Document Type

Journal Article

Date of this Version


Publication Source

European Journal of Cardiovascular Nursing





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Last Page





Background: Persons with heart failure (HF) have significantly lower sleep quantity and quality than persons without HF. The purpose of this article is to propose a conceptual model describing how poor sleep may contribute to inadequate self-care and untoward outcomes in persons with HF.

Aims: Our overarching hypothesis is that sleep affects self-care and outcomes through its effects on cognition. Building on the work of others, we outline a conceptual model that illustrates that even transient sleep disruption prevents sleep-related restorative processes and contributes to cognitive dysfunction—especially in the 25–50% of HF patients with existing cognitive impairment. Poor sleep may be sufficient to impair cognition to a level that interferes with higher order functions involved in effective HF self-care practices. Through these mechanisms, inadequate sleep may contribute to poor outcomes such as low health-related quality of life and greater risk of unplanned hospitalization.

Conclusion: The proposed model (1) bridges physical, neuropsychological and behavioral phenomena, (2) suggests a mechanism by which poor sleep affects daytime behavior, and (3) is empirically testable. Exploring factors that interfere with sleep may improve self-care and outcomes in persons with HF.

Copyright/Permission Statement

The final, definitive version of this article has been published in the Journal, European Journal of Cardiovascular Nursing, 2009, 8: 337-344, © SAGE Publications, Inc., 2009 by SAGE Publications, Inc. at 10.1016/j.ejcnurse.2009.06.003.


self-care, self-management, patient compliance, cognition disorders, sleep disorders, aging, theory



Date Posted: 01 June 2016

This document has been peer reviewed.