Adapting and Evaluating the Feasibility and Acceptability of a Behavioral Intervention to Promote Sleep Health in Cardiac Rehabilitation

ABSTRACT

Objectives

Study objectives were to: 1) iteratively adapt the Transdiagnostic Sleep and Circadian Intervention (TranS-C) for patients in cardiac rehabilitation (CR; Phase 1) and 2) conduct a preliminary single group pre-post intervention test to a) evaluate procedural feasibility and intervention acceptability and b) to explore preliminary pre-post changes in self-reported sleep, disability, and health-related quality of life (HRQoL; Phase 2).

Method

In Phase 1, 12 individuals in CR and six content experts completed interviews to inform TranS-C adaptations. Interviews were analyzed using rapid qualitative analysis. In Phase 2, eight individuals in CR completed a baseline assessment, the adapted TranS-C intervention, and a post-intervention assessment. Intervention acceptability was assessed via questionnaire and interview. Sleep, disability, and HRQoL outcomes were assessed using questionnaires. Descriptive statistics were calculated for quantitative measures; interviews were analyzed using rapid qualitative analysis.

Results

Phase 1 participants were receptive to the premise and structure of the adapted intervention. In Phase 2, participants endorsed positive attitudes toward the intervention. Seven of eight participants demonstrated improvements in sleep outcomes. Disability and HRQoL results did not consistently improve.

Conclusion

The adapted TranS-C intervention was acceptable to CR patients and could yield improvements in subjective sleep outcomes. Larger-scale testing in CR is warranted.

Acknowledgments

The authors would like to express our sincere gratitude to the study participants and clinical staff. We would also like to express our appreciation for Dr. Jon Walker, who assisted in creation of the study database. The views expressed in this article are those of the authors and do not necessarily represent the position or policy of the Department of Veterans Affairs or the United States Government. Because several of the authors of this manuscript are employees of the U.S. Government and contributed to this manuscript as part of their official duties, the work is not subject to US copyright.

Disclosure statement

Ms. Phares, Dr. Tighe, Dr. Weiner, Dr. Beehler, Dr. VanSwearingen, Dr. Hilgeman, and Dr. Forman have no conflicts to report. Dr. Harvey has received book royalties from the American Psychological Association, Guilford Press, and Oxford University Press. Over the past 3 years, Dr. Buysse has served as a paid or unpaid consultant to the following: National Cancer Institute, Pear Therapeutics, Sleep Number, Idorsia, Eisai. All consulting agreements have paid a total of less than $5000 per year from any single entity. Dr. Buysse is an author of the Pittsburgh Sleep Quality Index, Pittsburgh Sleep Quality Index Addendum for PTSD (PSQI-A), Brief Pittsburgh Sleep Quality Index (B-PSQI), Daytime Insomnia Symptoms Scale, Pittsburgh Sleep Diary, Insomnia Symptom Questionnaire, and RU_SATED (copyrights held by University of Pittsburgh). These instruments have been licensed to commercial entities for fees by the University of Pittsburgh; Dr. Buysse receives a portion of the licensing fees. He is also co-author of the Consensus Sleep Diary (copyright held by Ryerson University), which is licensed to commercial entities for a fee by Ryerson University; Dr. Buysse receives a portion of the licensing fees.

Data availability statement

Limited data available on request due to privacy/ethical restrictions.

Additional information

Funding

This work was supported by Career Development/Capacity Building Award Number [IK2 RX003393] from the United States (U.S.) Department of Veterans Affairs Rehabilitation R&D (Rehab RD) Service. This material is also the result of work supported with resources and the use of facilities at the Veterans Integrated Service Network 4 Mental Illness Research, Education, and Clinical Center at the VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania. Dr. Forman receives funding support through National Institute of Aging grants [R01AG060499, R01AG058883, and P30AG024827]. Dr. Beehler receives support from the VA Center for Integrated Healthcare and VA Rehabilitation R&D [I01RX003485]. Dr. Hilgeman receives grant support from VA research [I01HX003093], the VA Diffusion of Excellence, the VA Office of Health Equity, and NIH [NCT04850781]. Dr. Harvey receives funding support through the National Institute of Aging [R01AG082651] and the National Institute of Mental Health [NIMH; R01MH120147]. Dr. Buysse has received grant/contract support from NIH, PCORI, AHRQ, VA and Sleep Number for research relating to sleep, insomnia, sleep interventions, and questionnaire development.