Abstract
AIMS: Increases in stress, symptoms of anxiety and depression, and sleep problems have been reported during the Covid-19 pandemic, and people with chronic medical conditions such as heart failure (HF) are especially vulnerable. The purpose of this study was to examine the extent to which sleep characteristics, sleep-related cognitions, anxiety, depression, perceived stress, and changes in these phenomena over time predict ways of coping with pandemic-related stress among participants in the HeartSleep study, a randomized controlled trial of the effects of cognitive behavioural therapy for insomnia (CBT-I) in people with HF. METHODS AND RESULTS: Participants completed questionnaires to elicit sleep characteristics, daytime symptoms, mood and stress at baseline, 6 months after the intervention and during the Covid-19 pandemic. We added measures of coping during the pandemic (June-August 2020). The sample included 112 participants (M age = 63 ± 12.9 years; 47% women; 13% Black; 68% NY Heart Class II or III). Participants (43%) reported pandemic-related stressors and most often used secondary control coping. Insomnia severity, anxiety, depression, perceived stress, and sleep-related cognitions predicted secondary control coping (positive thinking, cognitive restructuring, acceptance, distraction), involuntary engagement (physiological arousal, rumination), and involuntary disengagement (emotional numbing). CONCLUSIONS: Insomnia and mood disturbance are important determinants of coping and responses to stress. Improving sleep and symptoms among people with HF may improve coping during stressful events, and CBT-I may have protective effects. REGISTRATION: ClinicalTrials.gov: NCT02660385.