Poor sleep and impaired self-care: towards a comprehensive model linking sleep, cognition, and heart failure outcomes

Persons with heart failure (HF) have significantly lower sleep quantity and quality than persons without HF. The purpose of this article is to propose a conceptual model describing how poor sleep may contribute to inadequate self-care and untoward outcomes in persons with HF.

Our overarching hypothesis is that sleep affects self-care and outcomes through its effects on cognition. Building on the work of others, we outline a conceptual model that illustrates that even transient sleep disruption prevents sleep-related restorative processes and contributes to cognitive dysfunction-especially in the 25-50% of HF patients with existing cognitive impairment. Poor sleep may be sufficient to impair cognition to a level that interferes with higher order functions involved in effective HF self-care practices. Through these mechanisms, inadequate sleep may contribute to poor outcomes such as low health-related quality of life and greater risk of unplanned hospitalization.

The proposed model (1) bridges physical, neuropsychological and behavioral phenomena, (2) suggests a mechanism by which poor sleep affects daytime behavior, and (3) is empirically testable. Exploring factors that interfere with sleep may improve self-care and outcomes in persons with HF.