Sleep-related predictors of quality of life in the elderly versus younger heart failure patients: a questionnaire survey.

BACKGROUND: Research has indicated that sleep disorders reduce the quality of life of heart failure patients. OBJECTIVES: To investigate quality of sleep, and the impact of poor sleep on quality of life among elderly versus younger heart failure patients. DESIGN: A two-group, cross-sectional study. SETTING: A community teaching hospital in Taipei, Taiwan. PARTICIPANTS: Voluntarily self-enrolled heart failure patients who did not have sleep apnea or restless leg syndrome. METHODS: There were 126 elderly and 67 young participants filled out five questionnaires (1) demographic information and current health status; (2) the Chinese Pittsburgh Sleep Quality Index; (3) the Chinese Epworth Sleepiness Scale, and (4) the short form (SF)-36 Taiwanese version. The major statistical procedures applied in this study were t-test, analysis of variance, Pearson's correlation, and a stepwise multiple linear regression. A p-value of <0.05 was adopted as significant. RESULTS: The prevalence of insomnia was 44.4% for the elderly group and 31.4% for the younger group. The top three prevalence sleep-disturbing events were: nocturia, long sleep latency, and early wake-up. In the elderly group, nocturnal dyspnea and long sleep latency were significant determinants of the mental (R(2)=0.23) and physical components (R(2)=0.21) of quality of life. In the young group, nocturnal dyspnea was a significant determinant of the mental component of quality of life (R(2)=0.15), and early wake-up was a significant determinant of the physical component of quality of life (R(2)=0.15). CONCLUSION: The sleep disorder of heart failure patients is disease-specific rather than a matter of age. The prevalence of insomnia of young heart failure patients was higher than that of the healthy elderly. The major determinants of poor night sleep quality in the elderly group were dyspnea and long sleep latency, and in the younger group, these were dyspnea and early wake-up. Those also were significant determinants of quality of life of the heart failure patients. IMPLICATIONS FOR NURSING PRACTICE: Since the sleep-related predictors of quality of life were different in the elderly versus younger heart failure patients, to identify the insomnia factors individually and to provide guidance of appropriate usage of sleep medications and other methods to promote sleep should be considered.

The effectiveness of intradialytic leg ergometry exercise for improving sedentary life style and fatigue among patients with chronic kidney disease: a randomized clinical trial.

BACKGROUND: Over the past three decades, research has been carried out on the effects of exercise on chronic kidney disease patients for improving their physical potential. OBJECTIVES: The purpose of this study is to evaluate the effect of intradialytic leg ergometry exercise for improving fatigue and daily physical activity levels among chronic kidney disease patients. DESIGN: A quasi-experimental clinical trial. SETTING: Two hemodialysis units in a medical center in northern Taiwan. METHOD: The leg ergometry exercise was performed within the first hour of each hemodialysis session for 30 min for 8 weeks. There were 36 subjects in the experimental group and 35 subjects in the control group who completed the study. Measurement on a fatigue scale and a physical activity log were done at the time of enrollment, and again on the fourth and eighth weeks. RESULT: Active subjects demonstrated significantly less fatigue and higher physical activity levels than those with a sedentary lifestyle at baseline. During the 8 weeks of intervention, subjects in both the active and sedentary groups reduced their fatigue levels significantly, with the exception of sedentary subjects in the control group. Only active subjects in the experimental group demonstrated an increase in activity levels. The 36 subjects performed 3456 leg ergometry exercise sessions with three early terminations (<.01%) among the sedentary subjects. CONCLUSIONS: Intradialytic leg ergometry is a safe exercise that is effective to reduce fatigue and improve physical fitness in already active chronic kidney disease patients and it also reduces fatigue in sedentary patients. Interventions to motivate sedentary patients to become active require further investigation. IMPLICATION FOR NURSING PRACTICE: Exercise during hemodialysis does not cost patients extra time and is effective in reducing fatigue and increasing physical activity potential as demonstrated by our study; 30 min of intradialytic leg ergometer exercise can be considered as routine care while delivering hemodialysis.