Cognitive behavioural therapy for insomnia does not appear to have a substantial impact on early markers of cardiovascular disease: A preliminary randomized controlled trial

Abstract

According to the World Health Organization, cardiovascular diseases are the leading cause of death in the world. Therefore, early prevention of these diseases is a public health priority. Epidemiological data suggest that insomnia may be a modifiable risk factor for cardiovascular diseases. A randomized controlled trial in a sample of insomnia patients without cardiovascular disease was conducted to investigate the effects of insomnia treatment on early markers of cardiovascular diseases assessed by 24‐hr ambulatory blood pressure, heart rate and heart rate variability monitoring, and morning fasting blood samples. Forty‐six patients with insomnia disorder were randomized to cognitive behavioural therapy for insomnia (CBT‐I; n = 23) or a waitlist control condition (n = 23). Contrary to the hypothesis, intention‐to‐treat analyses did not show any significant treatment effects on early markers of cardiovascular disease (d = 0.0–0.6) despite successful insomnia treatment (d = 1.3). Potential methodological and conceptual reasons for these negative findings are discussed. Future studies might include larger sample sizes that are at risk of cardiovascular diseases and focus on other cardiovascular markers.

Effect of Cognitive-Behavioral Therapy on Nocturnal Autonomic Activity in Patients with Fibromyalgia: A Preliminary Study

“…Thirdly, part of the treatment components delivered in CBT-C was based on the main evidence-based practice parameters for the psychological treatment of insomnia [ 41 ]. In contrast with our study, none of the studies referred to above [ 45 , 46 ] found benefits of CBT in autonomic cardiac regulation. Jarrin, et al (2016) [ 45 ], performed a secondary analysis of a clinical trial conducted among patients suffering from insomnia after receiving six weekly group sessions of CBT-I [ 65 ].…”

“…In addition, we can make comparisons between our clinical trial and those that have assessed HRV parameters as outcome results after CBT for insomnia delivered among insomnia patients [ 45 , 46 ]. Firstly, autonomic dysregulations in FM patients have similarities with the pattern observed in insomnia patients: increased sympathetic activation and decreased parasympathetic activity during sleep [ 23 , 29 ].…”

“…Johann, et al (2020) [ 46 ], obtained HRV parameters from a 24 h-ambulatory Holter. These authors hypothesized that CBT-I would have benefits on early markers of cardiovascular diseases (i.e., diastolic blood pressure, heart rate, HRV, C-reactive protein, N-terminal pro-brain natriuretic peptide and cystatin C) among patients diagnosed with insomnia, but the results of this clinical trial did not support that idea.…”

“…Considering this, the objective of this clinical trial was to explore the potential benefits in autonomic regulation after receiving one modality of CBT. Based on previous studies [ 45 , 46 ], we hypothesized that cardiac autonomic control during sleep would be improved following successful CBT-P/CBT-C, with regard to sleep quality improvement.…”

Insomnia symptoms and subclinical myocardial injury: Data from the Nord‐Trøndelag Health (HUNT) study

“…However, a newly published RCT assessed the short‐term effect of cognitive behavioural therapy for insomnia (CBT‐I) on CV risk factors such as 24‐hr ambulatory blood pressure, heart rate, CRP and N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) in 46 individuals without CVD before and after 8 weeks of CBT‐I therapy. The study found no significant treatment effects on these markers of CVD in those receiving treatment or randomised to waitlist control (Johann et al., 2020). That study did not include individuals at increased risk of CVD or elevated cTnI in their analysis, but reaches the same conclusion as a previous study published in 2017 that CBT‐I did not lower blood pressure in individuals free of known CVD (Mcgrath et al., 2017).…”