1
|
Beswick AD, Wylde V, Bertram W, Whale K. The effectiveness of non-pharmacological sleep interventions for improving inpatient sleep in hospital: A systematic review and meta-analysis. Sleep Med 2023; 107:243-267. [PMID: 37257367 DOI: 10.1016/j.sleep.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/26/2023] [Accepted: 05/03/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Sleep disturbance is common in hospital. The hospital environment can have a negative impact on sleep quality, through factors such as noise, light, temperature, and nursing care disruptions. Poor sleep can lead to delays in recovery, wound healing, and increase risk of post-operative infection. METHODS We conducted a systematic review evaluating the effectiveness of non-pharmacological sleep interventions for improving inpatient sleep. The primary outcome was sleep quality, the secondary outcome was length of hospital stay, the harm outcome was adverse events. MEDLINE, Embase, CINAHL, PsycINFO and the Cochrane Library were searched from inception to 17th February 2022. Meta-analysis was conducted using a fixed effects model, with narrative synthesis for studies with no useable data. Risk of bias was assessed with the Cochrane tool. RESULTS 76 studies identified with 5375 people randomised comparing 85 interventions. Interventions focused on physical sleep aids (n = 26), relaxation (n = 25), manual therapy (n = 12), music (n = 9), psychological therapy (n = 5), light therapy (n = 3), sleep protocols (n = 2), milk and honey (n = 1), exercise (n = 1), and nursing care (n = 1). In meta-analysis, medium to large improvements in sleep quality were noted for sleep aids, relaxation, music, and manual therapies. Results were generally consistent in studies at lower risk of bias. Length of hospital stay and adverse events were reported for some studies, with benefit in some trials but this was not consistent across all interventions. CONCLUSIONS Physical sleep aids, relaxation, manual therapy and music interventions have a strong evidence base for improving inpatient sleep quality. Research is needed to evaluate how to optimise interventions into routine care.
Collapse
Affiliation(s)
- A D Beswick
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, UK; NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK.
| | - V Wylde
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, UK; NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK
| | - W Bertram
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, UK; NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK
| | - K Whale
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, UK; NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK.
| |
Collapse
|
2
|
Burger P, Van den Ende ES, Lukman W, Burchell GL, Steur LM, Merten H, Nanayakkara PW, Gemke RJ. Sleep in hospitalized pediatric and adult patients - A systematic review and meta-analysis. Sleep Med X 2022; 4:100059. [PMID: 36406659 PMCID: PMC9672415 DOI: 10.1016/j.sleepx.2022.100059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/24/2022] [Accepted: 10/28/2022] [Indexed: 11/07/2022] Open
Abstract
Background Sleep is essential for recovery from illness. As a result, researchers have shown a growing interest in the sleep of hospitalized patients. Although many studies have been conducted over the past years, an up to date systematic review of the results is missing. Objective The objective of this systematic review was to assess sleep quality and quantity of hospitalized patients and sleep disturbing factors. Methods A systematic literature search was conducted within four scientific databases. The search focused on synonyms of 'sleep' and 'hospitalization'. Papers written in English or Dutch from inception to April 25th,2022 were included for hospitalized patients >1 year of age. Papers exclusively reporting about patients receiving palliative, obstetric or psychiatric care were excluded, as well as patients in rehabilitation and intensive care settings, and long-term hospitalized geriatric patients. This review was performed in accordance with the PRISMA guidelines. Results Out of 542 full text studies assessed for eligibility, 203 were included, describing sleep quality and/or quantity of 17,964 patients. The median sample size of the studies was 51 patients (IQR 67, range 6-1472). An exploratory meta-analysis of the Total Sleep Time showed an average of 7.2 h (95%-CI 4.3, 10.2) in hospitalized children, 5.7 h (95%-CI 4.8, 6.7) in adults and 5.8 h (95%-CI 5.3, 6.4) in older patients (>60y). In addition, a meta-analysis of the Wake After Sleep Onset (WASO) showed a combined high average of 1.8 h (95%-CI 0.7, 2.9). Overall sleep quality was poor, also due to nocturnal awakenings. The most frequently cited external factors for poor sleep were noise and number of patients in the room. Among the variety of internal/disease-related factors, pain and anxiety were most frequently mentioned to be associated with poor sleep. Conclusion Of all studies, 76% reported poor sleep quality and insufficient sleep duration in hospitalized patients. Children sleep on average 0.7-3.8 h less in the hospital than recommended. Hospitalized adults sleep 1.3-3.2 h less than recommended for healthy people. This underscores the need for interventions to improve sleep during hospitalization to support recovery.
