Impact of Sleep Apnea,Daytime Sleepiness,Comorbidities,and Depression on Patients’ Heart Failure Health Status

Abstract

There is a gap in current research on common factors that impact patients with advanced heart failure (HF). The purpose of this secondary data analysis was to explore associations of those factors with three empirically verified measures of HF-related clinical, physical, and mental health status. Baseline data of 198 advanced systolic HF (EF < 40%) patients were analyzed. Patients were 61.6% male, with a mean age of 62.3 (SD = 13.2) years. The multivariable general linear modeling results indicated that patients who had poorer scores on HF-related clinical status were those who had sleep apnea (β = −6.6, p < .05), daytime sleepiness (β = −9.4, p < .01), four or more comorbidities (β = −11.8, p < .001), and depression (β = −18.7, p < .001). Depression was associated with all three measures of HF-related health status. These findings alert nurses to assess for sleep apnea and to use known screening measures for daytime sleepiness, depression, and comorbidities.

Keywords

heart failure health status daytime sleepiness sleep apnea depression comorbidities

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References

Afifi

Clark

May

(2004). Computer-aided multivariate analysis (4th ed.). Chapman & Hall/CRC.

American Academy of Sleep Medicine. (2020). Sleep apnea – Overview & facts. http://sleepeducation.org/essentials-in-sleep/sleep-apnea

American Heart Association. (2021a). Causes of heart failure. https://www.heart.org/en/health-topics/heart-failure/causes-and-risks-for-heart-failure/causes-of-heart-failure

American Heart Association. (2021b). Get with the guidelines^® – Heart failure. https://www.heart.org/en/professional/quality-improvement/get-with-the-guidelines/get-with-the-guidelines-heart-failure

American Heart Association. (2021c). What you need to know about how sleep apnea affects your heart. https://www.heart.org/en/health-topics/sleep-disorders/sleep-apnea-and-heart-disease-stroke

American Sleep Association. (2020). What is sleep apnea? https://www.sleepassociation.org/sleep-apnea/

Andresen

E. M.

Byers

Friary

Kosloski

Montgomery

(2013). Performance of the 10-item Center for Epidemiologic Studies Depression scale for caregiving research. SAGE Open Medicine. Advance online publication. https://doi.org/10.1177/2050312113514576

Appleton

S. L.

Gill

T. K.

Lang

C. J.

Taylor

A. W.

McEvoy

R. D.

Stocks

N. P.

González-Chica

D. A.

Adams

R. J.

(2018). Prevalence and comorbidity of sleep conditions in Australian adults: 2016 Sleep Health Foundation national survey. Sleep Health, 4, 13–19. https://doi.org/10.1016/j.sleh.2017.10.006

Aurora

R. N.

Quan

S. F.

(2016). Quality measure for screening for adult obstructive sleep apnea by primary care physicians. Journal of Clinical Sleep Medicine, 12(8), 1185–1187. https://doi.org/10.5664/jcsm.6064

10.

Azarbarzin

Sands

S. A.

Taranto-Montemurro

Vena

Sofer

Kim

S. W.

Stone

K. L.

White

D. P.

Wellman

Redline

(2020). The sleep apnea-specific hypoxic burden predicts incident heart failure. Chest, 158(2), 739–750. https://doi.org/10.1016/j.chest.2020.03.053

11.

Baxter

Johnson

Chambers

Sutton

Goyder

Booth

(2018). The effects of integrated care: A systematic review of UK and international evidence. BMC Health Services Research, 18(1), 350. https://doi.org/10.1186/s12913-018-3161-3

12.

Bowden

Fitzgerald

S. A.

Piamjariyakul

Werkowitch

Thompson

N. C.

Keighley

Smith

C. E.

(2011). Comparing patient and nurse specialist reports of causative factors of depression related to heart failure. Perspectives in Psychiatric Care, 47(2), 98–104. https://doi.org/10.1111/j.1744-6163.2010.00279.x

13.

Charlson

M. E.

Pompei

Ales

K. L.

MacKenzie

C. R.

(1987). A new method of classification of prognostic comorbidity for longitudinal studies: Development and validation. Journal of Chronic Diseases, 40(5), 373–383.

