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Insomnia, cognitive impairment, and decision-making among patients with heart failure: A randomized study of brief behavioral treatment for insomnia

Harris, Kristie M
http://rave.ohiolink.edu/etdc/view?acc_num=osu1531350697660812

Abstract Details

2018, Doctor of Philosophy, Ohio State University, Psychology.
Comorbid insomnia is experienced by over half of heart failure (HF) patients and is associated with poorer health-related quality of life, elevated depression, daytime fatigue, excessive daytime sleepiness, and diminished functional performance. HF patients also experience deficits across several cognitive domains, including attention, memory, executive functioning, and psychomotor functioning, and these deficits appear to be exacerbated by the presence of insomnia. Initial investigations in HF patients document the effectiveness of cognitive-behavioral therapy for insomnia in reducing insomnia symptoms and daytime fatigue. However, such interventions require substantial time and energy investments. Due to the high symptom burden of HF, there exists a need for interventions that provide similar treatment benefits for insomnia, but with fewer time and physical endurance demands on patients. This study was designed to 1) evaluate the treatment effects of Brief Behavioral Treatment for Insomnia (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. Twenty-three patients with HF and comorbid insomnia (70% women; 65% white; mean age = 55.7 ± 11.3 years; NYHA Class III = 61%) were recruited from outpatient clinics and cardiac rehabilitation programs at Ohio State University Wexner Medical Center and through Research Match. Participants were prescreened for eligibility based on HF diagnosis and current symptoms, with presence of at least mild insomnia. Screening excluded patients with other untreated sleep disorders or psychiatric disorders contraindicated for BBTI. All participants completed two-week sleep diaries followed by baseline assessment and randomization to one of two conditions, a sleep monitoring (SM) control group (n = 11) or a behavioral intervention (BI) group (n = 12). BI participants completed the manualized BBTI intervention across four weekly sessions while SM participants received no contact during this time. After the intervention, all participants completed a second two-week sleep diary followed by a final assessment. The primary mode of data analysis was repeated measures multivariate analysis of variance. Results indicated that BI participants experienced significant improvements in insomnia symptoms, sleep quality, and sleep efficiency, while SM participants did not change. Post-intervention, 58% of participants in the BI group experienced clinically meaningful reductions in insomnia symptoms, with 27.3% achieving complete remission. BI participants also experienced improvements in depression, anxiety, and HF-related quality of life, whereas SM participants did not. At baseline there was no association between insomnia symptoms and cognitive functioning or decision-making, nor were there treatment effects on these outcomes. Neither BI nor SM participants experienced changes in HF self-care or functional status across the study period. Results of this study support the efficacy of BBTI for treatment of insomnia in HF patients. These data represent the first successful application of the BBTI intervention in a disease-specific population. The brief intervention demonstrated a high degree of acceptability within this symptom-limited patient population and was effective in improving insomnia, distress, and quality of life.
Charles Emery, Ph.D. (Advisor)
Barbara Andersen, Ph.D. (Committee Member)
Julian Thayer, Ph.D. (Committee Member)
148 p.
Clinical Psychology; Psychology
heart failure; insomnia; brief behavioral treatment for insomnia; sleep; decision-making; cognitive functioning; cognitive impairment; sleep quality; sleep efficiency

Recommended Citations

Citations

  • Harris, K. M. (2018). Insomnia, cognitive impairment, and decision-making among patients with heart failure: A randomized study of brief behavioral treatment for insomnia [Doctoral dissertation, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1531350697660812

    APA Style (7th edition)

  • Harris, Kristie. Insomnia, cognitive impairment, and decision-making among patients with heart failure: A randomized study of brief behavioral treatment for insomnia . 2018. Ohio State University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1531350697660812.

    MLA Style (8th edition)

  • Harris, Kristie. "Insomnia, cognitive impairment, and decision-making among patients with heart failure: A randomized study of brief behavioral treatment for insomnia ." Doctoral dissertation, Ohio State University, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=osu1531350697660812

    Chicago Manual of Style (17th edition)

osu1531350697660812
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This open access ETD is published by The Ohio State University and OhioLINK.