Patterns Of Contraindications And Initiation Of Guideline-Directed Medical Therapy Among Older Adults With Heart Failure, With And Without Polypharmacy
HFSA ePoster Library. Onyebeke C. 09/10/21; 343338; 116
Chukwuma Onyebeke
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Abstract
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Background: Sleep disturbances are highly prevalent in heart failure, but understudied in patients with left-ventricular assist devices (LVADs). This study examined the nighttime and daytime sleep patterns among patients following implantation of LVADs.
Method: This is an observational study involving 32 patients, aged 44-66 years. Patients were 41% female, 59% male, all with Stage D Heart Failure and average LVEF of 16.1%. Objectively, wrist actigraphs were used in measuring nighttime sleep latency (SL), total sleep time (TST), wake after sleep onset (WASO), sleep fragmentation (SF), sleep efficiency (SE), and daytime sleepiness (naps). Subjectively, we used the 14-item Subjective Sleep Quality Scale (SSQS) and 4-item Stanford Sleepiness Scale (SSS). Assessments were completed pre-implant and at 1, 3, and 6 months after LVAD implant. Data were analyzed with descriptive and inferential statistical procedures, using median scores due to the non-normal distribution of data.
Results: At baseline, elevated SF and WASO scores and reduced TST and SE scores were indicative of poor sleep health. In the first month post-LVAD, patients’ TST, SE and SSQS median scores were low, but increased at months 3 and 6 after implant. This was accompanied by increased median naptime scores from months 1 to 3 and 6 after implant, with decreased SSS median scores. Notably, patients' SSS scores tended to be lower at 8 AM and progressed into higher scores throughout the day. Median scores of WASO, SL, TST, and SE varied over time. WASO scores decreased at 3 months and increased at 6 months, while SL scores decreased at 3 and 6 months; however, these changes in scores were not significant. SF median scores significantly decreased at 3 and 6 months (p<.01) along with a decrease in TST score (p<.05). Increases in median scores of TST at 6 months and SE at 3 and 6 months after implant were notable, but not significant. Also, no significant associations among nighttime and daytime sleep variables with patients demographics and clinical characteristics.
Conclusion: Our data suggest that the patients’ sleep quality improved at months 3 and 6 after LVAD implantation hospitalization. This improvement may partially be explained by the decrease in daytime sleepiness scores. A large multicenter study is needed to further understand the pattern and mechanism of sleep quality and consequent daytime function impacting multiple health and quality of life outcomes. Despite the small sample size, our findings add to the very limited body of empirical data on sleep health in the LVAD population.
Method: This is an observational study involving 32 patients, aged 44-66 years. Patients were 41% female, 59% male, all with Stage D Heart Failure and average LVEF of 16.1%. Objectively, wrist actigraphs were used in measuring nighttime sleep latency (SL), total sleep time (TST), wake after sleep onset (WASO), sleep fragmentation (SF), sleep efficiency (SE), and daytime sleepiness (naps). Subjectively, we used the 14-item Subjective Sleep Quality Scale (SSQS) and 4-item Stanford Sleepiness Scale (SSS). Assessments were completed pre-implant and at 1, 3, and 6 months after LVAD implant. Data were analyzed with descriptive and inferential statistical procedures, using median scores due to the non-normal distribution of data.
Results: At baseline, elevated SF and WASO scores and reduced TST and SE scores were indicative of poor sleep health. In the first month post-LVAD, patients’ TST, SE and SSQS median scores were low, but increased at months 3 and 6 after implant. This was accompanied by increased median naptime scores from months 1 to 3 and 6 after implant, with decreased SSS median scores. Notably, patients' SSS scores tended to be lower at 8 AM and progressed into higher scores throughout the day. Median scores of WASO, SL, TST, and SE varied over time. WASO scores decreased at 3 months and increased at 6 months, while SL scores decreased at 3 and 6 months; however, these changes in scores were not significant. SF median scores significantly decreased at 3 and 6 months (p<.01) along with a decrease in TST score (p<.05). Increases in median scores of TST at 6 months and SE at 3 and 6 months after implant were notable, but not significant. Also, no significant associations among nighttime and daytime sleep variables with patients demographics and clinical characteristics.
Conclusion: Our data suggest that the patients’ sleep quality improved at months 3 and 6 after LVAD implantation hospitalization. This improvement may partially be explained by the decrease in daytime sleepiness scores. A large multicenter study is needed to further understand the pattern and mechanism of sleep quality and consequent daytime function impacting multiple health and quality of life outcomes. Despite the small sample size, our findings add to the very limited body of empirical data on sleep health in the LVAD population.
