Abstract 8266: Double Jeopardy: The Influence of Excessive Daytime Sleepiness and Impaired Cognition on Quality of Life in Adults with Heart Failure
Poor health-related quality of life (HRQL) is pervasive in adults with heart failure (HF). Others have shown that cognitive impairment (CI) is associated with poor HRQL, but the contribution of EDS to HRQL has not been described in HF.
Methods: Adults with a confirmed diagnosis of stage C chronic HF were enrolled into a prospective cohort comparison study. Those with dementia, recent drug or alcohol abuse, and night shift workers were excluded. Data were obtained from 280 subjects enrolled from 3 sites in the northeastern US, 242 of whom completed the 6-month follow-up. At baseline we identified a cohort with EDS and a control group without EDS using the Epworth Sleepiness Scale (score ≥6 = EDS). Each EDS group was further subdivided into those with and without CI using a battery of 5 neuropsychological tests (score > 1.5 SD on ≥2 tests). Two disease-specific measures, Kansas City Cardiomyopathy Questionnaire (KCCQ) and the Functional Outcomes of Sleep Questionnaire (FOSQ), were used to measure HRQL; higher scores indicate better HRQL. General linear modeling of square-transformed variables was used to test the hypothesis that cohort membership was a significant predictor of HRQL summary scores after adjusting for enrollment site, age, gender, race, income, NYHA functional class, depressive symptoms, and perceived health.
Results: At 6-months the remaining sample was 62.5 (SD 12) years old, mostly male (63%), white (65%), and functionally compromised (72% NYHA class III/IV). Cognitive impairment and EDS were unique constructs (r=0.05, p=0.44). The cohort with EDS+ and CI+ had the lowest overall KCCQ score (KCCQ: 62.1±22.3) compared to the cohort without EDS or CI (79.1±18.3, p=<.001). A similar effect was seen on the FOSQ (FOSQ: 16.7±2.7) compared to the cohort without EDS or CI (18.7±1.8, p=<.001). The cohort with CI but without EDS was not significantly different in HRQL from the cohort without EDS or CI (KCCQ: p=0.39, FOSQ: p=0.20).
Conclusion: Daytime sleepiness combined with CI is a significant predictor of HRQL in adults with HF. Cognitive impairment is challenging to influence but interventions designed to influence EDS may improve HRQL in this population.
- © 2011 by American Heart Association, Inc.