0326 Symptom trajectories in adults with stable heart failure and insomnia: Evidence from a randomized controlled trial of CBT-I

Abstract

Abstract Introduction Cognitive behavioral therapy for insomnia (CBT-I) improves individual symptoms of fatigue and daytime sleepiness; however, little is known how CBT-I improves multiple co-occurring daytime symptoms. The purposes of this study are to (1) identify daytime symptom trajectories in adults with insomnia and stable chronic heart failure (HF) over one year, and (2) determine how symptom trajectories vary based on participation in CBT-I or HF self-management education (attention control condition). Methods We conducted a retrospective analysis of data from a randomized controlled trial that looked the sustained effects of CBT-I compared to HF self-management over one year (NCT02660385). We measured daytime symptoms (fatigue, depression, anxiety, dyspnea, pain, and daytime sleepiness) at baseline (pre-treatment) and 3, 6 and 12 months. Symptom cluster trajectory were identified using group-based trajectory modeling, and the association with CBT-I was examined using logistic regressions. Results We randomized 175 participants (M age=63.0 (12.9) years, 57% men). We found four daytime symptom cluster trajectories, (A) low improving symptoms (N = 67, 38.3%); (B) low psychological symptoms and high improving physical symptoms (N = 40, 22.8%); (C), high improving symptoms (N = 42, 24.0%); and (D) high not improving symptoms (N = 26, 14.9%). There was no statistically significant difference between CBT-I and HF self-management across 4 symptom trajectories (p = .2509). However, people who received CBT-I vs. HF self-management education had higher odds of belonging to trajectory A compared to B/C/D after controlling for baseline fatigue (OR = 3.27 95% Confidence Intervals [1.39, 7.68]). Conclusion Most participants experienced improved daytime symptom profiles over 12 months after both interventions. Participants in the CBT-I group experienced symptom improvement even when they started with low symptoms. Support (if any) National Institute of Nursing Research [R01NR016191 and P20NR014126].