three insomnia symptoms, compared with people with none of the symptoms (P for trend 0.021). CONCLUSIONS Insomnia is associated with an increased risk of incident heart failure. If our results are confirmed by others and causation is proved, evaluation of insomnia symptoms might have consequences for cardiovascular prevention.
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Affiliation(s)
- Lars E Laugsand
- Department of Public Health, Faculty of Medicine, Norwegian University of Science and Technology, NTNU, Trondheim N-7491, Norway
| | - Linn B Strand
- Department of Public Health, Faculty of Medicine, Norwegian University of Science and Technology, NTNU, Trondheim N-7491, Norway
| | - Carl Platou
- Department of Public Health, Faculty of Medicine, Norwegian University of Science and Technology, NTNU, Trondheim N-7491, Norway HUNT Research Centre, Norwegian University of Technology and Science, Trondheim, Norway Medical Department, Nord-Trøndelag Health Trust, Levanger, Norway
| | - Lars J Vatten
- Department of Public Health, Faculty of Medicine, Norwegian University of Science and Technology, NTNU, Trondheim N-7491, Norway
| | - Imre Janszky
- Department of Public Health, Faculty of Medicine, Norwegian University of Science and Technology, NTNU, Trondheim N-7491, Norway Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Hjelm C, Strömberg A, Arestedt K, Broström A. Association between sleep-disordered breathing, sleep-wake pattern, and cognitive impairment among patients with chronic heart failure. Eur J Heart Fail 2013; 15:496-504. [PMID: 23392278 DOI: 10.1093/eurjhf/hft014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
AIMS Chronic heart failure (CHF) and sleep-disordered breathing (SDB) are often co-existing problems among the elderly. Apnoeic events may cause cognitive impairment. The aim of the study was to compare sleep and wake patterns, insomnia, daytime sleepiness, and cognitive function in community-dwelling CHF patients, with and without SDB, and to investigate the association between sleep-related factors and cognitive dysfunction. METHODS AND RESULTS In this cross-sectional observational study, SDB was measured with an ApneaLink device and defined as an apnoea-hypopnoea index (AHI) ≥15/h of sleep. Sleep and wake patterns were measured with actigraphy for 1 week. Insomnia was measured with the Minimal Insomnia Symptom Scale, daytime sleepiness with the Epworth Sleepiness Scale, and cognitive function with a neuropsychological test battery. A total of 137 patients (68% male, median age 72 years, 58% NYHA functional class II) were consecutively included. Forty-four per cent had SDB (AHI ≥15). The SDB group had significantly higher saturation time below 90%, more difficulties maintaining sleep, and lower levels of daytime sleepiness compared with the non-SDB group. Cognitive function and sleep and wake patterns did not differ between the SDB and the non-SDB group. Insomnia was associated with decreased global cognition. CONCLUSION The prevalence of cognitive dysfunction was low in this population with predominantly mild to moderate CHF. This might have influenced the lack of associations between cognitive function and SDB. Insomnia was the only sleep-related factor significantly influencing cognition.
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Affiliation(s)
- Carina Hjelm
- Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Linköping, Sweden.
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Johansson P, Broström A. Insomnia is associated to depressive symptoms in patients with chronic heart failure. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/ojn.2013.31005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Johansson P, Riegel B, Svensson E, Broström A, Alehagen U, Dahlström U, Jaarsma T. Sickness behavior in community-dwelling elderly: associations with impaired cardiac function and inflammation. Biol Res Nurs 2012; 16:105-13. [PMID: 23162010 DOI: 10.1177/1099800412466170] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Sickness behavior is a cluster of symptoms that occur as a response to an infection and alterations in the inflammatory response. Under normal circumstances, sickness behavior is fully reversible once the pathogen has been cleared. Aging and chronic illness such as heart failure are associated with enhanced inflammatory activity that lasts for a long duration and no longer represents an adaptive response. The aim of this study was to explore whether inflammation mediates the relationship between impaired cardiac function and a symptom cluster including anhedonia, fatigue, and sleepiness, which might represent sickness behavior in community-dwelling elders. Structural equation modeling (SEM) showed that the factor impaired cardiac function (i.e., N-terminal fragment of pro-brain natriuretic peptide, left ventricular ejection fraction, and the heart failure medications angiotensin converting enzyme inhibitor, angiotensin receptor blockade, β-blocker, and diuretics) was associated with both inflammation (i.e., C-reactive protein; β = .26) and the symptom cluster (β = .31). Inflammation had a significant direct, but smaller, association with the symptom cluster (β = .21). By this pathway, inflammation also mediated an indirect association between impaired cardiac function and the symptom cluster (β = .05). Including creatinine, blood glucose, ischemic heart disease, previous and current tumor, respiratory disease, age, and body mass index in the SEM model did not change these associations. Our results imply that some aspects of the symptom panorama in elderly individuals with impaired cardiac function or heart failure could represent sickness behavior.
