Abstract 13150: Daytime Sleepiness Makes Heart Failure Medication Nonadherence More Common
A relationship between excessive daytime sleepiness (EDS) and poor treatment adherence has been suspected but not confirmed. The objective of this study was to determine the extent to which EDS influences medication adherence and to explore cognitive impairment (CI) as the mechanism in adults with heart failure (HF).
Methods: Adults with a confirmed HF diagnosis were enrolled into a prospective cohort study. Those with severe depression, dementia, a prior neurologic event, terminal illness, recent drug or alcohol abuse, night shift workers were excluded. Baseline data were obtained from 278 subjects enrolled from 3 sites. We identified a cohort with EDS and a control group without EDS (both groups with and without CI) using the Epworth Sleepiness Scale (score ≥6 = EDS). Cognition was assessed using the Probed Memory Recall, Digit Symbol Substitution Test, Letter Number Sequencing test, Trail Making Test B, and Psychomotor Vigilance Task. The number of tests on which subjects scored below their age-based norm was used as the measure of CI. Medication adherence was assessed with the Basel Assessment of Compliance Scale, a structured interview assessing adherence with medication taking and timing over the past month. A positive answer on any of 4 questions classifies the subject as nonadherent. Chi square analysis was used to test the hypothesis that medication nonadherence is most common in subjects with EDS and CI (below expectations ≥2 tests). Binary regression analysis was used to clarify the contribution of EDS and CI to medication adherence after adjusting for age, enrollment site, gender, race, NYHA functional class, and premorbid intellect measured with the American National Adult Reading Test.
Results: Medication nonadherence was significantly more common in those with EDS, regardless of CI (p=0.003) (+EDS/+CI 68.3%; +EDS/no CI 73.7%; no EDS/+CI 50%; noEDS/no CI 49.2%). In regression analysis, EDS was a significant determinant of medication adherence (p=0.001, OR .899) but CI was not (p=0.752).
Conclusion: Adults with HF who have some degree of EDS are more likely to have problems adhering to their medication regimen than those without EDS, regardless of their cognitive status. Simply helping patients sleep better may improve medication adherence.
- © 2010 by American Heart Association, Inc.