Could behaviour change interventions be incorporated into cardiac rehabilitation programmes for insomnia and poor sleep quality management? A scoping review

BACKGROUND: Cardiovascular disease (CVD) is caused by modifiable and non-modifiable risk factors and is consistently recognised as a leading cause of morbidity and mortality. Poor sleep caused by sleep disorders such as insomnia are linked to increased mortality in patients with CVD, yet it is routinely overlooked as a cause to treat. Furthermore, despite the impact of sleep disorders, management strategies are notably underrepresented in cardiac care guidelines and cardiac rehabilitation. AIM OF REVIEW: This scoping review aimed to assemble recent published literature to explore how behaviour change interventions could be utilised as a method to integrate sleep management strategies into state-of-the-art cardiac rehabilitation for patients with cardiovascular disease. METHODS: Four medical databases (Cochrane Library, MEDLINE, PsycINFO and CINAHL+) were searched using a PICO framework, publishing a total of 782 results. Of the 782 records identified, 23 were included to inform this review, including an additional article found from bibliography searching. A variety of study designs were identified, including randomised controlled trials, pilot trials, secondary data analysis and systematic reviews. RESULTS: Cognitive behavioural therapy emerged as the most consistently effective intervention, particularly in group and web-based formats. Brief behavioural treatment for insomnia was also identified as an emerging flexible and easily adaptable approach, also producing promising reductions in insomnia severity. CONCLUSIONS: Behaviour change interventions demonstrate significant potential for improving sleep outcome measures and insomnia severity when tested among patients living with CVD. Evidence gaps include heterogeneity in intervention protocols and sample populations. Future studies must involve key stakeholders to better shape the suggested interventions. Also, they should consider this whilst exploring the role of tele-health and the need for flexibility for strategies to be implemented into cardiac rehabilitation.