Sleep quality patterns may predict outcomes in patients with heart failure:

1. Patients with severely disturbed sleep had the highest comorbidity burden, lowest ejection fraction, and poorest cognitive function.

2. Older age, higher physical symptom burden, and depression were significant predictors of worse sleep quality.

Evidence Rating Level: 1 (Excellent)

Sleep disturbances are highly prevalent in heart failure (HF) patients, affecting nearly 80% of individuals and significantly impairing quality of life and clinical outcomes. This secondary analysis of the MOTIVATE-HF trial used latent class analysis (LCA) to identify distinct sleep quality patterns in 510 Italian HF patients (mean age 72.4 years, NYHA class II–IV) based on Pittsburgh Sleep Quality Index (PSQI) components. Three clusters emerged: (1) Inadequate Sleep (46.1%)—adequate duration but frequent disturbances and daytime dysfunction; (2) Severely Disturbed Sleep (25.3%)—widespread sleep problems with low medication use; and (3) Mildly Disturbed Sleep (28.6%)—minor issues despite mild disturbances. Cluster 2 patients had the worst outcomes, including higher comorbidity burden (mean Charlson Index=3.55), lower ejection fraction (40%), and poorer cognitive function (MoCA=21.5), while Cluster 3 patients were younger with better cardiac and mental health. Predictors of poor sleep included older age, higher symptom burden, and depression. The study underscores the heterogeneity of sleep disturbances in HF and advocates for personalized interventions, such as targeted symptom management and psychological support, integrated into routine HF care to improve sleep quality and overall prognosis.

Click to read the study in BMJ Open

Image: PD

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