| BackgroundHeart failure(HF)is a prevalent cardiovascular disease with high morbidity and mortality.Previous studies suggest that insomnia occurs more frequently in patients with HF,with potential adverse impact on the disease development and prognosis.It has been postulated that insomnia or sleep deprivation may activate autonomic nervous system(ANS),disrupt hypothalamic-pituitary-adrenal axis,and promote systemic inflammation.However,there is a paucity of study,especially in China,to investigate the effects of insomnia on peripheral ANS function and prognosis in patients with chronic HF.ObjectivesThe aims of this study were to investigate the influence of insomnia on:(1)peripheral ANS function assessed by both subjective questionnaire assessment and objective sleep parameters,and(2)the prognosis in patients with chronic HF.MethodsThe subjects included in this study were all diagnosed with chronic HF in the Department of Cardiology,the First Affiliated Hospital of Xinxiang Medical University from April 2019 to October 2020.According to ‘Guidelines for the diagnosis and treatment of adult insomnia in China(2017)’,the participants were divided into insomnia group(50cases)and non-insomnia group(62 cases).The general clinical data,Hospital Anxiety Depression(HAD),Pittsburgh Sleep Quality Index(PSQI),Fatigue Scale-14(FS-14),echocardiographic analysis,laboratory biochemical tests,heart rate variability,dynamic blood pressure monitoring,and one night polysomnography which reflects objective sleep,were recorded and compared between two groups.Patients were then followed up by telephone consultations or medical records up to 1 year.Results1.A total of 112 patients eligible for the diagnosis of HF were included in this study,with mean age(60.6 ± 17.0),males(65 cases,58.0%),insomnia(50 cases,44.6%),hypertension(78 cases,69.6%),coronary heart disease(88 cases,78.6%),atrial fibrillation(24 cases,21.4%),diabetes mellitus(33 cases,29.5%),and chronic kidney disease(4 cases,3.6%).The use of medication including diuretics,positive inotropic drugs and sedative was more common in insomnia group than that in non-insomnia group(All P < 0.05).Scores of PSQI,HAD,and FS-14 were all higher in insomnia group(All P < 0.05).2.Objective sleep assessment: Polysomnography results indicated that,compared with the non-insomnia group,patients in insomnia group had longer time of sleep latency,REM latency,waking after sleep onset and more central sleep apnea(All P < 0.05).Sleep efficiency and REM percentage were lower in insomnia patients(both P < 0.05).3.Laboratory tests: Compared with non-insomnia group,the levels of NT-pro BNP,renin,angiotensin Ⅱ,and CRP in insomnia HF patients were significantly increased(All P< 0.05),while the levels of total protein and albumin were lower(both P < 0.05).Moreover,left ventricular end-diastolic volume and left ventricular mass index evaluated by echo were significantly higher in insomnia group(both P < 0.05).4.Heart rate variability: The indicators of time domain,the index of standard deviation of NN intervals(SDNN)and triangle index values were significantly decreased in all patients with HF,suggesting that autonomic nervous system function was impaired in both groups.There were no statistical significances in SDNN,the index of standard deviation of NN intervals,root mean square of successive differences,p NN50(proportion of the number of NN intervals which differ by more than 50 milliseconds from the previous interval),and triangle index between two groups(All P > 0.05).Dynamic blood pressure monitoring exhibited that there were no significant differences in 24-hour mean systolic blood pressure(SBP),diastolic blood pressure(DBP),daytime SBP,daytime DBP,nocturnal SBP and nocturnal DBP between two groups(All P > 0.05).However,the DBP of insomnia group was significantly lower than that of non-insomnia group between 08:00-16:00 and between19:00-02:00(both P < 0.05).5.Prognosis: A total of 109 patients were followed up and the rate of lost to followup was 2.7%.22 cases of HF-related events including readmission or death were identified,out of these 9 cases in non-insomnia group(14.5%)and 13 cases in insomnia group(26.0%)respectively,which was 44% higher in insomnia group than in the non-insomnia group.While Kaplan-Meier analysis showed no significant difference in the endpoint major events between two groups(P = 0.136),patients in the insomnia group trended to have a higher risk of adverse events.Conclusions1.Insomnia is common in patients with chronic HF,mainly characterized by poor selfreported sleep quality,prolonged objective sleep latency and decreased sleep efficiency.2.Compared with non-insomnia HF patients,patients with insomnia manifest higher scores of abnormal psychosocial states,abnormal cardiac structural.3.Compared with non-insomnia HF patients,patients with insomnia have impaired function of peripheral autonomic nerve system,increased plasma renin and angiotensin Ⅱlevel.4.Insomnia may be a potential risk factor for the progression of HF with worse prognosis. |
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