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Tadros M, Li S, Corkish B, Upton E, Newby J, Werner-Seidler A. Cognitive behavior therapy for insomnia in university students delivered via videoconferencing groups: A pilot study. Behav Sleep Med 2024:1-14. [PMID: 38949071 DOI: 10.1080/15402002.2024.2374258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
INTRODUCTION Sleep difficulties are common amongst university students and are associated with mental illness and reduced wellbeing. This paper reports a pilot study of Cognitive Behavior Therapy for Insomnia (CBT-I) tailored specifically for university students. It was hypothesized that the intervention would be feasible, acceptable, and improve sleep, anxiety, depression, and wellbeing. METHOD Students aged 18-25 participated via videoconferencing small group sessions of CBT-I. Feasibility was assessed through sign-up, consent rates, and study attrition, while acceptability was assessed using intervention adherence and a measure of intervention acceptability. Outcome measures included sleep quality, insomnia, suicidal ideation, symptoms of depression, anxiety, and wellbeing, and were assessed at baseline and post-intervention. RESULTS Participants were 44 students (M = 21.8 years). Feasibility was confirmed by sign-up and consent rates (80% of the students who expressed interest agreed to participate); overall study attrition was 48%, comprised largely of participants not commencing treatment (27%). Participants perceived the program as effective and logical and made use of the skills suggested. In terms of adherence, 82% of the participants who engaged with treatment attended two or more sessions and 63% attended all four sessions; and 92% were either very satisfied or mostly satisfied. Sleep quality, insomnia, depression, anxiety, and wellbeing all significantly improved from pre- to post-intervention. DISCUSSION There was evidence that the CBT-I intervention tailored for university students was acceptable to participants and could be feasible to deliver. Sleep quality, depression, anxiety, and wellbeing improved significantly. These findings suggest that the intervention is suitable for evaluation in a fully powered randomized controlled trial.
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Affiliation(s)
- Michelle Tadros
- The Black Dog Institute, University of New South Wales, Sydney, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Sophie Li
- The Black Dog Institute, University of New South Wales, Sydney, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Britt Corkish
- The Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Emily Upton
- The Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Jill Newby
- The Black Dog Institute, University of New South Wales, Sydney, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Aliza Werner-Seidler
- The Black Dog Institute, University of New South Wales, Sydney, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
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Fleming MK, Smejka T, Macey E, Luengo-Fernandez R, Henry AL, Robinson B, Kyle SD, Espie CA, Johansen-Berg H. Improving sleep after stroke: A randomised controlled trial of digital cognitive behavioural therapy for insomnia. J Sleep Res 2024; 33:e13971. [PMID: 37407096 DOI: 10.1111/jsr.13971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/11/2023] [Accepted: 06/08/2023] [Indexed: 07/07/2023]
Abstract
Stroke is frequently accompanied by long-term sleep disruption. We therefore aimed to assess the efficacy of digital cognitive behavioural therapy for insomnia to improve sleep after stroke. A parallel group randomised controlled trial was conducted remotely in participant's homes/online. Randomisation was online with minimisation of between-group differences in age and baseline Sleep Condition Indicator-8 score. In total, 86 community-dwelling stroke survivors consented, of whom 84 completed baseline assessments (39 female, mean 5.5 years post-stroke, mean 59 years old), and were randomised to digital cognitive behavioural therapy or control (sleep hygiene information). Follow-up was at post-intervention (mean 75 days after baseline) and 8 weeks later. The primary outcome was self-reported insomnia symptoms, as per the Sleep Condition Indicator-8 (range 0-32, lower numbers indicate more severe insomnia, reliable change 7 points) at post-intervention. There were significant improvements in Sleep Condition Indicator-8 for digital cognitive behavioural therapy compared with control (intention-to-treat, digital cognitive behavioural therapy n = 48, control n = 36, 5 imputed datasets, effect of group p ≤ 0.02,η p 2 = 0.07-0.12 [medium size effect], pooled mean difference = -3.35). Additionally, secondary outcomes showed shorter self-reported sleep-onset latencies and better mood for the digital cognitive behavioural therapy group, but no significant differences for self-efficacy, quality of life or actigraphy-derived sleep parameters. Cost-effectiveness analysis found that digital cognitive behavioural therapy dominates over control (non-significant cost savings and higher quality-adjusted life years). No related serious adverse events were reported to the researchers. Overall, digital cognitive behavioural therapy for insomnia effectively improves sleep after stroke. Future research is needed to assess earlier stages post-stroke, with a longer follow-up period to determine whether it should be included as part of routine post-stroke care. Clinicaltrials.gov NCT04272892.
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Affiliation(s)
- Melanie K Fleming
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Tom Smejka
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Ellie Macey
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Ramon Luengo-Fernandez
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alasdair L Henry
- Big Health Ltd, London, UK
- Sir Jules Thorn Sleep & Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Barbara Robinson
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Simon D Kyle
- Sir Jules Thorn Sleep & Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Colin A Espie
- Big Health Ltd, London, UK
- Sir Jules Thorn Sleep & Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Heidi Johansen-Berg
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Jansson-Fröjmark M, Nordenstam L, Alfonsson S, Bohman B, Rozental A, Norell-Clarke A. Stimulus control for insomnia: A systematic review and meta-analysis. J Sleep Res 2024; 33:e14002. [PMID: 37496454 DOI: 10.1111/jsr.14002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/29/2023] [Accepted: 07/01/2023] [Indexed: 07/28/2023]
Abstract
Stimulus control (SC) is commonly viewed as an evidence-based treatment for insomnia, but it has not been evaluated comprehensively with modern review and meta-analytic techniques. The aim of the current study was thus to perform a systematic review and meta-analysis of trials that examine the efficacy of stimulus control for insomnia. A systematic search for eligible articles and dissertations was conducted in six online bibliographic databases. The 11 included studies, with the majority published between 1978 and 1998, were randomised controlled and experimental studies in adults, comparing stimulus control for insomnia with passive and active comparators and assessing insomnia symptoms as outcomes. A random effects model was used to determine the standardised mean difference Hedge's g at post-treatment and follow-up for three sleep diary measures: the number of awakenings, sleep onset latency, and total sleep time. A test for heterogeneity was conducted, forest plots were produced, the risk of publication bias was estimated, and the study quality was assessed. In the trials identified, stimulus control resulted in small to large improvements on sleep onset latency and total sleep time, relative to passive comparators (g = 0.38-0.85). Compared with active comparators, the improvements following stimulus control were negligible (g = 0.06-0.30). Although methodological uncertainties were observed in the included trials, stimulus control appears to be an efficacious treatment for insomnia when compared with passive comparators and with similar effects to active comparators. More robust studies are, however, warranted before stronger conclusions are possible to infer.
