Day-to-day Relationships between Physical Activity and Sleep Characteristics among People with Heart Failure and Insomnia

ABSTRACT

Objective

Examine the bidirectional relationships between within-person day-to-day fluctuations in physical activity (PA) and sleep characteristics among people with heart failure (HF) and insomnia.

Participants

Ninety-seven community-dwelling adults [median age 61.9 (interquartile range 55.3,70.9) years, female 41%] with stable HF and insomnia (insomnia severity index >7).

Methods

This sub-study longitudinally analyzed 15 consecutive days and nights of wrist actigraphy recordings, that were collected for baseline data prior to participation in a randomized controlled trial of cognitive behavioral therapy for insomnia. We used two-level mixed models of within- (daily) and between-participants variation to predict daytime PA counts/minutes from sleep variables (total sleep time, sleep efficiency) and predict sleep variables from PA.

Results

PA counts/minutes were low compared to prior cohorts that did not have HF (209 (166,259)) and negatively associated with NYHA class (standardized coefficient β_s = −0.14, p < .01), age (β_s = −0.13, p = .01), comorbidities (β_s = −0.19, p < .01), and body mass index (β_s = −0.12, p = .04). After adjustment for all significant covariates, the within-participant association of total sleep time with next-day PA was estimated to be positive among participants with NYHA class II–IV HF (β_s = 0.09, p = .01), while the within-participant association of PA with same-night total sleep time was estimated to be positive among participants aged ≥60 years (β_s = 0.10, p = .03).

Conclusions

Depending upon age and HF class, daytime PA was associated with longer same-night sleep and/or longer sleep was associated with greater next-day PA. Among those with more advanced HF, realistic sleep improvements were associated with clinically meaningful PA gains the next day.

Acknowledgments

We thank the investigators and staff of the parent study that provided these data: James W. Darden IV, Jessica Kelly-Hauser, Beeba Mathew, Patrick A. Richardson, Edward C. Gaiser, Eileen Condon, Laura Andrews, Lisa Finoia, and Joanne Iennaco.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability

Data sharing is not applicable to this article as no new data were created or analyzed in this sub-study. The data from the parent study are pending publication.

Additional information

Funding

This work was supported by the National Institute of Nursing Research [R01NR016191] and the Yale Center for Sleep Disturbance in Acute and Chronic Conditions [P20NR014126]. GA was supported by a fellowship from the Office of Academic Affiliations at the United States Veterans Health Administration.