1
|
Exercise as an Adjunct Treatment to Cognitive Behavior Therapy for Insomnia. Sleep Med Clin 2023; 18:39-47. [PMID: 36764785 DOI: 10.1016/j.jsmc.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
The question that guided this review is whether exercise can add to the improvements in insomnia in patients treated with cognitive behavioral therapy for insomnia (CBT-I). CBT-I has long been recommended as the first-line treatment of chronic insomnia. However, CBT-I is not effective for as many as 30% to 40% of patients with insomnia. There is accumulating evidence for positive effects on insomnia following acute and chronic exercise. However, to the best of our knowledge, the effects of CBT-I combined with exercise have not been explored in clinical trials. In this article, we develop a rationale for combining CBT-I with exercise.
Collapse
|
2
|
Tighe CA, Buysse DJ, Weiner DK, Beehler GP, Forman DE. Prevalence, Impact, and Trajectories of Sleep Disturbance in Cardiac Rehabilitation: A NARRATIVE REVIEW AND SUGGESTIONS FOR EVALUATION AND TREATMENT. J Cardiopulm Rehabil Prev 2022; 42:316-323. [PMID: 35522949 PMCID: PMC9437109 DOI: 10.1097/hcr.0000000000000694] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of this review was to summarize literature examining the prevalence, impact, and trajectories of sleep disturbance in cardiac rehabilitation (CR) patients and discuss how CR programs may incorporate targeted evaluation and interventions to promote sleep health. REVIEW METHODS A narrative review of literature allowed for an examination of the prevalence of sleep disturbance in CR patients, the effects of sleep disturbance on CR outcomes, and trajectories of sleep disturbance in CR. SUMMARY Sleep disturbance is prevalent in CR patient populations and is related to clinical and functional outcomes. Sleep may be an important biobehavioral process to target in CR to improve important patient outcomes and achieve secondary prevention goals.
Collapse
Affiliation(s)
- Caitlan A. Tighe
- VISN 4 Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System
| | - Daniel J. Buysse
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Debra K. Weiner
- Department of Psychiatry, University of Pittsburgh School of Medicine
- Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System
- Department of Medicine, University of Pittsburgh School of Medicine
- Department of Anesthesiology, University of Pittsburgh School of Medicine
- Clinical and Translational Science Institute, University of Pittsburgh School of Medicine
| | - Gregory P. Beehler
- VA Center for Integrated Healthcare
- Community Health and Health Behavior, School of Public Health and Health Professions, University of Buffalo
| | - Daniel E. Forman
- Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System
- Department of Medicine, University of Pittsburgh School of Medicine
| |
Collapse
|
3
|
Huang L, Zhou J, Li H, Wang Y, Wu X, Wu J. Sleep behaviour and cardiorespiratory fitness in patients after percutaneous coronary intervention during cardiac rehabilitation: protocol for a longitudinal study. BMJ Open 2022; 12:e057117. [PMID: 35697460 PMCID: PMC9196170 DOI: 10.1136/bmjopen-2021-057117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Most patients with coronary heart disease experience sleep disturbances and low cardiorespiratory fitness (CRF), but their relationship during cardiac rehabilitation (CR) is still unclear. This article details a protocol for the study of sleep trajectory in patients with coronary heart disease during CR and the relationship between sleep and CRF. A better understanding of the relationship between sleep and CRF on patient outcomes can improve sleep management strategies. METHODS AND ANALYSIS This is a longitudinal study with a recruitment target of 101 patients after percutaneous cardiac intervention from the Seventh People's Hospital of Shanghai, China. Data collection will include demographic characteristics, medical history, physical examination, blood sampling, echocardiography and the results of cardiopulmonary exercise tests. The information provided by a 6-min walk test will be used to supplement the CPET. The Pittsburgh Sleep Quality Index will be used to understand the sleep conditions of the participants in the past month. The Patient Health Questionnaire and General Anxiety Disorder Scale will be used to assess depression and anxiety, respectively. All participants will be required to wear an actigraphy on their wrists for 72 hours to monitor objective sleep conditions. This information will be collected four times within 6 months of CR, and patients will be followed up for 1 year. The growth mixture model will be used to analyse the longitudinal sleep data. The generalised estimating equation will be used to examine the associations between sleep and CRF during CR. ETHICS AND DISSEMINATION Ethical approval for this observational longitudinal study was granted by the Shanghai Seventh People's Hospital Ethics Committee on 23 April 2021 (2021-7th-HIRB-012). Study results will be disseminated in peer-reviewed journal articles.