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Affiliation(s)
- Markus Jansson-Fröjmark
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm Health Care Services, Stockholm, Sweden
| | - Lisa Nordenstam
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm Health Care Services, Stockholm, Sweden
| | - Sven Alfonsson
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm Health Care Services, Stockholm, Sweden
| | - Benjamin Bohman
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm Health Care Services, Stockholm, Sweden
| | - Alexander Rozental
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm Health Care Services, Stockholm, Sweden
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Annika Norell-Clarke
- Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden
- Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
- School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
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Treacy T, O'Meara Y, Galligan MC, Henry AL, Lensen SF, Higgins MJ, Hickey M, Brennan DJ. The Sleepio After Cancer (SAC) study. Digital cognitive behavioural therapy for insomnia (dCBT-I) in women cancer patients - Trial protocol of a randomised controlled trial. Contemp Clin Trials 2024; 136:107337. [PMID: 37741507 DOI: 10.1016/j.cct.2023.107337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/24/2023] [Accepted: 09/15/2023] [Indexed: 09/25/2023]
Abstract
AIMS This study will assess the efficacy of digital CBT for insomnia (dCBT-I) compared to sleep hygiene education (SHE) for the management of insomnia in women with cancer. BACKGROUND 30% of patients with cancer meet insomnia diagnostic criteria and this can be detrimental to health outcomes. Insomnia disorder comprises a dissatisfaction with sleep quantity or quality characterized by difficulty initiating sleep, frequent awakenings, or early morning wakening without the ability to return to sleep, at least 3 nights per week, for at least 3 months, causing significant impairment or distress in areas of functioning. METHODS We will recruit 308 women with a current or prior cancer diagnosis who are currently experiencing insomnia; defined as a score of 16 or less on the Sleep Condition Indicator (SCI). Participants will be randomised to dCBT-I or SHE. dCBT-I will be delivered online via 6 sessions. SHE will be provided in an online format. Assessments of sleep and other related parameters, through validated questionnaires, will be taken at 12 and 24 weeks following intervention. Once 24 week assessments are completed, participants will crossover to the alternate arm (either SHE or dCBT-I) and undergo a final assessment at week 36. OUTCOMES The primary outcome will be the mean continuous change in SCI score in the intervention arm compared to the control arm at 24 weeks. Additionally, the proportion of women with an SCI > 16 at 24 weeks will be assessed. Secondary outcomes include fatigue, sleep related quality of life, depression, anxiety, and hot flush interference. REGISTRATION This study is registered on ClinicalTrials.gov with number NCT05816460.
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Affiliation(s)
- Teresa Treacy
- Living Well Cancer Programme, UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.
| | - Yvvonne O'Meara
- Living Well Cancer Programme, UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Marie C Galligan
- UCD Clinical Research Centre, School of Medicine, University College Dublin, Dublin, Ireland
| | | | - Sarah F Lensen
- Dept. of Obstetrics and Gynaecology, University of Melbourne, Royal Women's Hospital, Melbourne, VIC, Australia
| | - Michaela J Higgins
- Dept. of Medical Oncology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Martha Hickey
- Dept. of Obstetrics and Gynaecology, University of Melbourne, Royal Women's Hospital, Melbourne, VIC, Australia
| | - Donal J Brennan
- Living Well Cancer Programme, UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland; UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Belfield, Dublin 4, Ireland
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Lawrence K, Fibert P, Hobbs J, Myrissa K, Toribio-Mateas MA, Quadt F, Cotter PD, Gregory AM. Randomised controlled trial of the effects of kefir on behaviour, sleep and the microbiome in children with ADHD: a study protocol. BMJ Open 2023; 13:e071063. [PMID: 38149413 PMCID: PMC10711914 DOI: 10.1136/bmjopen-2022-071063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 11/07/2023] [Indexed: 12/28/2023] Open
Abstract
INTRODUCTION Current interventions for children with attention-deficit/hyperactivity disorder (ADHD) are primarily medication, behavioural therapy and parent training. However, research suggests dietary manipulations may provide therapeutic benefit for some. There is accumulating evidence that the gut microbiome may be atypical in ADHD, and therefore, manipulating gut bacteria in such individuals may help alleviate some of the symptoms of this condition. The aim of this study is to explore the effects of supplementation with kefir (a fermented dairy drink) on ADHD symptomatology, sleep, attention and the gut microbiome in children diagnosed with ADHD. METHODS AND ANALYSIS A 6-week randomised, double-blind, placebo-controlled trial in 70 children aged 8-13 years diagnosed with ADHD. Participants will be recruited throughout the UK, through support groups, community groups, schools, social media and word of mouth. Children will be randomised to consume daily either dairy kefir or a placebo dairy drink for 6 weeks. The primary outcome, ADHD symptomatology, will be measured by The Strengths and Weakness of ADHD-symptoms and Normal-behaviour scale. Secondary outcomes will include gut microbiota composition (using shotgun metagenomic microbiome sequencing), gut symptomatology (The Gastrointestinal Severity Index questionnaire), sleep (using 7-day actigraphy recordings, The Child's Sleep Habits Questionnaire and Sleep Self Report questionnaire), inattention and impulsivity (with a computerised Go/NoGo test). Assessments will be conducted prior to the intervention and at the end of the intervention. Interaction between time (preintervention/postintervention) and group (probiotic/placebo) is to be analysed using a Mixed Model Analysis of Variances. ETHICS AND DISSEMINATION Ethical approval for the study was granted by St Mary's University Ethics Committee. Results will be disseminated through peer-reviewed publications, presentations to the scientific community and support groups. TRIAL REGISTRATION NUMBER NCT05155696.
