Prognostic importance of sleep quality in patients with heart failure

Background Poor sleep quality is common and is associated with poor quality of life and health status in patients with heart failure. However, few investigators have focused on the impact of impaired sleep quality on survival in heart failure. Objective To examine whether self-reported sleep quality is associated with prognosis in patients with heart failure. Methods The study sample consisted of 204 patients with heart failure. Sleep quality was measured with the Pittsburgh Sleep Quality Index. Poor sleepers were defined as patients with scores greater than 5 on the index. Patients were followed up for a median of 364 days to determine cardiac events (a composite of cardiac death, hospitalizations, or emergency department visits for cardiac reasons). Multivariable Cox proportional hazard regression was used to examine whether poor sleepers were at a higher risk than good sleepers for shorter cardiac event-free survival after covariates were adjusted for. Results Of 204 patients, 129 (63%) reported poor sleep quality. Poor sleepers were 2.5 times more likely to have a shorter cardiac event-free survival (95% CI, 1.164-5.556) than were good sleepers after covariates were controlled for. Conclusions Impaired sleep quality was prevalent in patients with heart failure and was associated with poor cardiac event-free survival. Clinicians should assess and manage sleep quality in patients with heart failure to improve outcomes.