Jeon Sangchoon, Redeker Nancy S
Sangchoon Jeon, PhD, is Research Scientist, Yale School of Nursing, West Haven, Connecticut. Nancy S. Redeker, PhD, RN, FAHA, FAAN, is Beatrice Renfield Term Professor of Nursing, Yale School of Nursing, West Haven, Connecticut.
Nurs Res. 2016 Jul-Aug;65(4):259-67. doi: 10.1097/NNR.0000000000000169.
Sleep disturbance is common among patients with heart failure (HF) who also experience symptom burden and poor functional performance.
We evaluated the extent to which sleep-related, daytime symptoms (fatigue, excessive daytime sleepiness, and depressive symptoms) mediate the relationship between sleep disturbance and functional performance among patients with stable HF.
We recruited patients with stable HF for this secondary analysis of data from a cross-sectional, observational study. Participants completed unattended ambulatory polysomnography from which the Respiratory Disturbance Index was calculated, along with a Six-Minute Walk Test, questionnaires to elicit sleep disturbance (Pittsburgh Sleep Quality Index, Insomnia Symptoms from the Sleep Habits Questionnaire), daytime symptoms (Center for Epidemiologic Studies Depression Scale, Global Fatigue Index, Epworth Sleepiness Scale), and self-reported functional performance (Medical Outcomes Study SF36 V2 Physical Function Scale). We used structural equation modeling with latent variables for the key analysis. Follow-up, exploratory regression analysis with bootstrapped samples was used to examine the extent to which individual daytime symptoms mediated effects of sleep disturbance on functional performance after controlling for clinical and demographic covariates.
The sample included 173 New York Heart Association Class I-IV HF patients (n = 60/34.7% women; M = 60.7, SD = 16.07 years of age). Daytime symptoms mediated the relationship between sleep disturbance and functional performance. Fatigue and depression mediated the relationship between insomnia symptoms and self-reported functional performance, whereas fatigue and sleepiness mediated the relationship between sleep quality and functional performance. Sleepiness mediated the relationship between the respiratory index and self-reported functional performance only in people who did not report insomnia.
Daytime symptoms explain the relationships between sleep disturbance and functional performance in stable HF.
睡眠障碍在心力衰竭（HF）患者中很常见，这些患者还会经历症状负担和功能表现不佳。
我们评估了与睡眠相关的日间症状（疲劳、日间过度嗜睡和抑郁症状）在稳定型HF患者的睡眠障碍与功能表现之间的关系中所起的中介作用程度。
我们招募了稳定型HF患者，对一项横断面观察性研究的数据进行二次分析。参与者完成了无人值守的动态多导睡眠监测，据此计算呼吸紊乱指数，同时进行六分钟步行测试，以及用于评估睡眠障碍（匹兹堡睡眠质量指数、睡眠习惯问卷中的失眠症状）、日间症状（流行病学研究中心抑郁量表、全球疲劳指数、爱泼华嗜睡量表）和自我报告的功能表现（医学结局研究SF36 V2身体功能量表）的问卷调查。我们使用带有潜在变量的结构方程模型进行关键分析。采用带有自抽样样本的后续探索性回归分析，以检验在控制临床和人口统计学协变量后，个体日间症状在睡眠障碍对功能表现的影响中所起的中介作用程度。
样本包括173名纽约心脏协会心功能I-IV级的HF患者（n = 60/34.7%为女性；平均年龄M = 60.7，标准差SD = 16.07岁）。日间症状介导了睡眠障碍与功能表现之间的关系。疲劳和抑郁介导了失眠症状与自我报告的功能表现之间的关系，而疲劳和嗜睡介导了睡眠质量与功能表现之间的关系。嗜睡仅在未报告失眠的人群中介导了呼吸指数与自我报告的功能表现之间的关系。
日间症状解释了稳定型HF患者睡眠障碍与功能表现之间的关系。
