How do sleep difficulties interact with anxiety, depression and health‐related quality of life in pulmonary hypertension?

Sleeping difficulties are prevalent among adults with pulmonary hypertension (PH), with most individuals studied to date reporting poor sleep. However, research investigating the impact of sleep on psychological distress and health-related quality of life (HRQoL) in PH remains limited. This study aimed to identify the nature of common sleep difficulties in PH and the associated psychosocial impact using multiple self-reported measures. A cross-sectional survey was conducted with 111 adults with PH recruited from PH associations globally. Most identified as White (91%) and female (82%). Participants completed measures of overall sleep quality (Pittsburgh Sleep Quality Index), insomnia (Insomnia Severity Scale), daytime sleepiness (Epworth Sleepiness Scale), anxiety (Generalised Anxiety Disorder-7), depression (Patient Health Questionnaire-9) and HRQoL (emPHasis-10). Regression analyses were used to inspect relationships between measures and other PH variables. A total of 79.8% of participants were identified as having poor sleep quality. The most prevalent sleep-related difficulties were sleep disturbance and sleep latency issues. Insomnia and daytime sleepiness rates were also elevated (35% and 33.6%, respectively) and often co-occurred. In addition, 40% and 29% of participants had clinical levels of depression and anxiety, respectively. All types of sleep difficulties were associated with lower HRQoL. A series of parallel mediation analyses suggested that this association was partially mediated by depressive symptoms. The findings indicate the need to routinely screen for both sleep difficulties and mood disturbance in this population. Further work is needed to understand whether existing brief sleep interventions are effective for use in PH, where multiple factors are influencing sleep quality.