Sleep Patterns in Patients with Heart Failure and Associated Factors

Monday, July 11, 2011: 2:25 PM

Mariana Alvina dos Santos, RN, MNSc1
Dina de Almeida Lopes Monteiro Cruz, RN, PhD2
Erika de Souza Guedes, RN1
Fabiana Gonçalves Matos, RN, MNSc3
(1)School of Nursing, University of São Paulo, São Paulo, Brazil
(2)School of Nursing, University of Sao Paulo, Sao Paulo, Brazil
(3)Collegiate Nursing, State University of West Paraná, Cascavel, Brazil

Learning Objective 1: The learner will be able to describe the characteristics of sleep in patients with heart failure;

Learning Objective 2: The learner will be able to discuss factors associated with poor sleep in this sample.

Purpose: To describe sleep patterns in patients with HF and examine associations of sleep pattern and selected variables. 

Methods:  A cross sectional study, with a non-probability sample of 400 outpatients (average age 57.8 years, SD = 11.6, 64.8% were men, SD = 3.9; 82.5% in functional class II or III) under treatment of heart failure in a teaching hospital. Data were collected by interviews in which participants answered a set of tools including: personal and clinical data, and data on sleep pattern (PSQI Pittsburgh Sleep Quality Index), fatigue ( Dutch Fatigue Scale - DUFS), fatigue on exertion (Dutch Exertion Fatigue Scale), physical activity (International Physical Activity Questionnaire), and dyspnea, smoking and drug treatment. The tools showed good internal consistency in this sample study (PSQI α = 0.73; DUFS α = 0.90; DEFS α = 0.92). Nonparametric tests of association were applied and a regression model was adjusted to identify predictors of sleep disturbance.

 Results: The prevalence of bad sleepers (PSQI˃5) was 68.5%, and 46.5% of the participants rated sleep as poor or very poor.  Being bad sleeper was statistically associated with: female gender (p=0.009), unemployement (p=0.013), fatigue (p=0.000), fatigue on exertion (p=0.000), dyspnea (p=0.000) and higher HF functional class (p=0.000). Dyspnea (OR=3.23; CI 95% 1.72 to 6.07) and fatigue (OR=3.45; CI 95% 1.82 to 6.49) were  independent predictors of bad sleeper category.

Conclusion:  The findings of this study are empirical evidence that dyspnea and fatigue are related factors of sleep disturbance. Further studies to identify non-pharmacological interventions of nursing to improve sleep in heart failure patients are needed.