Therapy for insomnia with chronic obstructive pulmonary disease: a randomized trial of components.
J Clin Sleep Med
; 18(12): 2763-2774, 2022 12 01.
Article
em En
| MEDLINE
| ID: mdl-35946416
ABSTRACT
STUDY OBJECTIVES:
To determine efficacy and mechanisms of cognitive behavioral therapy for insomnia (CBT-I) and chronic obstructive pulmonary disease (COPD) education (COPD-ED) on clinical outcomes in adults with concurrent COPD and insomnia.METHODS:
We conducted a 2 × 2 factorial study to test the impact of CBT-I and COPD-ED delivered alone or in combination on severity of insomnia and fatigue, sleep, and dyspnea. Participants were randomized to 1 of 4 groups-group 1 CBT-I + attention control (AC; health videos, n = 27); group 2 COPD-ED + AC, n = 28; group 3 CBT-I + COPD-ED, n = 27; and group 4, AC only, n = 27. Participants received six 75-minute weekly sessions. Dependent variables included insomnia severity, sleep by actigraphy, fatigue, and dyspnea measured at baseline, immediately postintervention, and at 3 months postintervention. Presumed mediators of intervention effects included beliefs and attitudes about sleep, self-efficacy for sleep and COPD, and emotional function.RESULTS:
COPD patients (percent predicted forced expiratory volume in 1 second [FEV1pp] 67% ± 24% [mean ± standard deviation]), aged 65 ± 8 years, with insomnia participated in the study. Insomnia and sleep improved more in patients who received CBT-I than in those who did not, an effect that was sustained at 3 months postintervention and mediated by beliefs and attitudes about sleep. CBT-I was associated with clinically important improvements in fatigue and dyspnea. When CBT-I and COPD-ED were concurrently administered, effects on insomnia, fatigue, and dyspnea were attenuated.CONCLUSIONS:
CBT-I produced significant and sustained decreases in insomnia improved sleep and clinically important improvement in fatigue, and dyspnea. The combination of CBT-I and COPD-ED reduced CBT-I's effectiveness. Further research is needed to understand the mechanisms associated with effects of insomnia therapy on multiple symptoms in COPD. CLINICAL TRIAL REGISTRATION Registry ClinicalTrials.gov; Name A Behavioral Therapy for Insomnia Co-existing with COPD; URL https//clinicaltrials.gov/ct2/show/NCT01973647; Identifier NCT01973647. CITATION Kapella M, Steffen A, Prasad B, et al. Therapy for insomnia with chronic obstructive pulmonary disease a randomized trial of components. J Clin Sleep Med. 2022;18(12)2763-2774.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Terapia Cognitivo-Comportamental
/
Doença Pulmonar Obstrutiva Crônica
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Distúrbios do Início e da Manutenção do Sono
Tipo de estudo:
Clinical_trials
/
Prognostic_studies
Limite:
Adult
/
Humans
Idioma:
En
Revista:
J Clin Sleep Med
Ano de publicação:
2022
Tipo de documento:
Article