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Effects of Cognitive Behavioral Therapy for Insomnia on Sleep-Related Cognitions Among Patients With Stable Heart Failure.

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Title: Effects of Cognitive Behavioral Therapy for Insomnia on Sleep-Related Cognitions Among Patients With Stable Heart Failure.
Authors: Redeker, Nancy S., Jeon, Sangchoon, Andrews, Laura, Cline, John, Mohsenin, Vahid, Jacoby, Daniel
Source: Behavioral Sleep Medicine. May/Jun2019, Vol. 17 Issue 3, p342-354. 13p. 4 Charts, 2 Graphs.
Subjects: Fatigue (Physiology), Behavior therapy, Cognitive therapy, Heart failure patients, Insomnia, Cognition
Abstract: Objective/Background: Cognitive behavioral therapy for insomnia (CBT-I) improves insomnia and fatigue among chronic heart failure (HF) patients, but the extent to which sleep-related cognitions explain CBT-I outcomes in these patients is unknown. We examined the effects of CBT-I on sleep-related cognitions, associations between changes in sleep-related cognitions and changes in sleep and symptoms after CBT-I, and the extent to which cognitions mediated the effects of CBT-I. Participants: Stable New York Heart Association Class II-III HF patients (total n = 51; n = 26 or 51.0% women; M age = 59.1 ± 15.1 years). Methods: HF patients were randomized in groups to group CBT-I (n = 30) or attention control (HF self-management education, n = 21) and completed actigraphy, the Insomnia Severity Index, Pittsburgh Sleep Quality Index, Dysfunctional Beliefs and Attitudes about Sleep (DBAS) and Sleep Disturbance Questionnaires (SDQ), and self-reported fatigue, depression, anxiety, and sleepiness (baseline, immediately after treatment, six months). We used mixed-effects modeling, mediation analysis with a bootstrapping approach, and Pearson correlations. Results: There was a statistically significant group × mult time effect on DBAS. DBAS mediated the effects of CBT-I on insomnia severity and partially mediated CBT-I effects on fatigue. Improvements in dysfunctional cognitions were associated with improved sleep quality, insomnia severity, sleep latency and decreased fatigue, depression, and anxiety, with sustained effects at six months. Conclusions: Improvement in dysfunctional sleep-related cognitions is an important mechanism for CBT-I effects among HF patients who are especially vulnerable to poor sleep and high symptom burden. [ABSTRACT FROM AUTHOR]
Copyright of Behavioral Sleep Medicine is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Label: Title
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  Data: Effects of Cognitive Behavioral Therapy for Insomnia on Sleep-Related Cognitions Among Patients With Stable Heart Failure.
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  Data: <searchLink fieldCode="AR" term="%22Redeker%2C+Nancy+S%2E%22">Redeker, Nancy S.</searchLink><br /><searchLink fieldCode="AR" term="%22Jeon%2C+Sangchoon%22">Jeon, Sangchoon</searchLink><br /><searchLink fieldCode="AR" term="%22Andrews%2C+Laura%22">Andrews, Laura</searchLink><br /><searchLink fieldCode="AR" term="%22Cline%2C+John%22">Cline, John</searchLink><br /><searchLink fieldCode="AR" term="%22Mohsenin%2C+Vahid%22">Mohsenin, Vahid</searchLink><br /><searchLink fieldCode="AR" term="%22Jacoby%2C+Daniel%22">Jacoby, Daniel</searchLink>
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  Data: <searchLink fieldCode="JN" term="%22Behavioral+Sleep+Medicine%22">Behavioral Sleep Medicine</searchLink>. May/Jun2019, Vol. 17 Issue 3, p342-354. 13p. 4 Charts, 2 Graphs.
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  Data: <searchLink fieldCode="DE" term="%22Fatigue+%28Physiology%29%22">Fatigue (Physiology)</searchLink><br /><searchLink fieldCode="DE" term="%22Behavior+therapy%22">Behavior therapy</searchLink><br /><searchLink fieldCode="DE" term="%22Cognitive+therapy%22">Cognitive therapy</searchLink><br /><searchLink fieldCode="DE" term="%22Heart+failure+patients%22">Heart failure patients</searchLink><br /><searchLink fieldCode="DE" term="%22Insomnia%22">Insomnia</searchLink><br /><searchLink fieldCode="DE" term="%22Cognition%22">Cognition</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objective/Background: Cognitive behavioral therapy for insomnia (CBT-I) improves insomnia and fatigue among chronic heart failure (HF) patients, but the extent to which sleep-related cognitions explain CBT-I outcomes in these patients is unknown. We examined the effects of CBT-I on sleep-related cognitions, associations between changes in sleep-related cognitions and changes in sleep and symptoms after CBT-I, and the extent to which cognitions mediated the effects of CBT-I. Participants: Stable New York Heart Association Class II-III HF patients (total n = 51; n = 26 or 51.0% women; M age = 59.1 ± 15.1 years). Methods: HF patients were randomized in groups to group CBT-I (n = 30) or attention control (HF self-management education, n = 21) and completed actigraphy, the Insomnia Severity Index, Pittsburgh Sleep Quality Index, Dysfunctional Beliefs and Attitudes about Sleep (DBAS) and Sleep Disturbance Questionnaires (SDQ), and self-reported fatigue, depression, anxiety, and sleepiness (baseline, immediately after treatment, six months). We used mixed-effects modeling, mediation analysis with a bootstrapping approach, and Pearson correlations. Results: There was a statistically significant group × mult time effect on DBAS. DBAS mediated the effects of CBT-I on insomnia severity and partially mediated CBT-I effects on fatigue. Improvements in dysfunctional cognitions were associated with improved sleep quality, insomnia severity, sleep latency and decreased fatigue, depression, and anxiety, with sustained effects at six months. Conclusions: Improvement in dysfunctional sleep-related cognitions is an important mechanism for CBT-I effects among HF patients who are especially vulnerable to poor sleep and high symptom burden. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
  Group: Ab
  Data: <i>Copyright of Behavioral Sleep Medicine is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1080/15402002.2017.1357120
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        Text: English
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        Type: general
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      – SubjectFull: Cognitive therapy
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      – SubjectFull: Heart failure patients
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      – SubjectFull: Insomnia
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      – SubjectFull: Cognition
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      – TitleFull: Effects of Cognitive Behavioral Therapy for Insomnia on Sleep-Related Cognitions Among Patients With Stable Heart Failure.
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              Text: May/Jun2019
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