Clinical Investigation
Nocturia, Sleep and Daytime Function in Stable Heart Failure

https://doi.org/10.1016/j.cardfail.2012.05.002Get rights and content

Abstract

Background

The aim of this study was to evaluate nocturia severity and nocturia-related differences in sleep, daytime symptoms and functional performance among patients with stable heart failure (HF).

Methods and Results

In this cross-sectional observational study, we recruited 173 patients [mean age 60.3 ± 16.8 years; female n = 60 (35%); mean left ventricular ejection fraction 32 ± 14.6%] with stable chronic HF from HF disease management programs in the northeastern United States. Participants reported nocturia and completed a 6-minute walk test (6MWT), 1 night of ambulatory polysomnography, and the SF-36 Medical Outcomes Study, Epworth Sleepiness, Pittsburgh Sleep Quality Index, Multidimensional Assessment of Fatigue, and Centers for the Epidemiological Studies of Depression scales. Participants reported 0 (n = 30; 17.3%), 1–2 (n = 87; 50.2%), and ≥3 (n = 56; 32.4%) nightly episodes of nocturia. There were decreases in sleep duration and efficiency, REM and stage 3–4 sleep, physical function, and 6MWT distance and increases in the percentage of wake time after sleep onset, insomnia symptoms, fatigue, and sleepiness across levels of nocturia severity.

Conclusions

Nocturia is common, severe, and closely associated with decrements in sleep and functional performance and increases in fatigue and sleepiness in patients with stable HF.

Section snippets

Design

We conducted a cross-sectional study to evaluate the study aims. This report was part of a larger study that had the overall purpose of evaluating the extent to which sleep and SDB explained daytime symptoms and functional performance. Full details of the study design and methods have been previously published9, 19 but are summarized here as relevant to the present report.

Sample

The sample included patients with stable HF recruited from 5 specialized HF disease management programs in the northeastern

Sample Characteristics

The sample consisted of 173 patients who had stable HF (mean left ventricular ejection fraction [LVEF] 32.6 ± 15.2%; mean age 60.35 ± 16.07 years; women n = 60 [35%]). The sample included 110 (63.6%) European, 50 (29%) African, 7 (4%) Asian, and 10 (6%) Latino participants. The majority of participants used diuretics, including loop (n = 139; 80.3%), thiazides (n = 29; 16.7%), and potassium-sparing (n = 50; 28.9%) drugs. Detailed information on the clinical comorbidity and additional

Discussion

Nocturia is common and often severe in patients with stable HF. A full one-third of patients awakened ≥3 times per night to void. The prevalence of nocturia concurrent with the PSG recording is consistent with the report of another study of HF patients,1 but the rate of habitual nocturia is lower, and there are no comparative data on the nocturia severity as indicated by voiding frequency (such as measured in the present study) in patients with HF. Prevalence rates are higher than rates

Acknowledgments

The authors acknowledge the assistance of Laura Andrews, Nancy Bonnet, Della Campbell, George Evans, Marybeth Gregory, Rakiel Kanayefska, Agha Khan, Syed Naqvi, Eileen Oates, Rubab Qureshi, Leonie Rose, Alison Rosen, Leslie Faith Morritt-Taub, and Teresa Williams.

Disclosures

None.

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    Funding: National Institutes of Health R01NR008022.

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