14.

Chowdhury

Adams

Whellan

D. J.

(2010). Sleep-disordered breathing and heart failure: Focus on obstructive sleep apnea and treatment with continuous positive airway pressure. Journal of Cardiac Failure, 16(2), 164–74. https://doi.org/10.1016/j.cardfail.2009.08.006

15.

Conde-Martel

Hernández-Meneses

(2016). Prevalence and prognostic meaning of comorbidity in heart failure. Revista Clinica Espanola, 216, 222–228.

16.

De Vecchis

Manginas

Noutsias

Tschöpe

Noutsias

(2017). Comorbidity “depression” in heart failure – Potential target of patient education and self-management. BMC Cardiovascular Disorders, 17(1), 48. https://doi.org/10.1186/s12872-017-0487-4

17.

Drewes

H. W.

Steuten

L. M.

Lemmens

L. C.

Baan

C. A.

Boshuizen

H. C.

Elissen

A. M.

Lemmens

K. M. M.

Meeuwissen

J. A. C.

Vrijhoef

H. J. M.

(2012). The effectiveness of chronic care management for heart failure: meta-regression analyses to explain the heterogeneity in outcomes. Health Services Research, 47(5), 1926–1959. https://doi.org/10.1111/j.1475-6773.2012.01396.x

18.

Dunn

S. L.

Arslanian-Engoren

DeKoekkoek

Jadack

Scott

L. D.

(2015). Secondary data analysis as an efficient and effective approach to nursing research. Western Journal of Nursing Research, 37(10), 1295–1307. https://doi.org/10.1177/0193945915570042

19.

Edwards

Almeida

O. P.

Ford

A. H.

(2020). Obstructive sleep apnea and depression: A systematic review and meta-analysis. Maturitas, 142, 45–54. https://doi.org/10.1016/j.maturitas.2020.06.002

20.

Faul

Erdfelder

Buchner

Lang

A.-G.

(2009). Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods, 41, 1149–1160.

21.

Faul

Erdfelder

Lang

A.-G.

Buchner

(2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39, 175–191.

22.

Formiga

Moreno-Gonzalez

Chivite

Franco

Montero

Corbella

(2018). High comorbidity, measured by the Charlson Comorbidity Index, associates with higher 1-year mortality risks in elderly patients experiencing a first acute heart failure hospitalization. Aging Clinical and Experimental Research, 30(8), 927–933. https://doi.org/10.1007/s40520-017-0853-1

23.

Green

P. C.

Porter

C. B.

Bresnahan

D. R.

Spertus

J. A.

(2000). Development and evaluation of the Kansas City Cardiomyopathy Questionnaire: A new health status measure for HF. Journal of the American College of Cardiology, 35(5), 1245–1255. https://doi.org/10.1016/s0735-1097(00)00531-3

24.

Holt

Bjerre

Zareini

Koch

Tonnesen

Gislason

G. H.

Nielsen

O. W.

Schou

Lamberts

(2018). Sleep apnea, the risk of developing heart failure, and potential benefits of continuous positive airway pressure (CPAP) therapy. Journal of the American Heart Association, 7(13), e008684. https://doi.org/10.1161/JAHA.118.008684

25.

Jennum

P. J.

Larsen

Cerqueira

Schmidt

Tønnesen

(2016). The Danish national database for obstructive sleep apnea. Clinical Epidemiology, 8, 573–576. https://doi.org/10.2147/CLEP.S101969

26.

Johns

M. W.

(1992). Reliability and factor analysis of the Epworth Sleepiness Scale. Sleep, 15, 376–381. https://doi.org/10.1093/sleep/15.4.376

27.

Kasai

Arcand

Allard

J. P.

Mak

Azevedo

E. R.

Newton

G. E.

Bradley

T. D.

(2011). Relationship between sodium intake and sleep apnea in patients with heart failure. Journal of the American College of Cardiology, 58(19), 1970–1974. https://doi.org/10.1016/j.jacc.2011.08.012

28.

