ABSTRACT

Objective

Examine the bidirectional relationships between within-person day-to-day fluctuations in physical activity (PA) and sleep characteristics among people with heart failure (HF) and insomnia.

Participants

Ninety-seven community-dwelling adults [median age 61.9 (interquartile range 55.3,70.9) years, female 41%] with stable HF and insomnia (insomnia severity index >7).

Methods

This sub-study longitudinally analyzed 15 consecutive days and nights of wrist actigraphy recordings, that were collected for baseline data prior to participation in a randomized controlled trial of cognitive behavioral therapy for insomnia. We used two-level mixed models of within- (daily) and between-participants variation to predict daytime PA counts/minutes from sleep variables (total sleep time, sleep efficiency) and predict sleep variables from PA.

Results

PA counts/minutes were low compared to prior cohorts that did not have HF (209 (166,259)) and negatively associated with NYHA class (standardized coefficient β_s = −0.14, p < .01), age (β_s = −0.13, p = .01), comorbidities (β_s = −0.19, p < .01), and body mass index (β_s = −0.12, p = .04). After adjustment for all significant covariates, the within-participant association of total sleep time with next-day PA was estimated to be positive among participants with NYHA class II–IV HF (β_s = 0.09, p = .01), while the within-participant association of PA with same-night total sleep time was estimated to be positive among participants aged ≥60 years (β_s = 0.10, p = .03).

Conclusions

Depending upon age and HF class, daytime PA was associated with longer same-night sleep and/or longer sleep was associated with greater next-day PA. Among those with more advanced HF, realistic sleep improvements were associated with clinically meaningful PA gains the next day.

中文翻译：

---

心力衰竭和失眠患者体力活动与睡眠特征的日常关系

摘要

客观的

检查心力衰竭 (HF) 和失眠患者的身体活动 (PA) 日常波动与睡眠特征之间的双向关系。

参与者

97 名社区成人 [中位年龄 61.9（四分位距 55.3,70.9）岁，女性 41%] 患有稳定的心衰和失眠（失眠严重程度指数 >7）。

方法

该子研究纵向分析了连续 15 天和晚上的手腕活动记录，这些记录是在参与失眠症认知行为疗法的随机对照试验之前收集的基线数据。我们使用参与者内部（每日）和参与者之间变化的两级混合模型来预测来自睡眠变量（总睡眠时间、睡眠效率）的白天 PA 计数/分钟，并预测来自 PA 的睡眠变量。

结果

与没有 HF (209 (166,259)) 且与 NYHA 等级负相关（标准化系数 β _s  = -0.14，p < .01）、年龄（β _s  = -0.13，p = .01)、合并症 (β _s  = -0.19, p < .01) 和体重指数 (β _s  = -0.12, p = .04)。在对所有显着协变量进行调整后，在 NYHA II-IV 级心力衰竭的参与者中，总睡眠时间与次日 PA 的参与者内关联估计为正（β _s  = 0.09，p= .01），而在 ≥ 60 岁的参与者中，参与者内 PA 与当晚总睡眠时间的关联估计为阳性（β _s  = 0.10，p = .03）。

结论

根据年龄和 HF 等级，白天 PA 与更长的当晚睡眠相关和/或更长的睡眠与更大的次日 PA 相关。在更严重的 HF 患者中，现实的睡眠改善与第二天具有临床意义的 PA 增益相关。