The impact of sleep quality and daytime sleepiness on global quality of life in community-dwelling patients with heart failure

BACKGROUND AND RESEARCH OBJECTIVE: Although it is well established that symptom burden in heart failure (HF) often leads to poor health-related quality of life (QOL), the contributions of quality of sleep and daytime sleepiness to the overall perception and satisfaction with life in the HF population have yet to be determined. We thus tested the hypothesis that quality of sleep and daytime sleepiness are significant predictors of QOL as measured by the World Health Organization Quality of Life-BREF (WHOQOL-BREF) in patients with HF. SUBJECTS AND METHODS: Included were 88 medically stable patients with echocardiographically documented HF. This cross-sectional study used a correlational design, and data were collected using self-report questionnaires including the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI), Epworth Sleepiness Scale, and WHOQOL-BREF Taiwan version. Multiple linear regression analyses were used to address the study hypotheses. RESULTS AND CONCLUSIONS: With the exception of the environmental domain (P = .078), poor sleepers had significantly lower scores in physical (P <.001), psychological (P = .001), and social (P = .040) domains of the WHOQOL-BREF. Multivariate regression analysis revealed that age, CPSQI, perceived health status, and comorbidities significantly predicted the physical QOL (adjusted R = 0.59, P <.001). For the psychological QOL, only perceived health status and CPSQI score remained in the regression model (adjusted R = 0.28, P = .016). For the environmental QOL, perceived health status and Epworth Sleepiness Scale were the only predictors remaining in the model (adjusted R = 0.17, P <.001). The findings from this study add support to the evidence that in medically stable persons with HF, poor sleep independently predicts the overall perception and satisfaction with life, in particular, in the physical and psychological domains of QOL, whereas daytime sleepiness independently predicts the environmental QOL.