Exploring gender moderation effect on the association between sleep disturbance and quality of life in stable outpatients with heart failure

Abstract Background Sleep disturbance is a common symptom in patients with heart failure and a critical factor that impacts health outcomes, including quality of life. However, little is known about whether gender moderates the association between sleep disturbance and quality of life. The specific aims were to compare levels of sleep disturbance and quality of life between men and women and to determine whether gender moderates the association between sleep disturbance and quality of life in stable outpatients with heart failure. Methods In this secondary analysis, 718 stable outpatients with heart failure completed the survey. Sleep disturbance was assessed using a single item from the Patient Health Questionnaire: Over the last two weeks, how often have you been bothered by trouble falling or staying asleep or sleeping too much? Responses were recorded on a 4-point Likert scale: not at all, several days, more than half the days, and nearly every day. Quality of life was evaluated using the Minnesota Living with Heart Failure. An independent t-test and Chi-square test were used to examine the differences in sleep disturbance and quality of life based on gender. One-way ANOVA was used to examine the association between sleep disturbance and quality of life. A moderation analysis was conducted using the SPSS PROCESS macro program (Model 1), controlling for age, financial status, and living arrangement (living alone or with someone). Results Of 718 patients (66% male, mean aga = 60.6 years, 25% financially comfortable, and 79% lived with someone), 18.8% of patients reported sleep disturbance nearly every day, 17.5% more than half the days, 24.2% several days, and 39.4% not at all during the past two weeks. Women reported a worse quality of life than men (45.9 vs. 42.4, p = 0.039, respectively). Additionally, a low percentage of women reported no sleep disturbance compared to men (31.8% vs 43.3%, p =0.025). There was a significant difference in mean scores of the quality of life by the level of sleep disturbance (P . 001). Patients who reported sleep disturbance nearly every day had the highest mean quality of life score (M=60), indicating the worst quality of life (Figure 1). Notably, the moderation analysis reveals that the association between sleep disturbance and quality of life differs according to gender (interaction effect P = 0.044). As shown in Figure 2, men who reported no sleep disturbance and several days quality of life had better quality of life than women. In comparison, women who reported more than half the days and nearly every day had a better quality of life than men. Conclusion Despite the limitations of using a single-item measure for sleep disturbance, sleep disturbance was a significant factor impacting quality of life in stable patients with heart failure. To address the moderating effect of gender, further research is needed to explore whether biological or psychological factors contributed to these differences.Comparison of quality of life by sleep Moderation effect of gender