Evaluating the Feasibility and Efficacy of A Novel CBTi/SMT Treatment Protocol for Cardiac Rehab Patients: A Non-Randomized Pilot Trial.

INTRODUCTION: Cardiac patients and those with chronic medical conditions often suffer from comorbidities such as insomnia and mood disorders. Previous treatment protocols have focused on resolving symptoms of anxiety and depression in this population using Stress Management Training (SMT). However, these treatments have neglected the importance of sleep problems in these patients. This pilot trial sought to address this by examining the feasibility of a novel CBTi/SMT treatment protocol. METHODS: 42 participants attending a Cardiac Rehab (CR) exercise program registered in this 7-week non-randomized pilot trial. The primary objective of the pilot trial was to determine the feasibility of the protocol for retention and adherence rates. Secondarily, the authors sought to examine the potential efficacy of the program in terms of treating insomnia, depression, anxiety, emotion dysregulation, and arousal. RESULTS: 29 participants attended at least 1 class, with 21 participants completing the program. The average attendance for the program completers was 6 out of 7 classes (SD = 0.8) with four days of practice each week (SD = 1.6) for 33 minutes daily (SD = 16.8). Moreover, the number of participants meeting clinical threshold for insomnia, anxiety, and/or depression was significantly reduced at post-treatment and follow-up. Similarly, raw scores on the relevant scales were significantly reduced at both timepoints. CONCLUSION: This pilot trial provided preliminary evidence for the feasibility and efficacy of targeting sleep improvement with a combined CBTi/SMT protocol. This provides the groundwork for future RCTs to establish the effectiveness of targeting insomnia in a range of medical populations.

Utility of Screening for Obstructive Sleep Apnea in Cardiac Rehabilitation.

PURPOSE: Obstructive sleep apnea (OSA) is prevalent in patients with cardiovascular disease and is often undiagnosed. The purpose of this study was to determine the utility of communicating OSA risk with the patients in a diabetes and cardiac rehabilitation program (CRP) and primary care physicians. METHODS: Following an OSA education session, 295 patients in diabetes and CRPs were screened for OSA and daytime sleepiness by STOP-BANG and Epworth Sleepiness Scale questionnaires. Letters were sent to patients at high risk or noncompliant with continuous positive airway pressure (CPAP) treatment and their physicians. Follow-up questionnaires were sent to patients 6 months later. RESULTS: Of the 295 patients screened, 16.6% (n = 49) had an OSA diagnosis and had been prescribed CPAP. A smaller proportion patients in the diabetes program than in the CRP had discontinued CPAP (22.2% vs 45.2%; P = .03) with discomfort being the greatest barrier. Three of the 7 patients (42.9%) who had contact with their physician resumed CPAP. Of the remaining 246 patients who scored high on ≥1 questionnaire (77.6%; n = 191) and returned the 6-month questionnaire (53.9%; n = 103), communication of risk assessment resulted in 49.5% (n = 51) of patients consulting with their physician. Of those, half were referred for polysomnography. All were diagnosed with OSA. CONCLUSION: More than three quarters of patients in diabetes and CRPs scored high on ≥1 questionnaire suggesting signs/symptoms of OSA. However, only 16.6% were prescribed CPAP and compliance to treatment was poor (63.3%). Education and communication of OSA risk with patients and physicians resulted in a de novo diagnosis in at least 1 of 10 patients screened and 16.7% restarted CPAP.

Validity of the Center for Epidemiological Studies Depression scale in Type 2 diabetes.

OBJECTIVE: Depressive symptoms are common among people with Type 2 diabetes mellitus (T2DM). This study aimed to validate the 3-factor structure of the 14-item Center for Epidemiological Studies Depression (CES-D) scale proposed by Carleton et al. (2013) in a T2DM population. METHODS: The CES-D was administered to consecutive patients with T2DM entering a rehabilitation program. Construct validity was assessed using confirmatory factor analysis. Subscale viability, differential item functioning, and associations with clinical characteristics were tested in bifactor models. RESULTS: Among adults with T2DM (n=305, age 56.9±11.1, 44.9% male, duration of diabetes 7.8±7.9years, HbA1c 0.076±0.014%), the construct validity of Carleton's 3-factor solution (negative affective, positive affective and somatic symptoms) was confirmed, although negative affective and somatic symptoms were highly correlated (r=0.926). The CES-D items can be summed to arrive at a total score (ωH=0.869), but not subscale scores (ωS>0.7). Differential item functioning was not found based on age or body mass index (BMI), but Item 1 ("I was bothered by things that don't usually bother me") was inflated in women and Item 7 ("I felt that everything I did was an effort") was inflated in those with higher glycosylated haemoglobin (HbA1c). The general depression factor decreased with age (ß=-0.247, p<0.001) and increased with BMI (ß=0.102, p=0.041) but not HbA1c (ß=0.065, p=0.461). Negative affective symptoms (ß=0.743, p=0.001), but not other depressive symptoms, were higher in women. CONCLUSIONS: The 14-item CES-D retained construct validity in adults with T2DM. Depressive symptoms were associated with younger age, female gender and BMI, but not with glycemic control.

Perfectionism, Type D personality, and illness-related coping styles in cardiac rehabilitation patients.

This study investigated the associations among trait perfectionism, perfectionistic self-presentation, Type D personality, and illness-specific coping styles in 100 cardiac rehabilitation patients. Participants completed the Multidimensional Perfectionism Scale, the Perfectionistic Self-Presentation Scale, the Type D Scale-14, and the Coping with Health Injuries and Problems Scale. Correlational analyses established that emotional preoccupation coping was associated with trait perfectionism, perfectionistic self-presentation, and Type D personality. Perfectionism was linked with both facets of the Type D construct (negative emotionality and social inhibition). Our results suggest that perfectionistic Type D patients have maladaptive coping with potential negative implications for their cardiac rehabilitation outcomes.