Kasai

Bradley

T. D.

(2011). Obstructive sleep apnea and heart failure: Pathophysiologic and therapeutic implications. Journal of the American College of Cardiology, 57, 119–127. https://doi.org/10.1016/j.jacc.2010.08.627

29.

Khattak

H. K.

Hayat

Pamboukian

S. V.

Hahn

H. S.

Schwartz

B. P.

Stein

P. K.

(2018). Obstructive sleep apnea in heart failure: Review of prevalence, treatment with continuous positive airway pressure, and prognosis. Texas Heart Institute Journal, 45(3), 151–161. https://doi.org/10.14503/THIJ-15-5678

30.

Kilburn

Prencipe

Hjelm

Peterman

Handa

Palermo

(2018). Examination of performance of the Center for Epidemiologic Studies Depression Scale Short Form 10 among African youth in poor, rural households. BMC Psychiatry, 18(1), 201. https://doi.org/10.1186/s12888-018-1774-z

31.

McNicholas

W. T.

(2019). Obstructive sleep apnoea and comorbidity – An overview of the association and impact of continuous positive airway pressure therapy. Expert Review of Respiratory Medicine, 13(3), 251–261. https://doi.org/10.1080/17476348.2019.1575204

32.

Marrone

Lo Bue

Salvaggio

Dardanoni

Insalaco

(2013). Comorbidities and survival in obstructive sleep apnoea beyond the age of 50. European Journal of Clinical Investigation, 43(1), 27–33. https://doi.org/10.1111/eci.12011

33.

Montemurro

L. T.

Floras

J. S.

Millar

Kasai

Gabriel

J. M.

Spaak

Coelho

F. M. S.

Bradley

T. D.

(2012). Inverse relationship of subjective daytime sleepiness to sympathetic activity in patients with heart failure and obstructive sleep apnea. Chest, 142(5), 1222–1228. https://doi.org/10.1378/chest.11-2963

34.

Pak

V. M.

Strouss

Yaggi

H. K.

Redeker

N. S.

Mohsenin

Riegel

(2019). Mechanisms of reduced sleepiness symptoms in heart failure and obstructive sleep apnea. Journal of Sleep Research, 28(5), e12778. https://doi.org/10.1111/jsr.12778

35.

Pearse

S. G.

Cowie

M. R.

(2016). Sleep-disordered breathing in heart failure. European Journal of Heart Failure, 18(4), 353–361. https://doi.org/10.1002/ejhf.492

36.

Piamjariyakul

Thompson

N. C.

Russell

Smith

C. E.

(2018). The effect of nurse-led group discussions by race on depressive symptoms in patients with heart failure. Heart & Lung, 47(3), 211–215. https://doi.org/10.1016/j.hrtlng.2018.02.005

37.

Reynolds

Dennis

Hasan

Slewa

Chen

Tian

Bobba

Zwar

(2018). A systematic review of chronic disease management interventions in primary care. BMC Family Practice, 19(1), 11. https://doi.org/10.1186/s12875-017-0692-3

38.

Ruiz-Laiglesia

F. J.

Sánchez-Marteles

Pérez-Calvo

J. I.

Formiga

Bartolomé-Satué

J. A.

Armengou-Arxé

López-Quirós

Pérez-Silvestre

Serrado-Iglesias

Montero-Pérez-Barquero

(2014). Comorbidity in heart failure. Results of the Spanish RICA Registry. QJM: An International Journal of Medicine, 107(12), 989–994. https://doi.org/10.1093/qjmed/hcu127

39.

Rutledge

Reis

V. A.

Linke

S. E.

Greenberg

B. H.

Mills

P. J.

(2006). Depression in heart failure a meta-analytic review of prevalence, intervention effects, and associations with clinical outcomes. Journal of the American College of Cardiology, 48(8), 1527–1537. https://doi.org/10.1016/j.jacc.2006.06.055

40.

