Sleep Quality, Anxiety, and Depression in Patients With Heart Failure

Document Type : Original Articles

Authors

1 Bioinformatics and Computational Biology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

2 Noncommunicable Disease Research Center, Fasa University of Medical Sciences, Fasa, Iran.

10.32598/jamsat.3.4.213

Abstract

Objectives: Heart Failure (HF) is a chronic condition with great impact on the lifestyle of the patients. As many as 80% of HF patients report experiencing sleep difficulties. Thus, we try to detect clinical predictors of sleep quality and define probable relationship between anxiety, depression, and sleep quality in HF patients.Materials & Methods: One hundred patients (male: 50 persons, female: 50 persons) with ejection fraction less than 45% who were hospitalized in CCU and post-CCU ward, were included in this study. Hospital Anxiety and Depression Scale (HADS) and Pittsburg Sleep Quality Index (PSQI) questionnaire were used to collect the related data.Results: The patients’ mean (SD) total PSQI score was 9.07(4.43). The most problem was seen in sleep onset latency (1.85[1.15]) sub-score of PSQI and the sleep quality of 78% of patients was abnormal. This score was higher in patients with history of abnormal blood pressure (P=0.001). PSQI score have significant correlation with anxiety (r=0.216, P=0.035) as well as depression (r=0.351, P=0.000).Conclusion: Many HF patients suffer from sleep difficulties and PSQI score seems to have significant correlation with anxiety and depression.

