Yale School of Nursing.
Department Head of Health Policy and Administration, The Pennsylvania State University.
Behav Sleep Med. 2023 Mar-Apr;21(2):150-161. doi: 10.1080/15402002.2022.2060226. Epub 2022 Apr 7.
OBJECTIVE/BACKGROUND: Both heart failure (HF) and insomnia are associated with high symptom burden that may be manifested in clustered symptoms. To date, studies of insomnia have focused only on its association with single symptoms. The purposes of this study were to: (1) describe daytime symptom cluster profiles in adults with insomnia and chronic HF; and (2) determine the associations between demographic and clinical characteristics, insomnia and sleep characteristics and membership in symptom cluster profiles.
One hundred and ninety-five participants [ age 63.0 (SD12.8); 84 (43.1%) male; 148 (75.9%) New York Heart Association Class I/II] from the HeartSleep study (NCT0266038), a randomized controlled trial of the sustained effects of cognitive behavioral therapy for insomnia (CBT-I).
We analyzed baseline data, including daytime symptoms (fatigue, pain, anxiety, depression, dyspnea, sleepiness) and insomnia (Insomnia Severity Index), and sleep characteristics (Pittsburgh Sleep Quality Index, wrist actigraphy). We conducted latent class analysis to identify symptom cluster profiles, bivariate associations, and multinomial regression.
We identified three daytime symptom cluster profiles, physical (N = 73 participants; 37.4%), emotional (N = 12; 5.6%), and all-high symptoms (N = 111; 56.4%). Body mass index, beta blockers, and insomnia severity were independently associated with membership in the all-high symptom profile, compared with the other symptom profile groups.
Higher symptom burden is associated with more severe insomnia in people with stable HF. There is a need to understand whether treatment of insomnia improves symptom burden as reflected in transition from symptom cluster profiles reflecting higher to lower symptom burden.
目的/背景：心力衰竭（HF）和失眠均与高症状负担相关，这种负担可能表现为症状群。迄今为止，失眠研究仅关注其与单一症状的关联。本研究的目的是：（1）描述患有失眠和慢性 HF 的成年人日间症状群特征；（2）确定人口统计学和临床特征、失眠和睡眠特征与症状群特征之间的关系。
来自 HeartSleep 研究（NCT0266038）的 195 名参与者[年龄 63.0（SD12.8）；84（43.1%）男性；148（75.9%）纽约心脏协会心功能分级 I/II 级]，这是一项认知行为疗法治疗失眠（CBT-I）持续效果的随机对照试验。
我们分析了基线数据，包括日间症状（疲劳、疼痛、焦虑、抑郁、呼吸困难、嗜睡）和失眠（失眠严重程度指数）以及睡眠特征（匹兹堡睡眠质量指数、腕部活动记录仪）。我们进行了潜在类别分析以确定症状群特征、双变量关联和多项回归。
我们确定了三种日间症状群特征，分别是身体症状群（N=73 名参与者；37.4%）、情绪症状群（N=12 名参与者；5.6%）和所有高症状群（N=111 名参与者；56.4%）。与其他症状群特征组相比，体质指数、β受体阻滞剂和失眠严重程度与所有高症状群特征的相关性更大。
稳定 HF 患者的症状负担越高，失眠越严重。需要了解治疗失眠是否可以改善症状负担，从而反映出症状群特征从反映更高症状负担向更低症状负担的转变。