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Affiliation(s)
- Kate Lawrence
- School of Allied Health & Life Sciences, St Mary's University, Twickenham, UK
| | - Philippa Fibert
- School of Allied Health & Life Sciences, St Mary's University, Twickenham, UK
| | - Jemima Hobbs
- School of Allied Health & Life Sciences, St Mary's University, Twickenham, UK
| | - Kyriaki Myrissa
- School of Allied Health & Life Sciences, St Mary's University, Twickenham, UK
| | | | - Frits Quadt
- Quadt Consultancy B.V, Oostvoorne, The Netherlands
| | - Paul D Cotter
- SeqBiome Ltd, Cork, Ireland
- University College Cork APC Microbiome Institute, Cork, Ireland
- Teagasc Food Research Centre, Moorepark, Cork, Ireland
| | - Alice M Gregory
- Department of Psychology, Goldsmiths University of London, London, UK
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Nazem S, Barnes SM, Forster JE, Hostetter TA, Monteith LL, Kramer EB, Gaeddert LA, Brenner LA. Efficacy of an Internet-Delivered Intervention for Improving Insomnia Severity and Functioning in Veterans: Randomized Controlled Trial. JMIR Ment Health 2023; 10:e50516. [PMID: 37999953 DOI: 10.2196/50516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/26/2023] [Accepted: 10/06/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Despite a growing evidence base that internet-delivered cognitive behavioral therapy for insomnia (iCBT-I) is associated with decreased insomnia severity, its efficacy has been minimally examined in veterans. OBJECTIVE The objective of this study was to evaluate the efficacy of an unguided iCBT-I (Sleep Healthy Using the Internet [SHUTi]) among veterans. METHODS We conducted a single-blind, randomized controlled trial in Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn veterans eligible for Veterans Health Administration care. Participants were randomly assigned (1:1) to receive SHUTi (a self-guided and interactive program) or an Insomnia Education Website (IEW) that provided nontailored and fixed insomnia information. Web-based assessments were administered at baseline, postintervention, 6 months postintervention, and 1 year postintervention. The primary outcome was self-reported insomnia severity (Insomnia Severity Index [ISI]). Secondary outcomes were self-reported mental and physical health functioning (Veterans RAND 36-item Health Survey). Exploratory outcomes comprised sleep diary parameters. RESULTS Of the 231 randomized participants (mean age 39.3, SD 7.8 years; 170/231, 73.5% male sex; 26/231, 11.3% Black; 172/231, 74.5% White; 10/231, 4.3% multiracial; and 17/231, 7.4% other; 36/231, 15.6% Hispanic) randomized between April 2018 and January 2019, a total of 116 (50.2%) were randomly assigned to SHUTi and 115 (49.8%) to the IEW. In intent-to-treat analyses, SHUTi participants experienced significantly larger ISI decreases compared with IEW participants at all time points (generalized η2 values of 0.13, 0.12, and 0.10, respectively; all P<.0001). These corresponded to estimated larger differences in changes of -3.47 (95% CI -4.78 to -2.16), -3.80 (95% CI -5.34 to -2.27), and -3.42 (95% CI -4.97 to 1.88) points on the ISI for the SHUTi group. SHUTi participants experienced significant improvements in physical (6-month generalized η2=0.04; P=.004) and mental health functioning (6-month and 1-year generalized η2=0.04; P=.009 and P=.005, respectively). Significant sleep parameter improvements were noted for SHUTi (all P<.05), though the pattern and magnitude of these reductions varied by parameter. No adverse events were reported. CONCLUSIONS Self-administered iCBT-I was associated with immediate and long-term improvements in insomnia severity. Findings suggest that leveraging technology to meet insomnia treatment demands among veterans may be a promising approach. TRIAL REGISTRATION ClinicalTrials.gov NCT03366870; https://clinicaltrials.gov/ct2/show/NCT03366870.
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Affiliation(s)
- Sarra Nazem
- Dissemination & Training Division, National Center for Posttraumatic Stress Disorder, Menlo Park, CA, United States
- Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, United States
| | - Sean M Barnes
- Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, United States
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Jeri E Forster
- Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, United States
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Trisha A Hostetter
- Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, United States
| | - Lindsey L Monteith
- Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, United States
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Emily B Kramer
- Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, United States
| | - Laurel A Gaeddert
- Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, United States
| | - Lisa A Brenner
- Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, United States
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Lücke AJ, Wrzus C, Gerstorf D, Kunzmann U, Katzorreck M, Hoppmann C, Schilling OK. Bidirectional Links of Daily Sleep Quality and Duration With Pain and Self-rated Health in Older Adults' Daily Lives. J Gerontol A Biol Sci Med Sci 2023; 78:1887-1896. [PMID: 36124664 DOI: 10.1093/gerona/glac192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Sleep and health perceptions, such as self-ratings of pain and health are closely linked. However, the temporal ordering of such associations is not well understood, and it remains unclear whether sleep quality and sleep duration show similar or differential associations with health perceptions. METHODS We used ecological momentary assessment data from 123 young-old (66-69 years, 47% women) and 47 old-old adults (84-90 years, 60% women). Across 7 consecutive days, participants reported their sleep quality and sleep duration each morning and rated their momentary pain and health 6 times per day. We applied dynamic structural equation models to examine bidirectional links of morning reports of sleep quality and duration with daily levels of self-rated pain and health. RESULTS In line with the hypotheses, results showed that when participants reported better sleep quality than what is typical for them, they reported less pain and better self-rated health on the day that followed. Longer sleep duration was not linked with subsequent pain or self-rated health. On days when people rated their health as better than usual, they reported better sleep quality but not longer sleep duration the following night. These associations were not moderated by age, gender, or chronic pain. CONCLUSION Findings suggest that in old age, sleep quality is more relevant for health perceptions than sleep duration. Associations between sleep quality and self-rated health seem to be bidirectional; daily pain was linked to prior but not subsequent sleep quality.
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Affiliation(s)
- Anna J Lücke
- Psychological Institute, Ruprecht Karls University Heidelberg, Heidelberg, Germany
| | - Cornelia Wrzus
- Psychological Institute, Ruprecht Karls University Heidelberg, Heidelberg, Germany
| | - Denis Gerstorf
- Department of Psychology, Humboldt University Berlin, Berlin, Germany
| | - Ute Kunzmann
- Institute of Psychology, University of Leipzig, Leipzig, Germany
| | | | - Christiane Hoppmann
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Oliver K Schilling
- Psychological Institute, Ruprecht Karls University Heidelberg, Heidelberg, Germany
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Objective and Subjective Sleep Measures Are Related to Suicidal Ideation and Are Transdiagnostic Features of Major Depressive Disorder and Social Anxiety Disorder. Brain Sci 2023; 13:brainsci13020288. [PMID: 36831831 PMCID: PMC9953840 DOI: 10.3390/brainsci13020288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/01/2023] [Accepted: 02/04/2023] [Indexed: 02/11/2023] Open
Abstract
Suicide is a major public health problem and previous studies in major depression and anxiety show problematic sleep is a risk factor for suicidal ideation (SI). However, less is known about sleep and SI in social anxiety disorder (SAD), despite the pervasiveness of SAD. Therefore, the current study comprised participants with major depressive disorder (MDD) (without comorbid SAD) (n = 26) and participants with SAD (without comorbid MDD) (n = 41). Wrist actigraphy was used to estimate sleep duration, wake after sleep onset, and sleep efficiency; sleep quality was evaluated with self-report. Self-report was also used to examine SI. These measures were submitted to independent t-tests and multiple regression analysis. t-test results revealed sleep and SI did not differ between MDD and SAD groups. Multiple regression results showed shorter sleep duration and worse sleep quality related to greater SI when taking symptom severity and age into account. Post-hoc partial correlational analysis showed these sleep-SI relationships remained significant after controlling for symptom severity and age. Preliminary findings indicate sleep and SI may be transdiagnostic features of MDD and SAD. Evidence of distinct sleep-SI relationships are consistent with previous reports showing that sleep difficulties contribute to SI. Altogether, improving sleep duration and sleep quality may reduce the risk of SI.
