Sleep symptoms and clinical markers of illness in patients with heart failure

Abstract

The purpose of this study was to survey patients with heart failure (HF) for sleep symptoms using a standardized questionnaire and correlate symptoms with conventional markers of clinical status. A self-report paper questionnaire was offered to patients presenting to a tertiary care HF clinic. Symptoms were grouped according to "risk" categories and correlated with routine clinical information. One hundred six (52.7% of 201 with all data) respondents had a high pretest probability for sleep apnea syndrome. Sixty three (31.3%) reported symptoms suggesting the presence of chronic insomnia; seven (3.5%) and eight (4%) reported symptoms of narcolepsy and restless legs syndrome, respectively. High-risk respondents for sleep apnea had a higher body mass index (p<0.001), were younger (p<0.05), and had a higher ejection fraction (p<0.05). The odds ratio (confidence interval) for paroxysmal nocturnal dyspnea (PND) to a complaint of sleepiness was 1.99 (1.1-3.6) and to a complaint of insomnia was 3.5 (1.8-6.5). In men, complaints of sleepiness in patients with PND were correlated, 4.47 (1.9-10.3), as was a correlation to high pretest probability for sleep apnea, 2.47 (1.1-5.5). There were no correlation of New York Heart Association status classification to high risk for sleep apnea, but a complaint of insomnia tended to occur with worsening functional status (p<0.05). There was only modest correlation of self-reported symptoms as elicited by a questionnaire and risk for sleep disorders with common clinical assessments for HF. Such collection of symptoms might be useful in establishing guidelines for routine sleep testing or as an adjunct to clinical trials.

Prognostic Significance of Insomnia in Heart Failure

“…9 Thus, the associations between insomnia and inflammation are complex and not fully addressed especially in HF patients. Furthermore, symptoms of HF itself, including coughing, orthopnea, paroxysmal nocturnal dyspnea, and nocturia, often lead to insomnia, 13, 35 and insomnia itself may reflect the severity of HF. In addition, insomnia is also an indicator of depression, which is associated with adverse prognosis of HF.…”

Insomnia and chronic heart failure

“…In this cohort, 106 (52.7%) of respondents had a high pre-test probability for sleep apnea syndrome, 63 (31.3%) for chronic insomnia, 7 (3.5%) for narcolepsy, and 8 (4%) for restless legs syndrome [21]. High-risk respondents for sleep apnea syndrome had a higher body mass index (P \ 0.001), were younger (P \ 0.05), and had a higher ejection fraction (P \ 0.05) [21]. There were no correlation of New York Heart Association (NYHA) status classification and risk for sleep apnea syndrome; however, worsening functional status correlated with the complaint of insomnia (P \ 0.05) [21].…”

“…Despite considerable advances in the understanding of and treatment for insomnia, this condition remains inadequately identified and treated in the general population, including patients with CHF. Risk factors associated with insomnia in the general population include aging [2,14,15,19]; sleep apnea [20]; depression and psychiatric illness [10,16,21]; and chronic medical illness [2,14,15,19], including CHF [1,2,14,[21][22][23][24][25]. Table 1 outlines clinical manifestations of CHF according to symptoms.…”

“…Table 1 outlines clinical manifestations of CHF according to symptoms. Assessment of sleep symptoms in patients with CHF was performed using a standardized questionnaire with further correlation to conventional markers of clinical status [21]. In this cohort, 106 (52.7%) of respondents had a high pre-test probability for sleep apnea syndrome, 63 (31.3%) for chronic insomnia, 7 (3.5%) for narcolepsy, and 8 (4%) for restless legs syndrome [21].…”

“…Assessment of sleep symptoms in patients with CHF was performed using a standardized questionnaire with further correlation to conventional markers of clinical status [21]. In this cohort, 106 (52.7%) of respondents had a high pre-test probability for sleep apnea syndrome, 63 (31.3%) for chronic insomnia, 7 (3.5%) for narcolepsy, and 8 (4%) for restless legs syndrome [21]. High-risk respondents for sleep apnea syndrome had a higher body mass index (P \ 0.001), were younger (P \ 0.05), and had a higher ejection fraction (P \ 0.05) [21].…”