Abstract
Sleep disturbances are frequent among patients with heart failure (HF). We hypothesized that self-reported sleep disturbances are associated with a poor prognosis in patients with HF. A longitudinal study of 119 patients with HF was carried out to assess the association between sleep disturbances and the occurrence of major cardiovascular events (MACE). All patients with HF completed self-administered questionnaires on sleepiness, fatigue, insomnia, quality of sleep, sleep patterns, anxiety and depressive symptoms, and central nervous system (CNS) drugs intake. Patients were followed for a median of 888 days. Cox models were used to estimate the risk of MACE associated with baseline sleep characteristics. After adjustment for age, the risk of a future MACE increased with CNS drugs intake, sleep quality and insomnia scores as well with increased sleep latency, decreased sleep efficiency and total sleep time. However, after adjustment for left ventricular ejection fraction and hypercholesterolemia the HR failed to be significant except for CNS drugs and total sleep time. CNS drugs intake and decreased total sleep time were independently associated with an increased risk of MACE in patients with HF. Routine assessment of self-reported sleep disturbances should be considered to prevent the natural progression of HF.
Highlights
Heart failure (HF) is a common clinical syndrome characterized by inability of the ventricle to fill with or eject blood
Major adverse cardiac events (MACE) are frequent in the history of HF and often lead to hospitalization which is an important marker for poor prognosis [3]
We found an increased occurrence of fatal and non-fatal MACE when total sleep time was reduced by one hour
Summary
Heart failure (HF) is a common clinical syndrome characterized by inability of the ventricle to fill with or eject blood. HF is a major public health problem with a constantly increasing prevalence [1], a loss of quality of life, and a high mortality rate [2]. Major adverse cardiac events (MACE) are frequent in the history of HF and often lead to hospitalization which is an important marker for poor prognosis [3]. Patients with HF often have several non-cardiac comorbidities which are associated with an impaired quality of life and a poorer prognosis [4]. Identifying and treating the factors contributing to the progression of HF are essential goals for an optimized management. Sleep disturbances are frequent with 60–75% of patients with HF complaining of poor sleep quality, more than 50% of insomnia [5,6] and 35% using regularly hypnotics [7]
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