The Correlation Between Fatigue and Sleep Quality among Patients with Heart Failure
Heart failure (HF) patients may experience fatigue and poor sleep quality due to impairment in cardiac structure or function. These distressing symptoms may create a vicious circle leading to poor outcomes but often undervalued and ignored among patients. This study aimed to investigate the relationship between fatigue and sleep quality among patients with HF in Indonesia. A cross-sectional, correlational study design was performed with 153 convenience samples recruited from a cardiology outpatient department at a medical center in Indonesia. Descriptive statistics, bivariate analyses (independent t-tests, one-way Analysis of Variance, and Pearson correlation), and hierarchical regression analysis were utilized to analyze the data. Instruments included demographic characteristics and clinical variables questionnaire, the Multidimensional Assessment of Fatigue (MAF), and the Pittsburgh Sleep Quality Index (PSQI). The mean age of participants was 61.86±10.79 years old and the mean duration of HF diagnosis was 4.26±5.48 years. All participants complained of fatigue, while 73.2% had poor sleep quality. Participants who were poor sleepers had a higher proportion of individuals used massage, not having taken dyslipidemia drugs, had normotension or well-controlled blood pressure, and suffered from hypertensive heart disease (HHD) and renal diseases. All fatigue domains, except the degree of interference in ADL, was significantly associated with sleep quality. However, only the timing domain determined sleep quality, meaning, the longer the fatigue, the poorer the sleep quality. This study suggests future interventions should be directed to decrease the level of severity, distress reduction, and particularly shorten fatigue duration should be developed to improve the sleep quality.
Buysse, D. J., Reynolds, C. F., Monk, T. H., Berman, S. R. & Kupfer, D. J. 1989. The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Research, 28, 193-213.
Chen, H. M. & Clark, A. P. 2007. Sleep disturbances in people living with heart failure. Journal of Cardiovascular Nursing, 22, 177-185.
Chen, H. M., Clark, A. P., Tsai, L. M. & Lin, C. C. 2010. Self-reported health-related quality of life and sleep disturbances in Taiwanese people with heart failure. Journal of Cardiovascular Nursing, 25, 503-513.
Chen, H. M., Clark, A. P., Tsai, L. M., Liu, Y., Wu, L. M. & Wu, S. J. 2013a. Excessive daytime sleepiness in taiwanese people with heart failure. Journal of Nursing Research, 21, 39-48.
Chen, W. L., Liu, G. J., Yeh, S. H., Chiang, M. C., Fu, M. Y. & Hsieh, Y. K. 2013b. Effect of back massage intervention on anxiety, comfort, and physiologic responses in patients with congestive heart failure. Journal of Alternative & Complementary Medicine, 19, 464-470.
Cho, M. Y., Min, E. S., Hur, M. H. & Lee, M. S. 2013. Effects of aromatherapy on the anxiety, vital signs, and sleep quality of percutaneous coronary intervention patients in intensive care units. Evidence-based Complementary and Alternative Medicine : eCAM, 2013, 381381.
Dos Santos, M. A., da Cruz, D. d. A. L. M. & Barbosa, R. L. 2011. Factors associated to sleep pattern in heart failure patients. Revista da Escola de Enfermagem da USP, 45, 1105-1112.
Evangelista, L. S., Moser, D. K., Westlake, C., Pike, N., Ter-Galstanyan, A. & Dracup, K. 2008. Correlates of fatigue in patients with heart failure. Progress in Cardiovascular Nursing, 23, 12-17.
Faul, F., Erdfelder, E., Buchner, A. & Lang, A.-G. 2009. Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods, 41, 1149-1160.
Fink, A. M., Gonzalez, R. C., Lisowski, T., Pini, M., Fantuzzi, G., Levy, W. C. & Piano, M. R. 2012. Fatigue, inflammation, and projected mortality in heart failure. Journal of Cardiac Failure, 18, 711-716.
Garcia, S., Alosco, M. L., Spitznagel, M. B., Cohen, R., Raz, N., Sweet, L., Colbert, L., Josephson, R., Hughes, J. & Rosneck, J. 2012. Poor sleep quality and reduced cognitive function in persons with heart failure. International Journal of Cardiology, 156, 248.
Gau, F. Y., Chen, X. P., Wu, H. Y., Lin, M. L. & Chao, Y. F. C. 2011. Sleep-related predictors of quality of life in the elderly versus younger heart failure patients: A questionnaire survey. International Journal of Nursing Studies, 48, 419-428.
Hajibagheri, A., Babaii, A. & Adib-Hajbaghery, M. 2014. Effect of Rosa damascene aromatherapy on sleep quality in cardiac patients: A randomized controlled trial. Complementary Therapies in Clinical Practice, 20, 159-63.
Jamali, S., Ramezanli, S., Jahromi, M. K., Zare, A. & Poorgholami, F. 2016. Effect of massage therapy on physiologic responses in patients with congestive heart failure. Biosciences Biotechnology Research Asia, 13, 383-388.
