Cognitive behavioral therapy for insomnia in stable heart failure: Protocol for a randomized controlled trial

Nancy S. Redeker, Andrea K. Knies, Christopher Hollenbeak, H. Klar Yaggi, John Cline, Laura Andrews, Daniel Jacoby, Anna Sullivan, Meghan O'Connell, Joanne Iennaco, Lisa Finoia, Sangchoon Jeon

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background Chronic insomnia is associated with disabling symptoms and decrements in functional performance. It may contribute to the development of heart failure (HF) and incident mortality. In our previous work, cognitive-behavioral therapy for insomnia (CBT-I), compared to HF self-management education, provided as an attention control condition, was feasible, acceptable, and had large effects on insomnia and fatigue among HF patients. Objectives The purpose of this randomized controlled trial (RCT) is to evaluate the sustained effects of group CBT-I compared with HF self-management education (attention control) on insomnia severity, sleep characteristics, daytime symptoms, symptom clusters, functional performance, and health care utilization among patients with stable HF. We will estimate the cost-effectiveness of CBT-I and explore the effects of CBT-I on event-free survival (EFS). Methods Two hundred participants will be randomized in clusters to a single center parallel group (CBT-I vs. attention control) RCT. Wrist actigraphy and self-report will elicit insomnia, sleep characteristics, symptoms, and functional performance. We will use the psychomotor vigilance test to evaluate sleep loss effects and the Six Minute Walk Test to evaluate effects on daytime function. Medical record review and interviews will elicit health care utilization and EFS. Statistical methods will include general linear mixed models and latent transition analysis. Stochastic cost-effectiveness analysis with a competing risk approach will be employed to conduct the cost-effectiveness analysis. Discussion The results will be generalizable to HF patients with chronic comorbid insomnia and pave the way for future research focused on the dissemination and translation of CBT-I into HF settings.

Original languageEnglish (US)
Pages (from-to)16-23
Number of pages8
JournalContemporary Clinical Trials
Volume55
DOIs
StatePublished - Apr 1 2017

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Sleep Initiation and Maintenance Disorders
Cognitive Therapy
Randomized Controlled Trials
Heart Failure
Patient Acceptance of Health Care
Cost-Benefit Analysis
Sleep
Self Care
Disease-Free Survival
Actigraphy
Education
Wrist
Self Report
Medical Records
Fatigue
Linear Models
Interviews

All Science Journal Classification (ASJC) codes

  • Pharmacology (medical)

Cite this

Redeker, Nancy S. ; Knies, Andrea K. ; Hollenbeak, Christopher ; Klar Yaggi, H. ; Cline, John ; Andrews, Laura ; Jacoby, Daniel ; Sullivan, Anna ; O'Connell, Meghan ; Iennaco, Joanne ; Finoia, Lisa ; Jeon, Sangchoon. / Cognitive behavioral therapy for insomnia in stable heart failure : Protocol for a randomized controlled trial. In: Contemporary Clinical Trials. 2017 ; Vol. 55. pp. 16-23.
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Redeker, NS, Knies, AK, Hollenbeak, C, Klar Yaggi, H, Cline, J, Andrews, L, Jacoby, D, Sullivan, A, O'Connell, M, Iennaco, J, Finoia, L & Jeon, S 2017, 'Cognitive behavioral therapy for insomnia in stable heart failure: Protocol for a randomized controlled trial', Contemporary Clinical Trials, vol. 55, pp. 16-23. https://doi.org/10.1016/j.cct.2017.01.009

Cognitive behavioral therapy for insomnia in stable heart failure : Protocol for a randomized controlled trial. / Redeker, Nancy S.; Knies, Andrea K.; Hollenbeak, Christopher; Klar Yaggi, H.; Cline, John; Andrews, Laura; Jacoby, Daniel; Sullivan, Anna; O'Connell, Meghan; Iennaco, Joanne; Finoia, Lisa; Jeon, Sangchoon.

In: Contemporary Clinical Trials, Vol. 55, 01.04.2017, p. 16-23.

Research output: Contribution to journalArticle

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T2 - Protocol for a randomized controlled trial

AU - Redeker, Nancy S.

AU - Knies, Andrea K.

AU - Hollenbeak, Christopher

AU - Klar Yaggi, H.

AU - Cline, John

AU - Andrews, Laura

AU - Jacoby, Daniel

AU - Sullivan, Anna

AU - O'Connell, Meghan

AU - Iennaco, Joanne

AU - Finoia, Lisa

AU - Jeon, Sangchoon

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N2 - Background Chronic insomnia is associated with disabling symptoms and decrements in functional performance. It may contribute to the development of heart failure (HF) and incident mortality. In our previous work, cognitive-behavioral therapy for insomnia (CBT-I), compared to HF self-management education, provided as an attention control condition, was feasible, acceptable, and had large effects on insomnia and fatigue among HF patients. Objectives The purpose of this randomized controlled trial (RCT) is to evaluate the sustained effects of group CBT-I compared with HF self-management education (attention control) on insomnia severity, sleep characteristics, daytime symptoms, symptom clusters, functional performance, and health care utilization among patients with stable HF. We will estimate the cost-effectiveness of CBT-I and explore the effects of CBT-I on event-free survival (EFS). Methods Two hundred participants will be randomized in clusters to a single center parallel group (CBT-I vs. attention control) RCT. Wrist actigraphy and self-report will elicit insomnia, sleep characteristics, symptoms, and functional performance. We will use the psychomotor vigilance test to evaluate sleep loss effects and the Six Minute Walk Test to evaluate effects on daytime function. Medical record review and interviews will elicit health care utilization and EFS. Statistical methods will include general linear mixed models and latent transition analysis. Stochastic cost-effectiveness analysis with a competing risk approach will be employed to conduct the cost-effectiveness analysis. Discussion The results will be generalizable to HF patients with chronic comorbid insomnia and pave the way for future research focused on the dissemination and translation of CBT-I into HF settings.

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