Sleep and Functional Performance in Heart Failure

描述（由申请人提供）：心力衰竭（HF）因其对功能表现和生活质量的有害影响而闻名，尽管在药理学和其他治疗方面取得了进展，但这一问题一直存在。睡眠障碍，包括死亡数量、碎片化和自我报告质量差，以及睡眠呼吸障碍（Cheyne-Stokes呼吸/中枢性呼吸暂停和阻塞性睡眠呼吸暂停）在HF患者中很常见，并且有初步证据表明睡眠和SDB都有助于功能表现。然而，心衰患者睡眠的生物行为属性、睡眠障碍和SDB对功能表现的贡献以及可能发生这种情况的行为途径尚未得到很好的解释。因此，本研究的目的是阐明睡眠障碍的本质及其对稳定型心衰患者功能表现的影响。具体目标是：1。表征心衰患者睡眠的生理、行为和主观属性2. 评价睡眠障碍和SDB （CSB-CSA和OSA）对心衰患者功能表现的影响；3. 探讨夜间症状、睡眠障碍与SDB的关系；(1)情绪障碍；(2)白天嗜睡；(3)心衰患者易疲劳；4. 评估疲劳、白天过度嗜睡和情绪障碍在HF患者睡眠障碍对功能表现的影响程度；和5。评价年龄和性别对心衰患者睡眠障碍与功能表现关系的影响。本项目将采用多变量横断面设计，招募400名男性和女性稳定型心衰患者。在参与者家中获取睡眠和功能表现数据，使用生理、行为和自我报告测量，将为睡眠及其对功能表现的贡献提供生态学上有效的视角。使用夜间多导睡眠描记仪可以对睡眠本身以及睡眠呼吸紊乱进行全面检查。假设的中介变量将包括白天过度嗜睡、疲劳和情绪障碍，用有效的仪器测量。在多变量模型中，年龄、性别、选定的临床变量和原发性睡眠障碍（如Cheyne-Stokes呼吸和阻塞性睡眠呼吸暂停）对睡眠和功能表现变量的潜在影响将被解决。多元回归分析和结构方程建模（SEM）将是数据分析的主要方法。扫描电镜将用于评估睡眠障碍结构的因素结构，并作为探索连接主要研究变量的直接和间接途径的工具。

DESCRIPTION (provided by applicant): Heart failure (HF) is well known for its deleterious effects on functional performance and quality of life, and this problem has been persistent despite advances in pharmacological and other treatments. Sleep disturbance, including deceased quantity, fragmentation, and poor self-reported quality, and sleep disordered breathing (Cheyne-Stokes breathing/central apnea and obstructive sleep apnea) are common in HF patients and there is beginning evidence that both sleep and SDB contribute to functional performance. However, the bio-behavior attributes of sleep in HF patients, the contribution of sleep disturbance and SDB to function performance, and the behavioral pathways through which this may occur have not been well explained. Therefore, the purpose of this study is to explicate the nature of sleep disturbance and its contributions to functional performance in a well-defined group of stable HF patients. The specific aims are to: 1. Characterize the physiologic, behavioral, and subjective attributes of sleep in HF patients; 2. Evaluate the contributions of sleep disturbance and SDB (CSB-CSA and OSA) in functional performance of HF patients; 3. Examine the relationships among nocturnal symptoms, sleep disturbance and SDB; and to (1) mood disturbance; (2) excessive daytime sleepiness, and (3) fatigue in HF patients; 4. Evaluate the extent to which fatigue, excessive daytime sleepiness, and mood disturbance mediate the contributions of sleep disturbance to functional performance in HF patients; and 5. Evaluate the influence of age and gender on the relationships between sleep disturbance and functional performance in patients with HF. This project will use a multivariate cross-sectional design and enroll a sample of 400 male and female stable HF patients. Acquisition of sleep and functional performance data in participants' homes, using physiologic, behavioral, and self-report measures, will provide an ecologically valid perspective on sleep and its contribution to functional performance. The use of nocturnal polysomnography will permit a comprehensive examination of sleep itself, as well as sleep disordered breathing. Hypothesized mediator variables will include excessive daytime sleepiness, fatigue, and mood disturbance, measured with well-validated instruments. The potential influences of age, gender, selected clinical variables, and the role of primary sleep disorders (e.g. Cheyne-Stokes breathing and obstructive sleep apnea) on the sleep and the functional performance variables in a multivariate model will be addressed. Multiple regression analysis and structural equation modeling (SEM) will be the primary approaches to data analysis. SEM will be used to evaluate the factor structure of the sleep disturbance construct and serve as a tool to explore the direct and indirect pathways linking the major study variables.