| Background: Heart failure(HF)is very common in the elderly and is a leading cause of hospitalization and disability.Frailty is a condition in which the multi-dimensional cumulative decline in the function of organs and systems leads to increased susceptibility and injury to emergency sources,especially in patients with heart failure.There is a significant correlation between frailty and poor prognosis in patients with heart failure.Factors such as age,C-reactive protein,uric acid,and sleep quality play a role in it.In China,the decline of sleep quality is very common,about 37.75% of the urban elderly suffer from sleep disorders.Sleep disturbances such as dyspnea,cough and perspiration at night are common symptoms in patients with chronic heart failure,and affect the quality of life and psychological status of patients with heart failure.Experiments have gradually shown that the more sleep quality decreases,the higher frailty incidences and the more severe the frailty,and the mechanisms such as inflammatory reaction and oxidative stress play a major role in it.However,in patients with chronic heart failure,it is not clear how sleep quality affects the occurrence of frailty and which dimension of sleep quality is more important in the development of frailty.Therefore,this experiment using case control study model,and multidimensional standard evaluation method to evaluate the frailty condition in heart failure patients,investigate the relationship between different sleep quality dimensions and frailty in heart failure patients.We provide the scientific basis for sleep intervention for elderly chronic heart failure,make further effective management and control of heart failure,and improve the clinical prognosis of heart failure,reduce the case fatality rate.Objective: By evaluating the frailty and sleep conditions in elderly patients with heart failure,this experiment compares the correlation between different sleep quality dimensions and frailty,and explores the factors and influence degree that independently affect the frailty of patients with heart failure,so as to providing new treatment ideas and schemes for the prevention and treatment of the frailty of patients with heart failure.Methods A total of 158 patients with heart failure aged 65 years or above who were admitted to the Department of Cardiology of the Second Hospital of Jilin University from December 2019 to December 2020 were selected,and the inclusion criteria were in accordance with the Guidelines for the Diagnosis and Treatment of Heart Failure in China 2018.General clinical data of the population were collected at admission,including age,sex,years of education,smoking and alcohol consumption;The population was then collected to test for indicators including hemoglobin,C-reactive protein,creatinine,glomerular filtration rate,uric acid,albumin,D-II polymer,total bilirubin,triglyceride,low-density lipoprotein,homocysteine,ejection fraction,and N-terminal cardio-brain natriuretic peptide precursor.Failure Idex-Comprehensive Geriatric Assessment(FI-CGA)was used to evaluate the frailty of the population.According to the scores,111 patients were divided into frailty group(FI-CGA≥0.25)and 47 patients were divided into non-frailty group(FI-CGA < 0.25).The Pittsburgh Sleep Quality Index was used to assess sleep condition in the population.SPSS 25.0 statistical software was used to analyze the difference between the two groups of data,and P < 0.05 was considered to be statistically significant.Independent risk factors for frailty in elderly patients with chronic heart failure were then analyzed.Finally,the sleep quality was divided into 7 dimensions.Correlation analysis and univariate logistic regression analysis were conducted for different dimensions and fission respectively,and multivariate logistic regression analysis was conducted for relevant dimensions to explore the sleep quality dimension that independently affected fission.The mean standard deviation((?)±S)was used to describe the enumeration data,and t test and rank sum test were used to analyze the differences between groups according to whether they met the normality test.Classification data were described by the number of cases n(%),and differences between groups were analyzed by χ~2 test.Results: 1.Incidence of frailty and poor sleep quality in elderly patients with chronic heart failure A total of 158 patients were included in this study,including 111 in the frailty group and 47 in the non-frailty group,with a frailty incidence of 70.3%.The incidence of poor sleep quality was 69.6% and 78.4% in the frailty group.2.Comparison of general clinical data and laboratory examination results between frailty group and non-frailty group in elderly patients with chronic heart failureThe differences in age,uric acid,C-reactive protein,albumin,D-dimer,NT-pro BNP and sleep quality between the frailty group and the non-frailty group were statistically significant(P < 0.05).There were no statistically significant differences between the two groups in gender,smoking,alcohol consumption,years of education,hemoglobin,creatinine,glomerular filtration rate,total bilirubin,triglyceride,low-density lipoprotein,homocysteine,ejection fraction(P>0.05).3.Correlation between frailty and clinical indicators in elderly patients with chronic heart failureThe correlation between the above indicators and frailty scores was analyzed respectively,and the indicators with statistical significance and the frailty status were selected for binary logistic regression analysis to obtain the independent risk factors of frailty status: Age(OR=1.126,95%CI= 1.035-1.225,P=0.006 < 0.05),C-reactive protein(OR=1.040,95%CI=1.002-1.079,P=0.039 < 0.05),sleep quality(OR=1.181,95%CI= 1.080-1.292,P=0.000 < 0.05).Under the condition of P < 0.05,it can be considered that every increase of 1 point in PSQI score,the risk of frailty increases by 1.181 times.4.The influence of different sleep quality dimensions on frailtyAccording to the Pittsburgh Sleep Quality Index,sleep quality is divided into seven dimensions.The correlation between the 7 dimensions and frailty scores was explored,and univariate and multivariate logistic regression analysis was conducted for the correlated dimensions and frailty scores respectively.The results showed that:(1)Among the seven sleep quality dimensions,except the use of sleeping pills,self-reported sleep quality,sleep latency,sleep duration,sleep efficiency,sleep disturbance,daytime function and frailty were all correlated.(2)Sleep disturbance was the independent factor affecting frailty(OR=4.034,95%CI=1.088-14.960,P=0.037 < 0.05).At the level of P < 0.05,the probability of frailty is 4.034 times higher for each severe degree of sleep disturbance.Conclusion:1.Age,C-reactive protein and sleep quality are independent risk factors for frailty in elderly patients with chronic heart failure.Each 1-point increase in the Pittsburgh Sleep Quality Index score was associated with a 1.181-fold increase in the risk of frailty.2.Sleep disturbance independently affects the frailty of elderly patients with chronic heart failure.For each degree of increased sleep disturbance,the possibility of frailty was 4.034 times higher. |
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