Keywords


  1. Rector TS, Anand IS, Cohn JN. Relationships between clinical assessments and patients’ perceptions of the effects of heart failure on their quality of life. Journal of Cardiac Failure. 2006; 12(2):87-92. [DOI:10.1016/j.cardfail.2005.10.002] [PMID]
  2. Rahnavard Z, Zolfaghari M, Kazemnejad A, Hatamipour K. [An investigation of quality of life and factors affecting it in the patients with congestive heart failure (Persian)]. Hayat. 2006; 12(1):77-86.
  3. Suleiman KH, Yates BC, Berger AM, Pozehl B, Meza J. Translating the Pittsburgh sleep quality index into Arabic. Western Journal of Nursing Research. 2010; 32(2):250-68. [DOI:10.1177/0193945909348230] [PMID]
  4. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, et al. Heart disease and stroke statistics--2014 update: A report from the American Heart Association. Circulation. 2014; 129(3):e28-e292. [DOI:10.1161/01.cir.0000441139.02102.80]
  5. Tremel F, Pepin J, Veale D, Wuyam B, Siche J, Mallion J, et al. High prevalence and persistence of sleep apnoea in patients referred for acute left ventricular failure and medically treated over 2 months. European Heart Journal. 1999; 20(16):1201-9. [DOI:10.1053/euhj.1999.1546] [PMID]
  6. Wang TJ, Lee SC, Tsay SL, Tung HH. Factors influencing heart failure patients’ sleep quality. Journal of Advanced Nursing. 2010; 66(8):1730-40. [DOI:10.1111/j.1365-2648.2010.05342.x] [PMID]
  7. Santos MAd, Guedes EdS, Barbosa RL, Cruz DdALM. Sleeping difficulties reported by patients with heart failure. Revista Latino-Americana de Enfermagem. 2012; 20(4):644-50. [DOI:10.1590/S0104-11692012000400003]
  8. Erickson VS, Westlake CA, Dracup KA, Woo MA, Hage A. Sleep disturbance symptoms in patients with heart failure. AACN Clinical Issues. 2003; 14(4):477-87. [DOI:10.1097/00044067-200311000-00009] [PMID]
  9. Redeker NS. Sleep disturbance in people with heart failure: implications for self-care. The Journal of Cardiovascular Nursing. 2008; 23(3):231-8. [DOI:10.1097/01.JCN.0000305094.20012.76] [PMID]
  10. Redeker NS, Stein S. Characteristics of sleep in patients with stable heart failure versus a comparison group. Heart & Lung: The Journal of Critical Care. 2006; 35(4):252-61. [DOI:10.1016/j.hrtlng.2005.10.007] [PMID]
  11. Redeker NS, Muench U, Zucker MJ, Walsleben J, Gilbert M, Freudenberger R, et al. Sleep disordered breathing, daytime symptoms, and functional performance in stable heart failure. Sleep. 2010; 33(4):551-60. [DOI:10.1093/sleep/33.4.551] [PMID] [PMCID]
  12. Garcia S, Alosco ML, Spitznagel MB, Cohen R, Raz N, Sweet L, et al. Poor sleep quality and reduced cognitive function in persons with heart failure. International Journal of Cardiology. 2012; 156(2):248-9. [DOI:10.1016/j.ijcard.2012.01.037] [PMID] [PMCID]
  13. Izawa K, Watanabe S, Oka K, Hiraki K, Morio Y, Kasahara Y, et al. Relation between sleep quality and physical activity in chronic heart failure patients. Recent Patents on Cardiovascular Drug Discovery. 2011; 6(3):161-7. [DOI:10.2174/157489011797377004]
  14. Selim B, Won C, Yaggi HK. Cardiovascular consequences of sleep apnea. Clinics in Chest Medicine. 2010; 31(2):203-20. [DOI:10.1016/j.ccm.2010.02.010] [PMID]
  15. Alvaro PK, Roberts RM, Harris JK. A systematic review assessing bidirectionality between sleep disturbances, anxiety, and depression. Sleep. 2013; 36(7):1059-68. [DOI:10.5665/sleep.2810] [PMID] [PMCID]
  16. Garfield LD, Scherrer JF, Hauptman PJ, Freedland KE, Chrusciel T, Balasubramanian S, et al. Association of anxiety disorders and depression with incident heart failure. Psychosomatic Medicine. 2014; 76(2):128. [DOI:10.1097/PSY.0000000000000027] [PMID] [PMCID]
  17. Bitter T, Westerheide N, Prinz C, Hossain MS, Vogt J, Langer C, et al. Cheyne–Stokes respiration and obstructive sleep apnoea are independent risk factors for malignant ventricular arrhythmias requiring appropriate cardioverter-defibrillator therapies in patients with congestive heart failure. European Heart Journal. 2011; 32(1):61-74. [DOI:10.1093/eurheartj/ehq327] [PMID]
  18. Javaheri S, Shukla R, Zeigler H, Wexler L. Central sleep apnea, right ventricular dysfunction, and low diastolic blood pressure are predictors of mortality in systolic heart failure. Journal of the American College of Cardiology. 2007; 49(20):2028-34. [DOI:10.1016/j.jacc.2007.01.084] [PMID]
  19. Wang H, Parker JD, Newton GE, Floras JS, Mak S, Chiu K-L, et al. Influence of obstructive sleep apnea on mortality in patients with heart failure. Journal of the American College of Cardiology. 2007; 49(15):1625-31. [DOI:10.1016/j.jacc.2006.12.046] [PMID]
  20. Bradley TD, Logan AG, Kimoff RJ, Series F, Morrison D, Ferguson K, et al. Continuous positive airway pressure for central sleep apnea and heart failure. The New England Journal of Medicine. 2005; 353(19):2025-33. [DOI:10.1056/NEJMoa051001] [PMID]
