Department of Cardiology, Linköping University Hospital, Sweden.
J Cardiovasc Nurs. 2010 Sep-Oct;25(5):E16-26. doi: 10.1097/JCN.0b013e3181d6de6f.
The relationships between heart failure (HF), sleep-disordered breathing (SDB), insomnia, depressive symptoms, and excessive daytime sleepiness (EDS), as well as their relationship to Global Perceived Health (GPH) in an elderly community-dwelling population, have not been explored. Data from 331 community-dwelling elderly (71-87 years old) were collected by echocardiography, polygraphy, and specific questionnaires. Factor analyses and structural equation modeling were used to explore the relationships between HF, SDB, sleep, psychosocial factors, and GPH. Exploratory and confirmatory factor analyses derived a 5-factor model representing SDB, insomnia, systolic function, breathlessness/physical function, and psychosocial function. Structural equation modeling analyses were used to explore the relationships between the 5 factors and to GPH. Sleep-disordered breathing had a weak effect on systolic function, but no effects on any of the other factors or GPH were found. Psychosocial function and breathlessness/physical function directly affected GPH. Indirect effects on GPH, mediated by psychosocial function, were found for breathlessness/physical function and insomnia. Systolic function also had an indirect effect on GPH. The fact that SDB in the elderly has no obvious negative associations to sleep complaints or GPH does not exclude them from being adequately treated for SDB. However, the present study has shown that SDB, by means of self-rated sleep complaints and health-related quality of life, can be problematic to detect. Psychosocial function was the most important factor for perceived GPH as it had a direct effect, as well as mediated the factors breathlessness/physical function and insomnia effects, on GPH. This study indicates that interventions in clinical practice targeting psychosocial dysfunction, such as depressive symptoms, could help to improve GPH in the elderly with or without HF.
心力衰竭 (HF)、睡眠呼吸障碍 (SDB)、失眠、抑郁症状和日间过度嗜睡 (EDS) 之间的关系，以及它们与老年社区居民的总体健康感知 (GPH) 的关系，尚未得到探索。通过超声心动图、多导睡眠图和特定问卷收集了 331 名居住在社区的老年 (71-87 岁) 数据。使用因子分析和结构方程模型来探讨 HF、SDB、睡眠、心理社会因素与 GPH 之间的关系。探索性和验证性因子分析得出了一个代表 SDB、失眠、收缩功能、呼吸困难/身体功能和心理社会功能的 5 因素模型。结构方程模型分析用于探索 5 个因素之间的关系以及与 GPH 的关系。睡眠呼吸障碍对收缩功能有微弱影响，但对其他任何因素或 GPH 都没有影响。心理社会功能和呼吸困难/身体功能直接影响 GPH。通过心理社会功能，发现呼吸困难/身体功能和失眠对 GPH 有间接影响。收缩功能对 GPH 也有间接影响。老年人的 SDB 对睡眠抱怨或 GPH 没有明显的负面关联，并不能排除对 SDB 进行充分治疗的可能性。然而，本研究表明，通过自我报告的睡眠抱怨和与健康相关的生活质量，SDB 可能难以察觉。心理社会功能是感知 GPH 的最重要因素，因为它对 GPH 有直接影响，并且对呼吸困难/身体功能和失眠因素的影响具有中介作用。本研究表明，针对心理社会功能障碍（如抑郁症状）的临床实践干预措施可能有助于改善有或没有 HF 的老年患者的 GPH。
