Predictors of Poor Sleep Quality in Heart Failure Patients: A Cross-sectional Multivariable Analysis of Clinical, Demographic, and Psychosocial Factors

Abstract

Background: Sleep quality is crucial in heart failure (HF) patients, yet its associations with clinical, demographic, and psychosocial factors remain underexplored. This study examined these relationships to identify predictors of poor sleep quality. Study Design: A cross-sectional study. Methods: This cross-sectional was conducted on 354 HF patients at Shahid Chamran Heart Hospital, Isfahan, Iran (September 2023-2024). Pittsburgh Sleep Quality Index (PSQI) and Hospital Anxiety and Depression Scale (HADS) were used to evaluate sleep quality, anxiety, and depression, respectively. Random forest (RF) modeling and ordinary least squares (OLS) regression identified predictors of poor sleep quality. Results: Poor sleep quality (PSQI > 7) was observed in 18 of patients who were older (70.00 +/- 6.30, P < 0.001) and had lower ejection fraction (EF) (23.75 +/- 12.79, P < 0.001). This group also had higher systolic blood pressure (BP 140.67 +/- 12.50 mmHg, P = 0.014). beta-blockers, and diuretics, were associated with poor sleep (P < 0.001). Moreover, depression (HADS-depression: 5.36 +/- 0.70, P < 0.001) and anxiety (HADS-anxiety: 4.84 +/- 1.32, P < 0.001) were correlated with poor sleep. The RF model had an area under the curve of 0.79, and OLS regression (R-2 = 0.280) highlighted New York Heart Association (NYHA) class and medication type as significant predictors. Conclusion: Overall, poor sleep quality in HF patients was related to older age, reduced cardiac function, higher blood pressure (BP), complex medication regimens, and increased anxiety and depression. Accordingly, multidimensional management strategies are needed to improve sleep outcomes.