Collapse
Affiliation(s)
- Pia Burger
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC, Amsterdam, Netherlands
| | - Eva S. Van den Ende
- Section General Internal Medicine Unit Acute Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Wen Lukman
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC, Amsterdam, Netherlands
| | - George L. Burchell
- Medical Library, Vrije Universiteit, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Lindsay M.H. Steur
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC, Amsterdam, Netherlands
| | - Hanneke Merten
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Prabath W.B. Nanayakkara
- Section General Internal Medicine Unit Acute Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Reinoud J.B.J. Gemke
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC, Amsterdam, Netherlands
| |
Collapse
|
3
|
Neville HL, Granter C, Adibi P, Belliveau J, Isenor JE, Bowles SK. Interventions to reduce benzodiazepine and sedative-hypnotic drug use in acute care hospitals: A scoping review. Res Social Adm Pharm 2021; 18:2874-2886. [PMID: 34253470 DOI: 10.1016/j.sapharm.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 05/17/2021] [Accepted: 07/04/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Benzodiazepines and sedative-hypnotic drugs (BZD/SHD) are commonly utilized in the acute care setting for insomnia and anxiety and are associated with cognitive impairment, falls, and fractures. Interventions to reduce use of BZD/SHD in hospitals are not well characterized. OBJECTIVE The objective was to conduct a scoping review to identify and characterize interventions to reduce the use of BZD/SHD by adults in the acute care setting. METHODS English language studies and abstracts that described an intervention to reduce BZD/SHD in adult hospital patients were included. Six databases (PubMed, EMBASE, CINAHL, PsycINFO, Scopus, and Web of Science) were searched up to July 2018 and updated to February 3, 2021. The grey literature (Opengrey, Grey Matters, Google Advanced) was searched up to July 2018. Titles and abstracts were screened and full-text articles were reviewed and charted by three independent reviewers. Stakeholders were consulted to inform the scoping review and collect perspectives on the findings. RESULTS There were 13,046 records identified and 43 studies included. The most common study designs were uncontrolled before and after (23/43, 53.5%) and randomized controlled trials (7/43, 16.3%). The majority of studies tested a single intervention (32/43, 74.4%) such as education, deprescribing, relaxation training and sleep protocols. Patients were frequently the target of relaxation training and behavior change interventions; while sleep protocols, multifaceted interventions, education and deprescribing were usually directed at healthcare providers, either alone or in combination with patients. Most studies reported positive results in decreasing BZD/SHD use (27/43, 62.8%). CONCLUSIONS The scoping review found a variety of interventions to decrease the utilization of BZD/SHD in hospitals. Multifaceted interventions aimed at patients and healthcare providers that include a combination of education, sleep protocols, and deprescribing may support reductions in BZD/SHD use. Stakeholders also recommended policy and system changes such as computer alerts due to feasibility and workload.
Collapse
Affiliation(s)
- Heather L Neville
- Nova Scotia Health, 1276 South Park Street, Halifax, Nova Scotia, B3H 2Y9, Canada.
| | - Courtney Granter
- Nova Scotia Health, 1276 South Park Street, Halifax, Nova Scotia, B3H 2Y9, Canada; IWK Health Centre, 5980 University Ave, Halifax, Nova Scotia, B3H 1V7, Canada.
| | - Pegah Adibi
- Nova Scotia Health, 1276 South Park Street, Halifax, Nova Scotia, B3H 2Y9, Canada.
| | - Julia Belliveau
- Nova Scotia Health, 1276 South Park Street, Halifax, Nova Scotia, B3H 2Y9, Canada.
| | - Jennifer E Isenor
- College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Susan K Bowles
- Nova Scotia Health, 1276 South Park Street, Halifax, Nova Scotia, B3H 2Y9, Canada; College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada.