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Affiliation(s)
- Peter Johansson
- 1Department of Cardiology, Linköping University Hospital, Linköping, Sweden
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Johansson P, Riegel B, Svensson E, Broström A, Alehagen U, Dahlström U, Jaarsma T. The contribution of heart failure to sleep disturbances and depressive symptoms in older adults. J Geriatr Psychiatry Neurol 2012; 25:179-87. [PMID: 23124012 DOI: 10.1177/0891988712458366] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The aim of this study was to explore the associations between physical symptoms, sleep disturbances, and depressive symptoms in community-dwelling elderly individuals, comparing persons with and without heart failure (HF). METHODS A total of 613 older adults (mean age 78 years) underwent clinical and echocardiographic examinations. Questionnaires were used to evaluate sleep disturbances and depressive symptoms. A model was developed in those with HF (n = 107) and compared with those without HF (n = 506). RESULTS Cardiopulmonary symptoms (ie, dyspnea and nighttime palpitations) and pain had significant direct associations with sleep disturbances, which indirectly affected depressive symptoms. The model was essentially the same in those with and without HF except that the effect of sleep disturbances on depressive symptoms was stronger in those with HF (β = 0.64 vs β = 0.45, P = .006). CONCLUSION In community-dwelling older adults, regardless of their diagnosis, physical symptoms had a direct effect on sleep disturbances and an indirect effect on depressive symptoms.
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Affiliation(s)
- Peter Johansson
- Department of Cardiology, Linköping University Hospital, S-58185 Linköping, Sweden.
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An Exploratory Study of Sleep Quality, Daytime Function, and Quality of Life in Patients with Mechanical Circulatory Support. Int J Artif Organs 2012; 35:531-7. [DOI: 10.5301/ijao.5000109] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2012] [Indexed: 11/20/2022]
Abstract
Purpose: To identify and describe: (1) characteristics of sleep quality, daytime sleepiness, and quality of life (QOL) pre and post implantation of a left ventricular assist device (LVAD); (2) changes in sleep quality, daytime sleepiness, and QOL at baseline and 6 months post implant; and (3) relationships among the sleep quality, daytime sleepiness, and QOL variables. Methods: We employed an exploratory research design. Fifteen patients with continuous/non-pulsatile flow LVAD consented to partake in the study. However, only 12 patients completed the baseline and 6-month post-LVAD implant data. We used the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Minnesota Living with Heart Failure Questionnaire (MLHFQ) to measure study variables. Data were analyzed using IBM SPSS 19.0 software. Results: Patients reported worse sleep quality accompanied by daytime sleepiness particularly at baseline, and persisting up to 6 months post LVAD implant. A significant improvement in QOL was observed at 6 months post implant, but remained at poor levels. Correlations among sleep disturbance and daytime dysfunction components of PSQI and global daytime sleepiness (ESS) with QOL were strong (Pearson's correlations r>.60; p values <.05). Conclusions: We report the first empirical data describing the characteristics and correlations among sleep quality, daytime sleepiness, and QOL in patients with LVADs. Our findings offer beginning evidence about the sleep-QOL connection in this population which warrants attention in clinical practice and research. Further research is required to clearly elucidate these phenomena in patients with mechanical circulatory support and other implantable artificial organs.
