Cognitive Behavioral Therapy for Insomnia in Stable Heart Failure
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 51
- 试验地点
- 2
- 主要终点
- Insomnia severity
研究概览
简要总结
The purpose of this exploratory developmental study is to test the feasibility, acceptability, and preliminary efficacy of cognitive behavioral therapy for insomnia (CBT-I) among adults who have stable Heart Failure. Participants were randomized either to a treatment (CBT-I) or attention-control condition (heart failure self management education).
详细描述
Insomnia is common in adults with chronic heart failure (HF), a condition associated with functional performance deficits, symptom burden, and high levels of morbidity and mortality. To date there has been little study of strategies to improve sleep in this large population. Cognitive behavioral therapy for insomnia (CBT-I) is an effective treatment for insomnia comorbid with several medical and psychiatric disorders, but has not been tested in HF. The purpose of this exploratory developmental research is to test the feasibility, acceptability, and size of the effects of CBT-I on subjective and objective characteristics of sleep and insomnia symptoms and functional performance in patients with stable HF. Forty patients with stable HF will be randomized to 7 weeks of CBT-I or 7-weeks of HF self-management education with sleep hygiene (attention control). Subjective (diaries, questionnaires) and objective (wrist actigraphy) characteristics of sleep; symptoms, and self-reported functional performance will be measured pre- and post-intervention. The investigators will also obtain day and night measures of urinary free cortisol, free epinephrine/norepinephrine, and melatonin sulfate. They will: 1) refine the protocol, procedures, patient materials, and training manual for the CBT-I intervention and a group HF self-management class (attention-control); 2) evaluate the feasibility and acceptability of the CBT-I intervention and the attention-control conditions; 3) evaluate the size of the effects of group CBT-I, compared with attention-control, on objective (actigraph) and subjective (questionnaire and sleep diary) sleep characteristics, self-report of insomnia symptoms, and beliefs and attitudes about sleep; and 4) evaluate the size of the effects of CBT-I, compared with attention-control, on daytime symptoms (fatigue, depression, anxiety, excessive daytime sleepiness) and functional performance. The primary outcome will be self-reported sleep continuity (sleep efficiency). Investigators will also explore the effects of changes in characteristics of sleep and insomnia symptoms on symptoms and daytime function; the effects of CBT-I, compared with attention control, on nocturnal symptoms, and the effects of CBT-I, compared with attention control, on biological indicators of nocturnal and daytime Hypothalamic Adrenal Pituitary axis (urinary free cortisol), sympathetic nervous system (urinary epinephrine/norepinephrine, and pineal (urinary melatonin) function. The results will be used to support design decisions for a future larger scale efficacy study and may ultimately lead to translation of CBT-I into the care of patients with HF.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Factorial
- 主要目的
- Other
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Stable chronic heart failure
- •reports of difficulty initiating or maintaining sleep or waking too early in the morning
- •English speaking/reading
排除标准
- •untreated sleep disordered breathing or restless legs syndrome
- •rotating/night shift work
- •active illicit drug use
- •bipolar disorder
- •neuromuscular conditions affecting the non-dominant arm
- •end-stage renal failure
- •significant cognitive impairment
- •unstable medical or psychiatric disorders
结局指标
主要结局
Insomnia severity
时间窗: baseline two weeks after completing treatment or attention/control
Insomnia severity will be measured with the Insomnia Severity Index, a brief self-report instrument measuring patients' perception of their insomnia. The instrument includes 7 items assessing the severity of sleep onset and sleep maintenance difficulties, satisfaction with current sleep pattern, interference with daily functioning, noticeability of impairment attributed to the sleep problem, and degree of distress or concern caused by the sleep problem. Each item is rated on a 0-4 scale (4 indicates greater severity) with a total score ranging from 0 to 28. Scores are categorized as not clinically significant, subthreshold insomnia, moderate insomnia or severe insomnia.
次要结局
- Depressive symptoms(Baseline and two weeks after completing treatment or attention control)
- Sleepiness(Baseline and two weeks after completing treatment or attention control)
- Anxiety(Baseline and two weeks after completing treatment or attention-control)
- Sleep efficiency(baseline and two weeks after completing treatment or attention control)
- Cortisol(baseline and two weeks after completing treatment or attention control.)
- Norepinephrine(baseline and two weeks after completing treatment or attention control.)
- Nocturnal symptoms(baseline and two weeks after completing treatment or attention control)
- Fatigue(baseline and two weeks after completing treatment or attention-control)
- Thoughts and beliefs about sleep(Baseline and two weeks after completing treatment or attention control.)
- Melatonin(baseline and two weeks after completing treatment or attention control.)
- Functional Performance(baseline and two weeks after completing treatment or attention control)
- Epinephrine(baseline and two weeks after completing treatment or attention control.)