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J Nurs Res. 2013 Mar;21(1):39-48. doi: 10.1097/jnr.0b013e3182828f2f.

Excessive daytime sleepiness in Taiwanese people with heart failure.

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  • 1School of Nursing, Kaohsiung Medical University, Taiwan, ROC.



Excessive daytime sleepiness can increase heart failure (HF) mortality, cause poor medication adherence, and worsen quality of life in people with HF. Recognition of excessive daytime sleepiness can help improve HF management outcomes.


This study was designed to identify the determinants of daytime sleepiness in patients with HF in Taiwan.


A cross-sectional and correlational study design was employed. We used nonprobability sampling to recruit 133 participants during their regular visits to a cardiovascular outpatient department of a medical center. Instruments used included the Epworth Sleepiness Scale, Symptom Subscale of Kansas City Cardiomyopathy Questionnaire, and Pittsburgh Sleep Quality Index.


Excessive daytime sleepiness occurred in 23.3% of study participants. Significant determinants of excessive daytime sleepiness were daytime dysfunction, body mass index, and HF symptom frequency. Use of angiotensin-converting enzyme inhibitors was correlated with excessive daytime sleepiness but was not identified as a determinant.


Approximately one quarter of participants reported subjective excessive daytime sleepiness, suggesting that recognition of this symptom should be incorporated into HF management. Interventions for improving daytime dysfunction, decreasing body mass index, and ameliorating HF symptoms may help improve excessive daytime sleepiness. Habitual daytime napping may assist Taiwanese patients with chronic HF to overcome poor nocturnal sleep and restore energy. However, extra daytime sleep and changes in the duration and pattern of daytime napping during the HF trajectory should be recognized early to maintain daytime functioning. Medical treatments may help control HF symptoms. Optimizing medications to minimize adverse effects may help patients maintain better treatment adherence.

[PubMed - indexed for MEDLINE]
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