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Jean-Louis G, Weber KM, Aouizerat BE, Levine AM, Maki PM, Liu C, Anastos KM, Milam J, Althoff KN, Wilson TE. Insomnia symptoms and HIV infection among participants in the Women's Interagency HIV Study. Sleep 2012; 35:131-7. [PMID: 22215927 DOI: 10.5665/sleep.1602] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This study assessed the prevalence of insomnia symptoms among women with and without HIV-infection and examined factors associated with insomnia. DESIGN Participants (n = 1682) were enrolled in the Women's Interagency HIV Study (WIHS); 69% were infected with HIV. This was a cross-sectional analysis of data from standardized interviewer-administered instruments and physical/gynecological exams. Analysis focused on sociodemographics, sleep measures, depressive symptoms, drug use, alcohol consumption, medications, and HIV-related clinical variables. Women were classified as having symptoms of insomnia if they reported either difficulty initiating sleep, difficulty maintaining sleep, or early morning awakening ≥ 3 times a week in the past 2 weeks. RESULTS Overall, HIV-infected women were 17% more likely to endorse insomnia symptoms than uninfected women (OR = 1.17, 95% CI: 1.04-1.34, P < 0.05). The adjusted prevalence of insomnia symptoms varied by HIV status and age groups. Among women ages 31-40 years, those with HIV infection were 26% more likely to endorse insomnia symptoms than their counterparts (OR = 1.26, 95% CI: 1.01-1.59, P < 0.05). No significant differences were observed in the likelihood of reporting insomnia symptoms based on HIV treatment type. Multivariate-adjusted regression analyses showed that depression was the most consistent and significant independent predictor of the likelihood of reporting insomnia symptoms across all age strata. CONCLUSIONS Insomnia symptoms are common among both HIV-infected and uninfected women. Prevalence of insomnia did not vary significantly by HIV status, except among younger women. Younger women with HIV infection are at greater risk for experiencing insomnia symptoms.
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Affiliation(s)
- Girardin Jean-Louis
- Sleep Disorders Center, Department of Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203-2098, USA.
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18
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Riegel B, Ratcliffe SJ, Sayers SL, Potashnik S, Buck HG, Jurkovitz C, Fontana S, Weaver TE, Weintraub WS, Goldberg LR. Determinants of excessive daytime sleepiness and fatigue in adults with heart failure. Clin Nurs Res 2011; 21:271-93. [PMID: 21878581 DOI: 10.1177/1054773811419842] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Little is known about excessive daytime sleepiness (EDS) in heart failure (HF). The aim of this cross-sectional descriptive study was to describe the prevalence of EDS and factors associated with it in HF. A secondary purpose was to explore the correlates of fatigue. We enrolled a consecutive sample of 280 adults with a confirmed diagnosis of chronic HF from three outpatient settings in the northeastern United States. Patients with major depressive illness were excluded. Clinical, sociodemographic, behavioral, and perceptual factors were explored as possible correlates of EDS. Using an Epworth Sleepiness Scale score > 10, the prevalence of EDS was 23.6%. Significant determinants of EDS were worse sleep quality (p = .048), worse functional class (p = .004), not taking a diuretic (p = .005), and lack of physical activity (p = .04). Only sleep quality was associated with fatigue (p < .001). Sleep-disordered breathing was not significantly associated with EDS or with fatigue. These factors may be amenable to intervention.
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Affiliation(s)
- Barbara Riegel
- School of Nursing, University of Pennsylvania, Philadelphia, PA 19104-4217, USA.
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19
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Casida JM, Davis JE, Brewer RJ, Smith C, Yarandi H. Sleep and daytime sleepiness of patients with left ventricular assist devices: a longitudinal pilot study. Prog Transplant 2011. [PMID: 21736242 DOI: 10.7182/prtr.21.2.cp5874v2l28g62x6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT No empirical longitudinal data on sleep and daytime sleepiness patterns in patients with an implantable left ventricular assist device (LVAD) exist. OBJECTIVE (1) To describe the sleep patterns (sleep onset latency, sleep efficiency, sleep fragmentation index, total sleep time, and wake after sleep onset), sleep quality, and daytime sleepiness variables and (2) to determine the change in the pattern of these variables before and up to 6 months after LVAD implantation. DESIGN A longitudinal descriptive repeated-measures design was used. Patients wore wrist actigraphs (AW64 Actiwatch), which objectively measured sleep, for 3 consecutive days and nights before LVAD implant and at the first and second week and first, third, and sixth month after implantation. During these periods, patients also completed questionnaires on sleep quality and daytime sleepiness. Patients-Twelve of 15 patients completed the 6-month data. Data were analyzed by using descriptive statistics and repeated-measures analysis of variance. RESULTS We found long sleep onset latencies and low sleep efficiency across time periods. High sleep fragmentation index was noted at baseline and 1 week after LVAD. Short total sleep times, long wake-after-sleep-onset durations, and poor sleep quality were evident at baseline and persisted up to 6 months after LVAD implantation. Low alertness level, a manifestation of sleepiness, was common during late morning to early evening hours. However, only sleep efficiency and wake after sleep onset showed significant changes in pattern (P < .05). CONCLUSION Sleep disturbance and daytime sleepiness may be prevalent before and up to 6 months after LVAD implantation, warranting further investigation.
