ABSTRACT

Background: Heart failure (HF) patients may experience fatigue and poor sleep quality due to impairment in cardiac structure or function. These distressing symptoms may create a vicious circle leading to poor outcomes. However, both are often undervalued and ignored among patients. Many factors are associated with sleep quality, but there is limited information regarding the relationship between fatigue and sleep quality among patients with HF in Indonesia.

Purpose: This study aimed to investigate the relationship between fatigue and sleep quality among patients with HF in Indonesia.

Method: A cross-sectional study design was performed with 153 convenience samples recruited from a cardiology outpatient department of the Cardiovascular and Brain Center at a medical center located in Northern Sulawesi, Indonesia. Instruments included demographic factors and clinical variables questionnaire, the Multidimensional Assessment of Fatigue (MAF), and the Pittsburgh Sleep Quality Index (PSQI). Descriptive statistics, bivariate analyses (independent t-tests, one-way ANOVA, and Pearson correlation), and hierarchical regression analysis were utilized to analyze the data.

Result: The mean age of the participants was 61.86±10.79 years old, and the mean duration of HF diagnosis was 4.26±5.48 years. All participants complained of fatigue, while 73.2% had poor sleep quality. Participants who were poor sleepers had a higher proportion of individuals used massage, not having taken dyslipidemia drugs, had normotension or well-controlled blood pressure, and suffered from hypertensive heart disease (HHD) and renal diseases. The global fatigue index (GFI) score (r = .39, p<.01) and its three domains, severity (r = .35, p<.01), distress (r = .37, p< .01), and timing (r = .39, p<.01) were significantly associated with the global PSQI score. A hierarchical multiple regression analysis showed three significant predictors were identified and accounted for 24.9% of the adjusted variance in sleep quality. After controlling for demographic factors and clinical variables, the analysis showed that fatigue severity, distress, and timing accounted for 10.5% of the variance in sleep quality. However, only timing domain was the significant predictor.

Conclusion: The study found that all fatigue domains, except the degree of interference in ADL, was significantly associated with sleep quality. However, only the timing domain predicted sleep quality, meaning, the longer the fatigue, the poorer the sleep quality. Future interventions directed to reduce the level of severity, the condition of distress, and especially shorten fatigue duration should be developed to improve the sleep quality of patients with HF.

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