0381 Cognitive Impairment Mediates The Relationship between Insomnia and Emotional Wellbeing among Patients with Stable Heart Failure

Cognitive impairment is common among patients with heart failure (HF) and interferes with self-care and function. Sleep disturbance may contribute to cognitive impairment. The purpose of this study was to examine: 1) the associations between cognitive function self-care, sleep characteristics and other symptoms and 2) the extent to which cognitive impairment mediates the relationship between insomnia and emotional wellbeing among patients with stable HF. We performed cross-sectional analysis with baseline data from an ongoing randomized controlled trial of cognitive behavioral therapy for insomnia (CBT-I) among patients with stable HF who had at least mild insomnia [(score > 7 on the Insomnia Severity Index (ISI)], were aged ≥ 18, and had none-mild or treated sleep disordered breathing. We measured cognitive function and symptoms [Patient-Reported Outcomes Measurement Information System scales (PROMIS®); Self-care [Self-Care of Heart Failure Index (SCHFI)], insomnia severity (ISI), sleep quality (Pittsburgh Sleep Quality Index-PSQI), excessive daytime sleepiness (Epworth Sleepiness Scale-ESS), and bodily pain and emotional wellbeing (SF36). Cross-sectional correlations were examined at a 5% significance and the mediation effect of cognitive impairment was estimated using bootstrap sampling with 3,000 repeats. The sample included 77 HF patients [M age=60.63(12.51) years; n=44(57.14%) male; n=51(63%) white]. Cognitive function was negatively associated with self-care maintenance (r=0 .27, p=.0171) and negatively associated with severity of anxiety, depression, and fatigue (r<-0.43, p<.0001). Insomnia severity (r=-0.28, p=.0144) and poor sleep quality (r=- 0.37, p=.0020) were negatively associated with cognitive ability. The estimated mediation effect (-0.33, 95%CI=[-0.75, 0.01]) showed that cognitive impairment mediated the effects of insomnia severity on emotional wellbeing while the direct effect of insomnia (-0.48, 95%CI=[-1.18, 0.13]) showed weak association without cognitive impairment. Cognitive impairment is substantively associated with insomnia severity, poor sleep and other symptoms, and may contribute to self-care maintenance in HF patients. CBT-I for insomnia may increase cognitive performance by improving insomnia and, in turn, may improve emotional wellbeing. N/A