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cognitive behavioral therapy, COVID-19, heart failure, sleep



  1. O'Connell, Meghan MPH
  2. Jeon, Sangchoon PhD
  3. Conley, Samantha PhD, RN
  4. Linsky, Sarah MPH
  5. Redeker, Nancy S. PhD, RN


Background: The COVID-19 pandemic raised concerns about the effects of stress on sleep and mental health, particularly among people with chronic conditions, including people with heart failure (HF).


Objective: The aim of this study was to examine changes in sleep, sleep-related cognitions, stress, anxiety, and depression among people with HF who participated in a randomized controlled trial of cognitive behavioral therapy for insomnia before the COVID-19 pandemic.


Methods: Participants self-reported sleep characteristics, symptoms, mood, and stress at baseline, 6 months after cognitive behavioral therapy for insomnia or HF self-management education (attention control), and during the pandemic.


Results: The sample included 112 participants (mean age, 63 +/- 12.9 years; 47% women; 13% Black; 68% New York Heart Association class II or III). Statistically significant improvements in sleep, stress, mood, and symptoms that occurred 6 months post treatment were sustained during the pandemic.


Conclusions: Improving sleep and symptoms among people with HF may improve coping during stressful events, and cognitive behavioral therapy for insomnia may be protective.