The effect of nurse‐led Internet‐based cognitive behavioural therapy for insomnia on patients with cardiovascular disease: A randomized controlled trial with 6‐month follow‐up

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Abstract

Aim

To test the effect of nurse‐led Internet‐based cognitive behavioural therapy for insomnia (I‐CBTI), tailored for patients with cardiovascular disease (CVD), with a 6‐month follow‐up.

Design

A two‐arm parallel‐group randomized controlled trial (RCT) registered at clinicaltrials.gov (NTC03938805) and reported according to the CONSORT checklist.

Methods

Forty‐eight patients (mean age 72 years, 65% men) diagnosed with CVD and insomnia were randomized to either 9‐week nurse‐led I‐CBTI with support, or an Internet‐based self‐study programme without support (control group). Insomnia Severity Index (ISI) and Short Form Health Survey (SF‐12) were used as primary and secondary outcomes.

Results

ISI showed a significant treatment effect of I‐CBTI compared to the control group at 9‐week follow‐up. The mean ISI score in the I‐CBTI group at 9 weeks post‐treatment was maintained at the 6‐month follow‐up. Patients' adherence to I‐CBTI was associated with a better effect on both the ISI and SF‐12.

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Most cited references 42

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The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response.

Charles Morin, Geneviève Belleville, Lynda Bélanger … (2011)

Although insomnia is a prevalent complaint with significant morbidity, it often remains unrecognized and untreated. Brief and valid instruments are needed both for screening and outcome assessment. This study examined psychometric indices of the Insomnia Severity Index (ISI) to detect cases of insomnia in a population-based sample and to evaluate treatment response in a clinical sample. Participants were 959 individuals selected from the community for an epidemiological study of insomnia (Community sample) and 183 individuals evaluated for insomnia treatment and 62 controls without insomnia (Clinical sample). They completed the ISI and several measures of sleep quality, fatigue, psychological symptoms, and quality of life; those in the Clinical sample also completed sleep diaries, polysomnography, and interviews to validate their insomnia/good sleep status and assess treatment response. In addition to standard psychometric indices of reliability and validity, item response theory analyses were computed to examine ISI item response patterns. Receiver operating curves were used to derive optimal cutoff scores for case identification and to quantify the minimally important changes in relation to global improvement ratings obtained by an independent assessor. ISI internal consistency was excellent for both samples (Cronbach α of 0.90 and 0.91). Item response analyses revealed adequate discriminatory capacity for 5 of the 7 items. Convergent validity was supported by significant correlations between total ISI score and measures of fatigue, quality of life, anxiety, and depression. A cutoff score of 10 was optimal (86.1% sensitivity and 87.7% specificity) for detecting insomnia cases in the community sample. In the clinical sample, a change score of -8.4 points (95% CI: -7.1, -9.4) was associated with moderate improvement as rated by an independent assessor after treatment. These findings provide further evidence that the ISI is a reliable and valid instrument to detect cases of insomnia in the population and is sensitive to treatment response in clinical patients.

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European guideline for the diagnosis and treatment of insomnia

Elisabeth Hertenstein, Colin Espie, Jason Ellis … (2017)

This European guideline for the diagnosis and treatment of insomnia was developed by a task force of the European Sleep Research Society, with the aim of providing clinical recommendations for the management of adult patients with insomnia. The guideline is based on a systematic review of relevant meta-analyses published till June 2016. The target audience for this guideline includes all clinicians involved in the management of insomnia, and the target patient population includes adults with chronic insomnia disorder. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to grade the evidence and guide recommendations. The diagnostic procedure for insomnia, and its co-morbidities, should include a clinical interview consisting of a sleep history (sleep habits, sleep environment, work schedules, circadian factors), the use of sleep questionnaires and sleep diaries, questions about somatic and mental health, a physical examination and additional measures if indicated (i.e. blood tests, electrocardiogram, electroencephalogram; strong recommendation, moderate- to high-quality evidence). Polysomnography can be used to evaluate other sleep disorders if suspected (i.e. periodic limb movement disorder, sleep-related breathing disorders), in treatment-resistant insomnia, for professional at-risk populations and when substantial sleep state misperception is suspected (strong recommendation, high-quality evidence). Cognitive behavioural therapy for insomnia is recommended as the first-line treatment for chronic insomnia in adults of any age (strong recommendation, high-quality evidence). A pharmacological intervention can be offered if cognitive behavioural therapy for insomnia is not sufficiently effective or not available. Benzodiazepines, benzodiazepine receptor agonists and some antidepressants are effective in the short-term treatment of insomnia (≤4 weeks; weak recommendation, moderate-quality evidence). Antihistamines, antipsychotics, melatonin and phytotherapeutics are not recommended for insomnia treatment (strong to weak recommendations, low- to very-low-quality evidence). Light therapy and exercise need to be further evaluated to judge their usefulness in the treatment of insomnia (weak recommendation, low-quality evidence). Complementary and alternative treatments (e.g. homeopathy, acupuncture) are not recommended for insomnia treatment (weak recommendation, very-low-quality evidence).

