THE ASSOCIATION BETWEEN SLEEP QUALITY AND ARRHYTHMIA SYMPTOMS IN PATIENTS WITH ATRIAL FIBRILLATION IN LEBANON

Abstract

Background: Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia globally causing a major burden on many quality of life determinants, including sleep quality. Although there is extensive evidence showing reduced sleep quality among AF patients, there are limited data on the predictors of poor sleep among this population, and how specific AF symptoms correlate with poor sleep quality. Aims: This study aimed to describe sleep quality in a sample of AF patients in Lebanon, examine the associations between sleep quality and the number and bothersomeness of specific AF symptoms, and determine the predictors of reduced sleep quality among these patients. Method: This was a cross-sectional descriptive/correlational study conducted at the cardiology clinics of the AUB Medical Center. One hundred and forty-four AF patients were recruited, assessed for their heart rhythm, and asked about their sleep quality and AF symptoms through individual interviews, using the Pittsburgh Sleep Quality Index (PSQI) and Patient’s Perspective of Arrhythmia Questionnaire (PPAQ). Clinical data were retrieved from the medical records. Statistical Analysis: Descriptive analyses were conducted to describe the sample demographics, sleep quality, and other characteristics. Pearson r correlation tests were run to determine associations between AF symptoms (frequency/bothersomeness) and sleep quality. In addition, t tests and ANOVA were conducted to measure the association between the sleep quality index, demographic and clinical variables. Multivariate linear regression analyses were conducted to determine the predictors of sleep quality among AF patients. Results: The majority of the sample suffered from poor sleep quality (91%). The most prevalent AF symptoms were fatigue, dyspnea, heart flutter and headache whereas the most bothersome symptoms were fatigue, chest pressure and dizziness. Most symptoms and their bothersomeness were significantly associated with sleep quality. The number of AF symptoms, bothersomeness of symptoms, intake of caffeine before bedtime, and history of COPD were independent predictors of poor sleep quality. Conclusions: Health care professionals need to manage the symptoms of AF patients and regularly assess their quality of sleep. Education to avoid caffeine intake late in the day is also recommended. Future studies are needed to test the effect of symptom management interventions on sleep quality in AF patients.