Device-assessed sleep health among older patients with heart failure: An actigraphy-based study

Background Poor sleep quality is common among older adults and in those with heart failure (HF). Sleep quality is typically assessed using self-reported questionnaires which are subject to recall bias. Actigraphy-based assessment permits more objective evaluation of sleep. We examined sleep among older patients with HF using actigraphy and examined associations between sleep outcomes and cardiac biomarkers, functional performance and quality of life (QoL). Methods We recruited 150 patients aged ≥ 65 with diagnosis of HF. They were given a wrist-accelerometer to wear for 7 days. Patients completed 4-meter walk test (4MWT), handgrip strength test (HGST), Timed Up and Go test (TUGT), Barthel Index (BI), Kansas City Cardiomyopathy Questionnaire (KCCQ-12) and frailty assessment (Clinical Frailty Scale, CFS). Sleep outcomes calculated include sleep period time window, sleep duration, sleep onset and wake up time, wake after sleep onset (WASO), sleep interruptions, sleep regularity index (SRI) and sleep efficiency (SE). Poor sleep quality was defined as SE < 80%. Regression analysis was used to examine associations between sleep outcomes and other variables adjusting for age, gender and comorbidities. Results Accelerometry data from 145 participants were analysed. Sixty-one (42%) patients had poor sleep quality. These patients had significantly higher plasma NT-proBNP ( p  = 0.044). No statistically significant difference was noted in 4MWT, HGST, TUGT, BI, KCCQ-12 and CFS between patients with SE < 80% and those with SE ≥ 80%. Lower SE was associated with worse frailty status and lower BI scores; lower SRI was associated with worse NYHA class, frailty, BI scores and QoL measures; longer WASO was associated with slower gait speed. Conclusions Forty-two percent of older patients with HF had poor sleep quality; they had significantly higher NT-proBNP levels. Poor sleep quality was associated with higher functional dependence and frailty. Sleep irregularity affected HF symptom load, frailty, functional performance and QoL, while sleep fragmentation was associated with impaired gait speed. These findings highlight the need to consider sleep assessment in the comprehensive management of older adults with HF.