Improving asthma control using Internet-based cognitive-behavioral treatment for insomnia

哮喘是一种普遍存在的慢性气道炎症性疾病，与一系列不良健康状况相关 结果。睡眠困难通常被认为是由于夜间哮喘引起的夜间觉醒的结果 症状，这将解决与适当的治疗哮喘症状。然而，失眠症状 即使在那些没有哮喘相关夜间觉醒的哮喘患者中也会发生，因此代表共病 失眠我们先前的工作表明，失眠可以通过进一步限制哮喘的控制， 参与活动和生活质量并增加未来哮喘恶化的风险和对哮喘的需求 急诊科就诊和住院。我们提出的研究采用了一种新的视角， 失眠和哮喘控制之间的相互作用：失眠的靶向治疗可以改善哮喘 控制和减轻疾病负担。我们建议测试认知行为治疗的有效性， CBT-I干预对成人睡眠和哮喘控制的影响我们将比较两个随机 干预措施：（1）自我指导，现实世界适用，互联网版本的CBT-I，睡眠健康使用 互联网（SHUTi），和（2）加强日常护理（EUC），涉及失眠的教育视频。目标 本研究的主要目的是：（1）比较SHUTi与EUC在3个月和6个月时对睡眠结果的疗效 在哮喘合并失眠的成人患者开始治疗后，（2）比较舒体的疗效 vs. EUC：哮喘控制从基线至3个月和6个月的变化，以及（3）确定是否发生变化 在3个月和6个月时，睡眠调节治疗对哮喘控制的影响。我们的探索目标是 确定3个月和6个月随访期间气道炎症生物标志物的变化是否解释了 睡眠变化（从基线到3个月）与哮喘控制改善之间的关系。的 使用有效的，低成本的，基于互联网的，认知行为干预失眠可以提供一个 可以在现实世界的临床环境中提供的治疗选择。我们的研究结果可以鼓励 包括失眠症-作为影响哮喘控制的共病，应加以识别， 治疗哮喘的正确管理的现行指南。

Asthma is a prevalent, chronic inflammatory disease of the airways associated with a range of adverse health outcomes. Sleep difficulties are often viewed as a consequence of nocturnal awakenings due to nighttime asthma symptoms, which will resolve with appropriate treatment of asthma symptoms. However, insomnia symptoms occur even in those asthmatics without asthma-related nocturnal awakenings, thus representing comorbid insomnia. Our prior work suggests that insomnia can negatively impact asthma control by further limiting engagement in activities and quality of life and increasing the risk for future asthma exacerbations and need for emergency department visits and hospitalizations. Our proposed study adopts a novel perspective on the interaction between insomnia and asthma control: targeted treatments for insomnia could improve asthma control and reduce the burden of disease. We propose to test the efficacy of a Cognitive-Behavioral Treatment of Insomnia (CBT-I) intervention on sleep and asthma control in adults. We will compare two randomized interventions: (1) a self-guided, real-world applicable, Internet version of CBT-I, Sleep Healthy Using The Internet (SHUTi), and (2) an enhanced usual care (EUC), involving an educational video on insomnia. The aims of this proposed study are: (1) to compare the efficacy of SHUTi vs. EUC on sleep outcomes at 3 and 6 months after initiation of treatment in adults with asthma and comorbid insomnia, (2) to compare the efficacy of SHUTi vs. EUC on changes in asthma control from baseline to 3 and 6 months, and (3) to determine whether changes in sleep mediate the effects of treatment on asthma control at 3 and 6 months. Our exploratory aim is to determine whether changes in biomarkers of airway inflammation across 3- and 6-month follow-up account for the relationship between changes in sleep (from baseline to 3 months) and improvements in asthma control. The use of an efficacious, low cost, Internet-based, cognitive-behavioral intervention for insomnia can provide a treatment option that could be delivered in real-world clinical settings. Findings from our study could encourage the inclusion of insomnia—as a comorbid condition that affects asthma control, and should be identified and treated—into the current guidelines for the proper management of asthma.