Ecological Momentary Assessment of Sleep Quality, Daytime Fatigue, and Outcomes in Cardiopulmonary Rehabilitation Patients
Midgette, Emily Paige
Background: Sleep-related difficulties are common among patients with cardiovascular and pulmonary diseases. Positive effects of cardiopulmonary rehabilitation (CVPR) programs on health outcomes have been found. Despite this, participation rates in CVPR programs remain suboptimal. Previous research suggests that CVPR may improve sleep quality and daytime fatigue; however, few studies have examined the association between specific sleep parameters and CVPR participation and outcomes. Ecological momentary assessment (EMA) may provide a unique context for patient adherence to CVPR programming, and may offer a better understanding of how daily changes in sleep patterns may affect CVPR outcomes. Purpose: The current research seeks to explore the potential impact of specific sleep parameters (subjective sleep quality, sleep duration, sleep latency, sleep disturbances, restfulness, daytime fatigue) on patient engagement and CVPR outcomes. Using an EMA paradigm to examine daily sleep patterns, the association between specific sleep parameters and CVPR participation can be more fully understood. Methods: The sample for this study consisted of 50 patients at a local CVPR center. Patients were first asked to complete a set of questionnaires assessing subjective sleep quality, fatigue, OSA status, and depression. Then, participants were introduced to a mobile EMA application with which they would track their daily sleep patterns and daytime fatigue over the course of two weeks. The number of sessions, completion status, and health outcomes (change in 6MWT, BMI, BP) were recorded after they finished the program.Results: Findings from this study suggested that there was a significant momentary association between subjective sleep quality, feelings of restfulness (B=-0.12, t=-0.03, p=.000), and daytime fatigue (B=-0.10, t=-0.03, p=.000). Furthermore, we found that poorer sleep quality (PSQI) at baseline was predictive for poorer perceived restfulness across two weeks (B=-0.02, t=0.01, p=.048). Similarly, we found that higher reported daytime fatigue (CFS) at baseline was predictive of restfulness (B=-0.05, t=0.02, p=.021), as well as perceived fatigue (B=-0.07, t=0.42, p=.003) and number of sleep disturbances at the momentary level (B=-0.03, t=0.01, p=.015). Symptoms of depression (B=-0.79, t=0.06, p=.000) and OSA (B=-0.49, t=0.04, p=.000) were also strong predictors for daytime fatigue. Results from this study did not suggest that there was a significant association between daily sleep patterns and number of sessions attended, completion status, or health outcomes. However, we did observe a statistically significant association between daily self-reported sleep duration and change in systolic (b=7.32, p=.047) and diastolic blood pressure (b=5.31, p=.026) from baseline to program completion.Discussion: Overall, the results from this study support the idea that EMA reports of sleep quality from the previous night's sleep are associated with restfulness and fatigue later in the day. This suggests that whether a CVPR patient rate themselves as being a good or poor-quality sleeper may be influenced by daytime sleep parameters. However, none of the momentary sleep predictors were associated with the number of sessions attended or completion status. Similarly, few of the momentary sleep predictors were associated with specific health outcomes. While methodological limitations must be considered, it appears as though daily fluctuations in specific sleep parameters are associated with common difficulties noted by CVPR patients. More research in this area is needed to fully examine whether sleep difficulties may influence CVPR engagement and completion, and to design interventions aimed toward improving daytime functioning may also improve patient's subjective evaluation of sleep quality.
Midgette, Emily Paige. (October 2020). Ecological Momentary Assessment of Sleep Quality, Daytime Fatigue, and Outcomes in Cardiopulmonary Rehabilitation Patients (Master's Thesis, East Carolina University). Retrieved from the Scholarship. (http://hdl.handle.net/10342/8819.)
Midgette, Emily Paige. Ecological Momentary Assessment of Sleep Quality, Daytime Fatigue, and Outcomes in Cardiopulmonary Rehabilitation Patients. Master's Thesis. East Carolina University, October 2020. The Scholarship. http://hdl.handle.net/10342/8819. December 08, 2023.
Midgette, Emily Paige, “Ecological Momentary Assessment of Sleep Quality, Daytime Fatigue, and Outcomes in Cardiopulmonary Rehabilitation Patients” (Master's Thesis., East Carolina University, October 2020).
Midgette, Emily Paige. Ecological Momentary Assessment of Sleep Quality, Daytime Fatigue, and Outcomes in Cardiopulmonary Rehabilitation Patients [Master's Thesis]. Greenville, NC: East Carolina University; October 2020.
East Carolina University