Abstract 1548: Determinants of Excessive Daytime Sleepiness in Adults With Heart Failure
Adults with heart failure (HF) have multiple reasons to have excessive daytime sleepiness (EDS), which may impair their abilities to function effectively during the day. The purpose of this study was to describe the factors associated with EDS in adults with HF.
Methods: Adults with a confirmed diagnosis of stage C chronic HF were enrolled into a 6-month prospective cohort study. Those with severe depression, dementia, a prior neurologic event, recent drug or alcohol abuse, and night shift workers were excluded. Baseline data were obtained from 185 subjects enrolled from 3 sites. Data on daytime sleepiness were collected using the Epworth Sleepiness Scale (ESS), classifying those with a score ≥6 as EDS. Hypothesized correlates of sleepiness were collected from the medical record, by self-report, and using standardized measures. Bivariate analyses were used to identify variables associated with EDS, which were entered into a multiple logistic regression model with backward elimination, controlling for age and gender.
Results: The sample was 34% female, 37% African American, mean age 63.2±12.3. Most (79.5%) had systolic dysfunction and 30.3% were known to have sleep disordered breathing (SDB). On the ESS, 58.1% reported EDS. Variables significant on bivariate analysis were perceived health, sleep hygiene, dimensions of sleep quality (Pittsburgh Sleep Quality Index), smoking, cerebrovascular disease, atrial fibrillation, depression (PHQ9), and functional status. Anemia, diabetes, SDB, CPAP use, medications that cause EDS, quality of HF care, exercise, and BMI were not associated with EDS. In the final model, significant determinants of EDS were: not smoking (odds ratio [OR] 2.80 vs. current smoker), no atrial fibrillation (OR 2.34), better perceived health (OR 3.69), shorter sleep duration (OR 2.00), and more daytime dysfunction due to poor sleep (OR 4.09).
Conclusion: In adults with HF, EDS is common. Smoking stimulates arousal, which decreases EDS and may make smoking cessation more difficult. Warfarin for atrial fibrillation may improve sleep and decrease EDS. Patients with better perceived health may be more aware of EDS. Interventions to increase sleep duration and decrease daytime dysfunction from poor sleep need to be tested.