Broström Anders, Strömberg Anna, Dahlström Ulf, Fridlund Bengt
Department of Cardiology, Linköping University, Linköping, Sweden.
J Cardiovasc Nurs. 2004 Jul-Aug;19(4):234-42. doi: 10.1097/00005082-200407000-00003.
Normal sleep changes with age in duration, fragmentation, and depth. The prevalence of insomnia is high in the elderly general population. In patients with chronic heart failure (HF) objective sleep assessments have shown disturbances such as a shorter total duration of sleep, frequent arousals, and sleep stage changes.
To describe self-assessed sleep difficulties, daytime sleepiness, and their relation to health-related quality of life (HRQOL) in men and women with HF, as well as to make a comparison to data from a norm population.
Cross-sectional design including 223 patients with HF, New York Heart Association classification II-IV, assessed using the Uppsala Sleep Inventory-Chronic Heart Failure, the Epworth Sleepiness Scale, Medical Outcomes Study 36-Item Short Form Health Survey, and Minnesota Living With Heart Failure Questionnaire.
The most commonly reported sleep difficulties were initiating and maintaining sleep. The ratio of habitual sleep to the amount of estimated need for sleep was significantly shorter for women (P < .05), and the number of awakenings per night was significantly increased for men (P < .001). A total of 21% suffered from daytime sleepiness. Patients suffering from difficulties maintaining sleep, initiating sleep, and early morning awakenings reported significantly lower HRQOL in almost all dimensions of the SF-36 (P < .05-P < .001) compared to patients without sleeping difficulties, as well as to the normal population. The disease-specific Minnesota Living With Heart Failure Questionnaire showed significantly reduced (P < .05-P < .001) HRQOL as measured by the total and subscale scores for patients suffering from sleeping difficulties compared to patients without sleeping difficulties.
Patients with HF have a reduced HRQOL especially if difficulties maintaining sleep, initiating sleep, and early morning awakenings are involved.
正常睡眠在时长、碎片化程度和深度方面会随着年龄变化。老年普通人群中失眠的患病率较高。在慢性心力衰竭（HF）患者中，客观睡眠评估显示存在睡眠障碍，如总睡眠时间缩短、频繁觉醒和睡眠阶段改变。
描述HF患者自我评估的睡眠困难、日间嗜睡情况及其与健康相关生活质量（HRQOL）的关系，并与正常人群的数据进行比较。
采用横断面设计，纳入223例纽约心脏协会心功能分级为II-IV级的HF患者，使用乌普萨拉睡眠量表 - 慢性心力衰竭版、爱泼华嗜睡量表、医学结局研究36项简短健康调查以及明尼苏达心力衰竭生活问卷进行评估。
最常报告的睡眠困难是入睡和维持睡眠。女性习惯性睡眠时间与估计所需睡眠时间的比例显著较短（P <.05），男性每晚觉醒次数显著增加（P <.001）。共有21%的患者存在日间嗜睡。与无睡眠困难的患者以及正常人群相比，存在维持睡眠困难、入睡困难和早醒问题的患者在SF-36几乎所有维度上的HRQOL均显著较低（P <.05 - P <.001）。特定疾病的明尼苏达心力衰竭生活问卷显示，与无睡眠困难的患者相比，存在睡眠困难的患者的总得分和各子量表得分所衡量的HRQOL显著降低（P <.05 - P <.001）。
HF患者的HRQOL降低，尤其是存在维持睡眠困难、入睡困难和早醒问题时。
