Najdaghi Soroush, Narimani Davani Delaram, Shafie Davood
Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Science, Isfahan, Iran.
J Res Health Sci. 2025 Apr 1;25(2):e00649. doi: 10.34172/jrhs.2025.184.
Sleep quality is crucial in heart failure (HF) patients, yet its associations with clinical, demographic, and psychosocial factors remain underexplored. This study examined these relationships to identify predictors of poor sleep quality. A cross-sectional study.
This cross-sectional was conducted on 354 HF patients at Shahid Chamran Heart Hospital, Isfahan, Iran (September 2023-2024). Pittsburgh Sleep Quality Index (PSQI) and Hospital Anxiety and Depression Scale (HADS) were used to evaluate sleep quality, anxiety, and depression, respectively. Random forest (RF) modeling and ordinary least squares (OLS) regression identified predictors of poor sleep quality.
Poor sleep quality (PSQI>7) was observed in 18% of patients who were older (70.00±6.30, <0.001) and had lower ejection fraction (EF) (23.75±12.79%, <0.001). This group also had higher systolic blood pressure (BP 140.67±12.50 mmHg, =0.014). Complex medication regimens, including angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, and diuretics, were associated with poor sleep (<0.001). Moreover, depression (HADS-depression: 5.36±0.70, <0.001) and anxiety (HADS-anxiety: 4.84±1.32, <0.001) were correlated with poor sleep. The RF model had an area under the curve of 0.79, and OLS regression (R=0.280) highlighted New York Heart Association (NYHA) class and medication type as significant predictors.
Overall, poor sleep quality in HF patients was related to older age, reduced cardiac function, higher blood pressure (BP), complex medication regimens, and increased anxiety and depression. Accordingly, multidimensional management strategies are needed to improve sleep outcomes.
睡眠质量对心力衰竭（HF）患者至关重要，但其与临床、人口统计学和心理社会因素之间的关联仍未得到充分研究。本研究对这些关系进行了考察，以确定睡眠质量差的预测因素。一项横断面研究。
本横断面研究于2023年9月至2024年在伊朗伊斯法罕的沙希德·查姆兰心脏医院对354例HF患者进行。匹兹堡睡眠质量指数（PSQI）和医院焦虑抑郁量表（HADS）分别用于评估睡眠质量、焦虑和抑郁。随机森林（RF）建模和普通最小二乘法（OLS）回归确定了睡眠质量差的预测因素。
18%的患者睡眠质量差（PSQI>7），这些患者年龄较大（70.00±6.30，<0.001）且射血分数（EF）较低（23.75±12.79%，<0.001）。该组患者的收缩压也较高（血压140.67±12.50 mmHg，=0.014）。包括血管紧张素转换酶（ACE）抑制剂、β受体阻滞剂和利尿剂在内的复杂药物治疗方案与睡眠质量差有关（<0.001）。此外，抑郁（HADS-抑郁：5.36±0.70，<0.001）和焦虑（HADS-焦虑：4.84±1.32，<0.001）与睡眠质量差相关。RF模型的曲线下面积为0.79，OLS回归（R=0.280）突出显示纽约心脏协会（NYHA）分级和药物类型是重要的预测因素。
总体而言，HF患者睡眠质量差与年龄较大、心脏功能降低、血压较高、药物治疗方案复杂以及焦虑和抑郁增加有关。因此，需要采取多维度管理策略来改善睡眠结果。
