Excessive Daytime Sleepiness Contributes to Medication Nonadherence

Chicago—Community-dwelling adults with heart failure (HF) often forget to take their HF medications due to excessive daytime sleepiness, according to a study reported at a poster session during the AHA meeting. “There are many reasons for excessive daytime sleepiness, and the major problem related to this seems to be forgetting to take medicines at the designated time,” said lead author of the poster, Barbara Riegel, RN, University of Pennsylvania, Philadelphia. Medication adherence was measured by a questionnaire during 1-to-1 interviews. Respondents answered questions about the previous month regarding memory of taking drugs, skipping drugs, taking them at different time intervals than those prescribed, and reducing the amount of medications. Domains of cognition assessed included simple attention, complex attention, working memory, processing speed, and short-term memory. The study enrolled 278 adults with chronic HF. Patients had sufficient visual acuity for reading, sufficient hearing for mutual conversation, and were literate. Sixty-three percent of the sample were Caucasian, 64% were male, mean age was 62 years, 54% had some college education, and about 50% had sufficient income “to make ends meet.” Sixty-nine percent had systolic HF, 59% were functionally compromised (chronic New York Heart Association Class III), and mean duration of HF was 6.1 years. Some of the reasons for sleepiness included apnea, the number of drugs a patient was taking (polypharmacy), and nocturia (frequent awakening during night). Adherence to HF medications was about 50% in patients with no excessive daytime sleepiness with or without mild cognitive impairment. Looking at patients with excessive daytime sleepiness and cognitive impairment, adherence to HF medication was reported in 31.7% and nonadherence in 68.3%. For patients with excessive daytime sleepiness and no evidence of mild cognitive impairment, only 26.3% were adherent and 73.7% were nonadherent. In regression analysis, excessive daytime sleepiness was a significant determinant of medication adherence (P=.001; odds ratio, 0.899), but cognitive impairment was not (P=.75). Ms. Riegel said that adherence to prescribed HF medications could improve sleep. She and her coinvestigators noted that patients taking diuretics were less sleepy, although urination is more frequent with diuretics. Anxiety about health contributes to sleepiness as well. She noted that “adults with HF who have some degree of excessive daytime sleepiness are more likely to have problems adhering to their medication regimen than those without excessive daytime sleepiness, regardless of their cognitive status. Simply helping patients sleep better may improve medication adherence.” “Physical activity, no matter what stage of HF, helps reduce anxiety and worries about health, as well as nocturia. Patients who have HF should be as physically active as possible,” she added.