1033 Sleep and Patient-Reported Outcomes in Persons With Heart Failure With Preserved Ejection Fraction

• Published in: Sleep (New York, N.Y.) Vol. 43; no. Supplement_1; pp. A392 - A393
• Main Authors: Baniak, L M, Atwood, C W, Strollo, P J, Forman, D E, Chasens, E R
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 27-05-2020
• Subjects: Efficiency; Ejection fraction; Fatigue; Heart failure; Insomnia; Quality of life; Questionnaires; Sleep apnea
• ISSN: 0161-8105; 1550-9109
• DOI: 10.1093/sleep/zsaa056.1029

Abstract
Introduction
Sleep quality has a significant bearing on disease. A better understanding of sleep quality may help identify opportunities to improve patient-reported outcomes (PROs) in persons with heart failure with preserved ejection fraction (HFpEF). We aimed to explore the association between sleep and PROs in patients clinically diagnosed with HFpEF.
Methods
Cross-sectional study of 22 participants (71.2±7.2 years, 95% male, 86.4% white) with HFpEF, recruited from a heart failure (n=14) and sleep clinic (n=8). Sleep disordered breathing was measured objectively using one-night in-home obstructive sleep apnea (OSA) testing (ApneaLink). Actigraphy (7 days) was used to assess sleep duration, efficiency, and wake after sleep onset (WASO). Subjective sleep measures included the Insomnia Severity Index (ISI), Epworth Sleepiness scale (ESS), and Pittsburgh Sleep Quality Index (PSQI). PROs included functional status (Functional Outcomes Sleep Questionnaire [FOSQ]), depression (PROMIS Depression), fatigue (PROMIS Fatigue), and heart failure specific quality of life (Kansas City Cardiomyopathy Questionnaire [KCCQ]; overall summary score [KCCQ-os] and clinical summary score [KCCQ-cs]). The KCCQ-cs includes physical function and symptom scores to corresponds with NYHA Classification.
Results
Fifty percent of the participants had poor sleep quality (PSQI >5) and 2 (9.1%) had ISI scores >14. The majority (64%; n=14) had OSA; 10 currently on OSA therapy. Mean oxygen desaturation index (ODI) was 20.8±17.8. Mean actigraphy data indicated poor sleep (sleep duration 302±116 minutes, sleep efficiency 70.0±18.6%, and WASO 52±28 minutes) despite only 5 (22.7%) participants reporting excessive daytime sleepiness (ESS>10). Greater insomnia symptom severity was associated with lower heart failure specific quality of life (KCCQ-os) and functional status, and, greater fatigue and depression (all p-values <.05). FOSQ was negatively associated with PSQI (r= -.710, p= <.001) and positively with sleep efficiency (r=.496, p=.026). The KCCQ-cs was positively associated with sleep duration (r=.496, p=.026) and negatively but not significantly associated with ODI (r= -.453, p=.07).
Conclusion
Impaired sleep and OSA are highly prevalent in patients with HFpEF and both are adversely associated with PROs. Goals to improve sleep is important for effective symptom management and for potential improvements in PROs.
Support
American Nurses Foundation, Preventative Cardiovascular Nurses Association