Sleep in Cardiac patients with Implantable Cardioverter Defibrillators (ICD)

使用植入式心脏复律除颤器 (ICD) 的心脏病患者的睡眠

基本信息

批准号：
7839764
负责人：
Christina S McCrae
金额：
$ 13.97万
依托单位：
UNIVERSITY OF FLORIDA
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-07-01 至 2011-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7839764
关键词：
Accidents Address Aftercare American Anxiety Arrhythmia Behavior Therapy Behavioral Cardiac Cause of Death Chronic Insomnia Clinic Clinical Cognition Comorbidity Development Diagnosis Effectiveness Fatigue Health Heart Diseases Implant Implantable Defibrillators Interview Manuals Methods Obstructive Sleep Apnea Outcome Patients Persons Pharmaceutical Preparations Physicians Polysomnography Prevalence Process Protocols documentation Public Health Quality of life Randomized Randomized Clinical Trials Recruitment Activity Research Research Personnel Risk Screening procedure Shock Sleep Sleep Apnea Syndromes Sleep Disorders Sleep disturbances Sleeplessness Staging Telephone Testing Universities Vulnerable Populations Weight alternative treatment base brief intervention chronic pain cognitive behavior therapy depression design diaries effective therapy experience follow-up implantation improved mortality novel patient population psychologic psychological outcomes public health relevance

项目摘要

DESCRIPTION (provided by investigator): Cardiac disease is the leading cause of death in the U.S. Because the Implantable Cardioverter Defibrillator (ICD) significantly reduces cardiac mortality, approximately 200,000 ICDs are implanted each year. Sleep disturbance represents a significant comorbidity for ~57 percent of ICD patients, potentially contributing to a variety of negative consequences (decreased quality of life, accidents) in this already vulnerable patient population. Unfortunately, information regarding the specific types of sleep disturbance experienced is not available. Such information is important, because different sleep disorders require very different treatment approaches. Specific Aim 1 addresses this issue by using a [3 stage] process to differentially diagnose sleep disorders in ICD patients: 1-clinical interview; 2-polysomnography; 3-sleep diaries. Obstructive sleep apnea (OSA) and insomnia are likely to be the two most common sleep disorders in ICD patients. Effective treatment exists for OSA. However, the best treatment approach for insomnia in these patients is unclear. Sleep medications provide effective short-term relief, but may not the best approach for chronic insomnia in ICD patients. Cognitive behavioral therapy for insomnia (CBTi) represents an attractive treatment alternative, because it is effective, carries little risk of unwanted effects, and is preferred to sleep medication by the majority of patients. Unfortunately, no definitive conclusions can be drawn about CBTi's effectiveness in ICD patients, because these patients are typically excluded from behavioral intervention protocols. Specific Aims 2 and 3 involve a randomized clinical trial (RCT) to evaluate the effects on sleep (Aim 2) and other daytime outcomes (Aim 3) of a brief cognitive-behavioral intervention against a waitlist control in ICD patients with insomnia. A brief, multiple-component CBTi protocol will be developed that includes established behavioral approaches to treating insomnia plus several novel components to target the negative cognitions and anxieties associated with cardiac disease and ICD implantation. ICD patients with insomnia will be randomly assigned to either treatment or a waitlist control. Treatment will be individually administered during 2 `in-person' sessions & 2 `telephone' sessions. Sleep and other outcomes (psychological functioning, daytime functioning, [quality of life, cardiac functioning (arrhythmic burden)], and ICD adjustment will be evaluated at baseline, post treatment, & 3 month follow-up. Sleep disturbance in the context of cardiac disease and ICD implantation represents a major health threat for many Americans. This research addresses the public health need for information on the types of sleep disorders experienced by ICD patients and for the development of behavioral interventions that target insomnia in this vulnerable population. The information to be gained has broad implications not only for other patient populations likely to suffer from insomnia (i.e., chronic pain), but also for those suffering from other behavioral/heath concerns (i.e., weight management, depression). PUBLIC HEALTH RELEVANCE: Sleep disturbance in the context of cardiac disease and ICD implantation represents a major health threat for many Americans. This research addresses the public health need for information on the types of sleep disorders experienced by ICD patients and for the development of behavioral interventions that target insomnia in this vulnerable population. The information to be gained has broad implications not only for other patient populations likely to suffer from insomnia (i.e., chronic pain), but also for those suffering from other behavioral/heath concerns (i.e., weight management, depression).

