Trajectories of Insomnia Symptoms in Patients with Heart Failure: A Longitudinal Analysis

Abstract Aim To describe trajectories of insomnia symptoms over 12 months in patients with heart failure (HF) and to identify characteristics associated with persistent, fluctuating, or low/no insomnia. Methods and Results This secondary analysis used data from the HF-Wii randomized trial, including 400 patients from 10 centers in six countries (Sweden, Italy, Israel, the Netherlands, Germany, USA). Insomnia was assessed at baseline, 3, 6, and 12 months using the Minimal Insomnia Symptom Scale. Patients were grouped into insomnia trajectories (persistent, fluctuating, low/no insomnia). Depression and anxiety were measured with the Hospital Anxiety and Depression Scale, well-being with Cantril’s Ladder, quality of life with the Minnesota Living with Heart Failure Questionnaire, comorbidity burden with the Charlson Comorbidity Index, and functional capacity with the 6-minute walk test. Group differences were examined with ANOVA and chi-square tests; variables with p ≤ 0.05 were entered into multivariate logistic regression. Associations were examined with ANOVA, chi-square, and multivariable logistic regression. At baseline, 126 patients (32%) reported insomnia: 51 (40%) had persistent, 48 (38%) fluctuating, and 27 (21%) recovered. Among 274 without baseline insomnia, 25 (9%) developed insomnia at 2–3 follow-ups and 36 (13%) at one time point. Persistent insomnia was independently associated with higher anxiety (OR = 2.73; p 0.001) and lower functional capacity (OR = 0.50; p 0.005). Conclusion A substantial proportion of HF patients experience persistent or fluctuating insomnia. Routine assessment—particularly in those with anxiety or low functional capacity—may aid early detection and guide targeted interventions.