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Chandler L, Patel C, Lovecka L, Gardani M, Walasek L, Ellis J, Meyer C, Johnson S, Tang NKY. Improving university students' mental health using multi-component and single-component sleep interventions: A systematic review and meta-analysis. Sleep Med 2022; 100:354-363. [PMID: 36198252 DOI: 10.1016/j.sleep.2022.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/08/2022] [Accepted: 09/06/2022] [Indexed: 01/11/2023]
Abstract
University is a time of significant transitions during a young adult's life, with delayed and shortened sleep and poor mental health a common occurrence. This systematic review and meta-analysis examined the effect of both multi-component and single-component sleep interventions on improving university students' sleep and mental health. Five databases (MEDLINE, PsycINFO, Embase, CINAHL and Cochrane Library) were searched for relevant literature published until April 2022. Treatment studies including university students aged 18-24 years, participating in a sleep intervention (multi-component, e.g., CBT-I, or single-component, e.g., sleep hygiene) were eligible. Comparator groups were either active, i.e., alternative intervention, or passive, i.e., waitlist control or treatment-as-usual, with study outcomes to include measures of sleep and mental health. Of 3435 references screened, 11 studies involving 5267 participants, with and without insomnia symptoms, were included for a narrative synthesis on intervention designs and methodology. Six studies eligible for meta-analyses showed a moderate effect of sleep interventions in reducing sleep disturbance (SMD = -0.548 [CI: -0.837, -0.258]) at post-treatment, alongside a small effect in improving anxiety (SMD = -0.226 [CI: -0.421, -0.031]) and depression (SMD = -0.295 [CI: -0.513, -0.077]). Meta-regression examining study and intervention characteristics identified subpopulation (experiencing insomnia or not) as a significant moderator for effects on sleep (p = 0.0003) and depression (p = 0.0063), with larger effects in studies with participants experiencing insomnia. Comparison group type (active or passive) was also a significant moderator (p = 0.0474), with larger effects on sleep in studies using passive comparison groups. Study type, delivery format, and intervention duration were not identified as significant moderators. At follow-ups, small but significant effects were sustained for anxiety and depression. Protecting and promoting sleep amongst university students may help safeguard and advance mental health.
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Affiliation(s)
| | - Chloe Patel
- Warwick Manufacturing Group, University of Warwick, UK
| | - Lia Lovecka
- Department of Psychology, University of Warwick, UK
| | - Maria Gardani
- School of Health in Social Science, University of Edinburgh, UK
| | | | - Jason Ellis
- Department of Psychology, Faculty of Health & Life Sciences, Northumbria University, UK
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Rehman A, Drake CL, Shiramizu V, Fleming L. Sleep reactivity predicts insomnia in patients diagnosed with breast cancer. J Clin Sleep Med 2022; 18:2597-2604. [PMID: 35912701 PMCID: PMC9622996 DOI: 10.5664/jcsm.10170] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To examine the role of sleep reactivity as a predictor of insomnia in patients diagnosed with breast cancer. METHODS A total of 173 women with breast cancer participated and were followed up over a period of 9 months. At baseline, participants were assigned to a high (n = 114) or low (n = 59) sleep reactivity group, based on their responses to the Ford Insomnia Response to Stress Test (FIRST). We assessed whether these FIRST groupings (high/low sleep reactivity) predicted changes in insomnia over time using the Insomnia Severity Index. We also tested if these FIRST groupings predicted insomnia disorder (using Insomnia Severity Index cutoffs) at 3 different time points (T3, T6, and T9). RESULTS Individuals with high sleep reactivity were more likely to experience a worsening of insomnia. Using logistic regression, we also found that FIRST grouping predicted insomnia disorder. Results remained significant after controlling for estimated premorbid sleep, age, and whether someone had chemotherapy. CONCLUSIONS Our study shows that sleep reactivity may be a robust predictor of insomnia within breast cancer populations. Sleep reactivity should be considered in routine clinical assessments as a reliable way to identify patients at risk of developing insomnia. This would facilitate early sleep intervention for those patients who are considered high risk. CITATION Rehman A, Drake CL, Shiramizu V, Fleming L. Sleep reactivity predicts insomnia in patients diagnosed with breast cancer. J Clin Sleep Med. 2022;18(11):2597-2604.
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Affiliation(s)
- Aliyah Rehman
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, Scotland, United Kingdom
| | - Christopher L. Drake
- Henry Ford Health System, Sleep Disorders and Research Center, Detroit, Michigan
| | - Victor Shiramizu
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, Scotland, United Kingdom
| | - Leanne Fleming
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, Scotland, United Kingdom
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11
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Peersmann SHM, Grootenhuis MA, van Straten A, Tissing WJE, Abbink F, de Vries ACH, Loonen J, van der Pal HJH, Kaspers GJL, van Litsenburg RRL. Insomnia Symptoms and Daytime Fatigue Co-Occurrence in Adolescent and Young Adult Childhood Cancer Patients in Follow-Up after Treatment: Prevalence and Associated Risk Factors. Cancers (Basel) 2022; 14:cancers14143316. [PMID: 35884378 PMCID: PMC9313407 DOI: 10.3390/cancers14143316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/23/2022] [Accepted: 07/02/2022] [Indexed: 01/09/2023] Open
Abstract
Insomnia symptoms and daytime fatigue commonly occur in pediatric oncology, which significantly impact physical and psychosocial health. This study evaluated the prevalence of insomnia only, daytime fatigue only, the co-occurrence of insomnia−daytime fatigue symptoms, and associated risk factors. Childhood cancer patients (n = 565, 12−26 years old, ≥6 months after treatment) participated in a national, cross-sectional questionnaire study, measuring insomnia symptoms (ISI; Insomnia Severity Index) and daytime fatigue (single item). Prevalence rates of insomnia and/or daytime fatigue subgroups and ISI severity ranges were calculated. Multinomial regression models were applied to assess risk factors. Most patients reported no insomnia symptoms or daytime fatigue (61.8%). In the 38.2% of patients who had symptoms, 48.1% reported insomnia and daytime fatigue, 34.7% insomnia only, and 17.1% daytime fatigue only. Insomnia scores were higher in patients with insomnia−daytime fatigue compared to insomnia only (p < 0.001). Risk factors that emerged were: female sex and co-morbidities (all), shorter time after treatment and bedtime gaming (insomnia only), young adulthood (insomnia−fatigue/fatigue only), needing someone else to fall asleep and inconsistent wake times (both insomnia groups), lower educational level and consistent bedtimes (insomnia−fatigue). Insomnia symptoms and daytime fatigue are common and often co-occur. While current fatigue guidelines do not include insomnia symptoms, healthcare providers should inquire about insomnia as this potentially provides additional options for treatment and prevention.
