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Rötger A, Schuffelen J, Maurer LF, Lorenz N, Pollok B, Gieselmann A. The clinical effect of digital cognitive behavioural therapy for insomnia in subgroups with depressive and anxiety symptoms: A secondary analysis of a randomized-controlled trial. J Sleep Res 2024:e14173. [PMID: 38356341 DOI: 10.1111/jsr.14173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/22/2024] [Accepted: 01/31/2024] [Indexed: 02/16/2024]
Abstract
Insomnia is a highly prevalent mental disorder, and is often co-occurring with depression and anxiety disorders. Cognitive behavioural therapy for insomnia as treatment of choice for insomnia can also be applied digitally (digital cognitive behavioural therapy for insomnia), making it more accessible. This is a secondary data analysis of a two-armed parallel randomized-controlled trial. In the primary publication, N = 238 participants meeting criteria for the 5th edition of Diagnostic and Statistical Manual of Mental Disorders chronic insomnia disorder were randomly assigned to either 8 weeks of digital cognitive behavioural therapy for insomnia + treatment-as-usual, or waitlist + treatment-as-usual. To determine the clinical effects of digital cognitive behavioural therapy for insomnia in populations with comorbid anxiety and depression symptoms, this secondary analysis focused on two subgroups: (1) participants with high initial depressive symptoms; and (2) participants with high initial anxiety symptoms. Symptoms of insomnia, depression and anxiety as primary outcome measures were obtained at baseline, 8 weeks post-randomization and, in the intervention group only, at 6- and 12-months follow-up. At 8 weeks post-randomization, the use of digital cognitive behavioural therapy for insomnia in both subgroups was associated with large reductions in insomnia severity in comparison to control (depression subgroup: d = 2.37; anxiety subgroup: d = 2.13). Between-group treatment effects were also observed for symptoms of depression in the depression subgroup (d = 1.59), and for symptoms of anxiety in the anxiety subgroup (d = 1.28). Within-group effects were stable over time (d = 0.64-1.63). This secondary analysis shows that digital cognitive behavioural therapy for insomnia reduces insomnia and comorbid symptoms in participants with high initial symptoms of either depression or anxiety with sustained long-term effects.
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Affiliation(s)
- Alexander Rötger
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Mementor DE GmbH, Research, Leipzig, Germany
| | - Jennifer Schuffelen
- Heinrich Heine University Düsseldorf, Institute of Experimental Psychology, Clinical Psychology, Düsseldorf, Germany
| | | | - Noah Lorenz
- Mementor DE GmbH, Research, Leipzig, Germany
| | - Bettina Pollok
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Annika Gieselmann
- Heinrich Heine University Düsseldorf, Institute of Experimental Psychology, Clinical Psychology, Düsseldorf, Germany
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Chung KF, Lee CT, Au CH, Kam KY, Lee CK, Yeung WF, Lau EYY, Ho FYY, Ho LM. Cognitive behavioural therapy for insomnia as an early intervention of mood disorders with comorbid insomnia: A randomized controlled trial. Early Interv Psychiatry 2024; 18:82-93. [PMID: 37192756 DOI: 10.1111/eip.13435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 03/30/2023] [Accepted: 05/05/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of small-group nurse-administered cognitive behavioural therapy for insomnia (CBTI) as an early intervention of mood disorders with comorbid insomnia. METHODS A total of 200 patients with first-episode depressive or bipolar disorders and comorbid insomnia were randomized in a ratio of 1:1 to receiving 4-session CBTI or not in a routine psychiatric care setting. Primary outcome was Insomnia Severity Index. Secondary outcomes included response and remission status; daytime symptomatology and quality of life; medication burden; sleep-related cognitions and behaviours; and the credibility, satisfaction, adherence and adverse events of CBTI. Assessments were conducted at baseline, 3, 6, and 12-month. RESULTS Only a significant time-effect but no group-by-time interaction was found in the primary outcome. Several secondary outcomes had significantly greater improvements in CBTI group, including higher depression remission at 12-month (59.7% vs. 37.9%, χ2 = 6.57, p = .01), lower anxiolytic use at 3-month (18.1% vs. 33.3%, χ2 = 4.72, p = .03) and 12-month (12.5% vs. 25.8%, χ2 = 3.26, p = .047), and lesser sleep-related dysfunctional cognitions at 3 and 6-month (mixed-effects model, F = 5.12, p = .001 and .03, respectively). Depression remission rate was 28.6%, 40.3%, and 59.7% at 3, 6, and 12-month, respectively in CBTI group and 28.4%, 31.1%, and 37.9%, respectively in no CBTI group. CONCLUSION CBTI may be a useful early intervention to enhance depression remission and reduce medication burden in patients with first-episode depressive disorder and comorbid insomnia.
