Sleep Quality, Depression, and Quality of Life in Patients with Pulmonary Hypertension

Abstract

Pulmonary hypertension is a disabling disease characterized by progressive functional worsening, right heart failure, and death. Although pulmonary hypertension has been associated with poor quality of life, sleep quality has not been investigated in pulmonary hypertension patients. This was a cross-sectional study in which patients (N = 40) were asked to complete standardized questionnaires to assess sleep quality [using Pittsburgh Sleep Quality Index (PSQI)], insomnia, sleepiness, dyspnea, depression, restless leg syndrome, and quality of life [using Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR)] during routine office visits. Baseline hemodynamics, pulmonary function tests, exercise capacity, and transthoracic echocardiogram were analyzed. Pulmonary hypertension functional class was World Health Organization class II [20 (50%)], III [18 (45%)], and IV [2 (5%)], and 29 (72.5%) had poor sleep quality. PSQI score was associated with CAMPHOR symptoms score (R = 0.61, P < 0.001), CAMPHOR activities score (R = 0.38, P = 0.016), CAMPHOR quality-of-life score (R = 0.45, P = 0.004), depression (R = 0.42, P = 0.007), and dyspnea (R = 0.36, P = 0.02). Sleep quality was not associated with age, gender, other comorbidities, pulmonary hypertension etiology, baseline hemodynamics, pulmonary function testing, echocardiographic parameters, or exercise capacity. Poor sleep quality is common in patients with pulmonary hypertension and correlates with depression, dyspnea, and poor quality of life. Improving sleep quality in patients with pulmonary hypertension may improve quality of life.

Inspiratory Muscle Training in Pulmonary Arterial Hypertension

“…27 We measured dyspnea severity during activity using the MMRC scale because the MMRC score has been previously used to quantify functional impairment due to dyspnea in patients with PAH. 33 Patients in our study reported an improvement in dyspnea perception using the MMRC in the IMT group compared with the control group after training. However, the minimal clinically important threshold has not been established, but a difference of 1 grade on the MMRC scale is considered to be indicative of a change in perceived dyspnea that is clinically significant in COPD.…”

Prevalence of Anxiety and Depression in Pulmonary Hypertension and Changes during Therapy

“…Several studies have shown that depression and anxiety are frequently reported symptoms in PH [9,10,11,12,14], and thus screening for mental disorders has been recommended [25,26]. …”

“…Furthermore, patients often appear healthy at rest and thus might not be taken seriously by health care providers or their environment in their constrained daily life [8]. Anxiety and depression are highly prevalent in chronic diseases and have also been commonly found in prevalent PAH patients under chronic therapy [9,10,11,12,13,14,15,16]. …”

“…Studies which conducted screening for depression with standardized instruments, mainly self-administered questionnaires, found a prevalence ranging from 10 to 55% [9,10,11,12,13,14]. …”

Clinical Characterization and Survival of Patients with Borderline Elevation in Pulmonary Artery Pressure

“…A diagnosis of pulmonary arterial hypertension (PAH) carries deep psychological 1 and financial 2 consequences.…”