The Association of Sleep Quality With Anorexia in Patients With Heart Failure: Do Anxiety and Depressive Symptoms Mediate This Association

J Cardiovasc Nurs. 2025 Aug 13. doi: 10.1097/JCN.0000000000001248. Online ahead of print.

ABSTRACT

BACKGROUND: Sleep problems and anorexia problems are common in patients with heart failure (HF). The relationship between sleep quality and anorexia has not been previously investigated among patients with HF.

OBJECTIVE: In this study, our aim was to determine whether the association of sleep quality with anorexia was mediated by anxiety and depressive symptoms in patients with HF.

METHODS: A cross-sectional survey was conducted using a paper-based questionnaire between January 1 and March 30, 2024. Data collection included 3 components: demographic and clinical characteristics, and standardized psychological assessments, including the Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale, and Functional Assessment of Anorexia/Cachexia Therapy-Anorexia Cachexia Subscale. Partial correlation analysis was performed using SPSS, and mediation analysis was conducted with the PROCESS macro.

RESULTS: The mean PSQI score was 7.69 (±4.13), and the mean scores for anxiety and depressive symptoms were 9.42 (±4.56) and 9.71 (±4.67), respectively. The mean Functional Assessment of Anorexia/Cachexia Therapy-Anorexia Cachexia Subscale score was 24.56 (±5.62), with a significant proportion of participants exhibiting anorexic behaviors. Correlation analysis revealed significant associations between sleep quality, anxiety, depressive symptoms, and anorexia. Mediation analysis demonstrated that anxiety and depressive symptoms significantly mediated the relationship between sleep quality and anorexia, with anxiety accounting for 43.61% of the total indirect effect.

CONCLUSIONS: Poor sleep quality is prevalent among patients with HF and is significantly associated with anxiety, depressive symptoms, and anorexia. Anxiety and depressive symptoms mediate the impact of poor sleep quality on anorexia, with anxiety symptoms exerting a stronger effect. Addressing sleep disturbances and psychological distress may help mitigate anorexia and improve clinical outcomes in patients with HF.

PMID:40801828 | DOI:10.1097/JCN.0000000000001248