Quality of relationship, depression, and sleep quality in patients with chronic heart failure and their spouse: an...

Sleep disturbances are highly prevalent in patients with chronic heart failure and may increase mortality risk. As primary caregivers, spouses often experience long-term care-giving responsibilities, leading to caregiver burden and reduced sleep quality. The sleep quality of spousal caregivers requires equal attention. There is an interdependence between the sleep health of patients and their spousal caregivers. Depression and the quality of the relationship may play an important role in this, but the mechanisms of the interaction are not yet clear. Therefore, we aimed to explore the correlation between sleep quality in patients with chronic heart failure and their spousal caregivers and the mechanisms by which depression plays a role in the quality of relationship and sleep quality.

A cross-sectional design was conducted from April to November 2023, involving 223 patients with chronic heart failure and spousal caregivers recruited from hospital outpatient clinics or home settings. Data were collected via on-site questionnaires or telephone follow-ups using validated instruments: Demographic questionnaire, Quality of Relationship Index, Hospital Anxiety and Depression Scale, and Pittsburgh Sleep Quality Index. SPSS 26.0 and AMOS 22.0 were employed for data analysis, including common method bias testing, paired samples t-tests, pearson correlations, and actor-partner interdependence mediation modeling.

Strong correlation between sleep quality in patients with chronic heart failure and spousal caregivers (r = 0.361, P < 0.001). Quality of relationship in both patients and spousal caregivers significantly influenced each other's sleep quality (β = -0.267, P < 0.001 for patients; β = -0.122, P < 0.001 for caregivers). Bootstrap analyses revealed that depression in both patients and caregivers partially mediated the relationship between caregivers' quality of relationship and patients' sleep quality (β = -0.091, 95% CI [-0.151, -0.041] for patients; β = -0.052, 95% CI [-0.099, -0.021] for caregivers), confirming partner-mediated effects.

Depression in both patients with chronic heart failure and caregivers are critical factors influencing sleep quality, underscoring the need to prioritize mental health support for chronic heart failure couples. Additionally, the positive impact of quality of relationship on sleep quality highlights the vital role of healthy spousal relationships in home-based healthy management.