Collapse
Affiliation(s)
- Lan Huang
- Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jie Zhou
- Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Husheng Li
- Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yiyan Wang
- Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xubo Wu
- Rehabilitation, Shanghai Seventh People's Hospital, Shanghai, China
- Rehabilitation, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jing Wu
- Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Rehabilitation, Shanghai Seventh People's Hospital, Shanghai, China
| |
Collapse
|
4
|
Validation of the PROMIS-29v2 Health-Related Quality-of-Life Questionnaire in Patients With Coronary Heart Disease Participating in Remote Cardiac Rehabilitation. J Cardiopulm Rehabil Prev 2022; 42:246-251. [PMID: 35135960 DOI: 10.1097/hcr.0000000000000676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to validate the 29-item Patient-Reported Outcomes Measurement Information System version 2.0 (PROMIS-29v2) health-related quality-of-life (HRQL) questionnaire for use in patients with coronary heart disease (CHD) participating in remotely delivered cardiac rehabilitation (CR). METHODS Patients commencing remote CR across four sites in New South Wales, Australia, answered the PROMIS-29v2 and 12-item Short Form Health Survey version 2.0 (SF-12v2) questionnaires at CR entry and completion (6 wk). The data were analyzed for validity, reliability, and responsiveness to change. RESULTS Patients (N = 89) had a mean age of 66.9 ± 9.3 yr; 83% were male and were referred to CR for elective percutaneous coronary intervention (PCI) (42%), myocardial infarction (36%), and coronary artery bypass grafting (22%). Internal consistency reliability was adequate, with the Cronbach α ranging from 0.78-0.98. Convergent validity between the PROMIS-29v2 and SF-12v2 summary scores showed significantly strong correlations for physical (r = 0.62) and moderate for mental (r = 0.36) health. Discriminant validity was confirmed for sex (women reported lower physical and mental health) and referral diagnosis (patients who had elective PCI reported better physical health). Effect size (ES) comparisons confirmed responsiveness to change from CR entry to completion in physical health (ES = 0.51) and demonstrated evidence of more responsiveness than SF-12v2 for mental health (ES = 0.70). CONCLUSION The PROMIS-29v2 is reliable, valid, and responsive to changes in patients with CHD attending remotely delivered CR and allows for baseline HRQL assessment, between-diagnosis comparisons, and evaluation of changes over time.
Collapse
|
5
|
Le Grande MR, Jackson AC, Beauchamp A, Kerr D, Driscoll A. Diagnostic accuracy and suitability of instruments that screen for obstructive sleep apnoea, insomnia and sleep quality in cardiac patients: a meta-analysis. Sleep Med 2021; 86:135-160. [PMID: 33674192 DOI: 10.1016/j.sleep.2021.02.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/29/2021] [Accepted: 02/08/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND A number of clinical guidelines recommend that all cardiac rehabilitation patients should be screened for potential sleep disorders with a validated screening instrument. There is currently no consensus on what specific tools should be used. OBJECTIVE To identify tools that are practical to use in the clinical environment and have high diagnostic accuracy. METHODS We systematically searched online databases to identify patient reported outcome instruments that have been used in published research studies to assess the likelihood of obstructive sleep apnoea (OSA) in cardiac patients. In studies that provided diagnostic data, these data were extracted and verified via an evidence-based diagnostic calculator. Where sufficient numbers of studies were available, a meta-analysis was conducted to determine pooled estimates of specificity, sensitivity and diagnostic odds ratios. Selected papers were qualitatively assessed using the Standards for Reporting Diagnostic accuracy studies (STARD). RESULTS Of the 21 instruments identified, six detected likelihood of OSA, two assessed daytime sleepiness, five assessed insomnia and eight examined sleep quality. A meta-analysis of 14 studies that assessed diagnostic accuracy of moderate OSA, revealed moderate sensitivity for the Berlin Questionnaire, Sens = 0.49 (95% CI 0.45-0.52) and good sensitivity for the Stop-BANG, Sens = 0.93 (95% CI 0.87-0.96) but poor specificity at standard cut-off criteria. CONCLUSION There are promising practical tools available to screen patients with OSA and other sleep disorders in cardiac rehabilitation settings, but specificity could be improved. Additional assessment of sleep quality may enhance prognostic ability with both OSA and insomnia screening.