描述（由研究者提供）：心脏病是美国的首要死因。由于植入式心脏复律除颤器 (ICD) 显着降低了心脏死亡率，每年大约植入 200,000 个 ICD。睡眠障碍是约 57% 的 ICD 患者的一种重要合并症，可能会给这个本已脆弱的患者群体带来各种负面后果（生活质量下降、事故）。不幸的是，没有关于所经历的特定类型的睡眠障碍的信息。这些信息很重要，因为不同的睡眠障碍需要非常不同的治疗方法。具体目标 1 通过使用 [3 阶段] 过程来鉴别诊断 ICD 患者的睡眠障碍来解决这个问题：1 临床访谈； 2-多导睡眠图； 3-睡眠日记。阻塞性睡眠呼吸暂停 (OSA) 和失眠可能是 ICD 患者最常见的两种睡眠障碍。 OSA 存在有效的治疗方法。然而，治疗这些患者失眠的最佳方法尚不清楚。睡眠药物可提供有效的短期缓解，但可能不是治疗 ICD 患者慢性失眠的最佳方法。失眠认知行为疗法（CBTi）是一种有吸引力的治疗选择，因为它有效，几乎没有不良影响的风险，并且比大多数患者更喜欢睡眠药物。不幸的是，关于 CBTi 对 ICD 患者的有效性无法得出明确的结论，因为这些患者通常被排除在行为干预方案之外。具体目标 2 和 3 涉及一项随机临床试验 (RCT)，旨在评估针对 ICD 失眠患者的候补名单控制的简短认知行为干预对睡眠（目标 2）和其他日间结果（目标 3）的影响。将开发一个简短的、多成分的 CBTi 方案，其中包括治疗失眠的既定行为方法以及一些针对与心脏病和 ICD 植入相关的负面认知和焦虑的新成分。失眠的 ICD 患者将被随机分配接受治疗或等待对照。治疗将在 2 次“面对面”治疗和 2 次“电话”治疗中单独进行。将在基线、治疗后和 3 个月随访时评估睡眠和其他结果（心理功能、白天功能、[生活质量、心脏功能（心律失常负担）] 和 ICD 调整。疾病和 ICD 植入对许多美国人来说是一个重大的健康威胁。这项研究满足了公众健康对 ICD 患者所经历的睡眠障碍类型的信息的需求，并针对这一弱势群体制定了针对失眠的行为干预措施。获得不仅对其他可能患有失眠（即慢性疼痛）的患者群体具有广泛的影响，而且对那些患有其他行为/健康问题（即体重管理、抑郁）的患者也具有广泛的影响。公共卫生相关性：心脏病和 ICD 植入引起的睡眠障碍对许多美国人来说是一个主要的健康威胁。这项研究满足了公共卫生对 ICD 患者所经历的睡眠障碍类型信息的需求，并针对这一弱势群体的失眠问题制定了行为干预措施。获得的信息不仅对可能患有失眠（即慢性疼痛）的其他患者群体具有广泛的影响，而且对那些患有其他行为/健康问题（即体重管理、抑郁）的患者也具有广泛的影响。

项目成果

期刊论文数量（2）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Cognitive performance in patients with implantable cardioverter defibrillators: Associations with objective sleep duration, age and anxiety.

植入式心脏复律除颤器患者的认知表现：与客观睡眠时间、年龄和焦虑的关联。

DOI：
发表时间：
2019
期刊：
影响因子：
4.4
作者：
Curtis, Ashley F;Roth, Alicia J;Sears, Samuel F;Conti, Jamie B;Berry, Richard B;Dzierzewski, Joseph M;Rathinakumar, Himangshu;McCrae, Christina S
通讯作者：
McCrae, Christina S

Associations between pain, objective sleep efficiency and cognition in patients with implantable cardioverter defibrillators.

植入式心脏复律除颤器患者的疼痛、客观睡眠效率和认知之间的关联。

DOI：
发表时间：
2020
期刊：
影响因子：
4.8
作者：
Curtis, Ashley F;Roth, Alicia J;Sears, Samuel F;Conti, Jamie B;Berry, Richard B;Dzierzewski, Joseph M;McCrae, Christina S
通讯作者：
McCrae, Christina S