  21. Luthje L, Renner B, Kessels R, Vollmann D, Raupach T, Gerritse B, et al. Cardiac resynchronization therapy and atrial overdrive pacing for the treatment of central sleep apnoea. European Journal of Heart Failure. 2009; 11(3):273-80. [DOI:10.1093/eurjhf/hfn042] [PMID] [PMCID]
  22. Nieto FJ, Young TB, Lind BK, Shahar E, Samet JM, Redline S, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA. 2000; 283(14):1829-36. [DOI:10.1001/jama.283.14.1829] [PMID]
  23. Orban M, Bruce CJ, Pressman GS, Leinveber P, Romero-Corral A, Korinek J, et al. Dynamic changes of left ventricular performance and left atrial volume induced by the mueller maneuver in healthy young adults and implications for obstructive sleep apnea, atrial fibrillation, and heart failure. The American Journal of Cardiology. 2008; 102(11):1557-61. [DOI:10.1016/j.amjcard.2008.07.050] [PMID] [PMCID]
  24. Romero-Corral A, Somers VK, Pellikka PA, Olson EJ, Bailey KR, Korinek J, et al. Decreased right and left ventricular myocardial performance in obstructive sleep apnea. Chest. 2007; 132(6):1863-70. [DOI:10.1378/chest.07-0966] [PMID]
  25. Valdivia-Arenas MA, Powers M, Khayat RN. Sleep-disordered breathing in patients with decompensated heart failure. Heart Failure Reviews. 2009; 14(3):183-93. [DOI:10.1007/s10741-008-9103-0] [PMID] [PMCID]
  26. Bitter T, Faber L, Hering D, Langer C, Horstkotte D, Oldenburg O. Sleep-disordered breathing in heart failure with normal left ventricular ejection fraction. European Journal of Heart Failure. 2009; 11(6):602-8. [DOI:10.1093/eurjhf/hfp057] [PMID]
  27. Khayat R, Small R, Rathman L, Krueger S, Gocke B, Clark L, et al. Sleep-disordered breathing in heart failure: Identifying and treating an important but often unrecognized comorbidity in heart failure patients. Journal of Cardiac Failure. 2013; 19(6):431-44. [DOI:10.1016/j.cardfail.2013.04.005] [PMID] [PMCID]
  28. Parker KP, Dunbar SB. Sleep and heart failure. Journal of Cardiovascular Nursing. 2002; 17(1):30-41. [DOI:10.1097/00005082-200210000-00004]
  29. Moghaddam JF, Nakhaee N, Sheibani V, Garrusi B, Amirkafi A. Reliability and validity of the Persian version of the Pittsburgh Sleep Quality Index (PSQI-P). Sleep and Breathing. 2012; 16(1):79-82. [DOI:10.1007/s11325-010-0478-5] [PMID]
  30. Herrmann C. International experiences with the Hospital Anxiety and Depression Scale: A review of validation data and clinical results. Journal of Psychosomatic Research. 1997; 42(1):17-41. [DOI:10.1016/S0022-3999(96)00216-4]
  31. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica. 1983; 67(6):361-70. [DOI:10.1111/j.1600-0447.1983.tb09716.x]
  32. Fritschi C, Redeker NS. Contributions of comorbid diabetes to sleep characteristics, daytime symptoms, and physical function among patients with stable heart failure. The Journal of Cardiovascular Nursing. 2015; 30(5):411-9. [DOI:10.1097/JCN.0000000000000183] [PMID] [PMCID]
  33. Farrahi Moghaddam J, Nakhaee N, Sheibani V, Garrusi B, Amirkafi A. Reliability and validity of the Persian version of the Pittsburgh Sleep Quality Index (PSQI-P). Sleep and Breathing. 2012; 16(1):79-82. [DOI:10.1007/s11325-010-0478-5] [PMID]
  34. Lee S, Cheong YS, Park EW, Choi EY, Yoo HK, Kang KH, et al. Prevalence of sleep disorder and associated factors in family practice. Korean Journal of Family Medicine. 2010; 31(11):837-44. [DOI:10.4082/kjfm.2010.31.11.837]
  35. Chung WS, Lin CL, Chen YF, Chiang JY, Sung FC, Chang YJ, et al. Sleep disorders and increased risk of subsequent acute coronary syndrome in individuals without sleep apnea: A nationwide population-based cohort study. Sleep. 2013; 36(12):1963-8. [DOI:10.5665/sleep.3240] [PMID] [PMCID]
  36. Herrscher TE, Akre H, Overland B, Sandvik L, Westheim AS. Clinical predictors of sleep apnoea in heart failure outpatients. International Journal of Clinical Practice. 2014; 68(6):725-30. [DOI:10.1111/ijcp.12396] [PMID]
  37. Yohannes AM, Willgoss TG, Baldwin RC, Connolly MJ. Depression and anxiety in chronic heart failure and chronic obstructive pulmonary disease: Prevalence, relevance, clinical implications and management principles. International Journal of Geriatric Psychiatry. 2010; 25(12):1209-21. [DOI:10.1002/gps.2463] [PMID]
  38. Ramsawh HJ, Stein MB, Belik SL, Jacobi F, Sareen J. Relationship of anxiety disorders, sleep quality, and functional impairment in a community sample. Journal of Psychiatric Research. 2009; 43(10):926-33. [DOI:10.1016/j.jpsychires.2009.01.009] [PMID]
  39. Haworth JE, Moniz-Cook E, Clark AL, Wang M, Waddington R, Cleland JG. Prevalence and predictors of anxiety and depression in a sample of chronic heart failure patients with left ventricular systolic dysfunction. European Journal of Heart Failure. 2005; 7(5):803-8. [DOI:10.1016/j.ejheart.2005.03.001] [PMID]
  40. Alexopoulos GS, Meyers BS, Young RC, Campbell S, Silbersweig D, Charlson M. ‘Vascular depression’ hypothesis. Archives of General Psychiatry. 1997; 54(10):915-22. [DOI:10.1001/archpsyc.1997.01830220033006] [PMID]