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Affiliation(s)
- Jesus M Casida
- Wayne State University, 5557 Cass Avenue, Cohn 352, Detroit, MI 48202, USA.
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20
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Casida JM, Davis JE, Brewer RJ, Smith C, Yarandi H. Sleep and Daytime Sleepiness of Patients with Left Ventricular Assist Devices: A Longitudinal Pilot Study. Prog Transplant 2011; 21:131-6. [DOI: 10.1177/152692481102100208] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Context No empirical longitudinal data on sleep and daytime sleepiness patterns in patients with an implantable left ventricular assist device (LVAD) exist. Objective (1) To describe the sleep patterns (sleep onset latency, sleep efficiency, sleep fragmentation index, total sleep time, and wake after sleep onset), sleep quality, and daytime sleepiness variables and (2) to determine the change in the pattern of these variables before and up to 6 months after LVAD implantation. Design A longitudinal descriptive repeated-measures design was used. Patients wore wrist actigraphs (AW64 Actiwatch), which objectively measured sleep, for 3 consecutive days and nights before LVAD implant and at the first and second week and first, third, and sixth month after implantation. During these periods, patients also completed questionnaires on sleep quality and daytime sleepiness. Patients Twelve of 15 patients completed the 6-month data. Data were analyzed by using descriptive statistics and repeated-measures analysis of variance. Results We found long sleep onset latencies and low sleep efficiency across time periods. High sleep fragmentation index was noted at baseline and 1 week after LVAD. Short total sleep times, long wake-after-sleep-onset durations, and poor sleep quality were evident at baseline and persisted up to 6 months after LVAD implantation. Low alertness level, a manifestation of sleepiness, was common during late morning to early evening hours. However, only sleep efficiency and wake after sleep onset showed significant changes in pattern (P < .05). Conclusion Sleep disturbance and daytime sleepiness may be prevalent before and up to 6 months after LVAD implantation, warranting further investigation.
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Affiliation(s)
- Jesus M. Casida
- Wayne State University (JMC, JED, HY), Henry Ford Hospital (RJB, CS), Detroit, Michigan
| | - Jean E. Davis
- Wayne State University (JMC, JED, HY), Henry Ford Hospital (RJB, CS), Detroit, Michigan
| | - Robert J. Brewer
- Wayne State University (JMC, JED, HY), Henry Ford Hospital (RJB, CS), Detroit, Michigan
| | - Cheryl Smith
- Wayne State University (JMC, JED, HY), Henry Ford Hospital (RJB, CS), Detroit, Michigan
| | - Hossein Yarandi
- Wayne State University (JMC, JED, HY), Henry Ford Hospital (RJB, CS), Detroit, Michigan
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21
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Sleep-related predictors of quality of life in the elderly versus younger heart failure patients: A questionnaire survey. Int J Nurs Stud 2011; 48:419-28. [DOI: 10.1016/j.ijnurstu.2010.07.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 07/06/2010] [Accepted: 07/15/2010] [Indexed: 11/24/2022]
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22
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Quality of life and symptoms of depression in advanced heart failure patients and their partners. Curr Opin Support Palliat Care 2010; 4:233-7. [PMID: 20966757 DOI: 10.1097/spc.0b013e328340744d] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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23
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Johansson P, Broström A. Sleep Disturbances — A Significant Problem for Cardiovascular Nurses in Practice and/or Research? Eur J Cardiovasc Nurs 2010; 9:75-6. [DOI: 10.1016/j.ejcnurse.2009.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 12/14/2009] [Accepted: 12/22/2009] [Indexed: 10/20/2022]
Affiliation(s)
- Peter Johansson
- Department of Cardiology, Linköping University Hospital, SE-581 85 Linköping, Sweden
| | - Anders Broström
- Department of Clinical Neurophysiology, Linköping University Hospital, SE-581 85 Linköping, Sweden
- Department of Nursing Science, School of Health Sciences, Jönköping University, Jönköping, Sweden
