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      Sleep quality and associated factors among patients with chronic heart failure in Iran

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          Abstract

          Background: Sleep disorders are common among patients with chronic heart failure (HF), and it can have a significant effect on patients’ daily activities as well as their health. The purpose of this study was to assess sleep quality and its predictors in Iranian patients with chronic HF.

          Methods: This cross-sectional study was conducted on a sample of 200 patients with HF in two hospitals of Tehran University of Medical Sciences from June to November 2009. These patients completed a demographic questionnaire, and their sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). One-way analysis of variance (ANOVA), Kruskal-Wallis test, t-test and Linear regression were used for data analysis.

          Results: Seventy-nine percent of patients (n = 158) reported poor sleep quality (PSQI > 5). The range of global PSQI scores was 3–20. Also, a significant relationship was found between PSQI scores and patients’ age (p<0.004), gender (p< 0.042), educational level (p< 0.001), occupational status (p< 0.038), number of hospitalizations (p< 0.005), type of referral (p< 0.001), non-cardiac diseases (p< 0.001), diuretic use (p< 0.021) and left ventricular ejection fraction (p< 0.015). Three predictors were identified using regression analyses with stepwise methods, and included age, type of referral and educational level.

          Conclusion: The high prevalence of poor sleep quality highlighted the importance of sleep disorders in HF patients. There are many factors associated with sleep quality and sleep disorders that health providers should recognize for improved and effective management.

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          Most cited references21

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          Impact of symptom prevalence and symptom burden on quality of life in patients with heart failure.

          Heart failure is an escalating health problem around the world. Despite significant scientific advances, heart failure patients experience multiple physical and psychological symptoms that can impact the quality of life. To determine the (1) symptom prevalence, severity, distress and symptom burden in patients with heart failure; (2) impact of age and gender on symptom prevalence, severity, distress and symptom burden; and (3) impact of symptom prevalence and symptom burden on health-related quality of life (HRQOL) in patients with heart failure. A convenience sample of 53 heart failure patients participated in this descriptive, cross-sectional design. Symptoms and HRQOL were measured using the Memorial Symptom Assessment Scale-Heart Failure and the Minnesota Living with Heart Failure Questionnaire. Patients experienced a mean of 15.1+/-8.0 symptoms. Shortness of breath and lack of energy were the most prevalent. Difficulty sleeping was the most burdensome symptom. Lower age, worse functional status, total symptom prevalence and total symptom burden predicted 67% of the variance in HRQOL. Patients with heart failure experience a high level of symptoms and symptom burden. Nurses should target interventions to decrease frequency, severity, distress and overall symptom burden and improve HRQOL.
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            Sleep and hypertension.

            Ambulatory BP studies indicate that even small increases in BP, particularly nighttime BP levels, are associated with significant increases in cardiovascular morbidity and mortality. Accordingly, sleep-related diseases that induce increases in BP would be anticipated to substantially affect cardiovascular risk. Both sleep deprivation and insomnia have been linked to increases in incidence and prevalence of hypertension. Likewise, sleep disruption attributable to restless legs syndrome increases the likelihood of having hypertension. Observational studies demonstrate a strong correlation between the severity of obstructive sleep apnea (OSA) and the risk and severity of hypertension, whereas prospective studies of patients with OSA demonstrate a positive relationship between OSA and risk of incident hypertension. Intervention trials with continuous positive airway pressure (CPAP) indicate a modest, but inconsistent effect on BP in patients with severe OSA and a greater likelihood of benefit in patients with most CPAP adherence. Additional prospective studies are needed to reconcile observational studies suggesting that OSA is a strong risk factor for hypertension with the modest antihypertensive effects of CPAP observed in intervention studies.
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              Sleep and quality of life in the Austrian population.

              To compare the self-reported estimation of sleep quality evaluated by the Pittsburgh Sleep Quality Index (PSQI) and life quality assessed by the Quality of Life Index (QLI). The PSQI comprised 19 questions and assessed a wide variety of factors relating to sleep quality. The QLI consisted of 10 items for self assessment of different dimensions of life quality. A representative Austrian sample (n = 1049) aged above 15 years. Interviews in the homes of the participants. 32.1% could be classified as poor sleepers (37% females, 26.5% males). Sleep quality decreased with increasing age, especially in women. Overall quality of life was highest in younger (15-29 years) and lowest in elderly subjects (over 50 years). Life quality decreased with increasing age. Between subjective sleep quality and quality of life a moderate, significant correlation was found (r2= 0.6721). Complaints about a bad quality of sleep could be used as a screening method in the exploration of patients' quality of life (QoL).
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                Author and article information

                Journal
                Med J Islam Repub Iran
                Med J Islam Repub Iran
                MJIRI
                Med J Islam Repub Iran
                Medical Journal of the Islamic Republic of Iran
                Iran University of Medical Sciences
                1016-1430
                2251-6840
                2014
                16 December 2014
                : 28
                : 149
                Affiliations
                1. BSc, MSc in Nursing, Teacher in School of Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran. m.moraditeacher@ 123456gmail.com
                2. MSc, PHD in Nursing, Associate Professor, Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences & Center for Nursing Care Research, Iran University of Medical Sciences, Tehran, Iran. nmehrdad@ 123456tums.ac.ir
                3. BSc, MSC in Nursing, Assistant Professor, Center for Nursing Care Research, School of Nursing & Midwifery, Iran University of Medical Sciences, Tehran, Iran. s-nikpour@ 123456iums.ac.ir
                4. MSc in Biostatistics. Faculty Member School of Public Health, Iran University of Medical Sciences, Tehran, Iran. haghani511@ 123456yahoo.com
                5. BSc in Nursing, MSc in Medical Education, Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. maryam_aalaa@ 123456yahoo.com
                6. Sc, MSc. PhD Student in Nursing, Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute. Tehran University of Medical Sciences, Tehran, Iran. sanjarim@ 123456yahoo.com
                7. MD, PhD by research Students, Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences & Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran. sharifi.tums.ac@ 123456gmail.com
                Author notes
                (Corresponding author) MSc, PHD in Nursing, Associate Professor, Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences & Center for Nursing Care Research, Iran University of Medical Sciences, Tehran, Iran. nmehrdad@ 123456tums.ac.ir
                Article
                4322339
                338e222b-d284-44d9-afe3-7a0b6ab15fcc
                © 2014 Iran University of Medical Sciences

                This is an open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0), which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.

                History
                : 13 June 2014
                : 27 October 2014
                Page count
                Tables: 5, References: 26, Pages: 7
                Categories
                Original Article

                sleep quality,heart failure,sleep disorder
                sleep quality, heart failure, sleep disorder

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