What is the best measure of daytime sleepiness in adults with heart failure?

Abstract

Purpose To identify the best screening measure of daytime sleepiness in adults with heart failure (HF). Data sources 280 adults with HF completed the Epworth Sleepiness Scale, the Stanford Sleepiness Scale, and a single Likert item measuring daytime sleepiness. The sensitivity and specificity of these self-report measures were assessed in relation to a measure of daytime dysfunction from poor sleep quality. Conclusions Only 16% of the sample reported significant daytime dysfunction due to poor sleep quality. Those reporting daytime dysfunction were likely to be younger (p<0.001), to be unmarried (p=0.002), to have New York Heart Association (NYHA) functional class IV HF (p=0.015), and to report low income (p=0.006) and fewer hours of sleep (p=0.015). The measure of daytime sleepiness that was most sensitive to daytime dysfunction was a single Likert item measured on a 10-point (1–10) scale. Patients with a score ≥ 4 were 2.4 times more likely to have daytime dysfunction than those with a score <4. Implications for practice Complaints of daytime dysfunction due to poor sleep are not common in adults with HF. Routine use of a single question about daytime sleepiness can help nurse practitioners to identify those HF patients with significant sleep issues that may require further screening.

The Course of Sleep Problems in Patients With Heart Failure and Associations to Rehospitalizations

“…On the other hand, a single-item measure seems to provide general but valid information regarding the presence of a possible sleeping problem. 29,30 This suggests that such a single-item measure may be used by nurses or other healthcare personnel as a first simple tool in clinical routine to detect HF patients in the need for a more careful sleep investigation, so does the fact that there are few, if any, studies that have studied the course of sleep problems and its associations with hospitalizations in HF patients. We therefore think that this study, despite its methodological limitations regarding assessment of sleep problems, can still provide important information.…”

“…However, this will not be applicable to all HF patients, and patients might also develop sleep problems later on. Awareness of sleep problems during follow-up visits, for example, with the help of a singleitem measure, 29,30 can be a first step. The second step is to determine the type of sleep problem (eg, insomnia, sleep apnea) by including questions focusing on the sleep situation in the clinical assessment, as well as by using validated questionnaires (eg, the Insomnia Severity Index 37 or the Berlin Sleep Apnea Questionnaire 38 ).…”

“…27,28 The use of single-item measures has previously been reported to provide valid information regarding the presence of sleeping problems or daytime sleepiness in patients with fibromyalgia or HF. 29,30 In the CES-D, patients are requested to indicate the answer that best describes their feelings or behaviors during the last week. The response options for the CES-D sleep problem item are rarely (G1 day), some of the time (1Y2 days), occasionally (3Y4 days), and most of the time (5Y7 days).…”

Daytime sleepiness and risk of coronary heart disease and stroke: results from the Nurses’ Health Study II

“…Given that some studies have shown poor correlation of sleepiness assessed with different measurement tools and poor agreement between subjective and objective measures of sleepiness [33], the use of a single question to measure daytime sleepiness could have led to measurement error that could have tempered a potential association. However, single-item measures of sleepiness have also been shown to serve as effective screening tools [34,35]. Third, we had limited power to observe significant associations due to low case counts, particularly for stroke, which had only 18 cases for women who reported experiencing daytime sleepiness almost every day.…”

What puts heart failure patients at risk for poor medication adherence?

“…Together, these three pairs suggest that clinicians caring for HF patients who are of older age, those with multiple comorbid conditions and taking numerous medications, and those who are newly diagnosed should anticipate problems with medication adherence and discuss ways to assist patients to avoid adherence problems. Asking patients about their sleep quality should be a routine element of all clinical encounters 52. Future research is needed to identify interventions that adequately address these predictors of nonadherence.…”