Sangchoon Jeon1, Nancy S Redeker. 1. Sangchoon Jeon, PhD, is Research Scientist, Yale School of Nursing, West Haven, Connecticut. Nancy S. Redeker, PhD, RN, FAHA, FAAN, is Beatrice Renfield Term Professor of Nursing, Yale School of Nursing, West Haven, Connecticut.
Abstract
BACKGROUND: Sleep disturbance is common among patients with heart failure (HF) who also experience symptom burden and poor functional performance. OBJECTIVE: We evaluated the extent to which sleep-related, daytime symptoms (fatigue, excessive daytime sleepiness, and depressive symptoms) mediate the relationship between sleep disturbance and functional performance among patients with stable HF. METHODS: We recruited patients with stable HF for this secondary analysis of data from a cross-sectional, observational study. Participants completed unattended ambulatory polysomnography from which the Respiratory Disturbance Index was calculated, along with a Six-Minute Walk Test, questionnaires to elicit sleep disturbance (Pittsburgh Sleep Quality Index, Insomnia Symptoms from the Sleep Habits Questionnaire), daytime symptoms (Center for Epidemiologic Studies Depression Scale, Global Fatigue Index, Epworth Sleepiness Scale), and self-reported functional performance (Medical Outcomes Study SF36 V2 Physical Function Scale). We used structural equation modeling with latent variables for the key analysis. Follow-up, exploratory regression analysis with bootstrapped samples was used to examine the extent to which individual daytime symptoms mediated effects of sleep disturbance on functional performance after controlling for clinical and demographic covariates. RESULTS: The sample included 173 New York Heart Association Class I-IV HF patients (n = 60/34.7% women; M = 60.7, SD = 16.07 years of age). Daytime symptoms mediated the relationship between sleep disturbance and functional performance. Fatigue and depression mediated the relationship between insomnia symptoms and self-reported functional performance, whereas fatigue and sleepiness mediated the relationship between sleep quality and functional performance. Sleepiness mediated the relationship between the respiratory index and self-reported functional performance only in people who did not report insomnia. CONCLUSIONS: Daytime symptoms explain the relationships between sleep disturbance and functional performance in stable HF.
BACKGROUND:Sleep disturbance is common among patients with heart failure (HF) who also experience symptom burden and poor functional performance. OBJECTIVE: We evaluated the extent to which sleep-related, daytime symptoms (fatigue, excessive daytime sleepiness, and depressive symptoms) mediate the relationship between sleep disturbance and functional performance among patients with stable HF. METHODS: We recruited patients with stable HF for this secondary analysis of data from a cross-sectional, observational study. Participants completed unattended ambulatory polysomnography from which the Respiratory Disturbance Index was calculated, along with a Six-Minute Walk Test, questionnaires to elicit sleep disturbance (Pittsburgh Sleep Quality Index, Insomnia Symptoms from the Sleep Habits Questionnaire), daytime symptoms (Center for Epidemiologic Studies Depression Scale, Global Fatigue Index, Epworth Sleepiness Scale), and self-reported functional performance (Medical Outcomes Study SF36 V2 Physical Function Scale). We used structural equation modeling with latent variables for the key analysis. Follow-up, exploratory regression analysis with bootstrapped samples was used to examine the extent to which individual daytime symptoms mediated effects of sleep disturbance on functional performance after controlling for clinical and demographic covariates. RESULTS: The sample included 173 New York Heart Association Class I-IV HF patients (n = 60/34.7% women; M = 60.7, SD = 16.07 years of age). Daytime symptoms mediated the relationship between sleep disturbance and functional performance. Fatigue and depression mediated the relationship between insomnia symptoms and self-reported functional performance, whereas fatigue and sleepiness mediated the relationship between sleep quality and functional performance. Sleepiness mediated the relationship between the respiratory index and self-reported functional performance only in people who did not report insomnia. CONCLUSIONS: Daytime symptoms explain the relationships between sleep disturbance and functional performance in stable HF.
Authors: Nancy S Redeker; Samantha Conley; George Anderson; John Cline; Laura Andrews; Vahid Mohsenin; Daniel Jacoby; Sangchoon Jeon Journal: Behav Sleep Med Date: 2018-11-21 Impact factor: 2.964
Authors: Makayla Cordoza; Brittany Koons; Michael L Perlis; Brian J Anderson; Joshua M Diamond; Barbara Riegel Journal: Transplant Rev (Orlando) Date: 2021-09-14 Impact factor: 3.943
Authors: Stephen Breazeale; Sangchoon Jeon; Youri Hwang; Meghan O'Connell; Uzoji Nwanaji-Enwerem; Sarah Linsky; H Klar Yaggi; Daniel L Jacoby; Samantha Conley; Nancy S Redeker Journal: Nurs Res Date: 2022 May-Jun 01 Impact factor: 2.364
Authors: Nancy S Redeker; Henry Klar Yaggi; Daniel Jacoby; Christopher S Hollenbeak; Stephen Breazeale; Samantha Conley; Youri Hwang; Joanne Iennaco; Sarah Linsky; Uzoji Nwanaji-Enwerem; Meghan O'Connell; Sangchoon Jeon Journal: Sleep Date: 2022-01-11 Impact factor: 6.313
Authors: Tiny Jaarsma; Loreena Hill; Antoni Bayes-Genis; Hans-Peter Brunner La Rocca; Teresa Castiello; Jelena Čelutkienė; Elena Marques-Sule; Carla M Plymen; Susan E Piper; Barbara Riegel; Frans H Rutten; Tuvia Ben Gal; Johann Bauersachs; Andrew J S Coats; Ovidiu Chioncel; Yuri Lopatin; Lars H Lund; Mitja Lainscak; Brenda Moura; Wilfried Mullens; Massimo F Piepoli; Giuseppe Rosano; Petar Seferovic; Anna Strömberg Journal: Eur J Heart Fail Date: 2020-10-20 Impact factor: 15.534