Can Sodium-Glucose Co-Transporter-2 Inhibitors Improve Sleep Quality, Anxiety, and Quality of Life in Patients With Heart Failure?

Abstract

Background: Sodium-glucose co-transporter-2 (SGLT2) inhibitors improve cardiovascular outcomes in heart failure (HF), but their effect on sleep quality (SQ) and patient-centered outcomes remains unclear. Objective: This study aims to evaluate the impact of SGLT2 inhibitor use on SQ, anxiety, and quality of life in patients with HF. Methods: This longitudinal observational study included 95 HF patients grouped by SGLT2 inhibitor use. A total of 79 patients (SGLT2 inhibitor group: 33; non-SGLT2 inhibitor group: 46) completed a 6-month follow-up. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), anxiety with the Beck Anxiety Inventory (BAI), and quality of life with the Short Form-36 (SF-36). Subgroup analyses were conducted based on left ventricular ejection fraction (LVEF), and logistic regression was used to identify predictors of PSQI improvement. Results: At baseline, PSQI scores were slightly better in the SGLT2 inhibitor group (p = 0.036), while BAI and SF-36 scores were similar. At follow-up, the SGLT2 inhibitor group showed significant improvements in PSQI (p < 0.001) and BAI (p = 0.002), whereas no significant changes were observed in the non-SGLT2 inhibitor group for either PSQI (p = 0.698) or BAI (p = 0.373). PSQI improvement was observed in SGLT2 users regardless of LVEF. In multivariate analysis, SGLT2 inhibitor use was an independent predictor of PSQI improvement (adjusted OR: 4.255; p = 0.010). Conclusion: SGLT2 inhibitor use was associated with improved SQ and reduced anxiety in patients with HF, suggesting symptom-related benefits beyond cardiovascular effects.