Sedlar

Lainscak

Mårtensson

Strömberg

Jaarsma

Farkas

(2017). Factors related to self-care behaviours in heart failure: A systematic review of European Heart Failure Self-Care Behaviour Scale studies. European Journal of Cardiovascular Nursing, 16(4), 272–282. https://doi.org/10.1177/1474515117691644

41.

Shapiro

A. L.

(2021). Effect of the CPAP-SAVER intervention on adherence. Clinical Nursing Research, 30(2), 110–119. https://doi.org/10.1177/1054773819865875

42.

Smith

C. E.

Piamjariyakul

Dalton

K. M.

Russell

Wick

Ellerbeck

E. F.

(2015). Nurse-led multidisciplinary heart failure group clinic appointments: Methods, materials, and outcomes used in the clinical trial. The Journal of Cardiovascular Nursing, 30(4 Suppl. 1), S25–S34. https://doi.org/10.1097/JCN.0000000000000255

43.

Smith

C. E.

Piamjariyakul

Wick

J. A.

Spertus

J. A.

Russell

Dalton

K. M.

Elyachar

Vacek

J. L.

Reeder

K. M.

Nazir

Ellerbeck

E. F.

(2014). Multidisciplinary group clinic appointments: The Self-Management and Care of Heart Failure (SMAC-HF) trial. Circulation: Heart Failure, 7(6), 888–894. https://doi.org/10.1161/CIRCHEARTFAILURE.113.001246

44.

Sokoreli

de Vries

Pauws

S. C.

Steyerberg

E. W.

(2016). Depression and anxiety as predictors of mortality among heart failure patients: Systematic review and meta-analysis. Heart Failure Reviews, 21(1), 49–63. https://doi.org/10.1007/s10741-015-9517-4

45.

Thomas

Khariton

Fonarow

G. C.

Arnold

S. V.

Hill

Nassif

M. E.

Sharma

P. P.

Butler

Thomas

Duffy

C. I.

DeVore

A. D.

Hernandez

Albert

N. M.

Patterson

J. H.

Williams

F. B.

McCague

Spertus

J. A.

(2019). Association of changes in heart failure treatment with patients’ health status real-world evidence from CHAMP-HF. JACC: Heart Failure, 7(7), 615–625. https://doi.org/10.1016/j.jchf.2019.03.020

46.

Timkova

Nagyova

Reijneveld

S. A.

Tkacova

van Dijk

J. P.

Bültmann

(2020). Quality of life of obstructive sleep apnoea patients receiving continuous positive airway pressure treatment: A systematic review and meta-analysis. Heart & Lung, 49(1), 10–24. https://doi.org/10.1016/j.hrtlng.2019.10.004

47.

Wagner

E. H.

(1998). Chronic disease management: What will it take to improve care for chronic illness? Effective Clinical Practice, 1(1), 2–4.

48.

Ware

J. E.

Kosinski

Keller

S. D.

(1998). SF12: How to score the SF-12 Physical and Mental Health Summary Scales. The Health Institute, New England Medical Center.

49.

Whitson

H. E.

Boyd

C. M.

(2020). Managing multiple comorbidities. https://www.uptodate.com/contents/managing-multiple-comorbidities

50.

Xie

Kuniyoshi

F. H. S.

Covassin

Singh

Gami

A. S.

Chahal

C. A. A.

Somers

(2018). Excessive daytime sleepiness independently predicts increased cardiovascular risk after myocardial infarction. Journal of the American Heart Association, 7(2), e007221. https://doi.org/10.1161/JAHA.117.007221

51.

Yancy

C. W.

Jessup

Bozkurt

Butler

Casey

D. E.

Jr Drazner

M. H.

Fonarow

G. C.

Geraci

S. A.

Horwich

Januzzi

J. L.

Johnson

M. R.

Kasper

E. K.

Levy

W. C.

Masoudi

F. A.

McBride

P. E.

McMurray

J. J. V.

Mitchell

J. E.

Peterson

P. N.

Riegel

. . . Wilkoff

B. L.

(2013). 2013 ACCF/AHA guideline for the management of heart failure: Executive summary: A report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation, 128(16), 1810–1852. https://doi.org/10.1161/CIR.0b013e31829e8807

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