Sleep and Breathing

, Volume 9, Issue 3, pp 127–133 | Cite as

Sleep symptoms and clinical markers of illness in patients with heart failure

  • Karem Príncipe-Rodríguez
  • Kingman P. Strohl
  • Selma Hadziefendic
  • Ileana L. Piña
Original Article


The purpose of this study was to survey patients with heart failure (HF) for sleep symptoms using a standardized questionnaire and correlate symptoms with conventional markers of clinical status. A self-report paper questionnaire was offered to patients presenting to a tertiary care HF clinic. Symptoms were grouped according to “risk” categories and correlated with routine clinical information. One hundred six (52.7% of 201 with all data) respondents had a high pretest probability for sleep apnea syndrome. Sixty three (31.3%) reported symptoms suggesting the presence of chronic insomnia; seven (3.5%) and eight (4%) reported symptoms of narcolepsy and restless legs syndrome, respectively. High-risk respondents for sleep apnea had a higher body mass index (p<0.001), were younger (p<0.05), and had a higher ejection fraction (p<0.05). The odds ratio (confidence interval) for paroxysmal nocturnal dyspnea (PND) to a complaint of sleepiness was 1.99 (1.1–3.6) and to a complaint of insomnia was 3.5 (1.8–6.5). In men, complaints of sleepiness in patients with PND were correlated, 4.47 (1.9–10.3), as was a correlation to high pretest probability for sleep apnea, 2.47 (1.1–5.5). There were no correlation of New York Heart Association status classification to high risk for sleep apnea, but a complaint of insomnia tended to occur with worsening functional status (p<0.05). There was only modest correlation of self-reported symptoms as elicited by a questionnaire and risk for sleep disorders with common clinical assessments for HF. Such collection of symptoms might be useful in establishing guidelines for routine sleep testing or as an adjunct to clinical trials.


Heart failure Sleep apnea Insomnia Paroxysmal nocturnal dyspnea 



Dr. Príncipe-Rodríguez held a position in the NIH Institutional Training Grant (T2HL07913). Dr. Strohl held a Sleep Academic Award KO7 HL03650 and a VA Merit Award. The Cleveland Sleep Habits Questionnaire is held in copyright by iONSLEEP, LLC (Shaker Heights, OH) and is freely available for use in academic or research settings.


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Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Karem Príncipe-Rodríguez
    • 1
  • Kingman P. Strohl
    • 1
  • Selma Hadziefendic
    • 2
  • Ileana L. Piña
    • 2
    • 3
  1. 1.Department of MedicineLouis Stokes VA Medical CenterClevelandUSA
  2. 2.Department of Medicine Section Heart Failure/Transplantation, University Hospital of ClevelandCase Western Reserve UniversityClevelandUSA
  3. 3.University Hospital of ClevelandClevelandUSA

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