| |
Collapse
|
4
|
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
|
5
|
Scott-Sheldon LAJ, Gathright EC, Salmoirago-Blother E, Wu WC. Women's participation in stress management interventions for chronic heart failure: a meta-analysis of randomized controlled trials. PSYCHOL HEALTH MED 2021; 27:761-779. [PMID: 33486993 DOI: 10.1080/13548506.2021.1874436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Stress management interventions (SMIs) can alleviate the psychosocial stress often experienced by women with heart failure. The purpose of this meta-analysis was to summarize women's participation rates, and predictors of participation, in SMIs for the management of psychosocial distress in women with chronic HF. Studies were retrieved from bibliographic databases, reference sections of relevant papers, and research registries. Included studies (a) evaluated a SMI approach for the management of chronic HF, (b) sampled chronic HF patients, and (c) used a randomized controlled trial (RCT) design. Independent coders extracted the relevant data. Thirty-five RCTs met inclusion criteria (N = 3,649; mean age = 63.5 ± 7.0 years). All studies sampled both men and women; the mean proportion of women who participated in the trials was 38.8% (95% confidence interval [CI] = 34.5-43.4; I2 = 82.4, 95% CI = 81.0-83.6). Women's participation rates were higher in studies sampling more HF patients with hypertension (B = 1.01, SE = 0.45, P = .046) but fewer HF patients prescribed beta blockers (B = -1.10, SE = 0.33, P = .006), F (2,12) = 6.27, P = 0.014, adjusted R2 = 61%. SMIs may offer women a complementary or integrative approach to standard treatment to help manage the psychological distress associated with HF. Future research should explore the potential benefits of offering stress management approaches to women as part of comprehensive HF care.
Collapse
Affiliation(s)
- Lori A J Scott-Sheldon
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States.,Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI.,Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| | - Emily C Gathright
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States.,Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI
| | - Elena Salmoirago-Blother
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States.,Department of Medicine, Alpert School of Medicine, Brown University, Providence, RI.,Department of Epidemiology, Brown University School of Public Health, Providence, RI
| | - Wen-Chih Wu
- Department of Medicine, Alpert School of Medicine, Brown University, Providence, RI.,Department of Epidemiology, Brown University School of Public Health, Providence, RI.,Chief of Cardiology, Providence VA Medical Center, Providence, RI.,Medical Director, Center for Cardiac Fitness, The Miriam Hospital, Providence, RI, USA
| |
Collapse
|
6
|
Miller MA, Renn BN, Chu F, Torrence N. Sleepless in the hospital: A systematic review of non-pharmacological sleep interventions. Gen Hosp Psychiatry 2019; 59:58-66. [PMID: 31170567 PMCID: PMC6620136 DOI: 10.1016/j.genhosppsych.2019.05.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/23/2019] [Accepted: 05/23/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Poor sleep is highly prevalent in inpatient medical settings and has been associated with attenuated healing and worsened outcomes following hospitalization. Although nonpharmacological interventions are preferred, little is known about the best way to intervene in hospital settings. METHOD A systematic review of published literature examining nonpharmacological sleep interventions among inpatients in Embase, PsycINFO and PubMed in accordance with PRISMA guidelines. RESULTS Forty-three of the 1529 originally identified manuscripts met inclusion criteria, encompassing 2713 hospitalized participants from 18 countries comprised of psychiatric and older adult patients living in hospital settings. Main outcomes were subjective and objective measures of sleep duration, quality, and insomnia. CONCLUSIONS Overall, the review was unable to recommend any specific intervention due to the current state of the literature. The majority of included research was limited in quality due to lack of controls, lack of blinding, and reliance on self-reported outcomes. However, the literature suggests melatonin and CBT-I likely have the most promise to improve sleep in inpatient medical settings. Additionally, environmental modifications, including designated quiet time and ear plugs/eye masks, could be easily adopted in the care environment and may support sleep improvement. More rigorous research in nonpharmacological sleep interventions for hospitalized individuals is required to inform clinical recommendations.
Collapse
Affiliation(s)
- Megan A Miller
- Rehabilitation Care Service, VA Puget Sound -Seattle Division, Seattle, WA, United States of America.
