Insomnia and the risk of incident heart failure: a population study

Laugsand, Lars Erik; Strand, Linn Beate; Platou, Carl; Vatten, Lars J.; Janszky, Imre

doi:10.1093/eurheartj/eht019

Cited by 203 publications

(146 citation statements)

References 39 publications

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“…Chronic insomnia contributes to incident HF and death. 6 It is distressing and associated with symptoms, such as fatigue, nocturnal dyspnea, depression, anxiety, pain, and excessive daytime sleepiness, poor quality of life, and decrements in functional performance. 3,5,[7][8][9][10][11][12][13] Health care providers frequently attribute sleep disturbance, including insomnia symptoms, to the pathophysiology (e.g., fl uid congestion) and symptoms of HF itself (e.g., nocturnal dyspnea, nocturia) or to sleep disordered breathing that occurs in about half the population.…”

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confidence: 99%

“…While a larger fully powered RCT is needed to further confirm these short-term effects and to established sustained efficacy, our results suggest the feasibility of the design and approach used in this preliminary study, as well as high levels of patient acceptability and use of the CBT-I components. Given recent evidence that insomnia predicts incident HF and death over a mean 11 year follow-up, 6 future studies should also focus on the effects of insomnia treatment, including CBT-I, on the pathophysiology of HF and event-free survival.…”

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confidence: 99%

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Feasibility and Efficacy of a Self-Management Intervention for Insomnia in Stable Heart Failure

Redeker

Jeon

Andrews

et al. 2015

Journal of Clinical Sleep Medicine

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Background: Chronic insomnia is common among patients with heart failure (HF) and may contribute to fatigue and poor function. However, to date there have been no randomized controlled trials focused on treatment of insomnia or daytime symptoms in this population. Objective: The purpose of this study was to examine the preliminary effi cacy, feasibility, and acceptability of a selfmanagement intervention (cognitive behavioral therapy [CBT-I]) for insomnia among patients with stable HF. Methods: We conducted a pilot randomized controlled trial (RCT) in which patients with stable Class I-III HF (n = 25/52.1% women; mean age = 59 ± 14.8 years) were randomized in groups to CBT-I (n = 29) or an attention control condition (HF self-management with sleep hygiene; n = 19). Participants completed 2 weeks of wrist actigraphy, the insomnia severity index, and measures of fatigue, depression, sleepiness, and functional performance at baseline and follow-up. We computed the size of the effects on the dependent variables and used MANOVA to evaluate the effects of CBT-I on insomnia and fatigue. Results: CBT-I was feasible and acceptable and had a statistically signifi cant effect on insomnia and fatigue, while controlling for the effects of comorbidity and age. Conclusions: CBT-I has short-term effi cacy as a treatment for chronic insomnia among patients with stable HF. Future studies are needed to address its sustained effects. Keywords: self-management, heart failure, insomnia, cognitive behavioral therapy, sleep, fatigue, depression Citation: Redeker NS, Jeon S, Andrews L, Cline J, Jacoby D, Mohsenin V. Feasibility and effi cacy of a self-management intervention for insomnia in stable heart failure. J Clin Sleep Med 2015;11(10):1109 -1119 .pii: jc-00335-14 http://dx.doi.org/10.5664/jcsm.5082 H eart failure (HF), a disabling chronic condition that affl icts over fi ve million Americans, 1 is associated with excess morbidity and mortality, comorbidity, poor daytime function, and high symptom burden. Almost 75% of HF patients report poor sleep.2,3 Insomnia, characterized by diffi culty initiating and maintaining sleep, early morning awakenings, non-restorative sleep, and daytime dysfunction, occurs in 25% to 56% of HF patients, 2-5 who report higher rates than "healthy" controls 2 and the general population. Chronic insomnia contributes to incident HF and death. 6 It is distressing and associated with symptoms, such as fatigue, nocturnal dyspnea, depression, anxiety, pain, and excessive daytime sleepiness, poor quality of life, and decrements in functional performance. 3,5,[7][8][9][10][11][12][13] Health care providers frequently attribute sleep disturbance, including insomnia symptoms, to the pathophysiology (e.g., fl uid congestion) and symptoms of HF itself (e.g., nocturnal dyspnea, nocturia) or to sleep disordered breathing that occurs in about half the population.14 However, sleep disordered breathing does not consistently explain insomnia, self-reported sleep quality, or fatigue; and insomnia was closely associated with...

