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Citation
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Redeker NS, Conley S, O'Connell M, Geer JH, Yaggi H, Jeon S. J. Clin. Sleep Med. 2023; ePub(ePub): ePub. |
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Abstract
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STUDY OBJECTIVES: Cognitive impairment and insomnia are common in chronic heart failure (HF). We examined the effects of cognitive behavioral therapy for insomnia (CBT-I) and the extent to which demographic, clinical, symptom, and functional characteristics predicted cognition among people with chronic HF and insomnia who participated in a randomized controlled trial of CBT-I.
METHODS: Participants with HF were randomized to group-based CBT-I or an attention control (HF self-management education). Outcomes were measured over one year. We measured psychomotor vigilance (PVT) and self-reported cognitive ability (PROMIS Cognitive Abilities Scale), clinical and demographic characteristics, history of sleep apnea, fatigue, pain, insomnia (Insomnia Severity Index), sleepiness (Epworth Sleepiness Scale), Six Minute Walk, EuroQoL Quality of Life, and wrist actigraphy (sleep characteristics and rest activity rhythms: RARs). We used cosinor analysis to compute RARs and general linear models (GLMM) and general estimating equations (GEE) to test the effects of predictors over one year.
RESULTS: The sample included 175 participants (M age = 63 + 12.9 years; 43% women). There was a statistically significant group-time effect on self-reported cognitive function and increases in the proportion of participants with < 3 PVT lapses in the CBT-I group. Controlling for group-time effects and baseline cognition, decreased sleepiness, improved RARs, and six-minute walk distance predicted a composite measure of cognition (PVT lapses and self-reported cognition).
CONCLUSIONS: CBT-I may improve cognition in adults with chronic HF. A future fully powered randomized controlled trial is needed to confirm the extent to which CBT-I improves multiple dimensions of cognition. CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov; Name: Cognitive Behavioral Therapy for Insomnia: A Self-Management Strategy for Chronic Illness in Heart Failure; Identifier: NCT02660385; URL: https://clinicaltrials.gov/ct2/show/NCT02660385.
Language: en |