Cognitive behavioral remedy for insomnia improves perform in folks with coronary heart failure, a Yale research finds

Insomnia is common in people with chronic heart failure (HF), affecting up to 75% of patients, and often leads to excessive daytime sleepiness, depression and anxiety, fatigue, and worsening heart failure symptoms. Research has looked at possible interventions to combat insomnia in this population, but so far the studies have not been comprehensive enough to have a significant impact.

Now Sleep magazine has published the results of the HeartSleep study by an interdisciplinary team from the Yale School of Medicine, led by Principal Investigator Nancy Redeker of the Yale School of Nursing and researchers from the Lung, Intensive Care and Sleep Medicine Section (Yale.) -PCCSM) and the Yale Centers for Sleep Medicine, a competence center. Funded by the National Institutes of , the study looked at the sustained effects of cognitive behavioral for insomnia (CBT-I) versus a behavioral self-management program, and found that CBT-I was more effective than standard self-management training for heart failure in heart failure Treatment of insomnia in people with heart failure.

“We’re the first to show the sustained effects of CBT-I on insomnia, fatigue and functioning after one year,” said Nancy Redeker, RN, MSN, PhD, lead author and lead reviewer on the study. “These are important findings for patients with heart failure.” Redeker is Beatrice Renfield Term Professor of Nursing and Professor of Medicine and Director of the Center for Biobehavioral Research, Yale School of Nursing.

CBT-I is a behavior modification approach that changes sleep habits and seeks to change deeply ingrained thoughts, behaviors, and environmental influences on sleep. The control group followed a standard self-care program for people with heart failure that included proper diet, regular exercise, and appropriate medication intake.

“These data support the inclusion of insomnia screening and treatment in the treatment of heart failure diseases. At Yale, based on what we’ve seen, we’re starting this, ”said Daniel Jacoby, MD, associate professor (cardiovascular medicine) and co-author of the study.

Redeker studied CBT-I for insomnia in people with HF, but for a shorter time in fewer people. Other research has largely focused on the sleep-disrupting effects of sleep-disturbed breathing, which is also common in people with heart failure.

“The patients with heart failure told us in the interview that they had a lot of sleep problems but didn’t want to take any medication because they were afraid of an addiction,” says Redeker. “Some of the over-the-counter drugs make you sleepy and incapacitated during the day. And they really wanted a behavioral approach. They also emphasized the importance of sleep to their daily and function and suggested that care providers help them manage it. “

The study randomly assigned 175 people with HF to either CBT-I or self-management. In addition to measuring the severity of insomnia and self-reported sleep characteristics and symptoms, the researchers measured the participants’ six-minute walking distance at the start of the study, within one month of treatment, and after six and 12 months. This test is widely used in cardiac and pulmonary settings.

“Indeed, the most notable result is the fact that we improved the 6-minute walk test distance in these patients.” [by 100 feet]”Said Redeker. “And that’s important because that’s a really important function marker. It is not just a self-disclosure, but an objective measure. We have shown that the improvement matches some drug studies and some cardiac device studies where they improved this. “

Henry Klar Yaggi, Dr The Clinical Epidemiology Research Center (CERC) highlights the interdisciplinary nature of sleep medicine, not just in patients with heart failure, but in general. Yaggi is the second author of the study.

“I’ve always felt [sleep medicine] was a turning point between many different specialties, ”said Yaggi. “And in that context, sleep affects a number of different areas. It affects cardiovascular health, like heart failure. It affects cognitive function. It affects the quality of life. It influences the mood. “

The next challenge is to make CBT-I accessible and widely available, the authors say, by training more healthcare providers in more settings about the technology.

“Sleep is really becoming that third pillar of health,” said Yaggi. “We have diet and exercise, but sleep has been ignored or minimized for so many years and we are beginning to see that it has a huge impact on individual wellbeing and health. And this study, I think, is a perfect example of that. Our study also shows the inherent interdisciplinarity of sleep. ”

Other authors of the School of Nursing: Stephen Breazeale, Samantha Conley, Youri Hwang, Joanne Iennaco, Sarah Linsky, Uzoji Nwanaji-I have, Meghan O’Connell, and Sangchoon Jeon

The lung, intensive care and sleep medicine section is one of eleven sections within the YSM’s internal medicine department. To learn more about Yale PCCSM, visit PCCSM’s website or follow them on Facebook and Twitter.

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