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Affiliation(s)
- Shosha H. M. Peersmann
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (S.H.M.P.); (M.A.G.); (W.J.E.T.); (A.C.H.d.V.); (H.J.H.v.d.P.); (G.J.L.K.)
- Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands;
| | - Martha A. Grootenhuis
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (S.H.M.P.); (M.A.G.); (W.J.E.T.); (A.C.H.d.V.); (H.J.H.v.d.P.); (G.J.L.K.)
- University Medical Center Utrecht, Wilhelmina Children’s Hospital, 3584 CX Utrecht, The Netherlands
| | - Annemieke van Straten
- Department of Clinical, Neuro, and Developmental Psychology, Faculty of Behavioural and Movement Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands;
| | - Wim J. E. Tissing
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (S.H.M.P.); (M.A.G.); (W.J.E.T.); (A.C.H.d.V.); (H.J.H.v.d.P.); (G.J.L.K.)
- Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, 9713 GX Groningen, The Netherlands
| | - Floor Abbink
- Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands;
| | - Andrica C. H. de Vries
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (S.H.M.P.); (M.A.G.); (W.J.E.T.); (A.C.H.d.V.); (H.J.H.v.d.P.); (G.J.L.K.)
- Erasmus MC—Sophia Children’s Hospital, Department of Pediatric Hemato-Oncology, 3015 GD Rotterdam, The Netherlands
| | - Jacqueline Loonen
- Department of Hematology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
| | - Helena J. H. van der Pal
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (S.H.M.P.); (M.A.G.); (W.J.E.T.); (A.C.H.d.V.); (H.J.H.v.d.P.); (G.J.L.K.)
| | - Gertjan J. L. Kaspers
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (S.H.M.P.); (M.A.G.); (W.J.E.T.); (A.C.H.d.V.); (H.J.H.v.d.P.); (G.J.L.K.)
- Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands;
| | - Raphaële R. L. van Litsenburg
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (S.H.M.P.); (M.A.G.); (W.J.E.T.); (A.C.H.d.V.); (H.J.H.v.d.P.); (G.J.L.K.)
- Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands;
- Correspondence:
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12
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Lawrence K, Myrissa K, Toribio-Mateas M, Minini L, Gregory AM. Trialling a microbiome-targeted dietary intervention in children with ADHD-the rationale and a non-randomised feasibility study. Pilot Feasibility Stud 2022; 8:108. [PMID: 35606889 PMCID: PMC9125862 DOI: 10.1186/s40814-022-01058-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 05/03/2022] [Indexed: 11/17/2022] Open
Abstract
Background Dietary interventions have been previously explored in children with ADHD. Elimination diets and supplementation can produce beneficial behaviour changes, but little is known about the mechanisms mediating change. We propose that these interventions may work, in part, by causing changes in the gut microbiota. A microbiome-targeted dietary intervention was developed, and its feasibility assessed. Methods A non-randomised feasibility study was conducted on nine non-medicated children with ADHD, aged 8–13 years (mean 10.39 years), using a prospective one-group pre-test/post-test design. Participants were recruited from ADHD support groups in London and took part in the 6-week microbiome-targeted dietary intervention, which was specifically designed to impact the composition of gut bacteria. Children were assessed pre- and post-intervention on measures of ADHD symptomatology, cognition, sleep, gut function and stool-sample microbiome analysis. The primary aim was to assess the study completion rate, with secondary aims assessing adherence, adverse events (aiming for no severe and minimal), acceptability and suitability of outcome measures. Results Recruitment proved to be challenging and despite targeting 230 participants directly through support groups, and many more through social media, nine families (of the planned 10) signed up for the trial. The completion rate for the study was excellent at 100%. Exploration of secondary aims revealed that (1) adherence to each aspect of the dietary protocol was very good; (2) two mild adverse events were reported; (3) parents rated the treatment as having good acceptability; (4) data collection and outcome measures were broadly feasible for use in an RCT with a few suggestions recommended; (5) descriptive data for outcome measures is presented and suggests that further exploration of gut microbiota, ADHD symptoms and sleep would be helpful in future research. Conclusions This study provides preliminary evidence for the feasibility of a microbiome-targeted dietary intervention in children with ADHD. Recruitment was challenging, but the diet itself was well-tolerated and adherence was very good. Families wishing to trial this diet may find it an acceptable intervention. However, recruitment, even for this small pilot study, was challenging. Because of the difficulty experienced recruiting participants, future randomised controlled trials may wish to adopt a simpler dietary approach which requires less parental time and engagement, in order to recruit the number of participants required to make meaningful statistical interpretations of efficacy. Trial registration ClinicalTrials.gov Identifier: NCT03737877. Registered 13 November 2018—retrospectively registered, within 2 days of the first participant being recruited. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01058-4.
