heart failure insomnia treatment study

Conditions: Heart Failure; Cardiac Failure; Congestive Heart Failure; Insomnia; Sleep Disorder; Sleep Initiation and Maintenance Disorders; Disorders of Initiating and Maintaining Sleep; Anxiety; Depression

Summary: the purpose of this study is to compare a short, behavioral treatment for insomnia with sleep monitoring to determine whether these approaches are effective in reducing insomnia and improving sleep quality among patients with heart failure (hf). this study will also examine the relationship between insomnia and cognitive functioning in hf and the effects of the behavioral treatment on cognitive functioning, self-care, distress, hf symptoms, and functional status. participants will be randomly assigned to four-sessions of a behavioral treatment (brief behavioral treatment for insomnia; bbti) or sleep monitoring.

comorbid insomnia is prevalent among heart failure (hf) patients and associated with poorer mental and physical functioning, including possible exacerbation of cognitive deficits. initial investigations document the effectiveness of cognitive-behavioral therapy for the treatment of insomnia in hf. however, the high symptom burden of hf necessitates alternative interventions for these patients with fewer time and physical endurance demands. brief behavioral treatment for insomnia (bbti) is a four-session behavioral intervention that emphasizes stimulus control and sleep restriction techniques, along with providing education to patients about healthy sleep practices and behaviors that adversely affect sleep. the efficacy of bbti has been previously documented in samples of older adults with insomnia, but the intervention has yet to be applied to a disease-specific patient population. this study was designed to 1) evaluate the treatment effects of bbti on insomnia among hf patients, 2) examine the relationship between insomnia, cognitive function, and decision-making in hf patients at baseline, and 3) evaluate the effects of bbti on relevant correlates of insomnia in hf patients, including cognitive functioning, decision-making, distress, self-care, quality of life, and functional status. participants will be randomized to either the four-session behavioral intervention (bbti) or a sleep monitoring condition. measures of sleep (insomnia, sleep efficiency, sleep quality), cognitive functioning (memory, attention, executive functioning, and decision making), distress (anxiety and depression), hf-related quality of life, hf self-care, and functional status will be obtained from participants at baseline, post-intervention, and 6 months post-intervention. repeated measures multivariate analysis of variance (manova) will serve as the primary mode of data analysis.

Eligibility criteria:
inclusion criteria: * 18 years of age or older * fluent in english * diagnosis of heart failure * at least mild chronic insomnia exclusion criteria: * restless legs syndrome * narcolepsy * perform night or rotating shift work * seizure disorder * excessive daytime sleepiness * current or past diagnosis of bipolar disorder or psychotic disorder * significant cognitive impairments * untreated moderate to severe sleep apnea or high risk for sleep apnea

Keywords: heart failure insomnia anxiety depression memory attention executive functioning decision making self-care quality of life functional status walk test sleep monitoring