Johansson, P., Brostrom, A., Sanderman, R. & Jaarsma, T. 2015. The course of sleep problems in patients with heart failure and associations to rehospitalizations. Journal of Cardiovascular Nursing, 30, 403-410.
Jones, J., McDermott, C. M., Nowels, C. T., Matlock, D. D. & Bekelman, D. B. 2012. The experience of fatigue as a distressing symptom of heart failure. Heart & Lung: The Journal of Acute and Critical Care, 41, 484-491.
Kishi, A., Struzik, Z. R., Natelson, B. H., Togo, F. & Yamamoto, Y. 2008. Dynamics of sleep stage transitions in healthy humans and patients with chronic fatigue syndrome. American Journal of Physiology - Regulatory, Integrative and Comparative Physiology, 294, R1980.
Liu, J. C., Hung, H. L., Shyu, Y. K. & Tsai, P. S. 2011. The impact of sleep quality and daytime sleepiness on global quality of life in community-dwelling patients with heart failure. Journal of Cardiovascular Nursing, 26, 99-105.
Mills, P., Wilson, K., Iqbal, N., Iqbal, F., Alvarez, M., Pung, M., Wachmann, K., Rutledge, T., Maglione, J., Zisook, S., Dimsdale, J., Lunde, O., Greenberg, B., Maisel, A., Raisinghani, A., Natarajan, L., Jain, S., Hufford, D. & Redwine, L. 2015. Depressive symptoms and spiritual wellbeing in asymptomatic heart failure patients. Journal of Behavioral Medicine, 38, 407-415.
Momayyezi, M., Fallahzadeh, H. & Barzegar, R. 2015. Sleep quality in patients with heart failure: Comparison between patients and non-patients in Yazd, Iran (2014). Iranian Heart Journal, 50, 28.
Moradi, M., Mehrdad, N., Nikpour, S., Haghani, H., Aalaa, M., Sanjari, M. & Sharifi, F. 2014. Sleep quality and associated factors among patients with chronic heart failure in Iran. Medical Journal of the Islamic Republic of Iran, 28, 149-149.
Nasir, U., Shahid, H. & Shabbir, M. O. 2015. Sleep quality and depression in hospitalized congestive heart failure patients. JPMA. The Journal of the Pakistan Medical Association, 65, 264-269.
Nasiri, M., Rahimian, B., Jahanshahi, M., Fotoukian, Z. & Motamed Omran Chaboki, A. 2016. Study of fatigue and associated factors in patients with chronic heart failure. Journal of Critical Care Nursing, 9, e8124.
Nerbass, F. B., Feltrim, M. I. Z., de Souza, S. A., Ykeda, D. S. & Lorenzi-Filho, G. 2010. Effects of massage therapy on sleep quality after coronary artery bypass graft surgery. Clinics, 65, 1105-1110.
Redeker, N. S., Jeon, S., Muench, U., Campbell, D., Walsleben, J. & Rapoport, D. M. 2010a. Insomnia symptoms and daytime function in stable heart failure. Sleep, 33, 1210-1216.
Redeker, N. S., Muench, U., Zucker, M. J., Walsleben, J., Gilbert, M., Freudenberger, R., Chen, M., Campbell, D., Blank, L., Berkowitz, R., Adams, L. & Rapoport, D. M. 2010b. Sleep disordered breathing, daytime symptoms, and functional performance in stable heart failure. Sleep, 33, 551-560.
Riegel, B. 2012. Determinants of excessive daytime sleepiness and fatigue in adults with heart failure. Clinical Nursing Research, 21, 271.
Roberts, M. B., Sullivan, M. C. & Winchester, S. B. 2017. Examining solutions to missing data in longitudinal nursing research. Journal for Specialists in Pediatric Nursing, 22, e12179.
Stephen, S. A. 2008. Fatigue in older adults with stable heart failure. Heart & Lung: The Journal of Acute and Critical Care, 37, 122-131.
Wang, T. J., Lee, S. C., Tsay, S. L. & Tung, H. H. 2010. Factors influencing heart failure patients' sleep quality. Journal of Advanced Nursing, 66, 1730-40.
Wu, H. S., Davis, J. E. & Natavio, T. 2012. Fatigue and disrupted sleep-wake patterns in patients with cancer: A shared mechanism. Clinical Journal of Oncology Nursing, 16, E56.
Yancy, C., Jessup, M., Bozkurt, B., Butler, J., Casey, D., Drazner, M., Fonarow, G., Geraci, S., Horwich, T., Januzzi, J., Johnson, M., Kasper, E., Levy, W., Masoudi, F., McBride, P., McMurray, J. J. V., Mitchell, J., Peterson, P., Riegel, B., Sam, F., Stevenson, L., Tang, W. H. W., Tsai, E. & Wilkoff, B. 2013. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 62, e147-239.
Yeatts, S. D. & Martin, R. H. 2015. What is missing from my missing data plan? Stroke, 46, e130-e132.
Yu, D. S. F., Lee, D. T. F. & Man, N. W. 2010. Fatigue among older people: A review of the research literature. International Journal of Nursing Studies, 47, 216-228.
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.