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

哮喘是一种流行的慢性呼吸道炎症性疾病，与一系列不利健康有关。 结果。睡眠困难通常被认为是夜间哮喘引起的夜间醒来的结果。 通过对哮喘症状的适当治疗，这些症状将得到缓解。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，因此代表着并存 失眠。我们之前的工作表明，失眠会进一步限制哮喘的控制，从而对哮喘控制产生负面影响 参与活动和生活质量，增加未来哮喘恶化的风险和需要 急诊科就诊和住院治疗。我们建议的研究采用了一种新的视角 失眠与哮喘控制的相互作用：针对失眠的靶向治疗可以改善哮喘 控制和减轻疾病负担。我们建议测试一种认知行为疗法的疗效 失眠(CBT-I)对成人睡眠和哮喘控制的干预。我们将比较两个随机的 干预措施：(1)CBT-I的自我指导、适用于现实世界的互联网版本，使用 (2)加强日常护理(EUC)，其中包括关于失眠的教育视频。目标 这项研究的主要目的是：(1)比较舒体贴片和EUC在3个月和6个月时对睡眠结果的影响。 成人哮喘合并失眠患者开始治疗后，(2)舒体的疗效比较 对比EUC对哮喘控制从基线到3个月和6个月的变化，以及(3)确定是否变化 在睡眠中调节治疗3个月和6个月的哮喘控制效果。我们的探索目标是 确定3个月和6个月随访期间呼吸道炎症生物标志物的变化是否可以解释 睡眠变化(从基线到3个月)与哮喘控制改善之间的关系。这个 使用一种有效的、低成本的、基于互联网的认知行为干预措施可以为失眠提供 可以在现实世界的临床环境中提供的治疗选项。我们的研究结果可能会鼓励 包括失眠--作为影响哮喘控制的一种共病情况，应确定和 治疗--纳入目前适当治疗哮喘的指南。

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.