Collapse
Affiliation(s)
- Michael R Le Grande
- Australian Centre for Heart Health, 75 Chetwynd Street, North Melbourne, VIC, 3051, Australia; Faculty of Health, Deakin University, Burwood, VIC, 3216, Australia; Melbourne Centre for Behaviour Change, School of Psychological Sciences, The University of Melbourne, Parkville, VIC, 3052, Australia.
| | - Alun C Jackson
- Australian Centre for Heart Health, 75 Chetwynd Street, North Melbourne, VIC, 3051, Australia; Faculty of Health, Deakin University, Burwood, VIC, 3216, Australia; Centre on Behavioural Health, Hong Kong University, Pakfulam, Hong Kong
| | - Alison Beauchamp
- Australian Centre for Heart Health, 75 Chetwynd Street, North Melbourne, VIC, 3051, Australia; Department of Medicine - Western Health, The University of Melbourne, VIC, 3052, Australia; Australian Institute for Musculoskeletal Science (AIMSS), St. Albans, VIC, 3021, Australia; School of Rural Health, Monash University, Newborough, VIC, 3825, Australia
| | - Debra Kerr
- Faculty of Health, Deakin University, Burwood, VIC, 3216, Australia
| | - Andrea Driscoll
- Faculty of Health, Deakin University, Burwood, VIC, 3216, Australia; Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, Geelong, VIC, 3220, Australia
| |
Collapse
|
6
|
|
7
|
Edwards KS, Hekler AC, Baum J, Nejedly M, Tsai S, Khandelwal A, Naderi S, Hoover V, Tremmel JA. Psychological Distress Among Female Cardiac Patients Presenting to a Women's Heart Health Clinic. Am J Cardiol 2019; 123:2026-2030. [PMID: 31006484 DOI: 10.1016/j.amjcard.2019.03.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 03/08/2019] [Accepted: 03/14/2019] [Indexed: 01/17/2023]
Abstract
Female cardiac patients are at greater risk for mental health disorders than their male counterparts, and these mental health disorders have been associated with increased cardiac morbidity and mortality. However, few studies have closely examined the mental health disorders found among the female cardiac population. The primary aim of this study was to examine the prevalence of psychological distress in a sample of female cardiac outpatients at an academic medical center. A secondary aim was to determine whether different demographic variables, cardiac risk factors, or cardiac diagnoses were associated with different levels of emotional distress. A survey, including demographic information, medical status, and standardized symptom measures was completed by 117 female patients scheduled for medical visits at an outpatient women's heart health clinic over a 4-month period. Using standardized self-report questionnaires, 38% scored in the moderate-to-severe range for at least 1 mental disorder and 50% endorsed current insomnia. Symptoms of clinical depression (20%) and anxiety (42)% were endorsed at higher rates than predominantly male or mixed comparison samples. Although there was no apparent relation between the severity of cardiac problems and the degree of psychological distress, women with diagnoses of hyperlipidemia, prediabetes, and diabetes reported greater psychological distress than those without these problems. Women with lower income also reported more psychological distress. In conclusion, our findings suggest an unmet need for integrated mental health services for female cardiac patients.
Collapse
|
8
|
Le Grande MR, Neubeck L, Murphy BM, McIvor D, Lynch D, McLean H, Jackson AC. Screening for obstructive sleep apnoea in cardiac rehabilitation: A position statement from the Australian Centre for Heart Health and the Australian Cardiovascular Health and Rehabilitation Association. Eur J Prev Cardiol 2016; 23:1466-75. [DOI: 10.1177/2047487316652975] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 05/13/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Michael R Le Grande
- Australian Centre for Heart Health (formerly Heart Research Centre), Melbourne, Australia
- Faculty of Health, Deakin University, Melbourne, Australia
| | - Lis Neubeck
- Sydney Nursing School and Charles Perkins Centre, University of Sydney, Australia
- Australian Cardiovascular Health and Rehabilitation Association, Australia
| | - Barbara M Murphy
- Australian Centre for Heart Health (formerly Heart Research Centre), Melbourne, Australia
- Faculty of Health, Deakin University, Melbourne, Australia
- School of Psychological Sciences, University of Melbourne, Australia
- School of Medicine and Public Health, University of Newcastle, Australia
| | - Dawn McIvor
- Australian Cardiovascular Health and Rehabilitation Association, Australia
- CNC Cardiology, John Hunter Hospital, Hunter New England Health, Newcastle, Australia
| | - Dianna Lynch
- Australian Cardiovascular Health and Rehabilitation Association, Australia
- Ashford Hospital, Australia
| | - Helen McLean
- Australian Cardiovascular Health and Rehabilitation Association, Australia
- Royal Perth Hospital, Australia
| | - Alun C Jackson
- Australian Centre for Heart Health (formerly Heart Research Centre), Melbourne, Australia
- Faculty of Health, Deakin University, Melbourne, Australia
- Australian Cardiovascular Health and Rehabilitation Association, Australia
- University of Hong Kong, Centre on Behavioural Health, Hong Kong
| |
Collapse
|