Optimizing Cardiac Rehabilitation by Integrating Sleep Therapeutics

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The proposed CDA-2 will provide the candidate, Caitlan Tighe, PhD, with a specialized program of research career development and mentoring to support her goal of becoming a clinical investigator who focuses on developing and evaluating behavioral sleep interventions to enhance functioning and quality of life in older Veterans with aging-related diseases. Dr. Tighe will seek mentored training to: 1) increase her proficiency in the design and conduct of behavioral sleep intervention research in Veterans with aging-related diseases, 2) establish conceptual knowledge and skills in the measurement of physical functioning (e.g., mobility, frailty) and symptoms (e.g., pain) relevant to quality of life in these Veterans, 3) expand her expertise in the development and adaptation of behavioral sleep interventions for integration into VA outpatient rehabilitation and specialty medical care settings, and 4) enhance her grantsmanship, leadership, and organizational management skills. These Training Aims are supported by her proposed research, in which the Transdiagnostic Sleep and Circadian Intervention (TranS-C) will be adapted for delivery to Veterans in Cardiac Rehabilitation and pilot-tested in this population. Cardiac Rehabilitation is a multicomponent secondary prevention program for individuals who have experienced a cardiac event, including a cardiac procedure or an exacerbation of disease. The goals of Cardiac Rehabilitation primarily center around the recovery of physical functioning and the reduction of cardiovascular risk through physical activity, education, and counseling. Patients in Cardiac Rehabilitation are now older and more medically complex than in the past, prompting a need to broaden the scope of Cardiac Rehabilitation to address factors beyond cardiovascular disease that contribute to functioning and quality of life. Sleep health is linked to cardiovascular morbidity and mortality, as well as functioning and health-related quality of life. Cardiac Rehabilitation patients commonly experience poor sleep health yet it is not formally intervened upon in Cardiac Rehabilitation. A behavioral intervention for sleep and circadian problems, TranS-C was designed to promote sleep health across sleep problems of differing types and degrees of severity thus having great potential to benefit those served in Cardiac Rehabilitation. The proposed research plan draws from the NIH Stage Model of behavioral intervention development. Research Aim 1 will involve formative work to optimize the TranS-C manual and protocol for delivery in Cardiac Rehabilitation, with input from Veterans, content experts, and providers. Research Aim 2 will involve a preliminary test and refinement of the adapted TranS-C manual and protocol with a small sample (N=10) of Veterans who are participating in Cardiac Rehabilitation and report sleep disturbance and/or sleep-related impairment. Research Aim 3 will involve a pilot randomized trial to establish the feasibility, acceptability, and plausibility of the intervention protocol and study procedures. Veterans in Cardiac Rehabilitation with sleep disturbance and/or sleep-related impairment will be randomized to TranS-C + Cardiac Rehabilitation (n=25) or Usual Care (n=25). Sleep disturbance and sleep-related impairment, disability and functioning, and health- related quality of life will be assessed at 3- and 6-months to determine measure responsiveness and provide preliminary insight into treatment effects.