Background: Sleep disturbances are highly prevalent in heart failure, but understudied in patients with left-ventricular assist devices (LVADs). This study examined the nighttime and daytime sleep patterns among patients following implantation of LVADs.
Method: This is an observational study involving 32 patients, aged 44-66 years. Patients were 41% female, 59% male, all with Stage D Heart Failure and average LVEF of 16.1%. Objectively, wrist actigraphs were used in measuring nighttime sleep latency (SL), total sleep time (TST), wake after sleep onset (WASO), sleep fragmentation (SF), sleep efficiency (SE), and daytime sleepiness (naps). Subjectively, we used the 14-item Subjective Sleep Quality Scale (SSQS) and 4-item Stanford Sleepiness Scale (SSS). Assessments were completed pre-implant and at 1, 3, and 6 months after LVAD implant. Data were analyzed with descriptive and inferential statistical procedures, using median scores due to the non-normal distribution of data.
Results: At baseline, elevated SF and WASO scores and reduced TST and SE scores were indicative of poor sleep health. In the first month post-LVAD, patients’ TST, SE and SSQS median scores were low, but increased at months 3 and 6 after implant. This was accompanied by increased median naptime scores from months 1 to 3 and 6 after implant, with decreased SSS median scores. Notably, patients' SSS scores tended to be lower at 8 AM and progressed into higher scores throughout the day. Median scores of WASO, SL, TST, and SE varied over time. WASO scores decreased at 3 months and increased at 6 months, while SL scores decreased at 3 and 6 months; however, these changes in scores were not significant. SF median scores significantly decreased at 3 and 6 months (p<.01) along with a decrease in TST score (p<.05). Increases in median scores of TST at 6 months and SE at 3 and 6 months after implant were notable, but not significant. Also, no significant associations among nighttime and daytime sleep variables with patients demographics and clinical characteristics.
Conclusion: Our data suggest that the patients’ sleep quality improved at months 3 and 6 after LVAD implantation hospitalization. This improvement may partially be explained by the decrease in daytime sleepiness scores. A large multicenter study is needed to further understand the pattern and mechanism of sleep quality and consequent daytime function impacting multiple health and quality of life outcomes. Despite the small sample size, our findings add to the very limited body of empirical data on sleep health in the LVAD population.
Method: This is an observational study involving 32 patients, aged 44-66 years. Patients were 41% female, 59% male, all with Stage D Heart Failure and average LVEF of 16.1%. Objectively, wrist actigraphs were used in measuring nighttime sleep latency (SL), total sleep time (TST), wake after sleep onset (WASO), sleep fragmentation (SF), sleep efficiency (SE), and daytime sleepiness (naps). Subjectively, we used the 14-item Subjective Sleep Quality Scale (SSQS) and 4-item Stanford Sleepiness Scale (SSS). Assessments were completed pre-implant and at 1, 3, and 6 months after LVAD implant. Data were analyzed with descriptive and inferential statistical procedures, using median scores due to the non-normal distribution of data.
Results: At baseline, elevated SF and WASO scores and reduced TST and SE scores were indicative of poor sleep health. In the first month post-LVAD, patients’ TST, SE and SSQS median scores were low, but increased at months 3 and 6 after implant. This was accompanied by increased median naptime scores from months 1 to 3 and 6 after implant, with decreased SSS median scores. Notably, patients' SSS scores tended to be lower at 8 AM and progressed into higher scores throughout the day. Median scores of WASO, SL, TST, and SE varied over time. WASO scores decreased at 3 months and increased at 6 months, while SL scores decreased at 3 and 6 months; however, these changes in scores were not significant. SF median scores significantly decreased at 3 and 6 months (p<.01) along with a decrease in TST score (p<.05). Increases in median scores of TST at 6 months and SE at 3 and 6 months after implant were notable, but not significant. Also, no significant associations among nighttime and daytime sleep variables with patients demographics and clinical characteristics.
Conclusion: Our data suggest that the patients’ sleep quality improved at months 3 and 6 after LVAD implantation hospitalization. This improvement may partially be explained by the decrease in daytime sleepiness scores. A large multicenter study is needed to further understand the pattern and mechanism of sleep quality and consequent daytime function impacting multiple health and quality of life outcomes. Despite the small sample size, our findings add to the very limited body of empirical data on sleep health in the LVAD population.
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