Irregular Sleep Linked to Higher Risk of ER Visits in Heart Failure Patients

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For people with heart failure, having a regular sleep routine may help lower the risk of hospital visits or other serious events after being discharged, according to research published in JACC: Advances.

“Going to bed and waking up at consistent times is important for overall health,” said lead investigator Brooke Shafer, Ph.D., a research assistant professor in the Sleep, Chronobiology and Health Laboratory in the Oregon Health & Science University School of Nursing. “Our study suggests that consistency in sleep timing may be especially important for adults with heart failure.”

The study looked at how sleep patterns affect health outcomes for people living with heart failure — the leading cause of repeated hospitalizations among older adults. Investigators wanted to know whether having a consistent sleep routine — going to bed and waking up around the same times each day — makes a difference in recovery and future health events after a hospital stay.

The investigators used the Sleep Regularity Index (SRI) to measure how consistent people’s sleep and wake times were. Regular sleepers had an SRI score above 87%, while moderately irregular sleepers had an SRI score of 87% or below. The team then followed participants for six months after their hospitalization to see if they had another emergency room visit, a hospital stay or death.

A total of 32 participants who had been hospitalized for worsening heart failure were recruited into the study. The average age of patients was 63 years, most (75%) were White, and most were living with additional conditions such as Type 2 diabetes, kidney disease or sleep apnea. Just over half had a type of heart failure called heart failure with reduced ejection fraction (weaker pumping function of the heart).

Key findings

• Most patients (21 out of 32) had another health event within six months.
• People with irregular sleep schedules were more likely to have these events and experienced them sooner (about 26 days on average versus 35 days for regular sleepers).
• Even after accounting for other health risks (like heart failure severity, other medical conditions and sleep apnea), irregular sleepers had about 3.7 times higher risk of another health event.
• Importantly, the total amount of sleep and bedtime were not very different between the two groups. It was the consistency of sleep, not how long people slept, that seemed to matter most.

“When we’re asleep and in a resting state, our blood pressure and heart rate decrease compared with daytime levels,” Shafer said. “But variability in sleep timing may disrupt mechanisms involved in the regulation of the cardiovascular system. Irregular sleep may contribute to adverse outcomes, especially for people already affected by heart failure.”

While the study was small, it suggests that sleep timing could play an important role in managing heart failure alongside medications and lifestyle changes.

Investigators noted a few limitations, including the difficulty accounting for all possible influencing factors — such as whether participants were being treated for sleep apnea — due to the small number of participants. The findings also need to be confirmed in larger, more diverse groups of patients to make sure they apply widely. They mentioned that future studies will help clarify how regular sleep patterns affect heart failure outcomes and whether improving sleep regularity could eventually lead to new treatment recommendations.

“Improving sleep regularity may be a low-cost therapeutic approach to mitigate adverse events in adults with heart failure,” investigators concluded.