| | - Brenna N Renn
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States of America
| | - Frances Chu
- University of Washington Health Sciences Library, Seattle, WA, United States of America
| | - Nicole Torrence
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States of America; Geriatrics and Extended Care Service, VA Puget Sound - Seattle Division, Seattle, WA, United States of America
| |
Collapse
|
7
|
Madsen MT, Huang C, Zangger G, Zwisler ADO, Gögenur I. Sleep Disturbances in Patients With Coronary Heart Disease: A Systematic Review. J Clin Sleep Med 2019; 15:489-504. [PMID: 30853047 DOI: 10.5664/jcsm.7684] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 01/08/2019] [Indexed: 12/19/2022]
Abstract
STUDY OBJECTIVES Investigation into sleep and coronary heart disease (CHD) has predominantly been focused on sleep disturbances as a risk factor for developing CHD. Objectively measured and self-reported sleep at a patient level has only been sparsely and not systematically reported. Therefore, we set out to review the literature for studies using objectively measured and self-reported sleep in patients with CHD. The review focuses on patients with acute coronary syndrome (ACS) and stable CHD. METHODS A systematic review performed in four databases adhering to the PRISMA guidelines applying a qualitative synthesis of evidence. RESULTS Following ACS, we found sleep architecture to be significantly disturbed with changes normalizing over a period of up to 6 months. With increasing severity of CHD, sleep disturbances were more pronounced; however, the modulating effects of sleep-disordered breathing and ejection fraction on sleep in patients with CHD are conflicting. Overall, studies were predominantly cross-sectional in design and of low methodological quality. Polysomnography was the predominant outcome assessment tool and validated self-reported assessment tools were limited. CONCLUSIONS Future investigations in sleep and CHD applying both a longitudinal design and investigating objective and self-reported sleep assessments are warranted. SYSTEMATIC REVIEW REGISTRATION Registry: PROSPERO, Title: Sleep measures in relation to coronary heart disease: a systematic review, Identifier: CRD42017056377, URL: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=56377.
Collapse
Affiliation(s)
- Michael Tilling Madsen
- Center for Surgical Science, Zealand University Hospital, Denmark.,Department of Emergency, Zealand University Hospital, Denmark
| | - Chenxi Huang
- Center for Surgical Science, Zealand University Hospital, Denmark
| | - Graziella Zangger
- REHPA - Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Denmark
| | - Ann Dorthe Olsen Zwisler
- REHPA - Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Denmark
| | - Ismail Gögenur
- Center for Surgical Science, Zealand University Hospital, Denmark
| |
Collapse
|
8
|
Kwekkeboom KL, Bratzke LC. A Systematic Review of Relaxation, Meditation, and Guided Imagery Strategies for Symptom Management in Heart Failure. J Cardiovasc Nurs 2016; 31:457-68. [PMID: 26065388 PMCID: PMC4675700 DOI: 10.1097/jcn.0000000000000274] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Pain, dyspnea, fatigue, and sleep disturbance are prevalent and distressing symptoms in persons with advanced heart failure. Although many lifestyle and self-care interventions have been developed to control heart failure progression, very few studies have explored treatments exclusively for symptom palliation. Cognitive-behavioral strategies may be effective treatment for these symptoms in advanced heart failure. OBJECTIVE A systemic review was conducted to describe the effect of cognitive-behavioral strategies on pain, dyspnea, fatigue, and sleep disturbance in patients with heart failure. METHODS CINAHL, Medline, and PsychINFO were searched from inception through December 2014. Articles were selected for inclusion if they tested a cognitive-behavioral strategy using a quasi-experimental or experimental design, involved a sample of adults with heart failure, and measured pain, dyspnea, fatigue, sleep disturbance, or symptom-related quality of life. The 2 authors evaluated study quality, abstracted data elements from each study, and synthesized findings. RESULTS Thirteen articles describing 9 unique studies met criteria and were included in the review. Five studies tested relaxation strategies, 3 tested meditation strategies, and 1 tested a guided imagery strategy. Of the 9 studies, 7 demonstrated some improvement in symptom outcomes. Relaxation, meditation, guided imagery, or combinations of these strategies resulted in less dyspnea and better sleep compared with attention control or usual care conditions and reduced pain, dyspnea, fatigue, and sleep disturbance within treatment groups (pretreatment to posttreatment). Symptom-related quality of life was improved with meditation compared with attention control and usual care conditions and improved pre- to post-guided imagery. CONCLUSIONS Studies exploring cognitive-behavioral symptom management strategies in heart failure vary in quality and report mixed findings but indicate potential beneficial effects of relaxation, meditation, and guided imagery on heart failure-related symptoms. Future research should test cognitive-behavioral strategies in rigorously designed efficacy trials, using samples selected for their symptom experience, and measure pain, dyspnea, fatigue, and sleep disturbance outcomes with targeted symptom measures.
Collapse
Affiliation(s)
- Kristine L Kwekkeboom
- Kristine L. Kwekkeboom, PhD, RN Professor, School of Nursing, University of Wisconsin-Madison. Lisa C. Bratzke, PhD, RN, ANP-BC Assistant Professor, School of Nursing, University of Wisconsin-Madison
| | | |
Collapse
|