0381 Cognitive Impairment Mediates The Relationship between Insomnia and Emotional Wellbeing among Patients with Stable Heart Failure. (27th April 2018) - Jeon, S
Abstract: Introduction: Cognitive impairment is common among patients with heart failure (HF) and interferes with self-care and function. Sleep disturbance may contribute to cognitive impairment. The purpose of this study was to examine: 1) the associations between cognitive function self-care, sleep characteristics and other symptoms and 2) the extent to which cognitive impairment mediates the relationship between insomnia and emotional wellbeing among patients with stable HF. Methods: We performed cross-sectional analysis with baseline data from an ongoing randomized controlled trial of cognitive behavioral therapy for insomnia (CBT-I) among patients with stable HF who had at least mild insomnia [(score > 7 on the Insomnia Severity Index (ISI)], were aged ≥ 18, and had none-mild or treated sleep disordered breathing. We measured cognitive function and symptoms [Patient-Reported Outcomes Measurement Information System scales (PROMIS®); Self-care [Self-Care of Heart Failure Index (SCHFI)], insomnia severity (ISI), sleep quality (Pittsburgh Sleep Quality Index-PSQI), excessive daytime sleepiness (Epworth Sleepiness Scale-ESS), and bodily pain and emotional wellbeing (SF36). Cross-sectional correlations were examined at a 5% significance and the mediation effect of cognitive impairment was estimated using bootstrap sampling with 3, 000 repeats. Results: The sample included 77 HF patients [M age=60.63(12.51) years; n=44(57.14%) male; n=51(63%) white]. Cognitive function was negatively associated with self-care maintenance (r=0 .27, p=.0171) and negatively associated with severity of anxiety, depression, and fatigue (r<-0.43, p<.0001). Insomnia severity (r=-0.28, p=.0144) and poor sleep quality (r=- 0.37, p=.0020) were negatively associated with cognitive ability. The estimated mediation effect (-0.33, 95%CI=[-0.75, 0.01]) showed that cognitive impairment mediated the effects of insomnia severity on emotional wellbeing while the direct effect of insomnia (-0.48, 95%CI=[-1.18, 0.13]) showed weak association without cognitive impairment. Conclusion: Cognitive impairment is substantively associated with insomnia severity, poor sleep and other symptoms, and may contribute to self-care maintenance in HF patients. CBT-I for insomnia may increase cognitive performance by improving insomnia and, in turn, may improve emotional wellbeing. Support (If Any): N/A