@article {12211,
	title = {Associations of insomnia symptoms with sociodemographic, clinical, and lifestyle factors in persons with HF: Health and retirement study.},
	journal = {Research in Nursing \& Health},
	volume = {45},
	year = {2022},
	pages = {364-379},
	abstract = {<p>Insomnia symptoms are very common in persons with heart failure (HF). However, many of the correlates and predictors of insomnia symptoms in this population remain unclear. The purpose of this study is~to investigate the associations of sociodemographic, clinical, and lifestyle factors with insomnia symptoms in persons with HF. A theoretical framework was adapted from the neurocognitive model of chronic insomnia to guide the study. Data from the health and retirement study were used for the analysis. Parametric and nonparametric bivariate and multivariate analyses were conducted to investigate these associations. Age, depressive symptoms, comorbidity, dyspnea, pain, and smoking had significant bivariate associations with all insomnia symptoms. Race, Hispanic ethnicity, marital status, household income, poverty, and physical activity were associated with difficulty initiating sleep (DIS) and early morning awakening (EMA). Female sex, education, and alcohol consumption had a significant bivariate association with DIS. Sleep-disordered breathing and body mass index were significantly associated with EMA. Multivariate analysis suggested that depressive symptoms, comorbidity, dyspnea, and pain had independent associations with each insomnia symptom. Age explained DIS and difficulty maintaining sleep, and significant interaction effects between age and physical activity on DIS and EMA were revealed. Results suggest that insomnia symptoms are associated with several sociodemographic, clinical, and lifestyle factors. Age below 70 years, depressive symptoms, comorbidity, dyspnea, and pain might be considered as a phenotype to identify persons with HF who are at increased risk for insomnia symptoms.</p>},
	keywords = {difficulty initiating and maintaining sleep, Heart Failure, insomnia symptoms},
	issn = {1098-240X},
	doi = {10.1002/nur.22211},
	author = {Rida Gharzeddine and Margaret M McCarthy and Yu, Gary and Victoria V Dickson}
}
@article {11383,
	title = {Associations of Insomnia Symptoms With Cognition in Persons With Heart Failure.},
	journal = {Western Journal of Nursing Research},
	volume = {43},
	year = {2021},
	pages = {1105-1117},
	abstract = {<p>Although cognitive impairment is common among persons with heart failure and negatively impacts self-care, hospitalization, and mortality, the associations between cognitive impairment and insomnia symptoms are not clearly understood. The purpose of this study was to explore these associations and examine if they are maintained after adjusting for relevant sociodemographic, clinical, and lifestyle factors. Guided by the Neurocognitive model of insomnia and sleep and the self-care conceptual model, a cross-sectional data analysis using parametric testing was conducted on the Health and Retirement Study wave 2016. Difficulty initiating sleep and early morning awakening, but not difficulty maintaining sleep were significantly associated with poorer cognitive performance in the bivariate and multivariate analysis. Our results are suggestive of different phenotypes of insomnia symptoms that may have different associations with cognition in persons with heart failure. Further research using objective measurements of insomnia symptoms and detailed neuropsychiatric testing of cognition is needed to confirm this conclusion.</p>},
	keywords = {Cognition, Heart Failure, insomnia symptoms, sleep initiation and maintenance disorder},
	issn = {1552-8456},
	doi = {10.1177/0193945920988840},
	author = {Rida Gharzeddine and Yu, Gary and Margaret M McCarthy and Victoria V Dickson}
}
@article {11991,
	title = {Heart Failure as an Independent Predictor of Insomnia Symptoms},
	journal = {Circulation},
	volume = {144},
	year = {2021},
	pages = {A12801},
	abstract = {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 \&lt;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\&lt;0.05). When looking at each insomnia symptom separately, HF significantly predicted difficulty initiating sleep (OR: 1.23, p \&lt; 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.},
	keywords = {Heart Failure, insomnia symptoms},
	doi = {10.1161/circ.144.suppl_1.12801},
	author = {Rida Gharzeddine and Margaret M McCarthy and Gary Yu and Victoria V Dickson}
}
@mastersthesis {11382,
	title = {An Exploratory Analysis of Sociodemographic, Clinical, and Lifestyle Factors Associated with Insomnia Symptoms and the Relationship Between Insomnia Symptoms and Medication Adherence Among Individuals with Heart Failure.},
	volume = {Doctor of Philosophy},
	year = {2020},
	school = {Rory Meyers College of Nursing, New York University},
	address = {New York, New York },
	abstract = {Background/Objective: Insomnia symptoms are common in persons with heart failure (HF) and
characterized by untoward outcomes. Insomnia symptoms are not clearly understood in persons with HF
as this literature is not yet fully developed. The purpose of this study was to investigate the association
of insomnia symptoms with sociodemographic, clinical, and lifestyle factors and explore the direct and
indirect associations between insomnia symptoms and medication adherence. Methods: This study was
guided by the Neurocognitive model of insomnia and the Riegel and Weaver{\textquoteright}s conceptual model. A
cross-sectional data analysis on the Health and Retirement Study (HRS) wave 2016 was conducted.
Parametric and non-parametric bivariate and multivariate statistical tests were used in the analysis.
Results: All sociodemographic, clinical, and lifestyle factors had significant bivariate associations with
at least one of the insomnia symptoms (i.e. difficulty initiating sleep (DIS), difficulty maintaining sleep
(DMS), ad early morning awakening (EMA)). In the multivariate analysis adjusted for all covariates,
only age, comorbidity, depressive symptoms, dyspnea, pain, and alcohol consumption maintained their
association with at least one insomnia symptom. Sex and DIS had a borderline significant association
(p=0.053) in the adjusted model. HF significantly predicted DIS (OR=1.23, p <0.05) in the adjusted
model. EMA and DIS but not DMS had significant bivariate and multivariate associations with
cognitive performance. All insomnia symptoms had a bivariate association with medication adherence;
however, none was maintained in the multivariate analysis. Mediation analysis revealed that DIS, DMS,
and EMA had significant indirect effects on medication adherence. Conclusion: Insomnia symptoms
were associated with various sociodemographic, clinical, and lifestyle factors and had indirect effects on
medication adherence. Comorbidities and HF symptoms may mediate the associations between several
sociodemographic factors and insomnia symptoms. The increased sympathetic stimulation in HF could
be contributing to DIS. Insomnia symptoms may be associated with different sleep durations as DMS 
was not associated with cognition. Depressive symptoms, fatigue, and cognitive performance mediated
the association between insomnia symptoms and medication adherence. },
	keywords = {Heart Failure, insomnia},
	author = {Rida Gharzeddine}
}
