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The Course of Sleep Problems in Patients With Heart Failure and Associations to Rehospitalizations

Johansson, Peter PhD; Broström, Anders PhD; Sanderman, Robbert PhD; Jaarsma, Tiny PhD

doi: 10.1097/JCN.0000000000000176

Introduction: Sleep problems are common in patients with heart failure (HF) and might be associated with patient outcomes.

Aims: The aim of this study was to describe the course of sleep problems in HF patients over 1 year and the association between sleep problems and rehospitalization.

Methods: Data from 499 HF patients (mean age, 70 years) were used in this analysis. Sleep problems were assessed with the item “Was your sleep restless” from the Center for Epidemiological Studies Depression Scale during hospitalization for HF (baseline) and after 1 year.

Results: A total of 43% of patients (n = 215) reported sleep problems at baseline, and 21% of patients (n = 105), after 1 year. Among the 215 patients with problems with sleep at baseline, 30% (n = 65) continued to have sleep problems over time. Among the 284 patients without sleep problems at baseline, 14% (n = 40) reported sleep problems after 1 year. After adjustments for potential cofounders, patients with continued sleep problems had an almost 2-fold increased risk for all-cause hospitalizations (hazard ratio, 2.1; P = .002) and cardiovascular hospitalizations (hazard ratio, 2.2; P = .004).

Conclusion: One-third of HF patients with sleep problems at discharge experienced persistent sleep problems at follow-up. Continued sleep problems were associated with all-cause and cardiovascular rehospitalizations.

Peter Johansson, PhD Associate Professor, Department of Cardiology, and Department of Medicine and Health Sciences, Linköping University, Sweden.

Anders Broström, PhD Professor, Department of Clinical Neurophysiology, County Council of Östergötland, and School of Health Sciences, Department of Nursing Science, Jönköping University, Sweden.

Robbert Sanderman, PhD Professor, Health Psychology Section, Department of Health Sciences, University of Groningen, University Medical Centre Groningen, the Netherlands.

Tiny Jaarsma, PhD Professor, Department of Medicine and Health Sciences Linköping University, Sweden.

The authors have no funding or conflicts of interest to disclose.

Correspondence Peter Johansson, PhD, Department of Cardiology and Department of Medicine and Health Sciences, Linköping University, S-581 85 Linköping, Sweden (

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