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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.
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.
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