Sleep Quality And Its Influencing Factors In Patients With Heart Failure

ObjectivesThe objectives of this study were to assess heart failure patients' sleep quality,to explore the relationship between heart failure symptoms and heart failure patients'sleep quality,and to examine the multiple mediators in the relationship.It may provide rational references for the development of interventions to improve heart failure patients'sleep quality.MethodsThis study used a cross-sectional design.We recruited chronic heart failure patients in a large,university-affiliated hospital in shandong province,China by convenience sampling from November 2018 to November 2019.Pittsburgh Sleep Quality Index,Heart Failure Somatic Perception Scale,Hospital Anxiety and Depression Scale and Sleep Hygiene Practice scale were used to assess patients'sleep quality,heart failure symptoms,psychological distress and sleep hygiene practices.SPSS 22.0 was used for data analysis.Descriptive statistics were used to characterize the sample.The comparisons of PSQI scores by different characteristics were conducted using t tests or analysis of variance.Pearson correlations were conducted to assess the bivariate correlations among study variables.Multiple linear regression was used to determine the influencing factors of sleep quality.A series of regression was conducted to examine the mediation effects of psychological distress and sleep hygiene practices on the relationship between heart failure symptoms and sleep quality.Indirect effects with 95%confidence intervals were estimated using PROCESS tool.Results1.The sleep quality in patients with heart failureTwo hundred and thirty seven heart failure patients were included in the final analyses.The mean score for sleep quality was 7.94±4.12,and 159 heart failure patients(67.1%)had poor sleep quality.2.Relationships between sociodemographic and clinical characteristics and sleep quality in patients with heart failureHigher scores for sleep quality,which mean poorer sleep quality,were found in heart failure patients who were 60 years or older(p=0.032),whose New York Heart Association functional class was ?/?(p=0.016),whose heart failure duration was 6 months or longer(p=0.034).3.Correlations among scores for heart failure symptoms,psychological distress,sleep hygiene practices,and sleep qualityScores for heart failure symptoms(r=0.481,P<0.001),psychological distress(r=0.534,p<0.001),and sleep hygiene practices(r=0.497,p<0.001)were positively correlated with score for sleep quality.Score for heart failure symptoms was positively correlated with both scores for psychological distress(r=0.600,p<0.001)and sleep hygiene practices(r=0.521,p<0.001).Score for psychological distress was positively correlated with score for sleep hygiene practices(r=0.537,p<0.001).4.Multiple linear regression analysis of heart failure patients' sleep qualityIn the multiple linear regression analysis,severe heart failure symptoms,high levels of psychological distress,poor sleep hygiene practices,and age of older were associated with poor sleep quality.These factors accounted for 37%of the variances in sleep quality(adjusted R2=0.37).5.The mediation effects of psychological distress and sleep hygiene practices in the relationship between heart failure symptoms and sleep qualityThe mediation effects of psychological distress and sleep hygiene practices on the relationship between heart failure symptoms and sleep quality included three indirect effects.The indirect effect of heart failure symptoms on sleep quality through psychological distress(heart failure symptoms?psychological distress?sleep quality)was significant(0.052<CI<0.146).The indirect effect of heart failure symptoms on sleep quality through sleep hygiene practices(heart failure symptoms?sleep hygiene practices?sleep quality)was significant(0.011<CI<0.063).The indirect effect of the serial mediation that heart failure symptoms affect sleep quality through psychological distress and sleep hygiene practices(heart failure symptoms?psychological distress?sleep hygiene practices?sleep quality)was significant(0.013<CI<0.068).Conclusions1.Patients with heart failure have poor sleep quality,which needs to be improved.Healthcare providers should pay more attention to heart failure patients'sleep quality,especially in older patients.2.Heart failure patients' poor sleep quality could be explained by their severe heart failure symptoms,high level of psychological distress,and poor sleep hygiene practices.These factors should be fully considered in the development of interventions aimed to improve heart failure patients' sleep quality3.Patients' heart failure symptoms could affect their sleep quality through psychological distress and sleep hygiene practices in serial.To improve sleep quality in patients with severe heart failure symptoms,healthcare providers could alleviate their psychological distress and correct their poor sleep hygiene practices,in addition to reducing their severe heart failure symptoms.