Cognitive behavioral therapy for insomnia has sustained effects on insomnia, fatigue, and function among people with chronic heart failure and insomnia: the HeartSleep Study

Abstract

Study Objectives Insomnia is common among adults with chronic heart failure (HF) and associated with daytime symptoms and decrements in function. The purpose of this randomized controlled trial (RCT) was to evaluate the sustained effects over one year of CBT-I (Healthy Sleep: HS) compared with HF self-management education (Healthy Hearts; attention control: HH) on insomnia severity, sleep characteristics, symptoms, and function among people with stable HF. The primary outcomes were insomnia severity, actigraph-recorded sleep efficiency, and fatigue. Methods We randomized adults with stable HF with preserved or reduced ejection fraction who had at least mild insomnia (Insomnia severity index >7) in groups to HS or HH (4 sessions/8 weeks). We obtained wrist actigraphy and measured insomnia severity, self-reported sleep characteristics, symptoms (fatigue, excessive daytime sleepiness, anxiety, depression), and six-minute walk distance at baseline, within one month of treatment, and at 6 and 12 months. We used general linear mixed models (GLMM) and generalized estimating equations (GEE) to evaluate the effects. Results The sample included 175 participants (M age = 63 +12.9 years; 43% women; 18% Black; 68% New York Heart Association Class II or II; 33%; LVEF < 45%) randomized to HS (n = 91) or HH (N = 84). HS had sustained effects on insomnia severity, sleep quality, self-reported sleep latency and efficiency, fatigue, excessive daytime sleepiness, and six-minute walk distance at 12 months. Conclusions CBT-I produced sustained improvements in insomnia, fatigue, daytime sleepiness, and objectively measured physical function among adults with chronic HF, compared with a robust HF self-management program that included sleep hygiene education.

Sleep, Stress, and Symptoms Among People With Heart Failure During the COVID-19 Pandemic

“…Although posttreatment levels of sleep impairment and sleep duration were not sustained, levels approximated normal levels during the pandemic. These finding confirm the clinical benefits of CBT-I for people with HF and comorbidities 13 , 27 and also suggest the potential benefits of HF self-management education. Given our findings, future prospective studies are needed to examine the extent to which these and other behavioral interventions improve the ability of people with HF to manage stressful events, such as the pandemic.…”

“…We included participants with no or no more than mild untreated sleep-disordered breathing and those treated with continuous positive airway pressure. We excluded people with seizure disorders, severe sleepiness, narcolepsy, end-stage renal failure, bipolar disorder, severe depression, current illicit drug use, restless leg syndrome, and/or more than mild untreated sleep apnea, and people working nights or shift work 13,14 …”

“…We provided $25 electronic gift cards to all participants for completing the surveys during the pandemic period. Participants received honoraria for earlier phases of the study 13,14 …”

“…We excluded people with seizure disorders, severe sleepiness, narcolepsy, end-stage renal failure, bipolar disorder, severe depression, current illicit drug use, restless leg syndrome, and/or more than mild untreated sleep apnea, and people working nights or shift work. 13,14 Procedures Participants completed questionnaires to elicit sleep characteristics, daytime symptoms, mood, and stress at baseline and over 1 year after their participation in the intervention. In this report, we include baseline and 6month data from variables measured during the pandemic period.…”

The effect of cognitive‐behavioral therapy on death anxiety and depression in patients with heart failure: A quasi‐experimental study

“…So far, several studies have been conducted investigating the effect of CBT on mental health status and its indicators in patients. For example, Redeker et al, found that CBT had a significant effect on the improvement of fatigue, insomnia, and performance in patients (Redeker et al, 2021). Numerous studies, such as those done by Heslop‐Marshall et al (2021), Fenlon et al (2020), and Siebmanns et al (2021), also acknowledged that nurses were capable of performing this therapeutic intervention in the clinical settings.…”