Factors Affecting Sleep Quality in Patients with Chronic Heart Failure

Main Article Content

Sumaiyah Assomadi
Doungrut Wattanakitkrilert
Kanaungnit Pongthavornkamol
Chatkanok Dumavibhat


Purpose: To explore the predictive ability of fatigue, dyspnea, depression and comorbidities over sleep quality in patients with chronic heart failure.

Design: Predictive correlational research design.

Methods: The sample was composed of 102 patients with chronic heart failure in New York Heart Association (NYHA) Class 1-3, followed-up at the medical outpatient department of a tertiary hospital in Bangkok, Thailand from March to April 2018. Data were collected using record forms of the patients’ personal information and medical history, the Pittsburg Quality of Sleep Index (PSQI), the Piper Fatigue Scale-12 (PFS-12), the Dyspnea Visual Analogue Scale (DVAS), the Center for Epidemiological Studies-Depression Scale (CES-D), and the Charlson Comorbidity Index (CCI). Data were analyzed by descriptive statistics and multiple regression statistics.

Main findings: The sample had a mean age of 65.62 years (SD = 10.31) of which 60.8 percent were males. Overall, the average score of sleep quality of the sample was 6.70 (SD = 3.99) indicating a poor sleep quality. Fatigue, dyspnea, depression, and co-morbidities were able to jointly explain 31.4 percent of the variances in sleep quality in patients with chronic heart failure (R2 = .314, F = 11.125, p < .001). Fatigue and depression were the variables found to be capable in predicting the sleep quality of patients with chronic heart failure with statistical significance (b = .393, .283 respectively, p < .05).

Conclusion and recommendations: Fatigue and depression could affect the sleep quality. Nurses and healthcare teams should assess patients with chronic heart failure in order to prevent and manage of the aforementioned symptoms for promoting sleep quality in patients with chronic heart failure.

Article Details

How to Cite
Assomadi, S., Wattanakitkrilert, D., Pongthavornkamol, K., & Dumavibhat, C. (2019). Factors Affecting Sleep Quality in Patients with Chronic Heart Failure. Nursing Science Journal of Thailand, 37(2), 43–59. Retrieved from https://he02.tci-thaijo.org/index.php/ns/article/view/192585
Research Papers


1. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129-200.
2. Strategy and Planning Division, Office of the Permanent Secretary, Ministry of Public Health. Summary report of illness A.D.2012-2016 [Internet]. Nonthaburi: Strategy and Planning Division; 2016 [cited 2018 Jul 2]. Available from: http://bps.moph.go.th/new_bps/สรุปรายงานการป่วย. (in Thai).
3. Wang TJ, Lee SC, Tsay SL, Tung HH. Factors influencing heart failure patients' sleep quality. J Adv Nurs. 2010;66(8):1730-40.
4. Moradi M, Mehrdad N, Nikpour S, Haghani H, Aalaa M, Sanjari M, et al. Sleep quality and associated factors among patients with chronic heart failure in Iran. Med J Islamic Repub Iran. 2014;28:149.
5. Javadi N, Darvishpour A, Mehrdad N, Lakeh NM. Survey of sleep status and its related factors among hospitalized patients with heart failure. J Tehran Heart Cent. 2015;10(1):9-17.
6. Hayes D Jr., Anstead MI, Ho J, Phillips BA. Insomnia and chronic heart failure. Heart Fail Rev. 2009;14(3):171-82.
7. Spielman AJ. Assessment of insomnia. Clin Psychol Rev. 1986;6(1):11-25.
8. Kronkasem A, Wattanakitkrilert D, Pongthavornkamol K, Kanoksin A. Fatigue experience, symptom management strategies, and functional status in patients with congestive heart failure. Journal of Nursing Science. 2014;32(4):35-42. (in Thai).
9. Yodchai K, Jitpanya C. Selected factors related to quality of sleep in hospitalized cardiac disease patients. Journal of Nursing Science Chulalongkorn University. 2006;18(2):20-32. (in Thai).
10. Suwanratsamee W, Pinyopasakul W, Charoenkitkarn V, Dumavibhat C. Symptom experiences, symptom management, and functional status in patients with heart failure. Thai Journal of Cardio-Thoracic Nursing. 2013;24(1):2-16. (in Thai).
11. Dos Santos MA, da Cruz Dde A, Barbosa RL. Factors associated to sleep pattern in heart failure patients. Rev Esc Enferm USP. 2011;45(5):1105-12.
12. Chimluang J, Aungsuroch Y, Jitpanya C. Descriptors of insomnia among patients with heart failure. J Med Assoc Thai. 2017;100(4):403-9.
13. Karnchanakomate J, Pinyopasakul W, Kusuma Na Ayuthya S, Sriprasong S. Factors predicting quality of sleep in patients with heart failure. Thai Journal of Cardio-Thoracic Nursing. 2014;25(2):49-61. (in Thai).
14. Brodaty H, Pond D, Kemp NM, Luscombe G, Harding L, Berman K, et al. The GPCOG: a new screening test for dementia designed for general practice. J Am Geriatr Soc. 2002;50(3):530-4.
15. Griffiths J, Putthioi S, Pongsuksri M. The General Practitioner Assessment of Cognition; GP-COG (Thai version): validity and reliability. In: 9th Pan-Pacific Conference on Rehabilitation cum 21st Annual Congress of Gerontology; 2014 November 29-30; Hong Kong. Kowloon: The Hong Kong Polytechnic University; [2014]. p.B65. (in Thai).
16. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193-213.
17. Jirapramukpitak T, Tanchaiswad W. Sleep disturbances among nurses of Songklanagarind Hospital. Journal of the Psychiatrist Association of Thailand. 1997;42(3):123-32.
18. Reeve BB, Stover AM, Alfano CM, Smith AW, Ballard-Barbash R, Bernstein L, et al. The Piper Fatigue Scale-12 (PFS-12): psychometric findings and item reduction in a cohort of breast cancer survivors. Breast Cancer Res Treat. 2012;136(1):9-20.
19. Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385-401.
20. Kuptniratsaikul V, Pekuman P. The study of the Center for Epidemiologic Studies-Depression scale (CES-D) in Thai people. Siriraj Medical Journal. 1997;49(5):442-8. (in Thai).
21. Charlson ME, Charlson RE, Petersona JC, Marinopoulos SS, Briggs WM, Hollenberg JP. The Charlson comorbidity index is adapted to predict costs of chronic disease in primary care patients. J Clin Epidemiol. 2008;61(12):1234-40.
22. Unruh ML, Redline S, An MW, Buysse DJ, Nieto FJ, Yeh JL, et al. Subjective and objective sleep quality and aging in the sleep heart health study. J Am Geriatr Soc. 2008;56(7):1218-27.
23. Buysse DJ, Germain A, Hall M, Monk TH, Nofzinger EA. A neurobiological model of insomnia. Drug Discov Today Dis Models. 2011;8(4):129-37.
24. Hallas CN, Wray J, Andreou P, Banner NR. Depression and perceptions about heart failure predict quality of life in patients with advanced heart failure. Heart Lung. 2011;40(2):111-21.
25. Wolkove N, Elkholy O, Baltzan M, Palayew M. Sleep and aging: 2. Management of sleep disorders in older people. CMAJ. 2007;176(10):1449-54.