The need for a greater focus on obesity and its treatment in sleep medicine

Effects of cognitive behavioural therapy for depression in heart failure patients: a systematic review and meta-analysis

This systematic review and meta-analysis aimed to evaluate the effects of cognitive behavioural therapy (CBT) on depression, quality of life, hospitalisations and mortality in heart failure patients. The search strategy was developed for Ovid MEDLINE and modified accordingly to search the following bibliographic databases: PubMed, EMBASE, PsycINFO, CENTRAL and CINAHL. Databases were searched from inception to 6 March 2016 for randomised controlled trials (RCTs) or observational studies that used CBT in heart failure patients with depression or depressive symptoms. Six studies were identified: 5 RCTs and 1 observational study, comprising 320 participants with predominantly NYHA classes II-III, who were mostly male, with mean age ranging from 55 to 66 years. Compared to usual care, CBT was associated with a greater improvement in depression scores both initially after CBT sessions (standardised mean difference -0.34, 95% CI -0.60 to -0.08, p = 0.01) and at 3 months follow-up (standardised mean difference -0.32, 95% CI -0.59 to -0.04, p = 0.03). Greater improvement in quality of life scores was evident for the CBT group initially after CBT sessions, but with no difference at 3 months. Hospital admissions and mortality were similar, regardless of treatment group. CBT may be more effective than usual care at improving depression scores and quality of life for heart failure patients initially following CBT and for depression at 3 months. Larger and more robust RCTs are needed to evaluate the long-term clinical effects of CBT in heart failure patients.

Cognitive Behavioral Therapy for Insomnia in the Context of Cardiovascular Conditions

Cardiovascular disease (CVD) is the leading cause of death worldwide and is associated with high levels of morbidity, disability and poor quality of life. The prevalence of insomnia symptoms and diagnosis of insomnia are high among those with CVD. Although insomnia appears to be important to CVD, less is known about the effects of insomnia treatment on important biological, sleep, symptom, quality of life, functional and morbidity or mortality outcomes in people with or at-risk for CVD. The purposes of this paper are to review the literature on the effects of CBT-I on insomnia, sleep, daytime symptoms, function, and biological outcomes in the context of CVD and to suggest implications for future research and practice. Limited available evidence suggests that CBT-I improves biomarkers that may contribute to CVD risk. CBT-I shows promise as a way to improve cardiovascular morbidity associated with the negative biological consequences of chronic insomnia, as well as symptom burden, functional performance and quality of life in the large population of people who are living with chronic CVD and insomnia. Additional research is needed to answer basic questions about short and long term outcomes, the role of biomarkers, and optimal delivery methods of CBT-I in cardiac conditions.