title: Feasibility and Efficacy of a Self-Management Intervention for Insomnia in Stable Heart Failure.
abstract: BACKGROUND
  Chronic insomnia is common among patients with heart failure (HF) and may contribute to fatigue and poor function. However, to date there have been no randomized controlled trials focused on treatment of insomnia or daytime symptoms in this population.
  
  
  OBJECTIVE
  The purpose of this study was to examine the preliminary efficacy, feasibility, and acceptability of a self-management intervention (cognitive behavioral therapy [CBT-I]) for insomnia among patients with stable HF.
  
  
  METHODS
  We conducted a pilot randomized controlled trial (RCT) in which patients with stable Class I-III HF (n = 25/52.1% women; mean age = 59 ± 14.8 years) were randomized in groups to CBT-I (n = 29) or an attention control condition (HF self-management with sleep hygiene; n = 19). Participants completed 2 weeks of wrist actigraphy, the insomnia severity index, and measures of fatigue, depression, sleepiness, and functional performance at baseline and follow-up. We computed the size of the effects on the dependent variables and used MANOVA to evaluate the effects of CBT-I on insomnia and fatigue.
  
  
  RESULTS
  CBT-I was feasible and acceptable and had a statistically significant effect on insomnia and fatigue, while controlling for the effects of comorbidity and age.
  
  
  CONCLUSIONS
  CBT-I has short-term efficacy as a treatment for chronic insomnia among patients with stable HF. Future studies are needed to address its sustained effects.
authors.affiliation: Yale University School of Nursing, New Haven, CT.
authors.forename: Nancy S
authors.initials: NS
authors.lastname: Redeker
authors.affiliation: Yale University School of Nursing, New Haven, CT.
authors.forename: Sangchoon
authors.initials: S
authors.lastname: Jeon
authors.affiliation: Yale University School of Nursing, New Haven, CT.
authors.forename: Laura
authors.initials: L
authors.lastname: Andrews
authors.affiliation: Yale University School of Medicine, New Haven, CT.
authors.forename: John
authors.initials: J
authors.lastname: Cline
authors.affiliation: Yale University School of Medicine, New Haven, CT.
authors.forename: Daniel
authors.initials: D
authors.lastname: Jacoby
authors.affiliation: Yale University School of Medicine, New Haven, CT.
authors.forename: Vahid
authors.initials: V
authors.lastname: Mohsenin
mesh_terms: D000704:Analysis of Variance; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012648:Self Care / Q000379:methods*; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications* / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: cognitive behavioral therapy; depression; fatigue; heart failure; insomnia; self-management; sleep