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Affiliation(s)
- Kate Lawrence
- Department of Psychology & Pedagogic Science, Faculty of Sport, Allied Health and Performance Science, St Mary's University, Twickenham, London, UK.
| | - Kyriaki Myrissa
- Department of Health Sciences, Faculty of Sport, Allied Health and Performance Science, St Mary's University, Twickenham, London, UK
| | - Miguel Toribio-Mateas
- School of Health and Education, Middlesex University, London, UK.,School of Applied Science, London South Bank University, London, UK
| | - Lori Minini
- Department of Psychology & Pedagogic Science, Faculty of Sport, Allied Health and Performance Science, St Mary's University, Twickenham, London, UK
| | - Alice M Gregory
- Department of Psychology, Goldsmiths, University of London, London, UK
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13
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Smejka T, Henry AL, Wheatley C, Espie CA, Johansen-Berg H, Fleming MK. A qualitative examination of the usability of a digital cognitive behavioral therapy for insomnia program after stroke. Brain Inj 2022; 36:271-278. [PMID: 35108134 PMCID: PMC9162493 DOI: 10.1080/02699052.2022.2034182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 09/20/2021] [Accepted: 01/22/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Sleep is commonly impaired after stroke. Cognitive Behavioral Therapy for Insomnia (CBT-I) is the first-line recommended treatment for sleep difficulty. "Sleepio" is a digital CBT-I program, allowing delivery of this treatment at scale. However, Sleepio has not yet been tested specifically in people with stroke. Before doing so, we wanted to explore the experience of people with stroke using the program, and potential barriers to completion. METHOD Community dwelling survivors of stroke (n = 11, 41-78 years of age, 6 male) were given access to Sleepio. Participants discussed their experiences with the program during a semi-structured interview, which was analyzed using thematic analysis. RESULTS We found four common themes: (1) positive and negative experiences impacted engagement with the program, (2) motivation to follow the program was proportional to perceived severity of sleep problem, (3) impractical advice for people with stroke, (4) difficulty operating the program. CONCLUSION Sleepio can be used by some people at the chronic stage of stroke. However, some barriers to completion were highlighted, and not all suggestions were deemed practical for everyone. We therefore suggest possible adaptations which may make the program more easily usable and engaging for survivors of stroke with varying impairments.
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Affiliation(s)
- Tom Smejka
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Alasdair L Henry
- Big Health Ltd, London, UK
- Sleep & Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Catherine Wheatley
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Colin A Espie
- Big Health Ltd, London, UK
- Sleep & Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Heidi Johansen-Berg
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Melanie K Fleming
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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14
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Domhardt M, Engler S, Nowak H, Lutsch A, Baumel A, Baumeister H. Mechanisms of Change in Digital Health Interventions for Mental Disorders in Youth: Systematic Review. J Med Internet Res 2021; 23:e29742. [PMID: 34842543 PMCID: PMC8665396 DOI: 10.2196/29742] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/14/2021] [Accepted: 07/27/2021] [Indexed: 01/29/2023] Open
Abstract
Background Digital health interventions (DHIs) are efficacious for several mental disorders in youth; however, integrated, evidence-based knowledge about the mechanisms of change in these interventions is lacking. Objective This systematic review aims to comprehensively evaluate studies on mediators and mechanisms of change in different DHIs for common mental disorders in children and adolescents. Methods A systematic literature search of the electronic databases Cochrane Central Register of Controlled Trials, Embase, MEDLINE, and PsycINFO was conducted, complemented by backward and forward searches. Two independent reviewers selected studies for inclusion, extracted the data, and rated the methodological quality of eligible studies (ie, risk of bias and 8 quality criteria for process research). Results A total of 25 studies that have evaluated 39 potential mediators were included in this review. Cognitive mediators were the largest group of examined intervening variables, followed by a broad range of emotional and affective, interpersonal, parenting behavior, and other mediators. The mediator categories with the highest percentages of significant intervening variables were the groups of affective mediators (4/4, 100%) and combined cognitive mediators (13/19, 68%). Although more than three-quarters of the eligible studies met 5 or more quality criteria, causal conclusions have been widely precluded. Conclusions The findings of this review might guide the empirically informed advancement of DHIs, contributing to improved intervention outcomes, and the discussion of methodological recommendations for process research might facilitate mediation studies with more pertinent designs, allowing for conclusions with higher causal certainty in the future.
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Affiliation(s)
- Matthias Domhardt
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Sophie Engler
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Hannah Nowak
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Arne Lutsch
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Amit Baumel
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
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15
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Comparative efficacy of digital cognitive behavioral therapy for insomnia: A systematic review and network meta-analysis. Sleep Med Rev 2021; 61:101567. [PMID: 34902820 DOI: 10.1016/j.smrv.2021.101567] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 12/19/2022]
Abstract
The comparative efficacy of various approaches of digital cognitive behavioral therapy for insomnia (CBTi) is still unclear. This network meta-analysis explored the comparative efficacy of digital CBTi approaches in adults with insomnia. Four electronic databases were searched from inception to June 27, 2020. Primary outcomes were self-reported total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), sleep efficiency (SE), and insomnia symptoms; these were measured using sleep diaries or valid questionnaires. A random-effects network meta-analysis in a frequentist framework was used. Fifty-four randomized controlled trials comprising 11,815 participants were included. Compared with usual care, web-based CBTi with a therapist demonstrated significantly longer TST (mean difference [MD]: 23.19 min, 95% confidence interval [CI]: 18.98-27.39 min), shorter SOL (MD: -18.76 min, 95% CI -24.20 to -13.31 min), lower WASO (MD: -31.40 min, 95% CI: -36.26 to -26.55 min), and greater SE (MD: 10.37%, 95% CI: 8.08%-12.65%). The surface under the cumulative ranking curve indicates that web-based CBTi with therapists is most likely to be ranked the highest among all treatments, and thus, this network meta-analysis suggests that such a treatment is the optimal intervention for improving sleep duration and SE as well as the reductions in SOL and WASO. PROSPERO REGISTRATION NUMBER: CRD42020171134.
