Heart failure is considered to be one of the major causes of frequent hospitalization in the world, particularly in the elderly. Patients leaving the hospital after one of the stays go through a period of vulnerability where rehospitalization or even death is particularly a danger. Although physicians have always paid attention to the drugs, nutrition, and sport in the recovery process, a recent study points at one more unexpected aspect the regularity of sleep.
The study, to be published in the JACC: Advances, in September 2025, indicates that abnormal post discharge sleep schedule increases the likelihood of subsequent clinical events in heart failure patients, such as emergency admission, rehospitalization or mortality, more than twofold.
What the Study Investigated
The study was conducted by a team of scientists comprised of Oregon Health and Science University and Boston college to determine whether the regularity of sleep timing could serve as a predictor of health in individuals who were recently hospitalized due to heart failure.
Participants: 32 individuals (mean age of about 63 years, half having type 2 diabetes) were recruited following an acute hospitalization with heart failure.
Procedure: Sleep patterns were measured by the Sleep Regularity Index (SRI)- the tool that monitors the consistency of the sleep and wake patterns of an individual daily.
Follow up: The participants followed up six months to measure such clinical events as hospital readmissions, ER visits or death.
Key Findings
Disrupted Sleep Increases the risk dramatically.
The patients who had moderately irregular schedules were at a 2.6 times greater risk of experiencing a clinical event than patients with regular schedules of sleep. Once the severity of heart failure, comorbidities and sleep apnea are adjusted, the risk was increased to 3.7 times more.
Regularity of sleep is of greater importance than duration of sleep.
Interestingly, the sleep duration was not much different between the two groups or the bedtime. Consistency was the key element here–whether the patients went to bed and whether they slept at or near the same time each day.
Clinical Incidents occurred in short periods.
The median time to the first adverse event was 26 days in the case of irregular sleep compared to 35 days in the case of regular sleepers. This emphasizes the fact that abnormal sleeping habits can affect the recovery very fast.
The importance of Sleep Regularity in Heart Failure.
The research is based on the growing body of evidence that shows that sleep regularity might be more critical to long-term health outcomes than total sleep hours:
Heart stress: Abnormal sleep interferes with circadian rhythms, placing the heart at a higher risk.
Metabolic effect: Sleep disturbance has been associated with diabetes and obesity that tend to be prevalent in the heart failure patients.
Inflammation and stress: Sleep wake swings increase stress hormone and inflammation that may aggravate cardiovascular outcomes.
Indeed, past studies indicate that regularity of sleep is a stronger predictor of general mortality than sleep duration among the general population.
Implications in Practice to Patients and Clinicians.
This paper has highlighted how heart failure patients need to have sleep as a component of post-hospitalization care. Certain action measures involve:
Promoting regular sleep and wakefulness state. Patients are recommended to maintain a regular sleeping rhythm including the weekends.
Follow up by inquiring about sleep. Physicians need to regularly follow up with patients on their sleeping patterns when they have left the hospital, similarly to how they check on medications and food.
Sleep regularity is a risk marker. Monitoring sleep patterns might be used to determine patients that are more prone to rehospitalization.
Combining behavioral interventions. Programs of sleep coaching, cognitive behavioral therapy of insomnia and sleep hygiene can help.
Restrictions and Future Research.
Although the results are convincing, the sample size used by the researchers in the research was small (32 patients), and thus such a sample cannot be used to generalize the results. The vast majority were Whites, and most of them had comorbid conditions, thus the need to replicate in larger and more varied populations.
Future studies should examine:
The effectiveness of sleep regularity (enhancing or preventing) as a way to reduce risk of rehospitalization.
The biological processes that attach irregular sleep to heart failure development.
The digital technologies of monitoring and supporting sleep health in patients and improvements through the use of wearables.
Conclusion
Drug, diet, and exercise have been the focus of management of heart failure over several decades. This research paper is another fragment into the puzzle: the time and regularity of patient sleep can have a direct predictive impact on patient survival and recovery following hospitalization.
Patients with abnormal sleep cycles were over twice as many as likely to suffer adverse clinical events in the six months. Nonpharmacological intervention such as the sleep schedule may be less expensive, but it can work wonders in patients with heart failure.
To put it in other words: to people affected with heart failure, regular sleep may be as important as taking the appropriate medicines.
Reference:
Shafer BM, Hiatt SO, Kogan SA, et al. Effect of Posthospitalization Sleep Regularity on Clinical Events in Adults With Heart Failure. JACC: Advances. 2025;4(9):102109. https://doi.org/10.1016/j.jacadv.2025.102109