Abstract Body (Do not enter title and authors here): Background: Family caregivers of individuals with heart failure (HF) frequently report poor sleep and heightened psychological distress, which are linked to adverse health outcomes. Psychoeducational and exercise interventions (PsychEd+Ex) may mitigate these effects, but their combined and independent impacts on sleep and related biomarkers remain underexplored.
Hypothesis: We hypothesized that PsychEd+Ex would improve subjective sleep quality and reduce psychological distress and inflammatory markers in HF caregivers over six months.
Methods: We conducted a secondary analysis of data from the COOL HF randomized controlled trial. Caregivers (n=103) were randomized to usual care, PsychEd, or PsychEd+Ex. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), psychological distress using the CES-D, PROMIS Anxiety, STAI, and PSS, and inflammatory markers included IL-6 and CRP. Paired t-tests assessed within-group changes from baseline to 6 months. ANCOVA models evaluated between-group differences at 6 months, adjusting for baseline values. Pearson correlations examined associations between changes in sleep and psychological measures.
Results: Within-group analyses revealed significant improvement in the PsychEd group for total PSQI score (mean change= –1.67, p=.021) and sleep efficiency (p=.002, Cohen’s d=0.56). Usual care group also showed significant improvement in PSQI total score (p=.040), with smaller effect sizes. No significant changes were observed in the PsychEd+Ex group. Improvements in PSQI were positively correlated with reductions in CES-D (r=.372, p<.001), PROMIS Anxiety (r=.373, p<.001), STAI (r=.280, p=.006), and PSS (r= 246, p=.014), and negatively correlated with SF-36 Mental Component Scores (r=–.295, p=.003). There were no significant differences in PSQI total or component scores between groups. There was a significant decrease in IL-6 and CRP (p=.040) in the PsychEd+Ex group (p= 059, d=–0.34).
Conclusion: The COOL-HF psychoeducational intervention significantly improved sleep quality and efficiency among HF caregivers which was associated with reductions in depressive symptoms, anxiety, and perceived stress. While between-group differences at 6m were not statistically significant, within-group improvements and correlational patterns highlight the potential benefits of psychoeducation for sleep and psychological health in caregivers. Future studies with larger samples may clarify the additive effects of exercise.