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16
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Meaklim H, Junge MF, Varma P, Finck WA, Jackson ML. Pre-existing and post-pandemic insomnia symptoms are associated with high levels of stress, anxiety, and depression globally during the COVID-19 pandemic. J Clin Sleep Med 2021; 17:2085-2097. [PMID: 33985647 PMCID: PMC8494096 DOI: 10.5664/jcsm.9354] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/15/2021] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The coronavirus disease 2019 (COVID-19) pandemic has led to an increased prevalence of insomnia and mental health symptoms globally. However, most studies to date have not examined mental health symptoms between individuals with insomnia, either pre-existing or developing post-pandemic compared with good sleepers. This study examined differences in stress, anxiety, and depression between individuals with pre-existing insomnia symptoms, post-pandemic insomnia symptoms, and no insomnia symptoms in response to the COVID-19 pandemic. METHODS A cross-sectional survey was completed by 2724 participants from 67 countries during the COVID-19 pandemic. Perceived stress, anxiety, and depressive symptoms were compared between individuals with post-pandemic insomnia symptoms (n = 1007), pre-existing insomnia symptoms (n = 804), and no insomnia symptoms (n = 913). RESULTS Post-pandemic insomnia symptoms were associated with higher levels of stress, anxiety, and depression than pre-existing or no insomnia symptoms (P < .001). Pre-existing insomnia symptoms were also associated with higher levels of stress, anxiety, and depression than no insomnia symptoms (P < .001). Individuals who met likely criteria for acute insomnia also reported higher stress, anxiety, and depression than those with insomnia disorder (P < .001). Across all groups, individuals reporting a previous mental health diagnosis had worse stress, anxiety, and depression than those without a previous mental health diagnosis (P < .001). Last, individuals from South Africa reported higher levels of stress, anxiety, and depression than other countries (P < .01). CONCLUSIONS Internationally, individuals with pre-existing and post-pandemic insomnia symptoms may be more susceptible to stress, anxiety, and depression during the COVID-19 pandemic. Public health initiatives should include insomnia management to improve mental health during the pandemic. CITATION Meaklim H, Junge MF, Varma P, Finck WA, Jackson ML. Pre-existing and post-pandemic insomnia symptoms are associated with high levels of stress, anxiety, and depression globally during the COVID-19 pandemic. J Clin Sleep Med. 2021;17(10):2085-2097.
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Affiliation(s)
- Hailey Meaklim
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Moira F. Junge
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
- The Sleep Health Foundation, Blacktown, New South Wales, Australia
| | - Prerna Varma
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Wendy A. Finck
- Faculty of Education, Monash University, Melbourne, Victoria, Australia
| | - Melinda L. Jackson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
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17
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Jansson-Fröjmark M, Alfonsson S, Bohman B, Rozental A, Norell-Clarke A. Paradoxical intention for insomnia: A systematic review and meta-analysis. J Sleep Res 2021; 31:e13464. [PMID: 34405469 DOI: 10.1111/jsr.13464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/04/2021] [Accepted: 07/27/2021] [Indexed: 11/29/2022]
Abstract
Paradoxical intention (PI) has been considered an evidence-based treatment for insomnia since the 1990s, but it has not been evaluated with modern review techniques such as meta-analysis. The present study aimed to conduct the first systematic review and meta-analysis of studies that explore the effectiveness of PI for insomnia on insomnia symptomatology and theory-derived processes. A systematic review and meta-analysis was conducted by searching for eligible articles or dissertations in six online bibliographic databases. Randomised controlled trials and experimental studies comparing PI for insomnia to active and passive comparators and assessing insomnia symptoms as outcomes were included. A random effects model was estimated to determine the standardised mean difference Hedge's g at post-treatment. Test for heterogeneity was performed, fail-safe N was calculated, and study quality was assessed. The study was pre-registered at International Prospective Register of Systematic Reviews (PROSPERO, CRD42019137357). A total of 10 trials were identified. Compared to passive comparators, PI led to large improvements in key insomnia symptoms. Relative to active comparators, the improvements were smaller, but still moderate for several central outcomes. Compared to passive comparators, PI resulted in great reductions in sleep-related performance anxiety, one of several proposed mechanisms of change for PI. PI for insomnia resulted in marked clinical improvements, large relative to passive comparators and moderate compared to active comparators. However, methodologically stronger studies are needed before more firm conclusions can be drawn.
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Affiliation(s)
- Markus Jansson-Fröjmark
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Sven Alfonsson
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Benjamin Bohman
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Alexander Rozental
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.,Great Ormond Street Hospital Institute of Child Health, UCL, London, UK
| | - Annika Norell-Clarke
- Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden.,Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
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18
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Staines AC, Broomfield N, Pass L, Orchard F, Bridges J. Do non-pharmacological sleep interventions affect anxiety symptoms? A meta-analysis. J Sleep Res 2021; 31:e13451. [PMID: 34331373 DOI: 10.1111/jsr.13451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/09/2021] [Accepted: 07/16/2021] [Indexed: 12/13/2022]
Abstract
Research indicates a bidirectional relationship between sleep and anxiety, with findings suggesting anxiety can precede poor sleep and vice versa. Evidence suggests sleep-related thought processes associated with anxiety are involved in the maintenance of insomnia. Previous meta-analyses provide some evidence to suggest cognitive behavioural therapy for insomnia moderately improves anxiety, yet little research has investigated the effect of other sleep interventions on anxiety symptoms. The aim of this meta-analysis was to review whether non-pharmacological sleep interventions have an impact on anxiety symptoms immediately post-intervention. A systematic search of electronic databases was conducted to identify all randomized control trials (RCTs) investigating non-pharmacological sleep interventions that included anxiety symptoms as an outcome. Forty-three RCTs (n = 5945) met full inclusion criteria and were included in a random-effects meta-analysis model. The combined effect size of non-pharmacological sleep interventions on anxiety symptoms was moderate (Hedges' g = -0.38), indicating a reduction in symptoms. Subgroup analyses found a moderate effect for those with additional physical health difficulties (g = -0.46), a moderate effect for those with additional mental health difficulties (g = -0.47) and a moderate effect for those with elevated levels of anxiety at baseline (g = -0.43). A secondary meta-analysis found a large effect of non-pharmacological sleep interventions on sleep-related thought processes (g = -0.92). These findings indicate non-pharmacological sleep interventions are effective in reducing anxiety and sleep-related thought processes, and these effects may be larger in patients with anxiety. This has clinical implications for considering sleep interventions in the treatment of anxiety.
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Affiliation(s)
- Alex Catherine Staines
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Niall Broomfield
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Laura Pass
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Faith Orchard
- School of Psychology, University of Sussex, Brighton, UK
| | - Jessica Bridges
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK
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19
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Fleming MK, Smejka T, Henderson Slater D, Chiu EG, Demeyere N, Johansen-Berg H. Self-Reported and Objective Sleep Measures in Stroke Survivors With Incomplete Motor Recovery at the Chronic Stage. Neurorehabil Neural Repair 2021; 35:851-860. [PMID: 34196598 PMCID: PMC8442123 DOI: 10.1177/15459683211029889] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background. Stroke survivors commonly complain of difficulty sleeping. Poor sleep is associated with reduced quality of life and more understanding of long-term consequences of stroke on sleep is needed. Objective. The primary aims were to (1) compare sleep measures between chronic stroke survivors and healthy controls and (2) test for a relationship between motor impairment, time since stroke and sleep. Secondary aims were to explore mood and inactivity as potential correlates of sleep and test the correlation between self-reported and objective sleep measures. Methods. Cross-sectional sleep measures were obtained for 69 chronic stroke survivors (mean 65 months post-stroke, 63 years old, 24 female) and 63 healthy controls (mean 61 years old, 27 female). Self-reported sleep was assessed with the sleep condition indicator (SCI) and sleep diary ratings, objective sleep with 7-nights actigraphy and mood with the Hospital Anxiety and Depression Scale. Upper extremity motor impairment was assessed with the Fugl-Meyer assessment. Results. Stroke survivors had significantly poorer SCI score (P < .001) and higher wake after sleep onset (P = .005) than controls. Neither motor impairment, nor time since stroke, explained significant variance in sleep measures for the stroke group. For all participants together, greater depression was associated with poorer SCI score (R2adj = .197, P < .001) and higher age with more fragmented sleep (R2adj = .108, P < .001). There were weak correlations between nightly sleep ratings and actigraphy sleep measures (rs = .15-.24). Conclusions. Sleep disturbance is present long-term after stroke. Depressive symptoms may present a modifiable factor which should be investigated alongside techniques to improve sleep in this population.
