Yale School of Nursing, West Haven, CT, USA.
Pulmonary Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, CT, USA.
Sleep. 2022 Jan 11;45(1). doi: 10.1093/sleep/zsab252.
Insomnia is common among adults with chronic heart failure (HF) and associated with daytime symptoms and decrements in function. The purpose of this randomized controlled trial (RCT) was to evaluate the sustained effects over one year of CBT-I (Healthy Sleep: HS) compared with HF self-management education (Healthy Hearts; attention control: HH) on insomnia severity, sleep characteristics, symptoms, and function among people with stable HF. The primary outcomes were insomnia severity, actigraph-recorded sleep efficiency, and fatigue.
We randomized adults with stable HF with preserved or reduced ejection fraction who had at least mild insomnia (Insomnia severity index >7) in groups to HS or HH (4 sessions/8 weeks). We obtained wrist actigraphy and measured insomnia severity, self-reported sleep characteristics, symptoms (fatigue, excessive daytime sleepiness, anxiety, depression), and six-minute walk distance at baseline, within one month of treatment, and at 6 and 12 months. We used general linear mixed models (GLMM) and generalized estimating equations (GEE) to evaluate the effects.
The sample included 175 participants (M age = 63 ± 12.9 years; 43% women; 18% Black; 68% New York Heart Association Class II or II; 33%; LVEF < 45%) randomized to HS (n = 91) or HH (n = 84). HS had sustained effects on insomnia severity, sleep quality, self-reported sleep latency and efficiency, fatigue, excessive daytime sleepiness, and six-minute walk distance at 12 months.
CBT-I produced sustained improvements in insomnia, fatigue, daytime sleepiness, and objectively measured physical function among adults with chronic HF, compared with a robust HF self-management program that included sleep hygiene education.
Insomnia Self-Management in Heart Failure; https://clinicaltrials.gov/ct2/show/NCT02660385; NCT02660385.
慢性心力衰竭（HF）患者中失眠较为常见，与日间症状和功能下降有关。本随机对照试验（RCT）的目的是评估认知行为疗法（CBT-I）（健康睡眠：HS）与 HF 自我管理教育（健康心脏；对照：HH）对稳定 HF 患者的失眠严重程度、睡眠特征、症状和功能的持续影响，一年以上。主要结果是失眠严重程度、活动记录仪记录的睡眠效率和疲劳。
我们将至少有轻度失眠（失眠严重指数>7）的稳定 HF 患者（射血分数保留或降低）分为 HS 或 HH 组（4 次/8 周）。我们获得腕部活动记录仪并测量失眠严重程度、自我报告的睡眠特征、症状（疲劳、白天过度嗜睡、焦虑、抑郁）和 6 分钟步行距离，基线、治疗后 1 个月和 6 个月和 12 个月。我们使用一般线性混合模型（GLMM）和广义估计方程（GEE）进行评估。
样本包括 175 名参与者（M 年龄=63±12.9 岁；43%为女性；18%为黑人；68%为纽约心脏协会 II 级或 II 级；33%；LVEF<45%）随机分为 HS（n=91）或 HH（n=84）。HS 在 12 个月时对失眠严重程度、睡眠质量、自我报告的睡眠潜伏期和效率、疲劳、白天过度嗜睡和 6 分钟步行距离均有持续影响。
与包括睡眠卫生教育在内的强大 HF 自我管理计划相比，CBT-I 可持续改善慢性 HF 成人的失眠、疲劳、白天嗜睡和客观测量的身体功能。
心力衰竭中的失眠自我管理；https://clinicaltrials.gov/ct2/show/NCT02660385；NCT02660385。
