Sleep and Functional Performance in Heart Failure

描述(由申请人提供)：心力衰竭(HF)以其对功能表现和生活质量的有害影响而闻名，尽管药物和其他治疗方法取得了进展，但这个问题一直存在。睡眠障碍，包括死亡数量、支离破碎、自我报告质量差，以及睡眠障碍呼吸(Cheyne-Stokes呼吸/中枢性呼吸暂停和阻塞性睡眠呼吸暂停)在心力衰竭患者中很常见，而且开始有证据表明，睡眠和SDB都有助于功能表现。然而，心力衰竭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，以及这种作用可能发生的行为途径还没有得到很好的解释。因此，这项研究的目的是阐明睡眠障碍的性质及其对明确定义的稳定型心力衰竭患者功能表现的贡献。本研究的具体目的是：1.描述心力衰竭患者睡眠的生理、行为和主观属性；2.评估睡眠障碍和睡眠障碍(CSB-CSA和OSA)在心力衰竭患者功能表现中的作用；3.考察夜间症状、睡眠障碍和睡眠障碍之间的关系；(3)心力衰竭患者的情绪障碍；(2)日间过度嗜睡；(3)疲劳；4.评估疲劳、日间过度嗜睡和情绪障碍在多大程度上调节睡眠障碍对心力衰竭患者功能表现的影响；5.探讨年龄、性别对心力衰竭患者睡眠障碍与功能表现关系的影响。该项目将采用多因素横断面设计，纳入400名男性和女性稳定型心力衰竭患者。通过使用生理、行为和自我报告测量，获取参与者家中的睡眠和功能表现数据，将为研究睡眠及其对功能表现的贡献提供一个生态有效的视角。夜间多导睡眠图的使用将允许对睡眠本身以及睡眠障碍呼吸进行全面检查。假想的中介变量将包括日间过度嗜睡、疲劳和情绪紊乱，用经过充分验证的工具进行测量。在多变量模型中，将讨论年龄、性别、选定的临床变量以及原发睡眠障碍(例如，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。多元回归分析和结构方程建模将是数据分析的主要方法。结构方程被用来评估睡眠障碍结构的因素结构，并作为一个工具来探索连接主要研究变量的直接和间接路径。

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.