Psychological Variables, Sleep Factors, and Neurohormones in People with Heart Failure

Thursday, 25 July 2013: 1:55 PM

Hsing-Mei Chen, PhD, RN
School of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan
Shyh-Jong Wu, PhD
Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, Kaohsiung, Taiwan
Chee-Siong Lee, MD
Division of Cardiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
Hsueh-Wei Yen, MD
Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan
Wen-Hsien Lee, MD
Department of Internal Medicine, Kaohsiung Municipal HsiaoKang Hospital, Kaohsiung, Taiwan
Hui- Chin Chien, MSN, RN
Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

Learning Objective 1: understand the relationship between psychological variables, sleep factors, and serotonin.

Learning Objective 2: know about the correlation between psychological variables, sleep factors, and B-type natriuretic peptide.


Patients with heart failure suffer from anxiety, anger, depression, and sleep disturbances. These have been related to activation of neurohormone. The purpose of this study aimed to explore the relationship between serotonin, B-type natriuretic peptide (BNP), anxiety, anger, depression, night sleep quality, and daytime sleepiness.


A cross-sectional and correlational study design was employed. A nonprobability sampling was used to recruit 73 participants during their regular visits to a cardiovascular outpatient department of a medical center located in southern Taiwan. Inclusion criteria were as follows: 1) a diagnosis of HF, with a class of New York Heart Association (NYHA) II or above; 2) age 20 or older; 3) able to communicate either by speaking or writing Mandarin; and 4) willing to participate in this study. Instruments used included the Beck Anxiety Inventory, State-Trait Anger Expression Inventory-2, Patient Outcome Questionnaire-9, Pittsburgher Sleep Quality Index, Epworth Sleepiness Scale, serotonin, and BNP.


The average age of the participants was 65.63 years. The majority was male (58.9%), diastolic heart failure (65.8%), and having NYHA Classes II and III. The average duration of heart failure was 2.97 years and the mean comorbidity severity score was 3.85. The mean score of each factor stated as following: anxiety 6.33, anger 15.40, depression 5.71, night sleep quality 9.00, daytime sleepiness 5.08, serotonin level 46.44ng/dl, and BNP level 338.44pg/ml. Serotonin was significantly correlated with NYHA (r= .40, p< .001). BNP was correlated with night sleep quality (r= -.25, p< .05) and depression (r= -. 24, p< .05).


There were no significant correlations between serotonin and psychological factors as well as sleep variables. However, heart failure participants with lower BNP levels were more likely to experience poor sleep quality and depression. Findings from this study were inconsistent with those of previous studies. The mechanisms between BNP, sleep quality, and depression remain further discussed.