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24
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Johansson P, Arestedt K, Alehagen U, Svanborg E, Dahlström U, Broström A. Sleep disordered breathing, insomnia, and health related quality of life -- a comparison between age and gender matched elderly with heart failure or without cardiovascular disease. Eur J Cardiovasc Nurs 2010; 9:108-17. [PMID: 20056491 DOI: 10.1016/j.ejcnurse.2009.11.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Revised: 11/15/2009] [Accepted: 11/18/2009] [Indexed: 01/19/2023]
Abstract
AIMS The aims of this study are (I) to compare the prevalence of sleep disordered breathing (SDB) and insomnia between elderly with heart failure (HF) and age and gender matched elderly without cardiovascular disease (CVD), and (II) to examine the association between HF, SDB and insomnia, as well as their impact on health related quality of life (Hr-QoL). METHODS Three hundred and thirty-one elderly (71-87 years) community-living individuals underwent sleep recordings and echocardiography. Questionnaires assessed insomnia and Hr-QoL. Comparisons were made between age and gender matched individuals with HF (n=36) and without CVD (n=36). RESULTS The HF group had higher mean apnoea-hypopnoea index (17.6 vs. 6.3, p<0.001). Moderate/severe SDB was found in 42% of those with HF vs. 8% in those without CVD (p=0.001). Those with HF had more difficulties maintaining sleep (DMS) (72% vs. 50%, p=0.05) and excessive daytime sleepiness (EDS) (25% vs. 8%, p=0.05) and scored worse Hr-QoL in five of eight SF-36 domains. In regression analysis SDB had no association to Hr-QoL. DMS associated to the physical-, and non restorative sleep to the mental domain of Hr-QoL. SDB had no correlations to insomnia or EDS. CONCLUSIONS SDB, DMS and EDS are more common in elderly with HF. SDB is not an obvious cause for sleep complaints or poor Hr-QoL in elderly.
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Affiliation(s)
- Peter Johansson
- Department of Cardiology, Linköping University Hospital, S-58185 Linköping, Sweden.
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Hayes D, Anstead MI, Ho J, Phillips BA. Insomnia and chronic heart failure. Heart Fail Rev 2008; 14:171-82. [PMID: 18758945 DOI: 10.1007/s10741-008-9102-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Accepted: 07/01/2008] [Indexed: 11/29/2022]
Abstract
Insomnia is highly prevalent in patients with chronic disease including chronic heart failure (CHF) and is a significant contributing factor to fatigue and poor quality of life. The pathophysiology of CHF often leads to fatigue, due to nocturnal symptoms causing sleep disruption, including cough, orthopnea, paroxysmal nocturnal dyspnea, and nocturia. Inadequate cardiac function may lead to hypoxemia or poor perfusion of the cerebrum, skeletal muscle, or visceral body organs, which result in organ dysfunction or failure and may contribute to fatigue. Sleep disturbances negatively affect all dimensions of quality of life and is related to increased risk of comorbidities, including depression. This article reviews insomnia in CHF, cardiac medication side-effects related to sleep disturbances, and treatment options.
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Affiliation(s)
- Don Hayes
- Department of Pediatrics, University of Kentucky College of Medicine J410 Kentucky Clinic, 740 South Limestone Street, Lexington, KY 40536, USA.
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26
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Abstract
Symptoms utilized in the clinical care of heart failure as markers of disease severity include, dyspnea, insomnia, low energy, fatigue, poor appetite, and diminished memory. This is despite the fact that physiologic variables such as cardiac ejection fraction and oxygen consumption do not accurately predict functional state in individuals with congestive heart failure (CHF). Distress (anxiety and depression) may amplify symptom complaints without associated physiologic aberration. Personality traits and psychiatric illness, such as mood, anxiety, and psychotic illnesses may also alter perception of somatic symptoms that are associated with this chronic illness. The impact of distress and its treatment on functional performance and CHF symptom reporting deserve additional attention. The need to screen for distress in all with serious symptomatic heart failure is certain.