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Affiliation(s)
- Melanie K Fleming
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, 6396University of Oxford, Oxford, UK.,552380NIHR Oxford Biomedical Research Centre, UK.,212787Oxford Centre for Enablement, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Tom Smejka
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, 6396University of Oxford, Oxford, UK.,552380NIHR Oxford Biomedical Research Centre, UK.,212787Oxford Centre for Enablement, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - David Henderson Slater
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, 6396University of Oxford, Oxford, UK.,212787Oxford Centre for Enablement, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Nele Demeyere
- Department of Experimental Psychology, 6396University of Oxford, Oxford, UK
| | - Heidi Johansen-Berg
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, 6396University of Oxford, Oxford, UK.,552380NIHR Oxford Biomedical Research Centre, UK
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20
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Whibley D, Stelfox K, Henry AL, Tang NKY, Kratz AL. Development of a hybrid sleep and physical activity improvement intervention for adults with osteoarthritis-related pain and sleep disturbance: a focus group study with potential users. Br J Pain 2021; 16:136-148. [PMID: 35419203 PMCID: PMC8998527 DOI: 10.1177/20494637211026049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: Suboptimal sleep and physical activity are common among people living with osteoarthritis (OA) and simultaneous improvements in both may have a beneficial impact on pain. This study aimed to gather perspectives of people living with OA on important aspects to incorporate in a hybrid sleep and physical activity improvement intervention for OA pain management. Design: Qualitative study using two rounds of two focus groups. Setting and participants: Focus groups were conducted with adults living with OA-related chronic pain and sleep disturbances. Eighteen people attended focus groups in January 2020 and, of these, 16 attended subsequent focus groups in February 2020. Methods: Discussion at the first round of focus groups informed generation of prototype intervention materials that were shared, discussed and refined at the second round of focus groups. Thematic analysis was used to identify themes and sub-themes from the data. Results: Three themes, each with three sub-themes, were identified: facilitators of engagement with the intervention (sub-themes: motivational language, accountability and education); barriers to engagement (sub-themes: suboptimal interaction with healthcare practitioners, recording behaviour as burdensome/disruptive and uncertainty about technique) and characteristics of a physical activity intervention component (sub-themes: tailored, sustainable and supported). Conclusion: We have identified important aspects to incorporate into the design and delivery of a hybrid sleep and physical activity improvement intervention for OA pain management. Insights will be incorporated into intervention materials and protocols, with feasibility and acceptability assessed in a future study.
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Affiliation(s)
- Daniel Whibley
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI, USA
- Department of Anesthesiology, Chronic Pain & Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Kevin Stelfox
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
- School of Education, University of Aberdeen, Aberdeen, UK
| | - Alasdair L Henry
- Big Health Inc., San Francisco, CA, USA
- Big Health Inc., London, UK
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Nicole KY Tang
- Department of Psychology, University of Warwick, Coventry, UK
| | - Anna L Kratz
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI, USA
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Darden M, Espie CA, Carl JR, Henry AL, Kanady JC, Krystal AD, Miller CB. Cost-effectiveness of digital cognitive behavioral therapy (Sleepio) for insomnia: a Markov simulation model in the United States. Sleep 2021; 44:5957088. [PMID: 33151330 DOI: 10.1093/sleep/zsaa223] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 10/13/2020] [Indexed: 02/06/2023] Open
Abstract
STUDY OBJECTIVES To examine the cost-effectiveness and potential net monetary benefit (NMB) of a fully automated digital cognitive behavioral therapy (CBT) intervention for insomnia compared with no insomnia treatment in the United States (US). Similar relative comparisons were made for pharmacotherapy and clinician-delivered CBT (individual and group). METHODS We simulated a Markov model of 100,000 individuals using parameters calibrated from the literature including direct (treatment) and indirect costs (e.g. insomnia-related healthcare expenditure and lost workplace productivity). Health utility estimates were converted into quality-adjusted life years (QALYs) and one QALY was worth $50,000. Simulated individuals were randomized equally to one of five arms (digital CBT, pharmacotherapy, individual CBT, group CBT, or no insomnia treatment). Sensitivity was assessed by bootstrapping the calibrated parameters. Cost estimates were expressed in 2019 US dollars. RESULTS Digital CBT was cost beneficial when compared with no insomnia treatment and had a positive NMB of $681.06 (per individual over 6 months). Bootstrap sensitivity analysis demonstrated that the NMB was positive in 94.7% of simulations. Relative to other insomnia treatments, digital CBT was the most cost-effective treatment because it generated the smallest incremental cost-effectiveness ratio (-$3,124.73). CONCLUSIONS Digital CBT was the most cost-effective insomnia treatment followed by group CBT, pharmacotherapy, and individual CBT. It is financially prudent and beneficial from a societal perspective to utilize automated digital CBT to treat insomnia at a population scale.
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Affiliation(s)
- Michael Darden
- Carey Business School, Johns Hopkins University, Baltimore, MD
| | - Colin A Espie
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Big Health Inc., London, UK.,Big Health Inc., San Francisco, CA
| | - Jenna R Carl
- Big Health Inc., London, UK.,Big Health Inc., San Francisco, CA
| | - Alasdair L Henry
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Big Health Inc., London, UK.,Big Health Inc., San Francisco, CA
| | | | - Andrew D Krystal
- Department of Psychiatry, School of Medicine, University of California San Francisco, San Francisco, CA.,Department of Neurology, School of Medicine, University of California San Francisco, San Francisco, CA
| | - Christopher B Miller
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Big Health Inc., London, UK.,Big Health Inc., San Francisco, CA
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