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Health‐related quality of life, depression, sleep and breathing disorders in the elderly: With focus on those with impaired systolic function/heart failure
Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences.ORCID iD: 0000-0001-7431-2873
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to describe the prevalence of depressive symptoms, sleep disordered breathing (SDB) and sleep complaints, as well as to investigate the prognostic value of health-related quality of life (Hr-QoL) and depressive symptoms on mortality in an elderly community living population with a focus on those with impaired systolic function/heart failure (HF). Descriptive, prognostic and explorative study designs were used to examine if a single question about global perceived health (GPH) is associated with the domains of Hr-QoL as assessed by the SF-36 (I), as well as to evaluate whether GPH provided prognostic information concerning cardiovascular mortality (II). The aim was also to evaluate if depressive symptoms are associated with mortality (III), and to describe the prevalence of SDB and its relationship to impaired systolic function, different insomnia symptoms, as well as excessive daytime sleepiness (IV).

In primary care elderly patients with HF, GPH correlated to the physical and mental aspects of Hr-QoL. Patients who rated poor GPH also scored worse physical and mental Hr-QoL compared to patients with good GPH, but the mental aspect of Hr-QoL was however not significant (p<0.07) (I). Moreover, GPH also had an independent association with cardiovascular mortality during a ten-year follow-up. Compared to patients with good GPH, those who scored poor GPH had a four times increased risk for cardiovascular mortality (II). A total of 24% of the patients with HF suffered from depressive symptoms, not significantly different compared to 19% among those without HF. Depressive symptoms were a poor prognostic sign during the six-year follow-up and HF patients with depressive symptoms had the highest risk for cardiovascular mortality compared to HF patients without depressive symptoms (III). SDB is common among elderly people living in the community, almost one quarter (23%) had moderate or severe SDB. However, people with moderate impaired systolic function had a median apnea hypopnea index that was more than twice as high compared to those with normal systolic function (10.9 vs. 5.0, p<0.001). No obvious associations between SDB and excessive daytime sleepiness or the insomnia symptoms; difficulties maintaining sleep; non-restorative sleep; or early morning awakenings were detected. Difficulties initiating sleep were however more common in those with moderate or severe SDB (IV).

GPH can be used as a simple tool in clinical routine practice as an aid in identifying patients in need of additional management. SDB is a common phenomenon among elderly people and associated with impaired systolic function, but with a limited impact on subjective sleep complaints. Depressive symptoms were shown to be a poor prognostic sign and may amplify the patient’s experience of suffering. Screening for depressive symptoms could therefore be an important action in the management of patients with HF.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press , 2008. , 62 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1089
Keyword [en]
Elderly, cardiac function, chronic heart failure, health-related quality of life, depressive symptoms, prognosis, sleep disturbances, sleep disordered breathing
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-15784ISBN: 978-91-7393-749-8 (print)OAI: oai:DiVA.org:liu-15784DiVA: diva2:127274
Public defence
2008-12-19, Berzelius salen, Campus US, Hälsouniversitetet, Linköpings universitet, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2008-12-03 Created: 2008-12-03 Last updated: 2013-09-26Bibliographically approved
List of papers
1. Global perceived health and health-related quality of life in elderly primary care patients with symptoms of heart failure
Open this publication in new window or tab >>Global perceived health and health-related quality of life in elderly primary care patients with symptoms of heart failure
2008 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 7, no 4, 269-276 p.Article in journal (Refereed) Published
Abstract [en]

Background: The aim was to examine whether a single question about global perceived health (GPH) is associated with the domains of health-related quality of life (HR-QoL) as assessed by the SF-36, and whether the scores in these domains differ from the different scores of the GPH in relation to left ventricular ejection fraction (LVEF).

Method: The study included 412 elderly outpatients with symptoms of heart failure (HF). Echocardiography was used to determine their LVEF, and GPH was assessed by the first question on the SF-36.

Results: The correlations between GPH and the different domains in SF-36 ranged from 0.33 to 0.64 in patients with LVEF ≥ 50% and was between 0.29 and 0.59 in patients with LVEF < 40%. Regression analyses revealed GPH to be the strongest predictor of HR-QoL. Patients with LVEF < 40% rating poor GPH differed significantly (p < 0.05) from those with good or moderate GPH in six of the eight HR-QoL domains.

Conclusion: One question about GPH gives a good general description of HR-QoL and may therefore be used as a simple tool to assess HR-QoL in elderly outpatients with clinical symptoms of HF.

Place, publisher, year, edition, pages
Elsevier, 2008
Keyword
Heart failure, Health-related quality of life, Health
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-15780 (URN)10.1016/j.ejcnurse.2007.12.002 (DOI)
Available from: 2008-12-04 Created: 2008-12-03 Last updated: 2017-12-14Bibliographically approved
2. Global perceived health and ten-year cardiovascular mortality in elderly primary care patients with possible heart failure
Open this publication in new window or tab >>Global perceived health and ten-year cardiovascular mortality in elderly primary care patients with possible heart failure
2008 (English)In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 10, no 10, 1040-1047 p.Article in journal (Refereed) Published
Abstract [en]

Introduction: Although multi-item health-related quality of life (HRQoL) instruments provide prognostic information, they are rarely used in routine clinical practice.

