Effects of Cognitive Behavioral Therapy for Insomnia on Sleep-Related Cognitions Among Patients With Stable Heart Failure
| Autor: | Vahid Mohsenin, John Cline, Sangchoon Jeon, Nancy S. Redeker, Daniel Jacoby, Laura Kierol Andrews |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Neuroscience (miscellaneous) Medicine (miscellaneous) Cognitive behavioral therapy for insomnia behavioral disciplines and activities Article 03 medical and health sciences 0302 clinical medicine Sleep Initiation and Maintenance Disorders Surveys and Questionnaires mental disorders medicine Insomnia Humans Psychiatry Heart Failure Cognitive Behavioral Therapy Cognition Middle Aged medicine.disease Sleep in non-human animals nervous system diseases 030228 respiratory system Heart failure Female Neurology (clinical) Psychology (miscellaneous) medicine.symptom Psychology 030217 neurology & neurosurgery Clinical psychology |
| Zdroj: | Behav Sleep Med |
| ISSN: | 1540-2010 1540-2002 |
| Popis: | 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 = 26/51.0% 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 modelling, mediation analysis with a bootstrapping approach, and Pearson correlations. RESULTS: There was a statistically significant group by 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 6 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. |
| Databáze: | OpenAIRE |
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