HF may be an independent predictor of insomnia symptoms, according to a presentation from the American Heart Association Scientific Sessions.

“Several factors contribute to insomnia symptoms in heart failure, including advancing age, depression, comorbidities, symptom burden and pain,”Rida Gharzeddine, PhD, RN, assistant professor at Rutgers-Camden School of Nursing, New Jersey, said during a presentation. “However, it is unclear if heart failure itself independent of those associated factors contribute to insomnia symptoms.”

Researchers examined the association of HF with insomnia symptoms after adjusting for sociodemographic, clinical and lifestyle factors. These factors included age, sex, race, ethnicity, education, marital status, income, poverty level, sleep-disordered breathing, obesity, depression symptoms, comorbid diseases, smoking, alcohol consumption and physical activity.

Gharzeddine and colleagues conducted a secondary data analysis of data from the Health and Retirement Study using multiple logistic regression. Of 17,910 patients, 1,189 had HF.

In the unadjusted model, the results revealed that people with HF were nearly two times more likely to have insomnia symptoms (OR = 1.95; P < .001); however, HF maintained a significant association with insomnia symptoms (OR = 1.15; P < .05), even after adjusting for sociodemographic, clinical and lifestyle factors.

When researchers analyzed each insomnia symptom separately, they found that HF significantly predicted difficulty initiating sleep (OR = 1.23; P < .01) in the fully adjusted model, as well as continuing to show a trend with difficulty maintaining sleep and early morning awakening.

“In summary, heart failure predicted difficulty initiating sleep and the global insomnia symptoms [were] variable. These results, such as the neural-hormonal compensatory mechanism of heart failure, may play a role by exerting an alerting effect and leading to a hyperarousal state during the day and before sleep initiation,” Gharzeddine said. “Further research to investigate the sympathetic and the hypothalamic-pituitary-adrenal axis stimulation is needed and to confirm our hypothesis.”