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confidence: 99%

mentioning

confidence: 99%

Feasibility and Efficacy of a Self-Management Intervention for Insomnia in Stable Heart Failure

Redeker

Jeon

Andrews

et al. 2015

Journal of Clinical Sleep Medicine

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“…[10][11][12][13] Furthermore, diffi culty maintaining and initiating sleep are associated with incident HF. 14 …”

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confidence: 99%

Associations of Heart Failure with Sleep Quality: The Rotterdam Study

Zuurbier

Luik

Leening

et al. 2015

Journal of Clinical Sleep Medicine

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Study Objectives: The prevalence of sleep disturbances and heart failure increases with age. We aimed to evaluate the associations of incident heart failure and cardiac dysfunction with changes in sleep quality. Methods: This prospective population-based study was conducted in the Rotterdam Study. Of the 3,445 eligible persons (mean age 72.0 ± 7.1 years) available for crosssectional analyses, 8.9% (n = 307) had prevalent clinical heart failure. In longitudinal analyses, 1,989 eligible persons (mean age 70.0 ± 5.8 years) were followed for an average of 6.5 ± 0.4 years, of which 4.6% (n = 91) had prevalent or incident clinical heart failure. Heart failure was assessed according to European Society of Cardiology criteria. To estimate cardiac function, we measured left ventricular fractional shortening, left ventricular systolic function, and E/A ratio by echocardiography. Heart failure and cardiac dysfunction were studied with linear regression in relation to sleep quality, assessed by the Pittsburgh Sleep Quality Index. Results: No associations between clinical heart failure and sleep quality were observed in cross-sectional analyses. Clinical heart failure predicted a reduction of sleep quality (B = 1.00 points on the Pittsburgh Sleep Quality Index; 95% CI 0.40, 1.60) in longitudinal assessment. This association was driven by the sleep onset latency and sleep quality components of the Pittsburgh Sleep Quality Index. Cardiac dysfunction was not related to sleep quality in cross-sectional or longitudinal analyses. Conclusions: Clinical heart failure, but not cardiac dysfunction measured by echocardiography, increases the risk of poor sleep quality in the general population over time. These fi ndings suggest that clinical manifestations of heart failure negatively affect sleep. Keywords: sleep quality, heart failure, echocardiography, population-based, epidemiology Citation: Zuurbier LA, Luik AI, Leening MJ, Hofman A, FreakPoli R, Franco OH, Stricker BH, Tiemeier H. Associations of heart failure with sleep quality: the Rotterdam Study. J Clin Sleep Med 2015;11(2):117-121.pii: jc-00172-14 http://dx.doi.org/10.5664/jcsm.4454 S leep disturbances have been reported in around 60% of patients with heart failure (HF).1,2 Despite improved treatment and an overall decline in mortality after a cardiovascular event, the number of HF patients is increasing among the elderly.3 This is probably due to an aging population and to the improved chances of survival for HF patients. 4 Nevertheless, only 25% to 35% of patients with clinical HF survive up to 5 years after diagnosis, and HF poses a great burden in terms of treatment, hospitalization and quality of life. [5][6][7] HF is related to multiple physical and mental problems, including shortness of breath, depressive symptoms, cognitive impairment, and sleep problems. 8,9 Little is known about the changes in sleep occurring in these patients over time.Previous studies investigating HF and sleep have been mostly cross-sectional and cannot establish a temporal relation. Prospective...

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“…Sleep deprivation has also been shown [35] to be associated with heart failure in the HUNT Study. The data are quite robust as they are based on 54,279 Norwegians free of disease at baseline (men and women aged 20 -89 years).…”

Section: A Evansmentioning

confidence: 92%

Environmental Noise Pollution: Has Public Health Become too Utilitarian?

Evans¹

2017

JSS

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Environmental noise pollution is an ever-increasing problem. The various sources: Aircraft, Road Traffic and Wind Farms are reviewed, but the latter source, because of the intrusive, impulsive and incessant nature of the sound emitted, is the major focus of this review. Wind turbines produce a range of sound but it is the Infrasound and low frequency noise which deserves special attention. Infrasound is considered to be below the range of human hearing so it is not measured in routine noise assessments in the wind farm planning process. There is, however, evidence that many can register it and a sizeable minority is sensitive, or becomes sensitised to it. The actual route of transmission still requires elucidation. The net effect of the entire range of noise produced is interference with sleep and sleep deprivation. Sleep, far from being a luxury is vitally important to health and insufficient sleep, in the long term, is associated with a spectrum of diseases, particularly Cardiovascular. The physiological benefits of sleep are reviewed, as is the range of diseases which the sleep-deprived are predisposed to. Governments, anxious to meet Green targets and often receiving most of their advice on health matters from the wind industry, must commission independent studies so that the Health and Human Rights of their rural citizens is not infringed. Public Health, in particular, must remember its roots in Utilitarianism which condoned the acceptance of some Collateral Damage provided that the greatest happiness of the greatest number was ensured. The degree of Collateral Damage caused by wind farms should be totally unacceptable to Public Health which must, like good government, fully exercise the Precautionary Principle. The types of study which should be considered are discussed. Indeed, the father of Utilitarian Philosophy, Jeremy Bentham, urged that government policy should be fully evaluated.

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Insomnia and the risk of incident heart failure: a population study

Abstract: Insomnia is associated with an increased risk of incident heart failure. If our results are confirmed by others and causation is proved, evaluation of insomnia symptoms might have consequences for cardiovascular prevention.

Cited by 203 publications

References 39 publications

Feasibility and Efficacy of a Self-Management Intervention for Insomnia in Stable Heart Failure

Feasibility and Efficacy of a Self-Management Intervention for Insomnia in Stable Heart Failure

Associations of Heart Failure with Sleep Quality: The Rotterdam Study

Environmental Noise Pollution: Has Public Health Become too Utilitarian?

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