Insomnia concerns go unaddressed in heart failure patients

Nov 5 2013

By Lucy Piper, Senior medwireNews Reporter

The impact of insomnia on health and function is a major concern for patients with heart failure (HF), qualitative and quantitative research shows.

“Our findings underscore the critical importance of evaluating sleep, including insomnia,” says the research team, led by Laura Kierol Andrews (Yale University School of Nursing, New Haven, Connecticut, USA).

They found that the 11 HF patients with mild-to-moderate insomnia in the study “rarely if ever” discussed their sleep concerns with their physicians, despite wanting relief from the problem. They also reported wanting their physician to pay them personal attention and ask about how they were sleeping.

All the patients had scores of at least 8 on the Pittsburgh Sleep Quality Index (PSQI), indicating poor sleep quality, and Insomnia Severity Index (ISI) scores reflected moderate insomnia.

On average, patients reported sleeping 5.18 hours per night and had trouble with falling asleep, waking after sleep onset, insufficient sleep, and waking too early in the morning.

These quantitative findings of sleep disturbance were borne out in the patients’ responses during focus groups, with participants universally reporting poor sleep and insomnia symptoms.

The patients also all said that insomnia negatively impacted on their physical and psychologic wellbeing and quality of life and left them feeling depressed and anxious about the negative effects of poor sleep. Indeed, scores on the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS) were high (average 5 out of a possible 10, ranging from 2.13 to 8.06) and most of the patients were depressed, with four taking antidepressants.

Patients considered HF, including HF-related treatment, to be the primary precipitating factor for insomnia, with other comorbid conditions such as diabetes and psychologic concerns also an important consideration.

Additionally, patients frequently cited nocturia and pain as perpetuating factors. “Although patients and clinicians often presume that symptoms, such as nocturia and pain, as well as psychological symptoms, such as worries, fears, and mood disorders, contribute to insomnia, the converse may also be true,” Andrews et al write in Heart & Lung.

Seven of the patients were taking medications, such as hypnotics or anxiolytics, to help them sleep at least once a week, but most reported using them “only if absolutely necessary.”

The researchers note that cognitive behavioral therapy may be of benefit for these patients, given that this type of therapy addresses cognitive, perceptual, and behavioral perpetuating factors – “many of which were identified in this study.”

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