Sleep, Cognition, Psychological Symptoms, and Health-Related Quality of Life Among Heart Transplant and Left Ventricular Assist Device Recipients

Abstract

Heart failure (HF) is a chronic, progressive condition affecting an estimated 6.7 million Americans over age of 20. For individuals with advanced HF, treatment options such as heart transplantation (HTx) and left ventricular assist devices (LVADs) can significantly improve survival and health-related quality of life (HRQOL). Despite these interventions, many individuals continue to face persistent physiological and psychological challenges, including sleep disturbances, cognitive impairments, and psychological symptoms, which may hinder recovery and adversely affect overall well-being and HRQOL. The overarching purpose of this dissertation is to examine changes in sleep, cognition, psychological symptoms, and HRQOL from hospital discharge to 3 months post-discharge, and to explore interrelationships among these health outcomes in individuals who have received a LVAD or HTx. Specifically, the aims of this dissertation are to: 1) Conduct a comprehensive literature review on neurocognitive changes associated with HF, 2) Describe changes in objective and subjective sleep quality, cognition, psychological symptoms, and HRQOL from hospital discharge to 3 months post-discharge following a LVAD implant or HTx, 2) examine relationships between changes in sleep and changes in cognitive function, psychological symptoms, and HRQOL, and 3) Explore patient experiences, challenges, and perspectives on changes in sleep quality and its perceived impact on cognition, psychological wellbeing, and HRQOL during the initial 3 months post-discharge after LVAD or HTx. By characterizing these outcomes and their interconnections, this study provides novel insights into post-operative recovery in both LVAD and HTx recipients. The findings highlight critical gaps in current understanding, underscore the need for further research, and offer preliminary evidence to guide the design of future large-scale, multicenter studies. This work lays a foundation for improving care strategies and supporting multidimensional recovery in these growing patient populations.