Abstract Body (Do not enter title and authors here): Background: Sleep disturbances are prevalent in individuals with cardiovascular disease (CVD) and can have a substantially negative impact on daily functioning (e.g., reading, working, driving, and decision-making), also known as sleep-related functional outcomes. However, the relative contribution of demographic and clinical factors, cognitive function, health literacy, and depressive symptoms on sleep-related functional outcomes remains poorly understood.
Objective: To examine the influence of demographic and clinical factors, cognitive function, health literacy, and level of depressive symptoms on sleep-related functional outcomes in depressed rural patients with CVD.
Methods: We conducted secondary analyses using data from a large longitudinal randomized controlled trial and developed a hierarchical multiple linear regression model in depressed rural patients with CVD (N = 257; mean age 57±13; 47% women). Predictors of sleep-related functional outcomes were entered in five blocks, 1) demographic (age, sex, marital status, financial status), 2) New York Heart Association (NYHA) functional class, 3) cognitive function (Montreal Cognitive Assessment), 4) health literacy (Newest Vital Sign), and 5) depressive symptoms, (Patient Health Questionnaire-9). Sleep-related functional outcomes were measured using the Functional Outcome of Sleep Questionnaire-10 (FOSQ-10).
Results: The final model significantly predicted sleep-related functional outcome (R² = 0.135, adjusted R² = 0.108, p < .001). Among all predictors, only depressive symptoms were independently associated with sleep-related functional outcomes (B = -0.363, p < .001), indicating that greater depressive symptom burden was independently associated with worse sleep-related functioning. Demographic characteristics, NYHA class, cognitive scores, and health literacy were not significant predictors in the final model.
Conclusion: Depressive symptoms were the strongest and only significant predictors of sleep-related functional outcomes in rural depressed patients with CVD. These findings underscore the importance of integrating routine mental health screening and intervention, particularly for depressive symptoms, into cardiovascular care to address sleep-related functional outcomes.