Abstract
Background A relationship between excessive daytime sleepiness (EDS) and poor treatment adherence has been suspected but not confirmed. We hypothesized that medication adherence would be poorer in adults with heart failure (HF) and EDS and that cognitive status would be the mechanism of effect. Methods and Results A sample of 280 adults with chronic HF were enrolled into a prospective cohort comparison study. We identified a cohort with EDS and a control group without EDS and further divided both groups into those with and without mild cognitive decline. Data on medication adherence were obtained at baseline and 3 and 6 months by using the Basel Assessment of Adherence Scale. Regression analysis was used to clarify the contribution of EDS and cognition to medication adherence and to assess relationships over 6 months after adjusting for age, enrollment site, gender, race, functional class, depression, and premorbid intellect. At baseline, 62% of subjects were nonadherent to their medication regime. Nonadherence was significantly more common in those with EDS, regardless of cognitive status ( P = .035). The odds of nonadherence increased by 11% for each unit increase in EDS (adjusted odds ratio 1.11; 95% confidence interval 1.05–1.19; P = .001). In longitudinal models, there was a 10% increase in the odds of nonadherence for each unit increase in EDS ( P = .008). The only cognition measure significantly associated with medication adherence was attention ( P = .047). Conclusions Adults with HF and EDS are more likely to have problems adhering to their medication regimen than those without EDS, regardless of their cognitive status. Identifying and correcting factors that interfere with sleep may improve medication adherence.
Highlights
IntroductionCritical, yet unexplored, is the contribution of excessive daytime sleepiness (EDS) to poor self-care in heart failure (HF) patients
Adults with heart failure (HF) and excessive daytime sleepiness (EDS) are more likely to have problems adhering to their medication regimen than those without EDS, regardless of their cognitive status
A 2006 Institute of Medicine report called national attention to the devastating effects of daytime sleepiness, including potential problems with treatment adherence.[10]. Excessive daytime sleepiness (EDS) is the term used to describe decreased attention and increased sleep propensity during wakeful states.[11, 12] Sleep propensity reflects the interaction of homeostatic mechanisms that regulate sleep intensity, and circadian rhythm, which regulates the timing of sleep.[13, 14] The relative strength of the sleep and wake drives reflects chronobiological and environmental factors such as physical activity, which stimulate arousal.[15]. In adults with HF, contributors to EDS include older age, sleep disordered breathing, insomnia, depression, and polypharmacy, often with medications that cause somnolence as a primary side effect.[16,17,18,19]
Summary
Critical, yet unexplored, is the contribution of EDS to poor self-care in HF patients. We hypothesized that EDS may impair self-care through its effects on cognition.[20, 21] Inadequate sleep has been shown to impair information processing, memory, vigilance, judgment, motivation, and decision-making across a wide range of populations.[22,23,24] Most of these cognitive domains are susceptible to decline in people with HF,(25, 26) 25% to 50% of whom have impaired cognition.[27] the primary objective of this. We hypothesized that medication adherence would be poorer in adults with heart failure (HF) and EDS and that cognitive status would be the mechanism of effect
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