Heart Failure as an Independent Predictor of Insomnia Symptoms

Background: Heart failure (HF) is accompanied with several untoward outcomes including insomnia symptoms. Many factors including comorbidities, experienced symptoms, and psychosocial characteristics associated with HF were attributed to the high prevalence of insomnia symptoms in persons with HF. However, it is not yet clear if HF itself contributes to insomnia symptoms regardless of these associated factors. Purpose: The purpose of this analysis was to investigate the association of HF with insomnia symptoms in adjusted models for sociodemographic, clinical, and lifestyle factors. Methods: A secondary data analysis guided by the neurocognitive model of insomnia was conducted on data from the health and retirement study using multiple logistic regression. The total sample size included 17,910 subjects of which 1,189 were identified to have HF. Results: The results showed that those with HF were approximately two times more likely to have insomnia symptoms (OR:1.95, p <0.001) in the unadjusted model. After adjusting for age, sex, race, ethnicity, education, marital status, income, poverty level, sleep-disordered breathing, obesity, depression symptoms, comorbid diseases, smoking, alcohol consumption, and physical activity using block-wise selection, HF maintained a significant association with insomnia symptoms (OR:1.15, p<0.05). When looking at each insomnia symptom separately, HF significantly predicted difficulty initiating sleep (OR: 1.23, p < 0.01) in the fully adjusted model, but maintained a trend with difficulty maintaining sleep and early morning awakening. Conclusion: These results are suggestive of an alerting effect in HF which could be attributed to its pathophysiology. Specifically, the neurohormonal compensatory mechanism and the increased sympathetic stimulation in heart failure may exert an alerting effect during the day and contribute to a hyper-arousal state and difficulty initiating sleep before it partially wears off after sleep. Further studies are needed to investigate this hypothesis.