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27
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Gary R, Lee SYS. Physical function and quality of life in older women with diastolic heart failure: effects of a progressive walking program on sleep patterns. ACTA ACUST UNITED AC 2007; 22:72-80. [PMID: 17541316 DOI: 10.1111/j.0889-7204.2007.05375.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This preliminary study tested the effects of a home-based walking intervention on total sleep time (TST), nocturnal awakenings, depressive symptoms, physical function, and quality of life (QOL) in older women with diastolic heart failure (DHF). Twenty-three women (mean age, 68+/-11 years) with New York Heart Association class II or III DHF were randomized to either a 12-week home-based walking intervention (n=13) or education-only program (control, n=10). No between-group differences were found in women in the intervention and control groups on any of the outcome variables. When outcomes were compared within each group at baseline and 12 weeks, intervention-group patients had improvement in TST (P<.01) and heart failure-related QOL (P<.05) and a trend for decreased depressive symptoms (P<.07). Women randomized to the control group had no change in any outcomes. These preliminary findings suggest that a progressive walking program may improve TST and QOL in older women with DHF. Findings from this study support the need for larger studies to evaluate the long-term benefits of a walking program on sleep patterns, QOL, and psychologic function in this population.
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Affiliation(s)
- Rebecca Gary
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA.
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28
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Abstract
Approximately 10% to 70% of people living with chronic heart failure (HF) experience significant sleep disturbances, which have been shown to impair their health-related quality of life and overall functional performance. Research findings, however, report inconsistent conclusions about sleep disturbances and their adverse effects on HF. The purpose of this article is to review several research studies addressing sleep disturbances in patients with HF and to highlight contradictory and inconsistent findings. Further nursing research about the phenomena related to sleep disturbances in people with HF is warranted so that evidence-based assessments and interventions can be tested in the future.
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Affiliation(s)
- Hsing-Mei Chen
- School of Nursing, The University of Texas at Austin, Austin, TX 78701, USA.
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Rausch SM, Baker K, Boonmee J. Sleep Disturbances in Caregivers of Patients With End-Stage Congestive Heart Failure: Part II?Assess and Intervene. ACTA ACUST UNITED AC 2007; 22:93-6. [PMID: 17541319 DOI: 10.1111/j.0889-7204.2007.05988.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Sleep disturbances in caregivers of patients with congestive heart failure is common. The consequences of sleep disturbances are dire and have potential to seriously impact caregiver health and patient outcomes. Therefore, it is imperative that the health care team, especially nurses, assess and intervene. Basic assessment of caregiver sleep disturbance can be quick and simple and can be performed while assessing the congestive heart failure patient's health. If a more complex sleep disorder is suspected, other assessments can be conducted if time and money permit. The benefits to properly assessing sleep disturbance and subsequent treatment far outweigh the minimal time spent by the health care team or caregiver.
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Affiliation(s)
- Sarah M Rausch
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA.
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Rausch SM, Baker K, Boonmee J. Sleep Disturbances in Caregivers of Patients With End-Stage Congestive Heart Failure: Part I?The Problem. ACTA ACUST UNITED AC 2007; 22:38-40. [PMID: 17342005 DOI: 10.1111/j.0889-7204.2007.05818.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Up to 90% of caregivers report sleep disturbances, particularly congestive heart failure (CHF) caregivers. Sleep disturbances have numerous consequences that can negatively impact a wide domain of outcomes in both the caregiver and the patient for whom they care. Ultimately, these disturbances can lead to caregiver morbidity and CHF patient morbidity, readmission, and mortality. Nurses play a central role in patient education, especially with caregivers. Therefore, nurses can help to educate caregivers on the consequences of stress-related sleep disturbances, which are very prevalent in CHF caregivers.
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Affiliation(s)
- Sarah M Rausch
- Department of Psychology, School of Nursing, Virginia Commonwealth University, 806 W. Franklin Street, Richmond, VA 23284, USA.
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