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The intersection between aging and cardiovascular disease.

Brian North, David A Sinclair (2012)

The average lifespan of humans is increasing, and with it the percentage of people entering the 65 and older age group is growing rapidly and will continue to do so in the next 20 years. Within this age group, cardiovascular disease will remain the leading cause of death, and the cost associated with treatment will continue to increase. Aging is an inevitable part of life and unfortunately poses the largest risk factor for cardiovascular disease. Although numerous studies in the cardiovascular field have considered both young and aged humans, there are still many unanswered questions as to how the genetic pathways that regulate aging in model organisms influence cardiovascular aging. Likewise, in the molecular biology of aging field, few studies fully assess the role of these aging pathways in cardiovascular health. Fortunately, this gap is beginning to close, and these two fields are merging together. We provide an overview of some of the key genes involved in regulating lifespan and health span, including sirtuins, AMP-activated protein kinase, mammalian target of rapamycin, and insulin-like growth factor 1 and their roles regulating cardiovascular health. We then discuss a series of review articles that will appear in succession and provide a more comprehensive analysis of studies carried out linking genes of aging and cardiovascular health, and perspectives of future directions of these two intimately linked fields.

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Author and article information

Contributors

Sandra Siebmanns:

ORCID: https://orcid.org/0000-0001-9100-2674

sandra.siebmanns@ju.se

Journal

Journal ID (nlm-ta): Nurs Open

Journal ID (iso-abbrev): Nurs Open

Journal ID (doi): 10.1002/(ISSN)2054-1058

Journal ID (publisher-id): NOP2

Title: Nursing Open

Publisher: John Wiley and Sons Inc. (Hoboken )

ISSN (Electronic): 2054-1058

Publication date (Electronic): 20 February 2021

Publication date Collection: July 2021

Volume: 8

Issue: 4 ( doiID: 10.1002/nop2.v8.4 )

Pages: 1755-1768

Affiliations

[ ¹ ] Department of Nursing Science School of Health and Welfare Jönköping University Jönköping Sweden

[ ² ] Department of Health, Medicine and Care Linköping University Norrköping Sweden

[ ³ ] Department of Internal Medicine and Department of Health, Medicine and Care Linköping University Norrköping Sweden

[ ⁴ ] Department of Clinical Neurophysiology Linköping University Hospital Linköping Sweden

[ ⁵ ] Institute of Gerontology Aging Research Network‐Jönköping School of Health and Welfare Jönköping University Jönköping Sweden

[ ⁶ ] Department of Behavioral Sciences and Learning Linköping University Linköping Sweden

[ ⁷ ] Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden

Author notes

[*] [* ] Correspondence

Sandra Siebmanns, Department of Nursing Science, School of Health and Welfare, Jönköping University, Jönköping, S‐ 551 11 Jönköping, Sweden.

Email: sandra.siebmanns@ 123456ju.se

Author information

Sandra Siebmanns https://orcid.org/0000-0001-9100-2674

Article

Publisher ID: NOP2817

DOI: 10.1002/nop2.817

PMC ID: 8186676

PubMed ID: 33609425

SO-VID: 04d9b17d-5dd7-4bb7-8765-a94fff1894ba

License:

This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

History

Date revision received : 19 December 2020

Date received : 25 August 2020

Date accepted : 31 January 2021

Page count

Figures: 4, Tables: 4, Pages: 14, Words: 8921

Custom metadata

source-schema-version-number 2.0

cover-date July 2021

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.2 mode:remove_FC converted:08.06.2021

Keywords: cardiovascular disease,cognitive behavioural therapy,insomnia,internet‐based,nurse support

Data availability:

Keywords: cardiovascular disease, cognitive behavioural therapy, insomnia, internet‐based, nurse support

The effect of nurse‐led Internet‐based cognitive behavioural therapy for insomnia on patients with cardiovascular disease: A randomized controlled trial with 6‐month follow‐up

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Cardiovascular Innovations and Applications

Most cited references 42

The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response.

European guideline for the diagnosis and treatment of insomnia

The intersection between aging and cardiovascular disease.

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