Aim: To examine whether a single question about global perceived health (GPH) was a prognostic indicator of cardiovascular (CV) mortality over 10 years of follow-up in elderly patients with possible heart failure (HF) in primary care.

Method: GPH was measured using the first question on the Short-Form-36 concerning current health status. Of the 510 patients who underwent baseline evaluation, 448 patients were included.

Results: Cox proportional regression hazard analysis controlled for age, sex, NYHA class, diabetes, ischaemic heart disease, left ventricular ejection fraction and B-type natriuretic peptide plasma concentrations, showed that patients with GPH rated as “poor” or “good” were at four (HR 4.1 CI 95% 1.8–9.4) and three times (HR 3.4 CI 95% 1.4–7.8) the risk of CV mortality, respectively.

Conclusion: GPH is an independent predictor of CV mortality in elderly patients with possible HF. As a complement to clinical factors when evaluating severity of HF, GPH could be an important tool for identifying patients at risk of adverse CV events and in need of improved treatment.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2008
Keyword
Health status indicator, Mortality, Aging, Chronic heart failure
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-15781 (URN)10.1016/j.ejheart.2008.07.003 (DOI)
Available from: 2008-12-04 Created: 2008-12-03 Last updated: 2017-12-14Bibliographically approved
3. Depressive symptoms and six-year cardiovascular mortality in elderly patients with and without heart failure
Open this publication in new window or tab >>Depressive symptoms and six-year cardiovascular mortality in elderly patients with and without heart failure
2007 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 41, no 5, 299-307 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: To evaluate whether depressive symptoms (DS) in elderly patients with heart failure (HF) in the community is associated with increased mortality.

Design: A cohort of 510 elderly patients (65-82 years) in a primary healthcare setting with symptoms associated with HF underwent a clinical and echocardiographic examination. A left ventricular ejection fraction (LVEF) <40% indicated HF. The mental health index scale was used to screen for DS. Cardiovascular and all-cause mortality was registered over 6 years.

Results: After adjustments those with DS had an increased risk (HR) of 3.0 (CI 95% 1.6-5.5, p=0.0001) and 2.2 (CI 95% 1.3-3.7, p=0.0004) of cardiovascular and all-cause mortality, respectively. Patients with HF and DS had the highest risk of cardiovascular mortality, HR 15.7 (CI 95% 4.8-52.2) compared to patients with HF without DS and those with LVEF ≥50% and normal left ventricular diastolic function with and without DS.

Conclusion: DS in elderly patients with HF is independently associated with increased mortality. Screening for DS is recommended as part of the clinical routine in managing patients with HF.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2007
Keyword
Heart failure, depressive symptoms, mortality
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-15782 (URN)10.1080/14017430701534829 (DOI)
Available from: 2008-12-04 Created: 2008-12-03 Last updated: 2017-12-14Bibliographically approved
4. Sleep disordered breathing in an elderly community-living population: Relationship to cardiac function, insomnia symptoms and daytime sleepiness
Open this publication in new window or tab >>Sleep disordered breathing in an elderly community-living population: Relationship to cardiac function, insomnia symptoms and daytime sleepiness
Show others...
2009 (English)In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 10, no 9, 1005-1011 p.Article in journal (Refereed) Published
Abstract [en]

Introduction: The relationship between sleep disordered breathing (SDB), systolic function/heart failure in elderly people living in community has not been investigated, nor has insomnia and excessive daytime sleepiness (EDS).

Aim: To describe the prevalence of SDB and its relationship to systolic function, the different insomnia symptoms as well as EDS.

Method: 331 subjects (71-87 years) underwent echocardiographic examinations and sleep respiratory recordings. Questionnaires were used to evaluate insomnia symptoms and EDS.

Results: Mild SDB (AHI 5-15), was found in 32%. Moderate SDB (AHI 15-30) occurred in 16%, and 7% had severe SDB (AHI >30). Median AHI was significantly higher (p<0.001) in those with mild impaired systolic function (AHI 11.7) and moderate impaired systolic function (AHI 10.9) compared to those with normal systolic function (AHI 5.0). Mild and moderate impaired systolic function was also independently associated to SDB as indicated by an AHI≥10. Concerning insomnia symptoms and EDS, only difficulties in initiating sleep correlated significantly (p<0.05) with AHI.

Conclusion: SDB is common among the elderly and may be related to impaired systolic function/heart failure. However, detection of SDB in such population may be problematic since insomnia symptoms and EDS correlated poorly with SDB.

Keyword
Sleep apnoea syndromes, aging, dyssomnia, excessive somnolence disorder, left ventricular dysfunction, heart failure
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-15783 (URN)10.1016/j.sleep.2009.01.011 (DOI)
Available from: 2008-12-04 Created: 2008-12-03 Last updated: 2017-12-14Bibliographically approved

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