Excessive Daytime Sleepiness is Associated With Poor Medication Adherence in Adults With Heart Failure

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 A sample of 280 adults with chronic HF was 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 was obtained at baseline, 3- and 6-months using the Basel Assessment of Adherence Scale (BAASIS). Regression analysis was used to clarify the contribution of EDS and cognition to medication adherence and to assess relationships over six months after adjusting for age, enrollment site, gender, race, functional class, depression, and premorbid intellect. Results 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=0.035). The odds of nonadherence increased by 11% for each unit increase in EDS (AOR=1.11, 95% CI=1.05–1.19, p=0.001). In longitudinal models there was a 10% increase in the odds of nonadherence for each unit increase in EDS (p=0.008). The only cognition measure significantly associated with medication adherence was attention (p=0.047). Conclusion 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.

The Pharmacist Role in Predicting and Improving Medication Adherence in Heart Failure Patients

“…Two smaller observational studies that followed patients for 3 to 6 months found that twice daily dosing of medication increased the likelihood of nonadherence to HF medications. 10,25 Some of these large cohort studies were in agreement that prior use of the same class of HF medication was a significant predictor for improved medication adherence. 23,27,29 Interestingly, 2 of these large cohort studies found that concomitant use of at least 3 cardiac medications was a significant predictor for medication adherence.…”

“…6,8,10,12,[21][22][23][24][25][26][27][28][29][30][31][32] Table 1 may assist the health care provider in recognizing predictors that may impact adherence to HF medications. Table 2 depicts a summary of the studies identifying predictors of decreased 6,8,10,[21][22][23][24][25][26]28,29,32 and increased 8,12,22,[26][27][28]30,31 HF medication adherence. Large, observational cohort studies extracting adherence and demographic data from health insurance claims databases or HF registries with 2 to 4 years of follow-up data from the United States found some similar significant predictors for nonadherence, including male gender or nonwhite race.…”

“…Wu et al (2012) conducted a series of studies in HF patients to determine factors affecting event-free survival, factors defined as ED visits for symptoms of decompensated HF, HF or cardiac hospitalizations, and all-cause mortality. 31 The studies found that those who were not married (P = 0.044), 31 Lapses in attention 24 Excessive daytime sleepiness with or without mild cognitive decline 24,25 Advanced age (≥ 65 years) 29 …”

Determinants of Behavioral Alertness in Adults with Heart Failure

“…A detailed description of the study methods has been published previously and are summarized briefly here. 3 Clinically stable patients were enrolled from outpatient settings and followed for 6 months. Data on sleep quality, daytime sleepiness, and behavioral alertness were collected in person at baseline, 3 months, and 6 months, usually during home visits.…”

“…Poor sleep quality is known to influence the ability to remember to take medications, eat a healthy diet, and respond appropriately to symptoms. 3 There is a growing awareness that sleep disturbances are common in HF and these symptoms are not explained by sleep disordered breathing. [4][5][6][7] Over half of HF patients report insomnia symptoms.…”