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Affiliation(s)
- Ka-Fai Chung
- Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Chit-Tat Lee
- Department of Psychiatry, Queen Mary Hospital, Hong Kong, China
| | - Chi-Hung Au
- Department of Psychiatry, Queen Mary Hospital, Hong Kong, China
| | - Ka-Yee Kam
- Department of Psychology, The University of Hong Kong, Hong Kong, China
| | - Che-Kin Lee
- Department of Psychiatry, Kowloon Hospital, Hong Kong, China
| | - Wing-Fai Yeung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Esther Yuet Ying Lau
- Department of Psychology, The Education University of Hong Kong, Hong Kong, China
| | - Fiona Yan-Yee Ho
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China
| | - Lai-Ming Ho
- School of Public Health, The University of Hong Kong, Hong Kong, China
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Putilina MV, Shabalina NI. [Results of a pilot study of the structure and evaluation of the therapy for chronic sleep disorders in comorbid patients with chronic cerebral ischemia]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:118-126. [PMID: 38676686 DOI: 10.17116/jnevro2024124041118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
OBJECTIVE To evaluate the effect of the drug Cortexin on the clinical course and treatment of comorbid insomnia. MATERIAL AND METHODS The study included 50 patients, average age 50.4±2.26 years, with CHI stage 1-2. with concomitant diseases arterial hypertension, atherosclerosis, diabetes mellitus (study CHRONAS). All patients were examined on the day of treatment, 11-15 days and 30-31 days after the end of therapy. At all visits, complaints, neurological status, and changes in physiological and laboratory parameters were assessed. The condition was assessed using the following scales: mental status assessment (MMSE), quality of life questionnaire (EQ-5D), assessment of general health, Pittsburgh Sleep Quality Index (PSQI), Epworth daytime sleepiness assessment, hospital anxiety and depression (HADS)).: Patients with additional diabetic polyneuropathy were assessed using the Central Sensitization Inventory (CSI). RESULTS A high percentage of the prevalence of comorbid insomnia in patients was revealed. The structure of sleep disturbances in patients with chronic cerebral ischemia consisted of disturbances in sleep duration, difficulty falling asleep, frequent awakenings at night, and daytime sleepiness. After treatment, there was a regression of the main complaints, the severity of symptoms, including anxiety and depression, decreased, and a significant stabilization of cognitive status was observed. The positive dynamics persisted 1 month after the end of therapy. An additional normalizing effect of the drug on a number of biochemical parameters was revealed. Clinical dynamics were recorded already by the 11-15th day of treatment and persisted for up to 1 month. During observation, no patient had adverse drug interactions with other drugs (hypotensives, antiplatelet agents, statins). CONCLUSIONS The clinical effectiveness of the drug Cortexin has been proven for all types of sleep disorders. The clinical effectiveness of the drug Cortexin at a dose of 10 mg IM for 10 days has been proven in patients with chronic sleep disorders due to CHI.
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Affiliation(s)
- M V Putilina
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - N I Shabalina
- Central Clinical Hospital «RZD-Medicine», Moscow, Russia
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Soreca I, Conklin CA, Vella EJ, Salkeld RP, Joyce CJ, Mumma JM, Jakicic JM, Kupfer DJ. Can exercise alleviate sleep disturbances during acute nicotine withdrawal in cigarette smokers? Exp Clin Psychopharmacol 2022; 30:82-92. [PMID: 33119386 PMCID: PMC8415013 DOI: 10.1037/pha0000390] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Sleep disturbances, including insomnia (difficulty falling or staying asleep), are common nicotine withdrawal symptoms particularly during the initial stage of nicotine abstinence, and increase the likelihood of relapse within the first 4 weeks of quitting. Although clinically recognized as a key symptom of nicotine withdrawal, sleep disturbances are not addressed in the clinical guidelines for nicotine dependence treatment. Unfortunately, Nicotine Replacement Therapy (NRT) and other pharmacologic interventions do not attenuate withdrawal-provoked sleep disturbances, with several even exacerbating sleep disruption. The present study tested the impact of 30-min of daily moderate exercise, morning versus evening, on key polysomnographic indicators of sleep disturbances during initial 3 days (72 hr) of nicotine withdrawal. Forty-nine daily smokers (53% male) completed 3 separate abstinence periods, during which they completed either morning exercise, evening exercise, or a nonexercising magazine reading control condition. Order of condition was counterbalanced across subjects with a 1-week wash out in between each 3-day abstinence period. Exercise engagement mitigated several changes in sleep architecture associated with acute nicotine deprivation and other time-related effects on sleep, specifically frequency of arousals (B = -2.8, SE = .95; t(1271) = -3.0, p = .003) and reductions in sleep maintenance (B = .58, SE = .21; t(1270) = 2.8, p = .005). Additionally, smokers who reported greater perceived withdrawal severity had the longest latency to fall asleep but experienced the greatest attenuation of this effect following PM exercise. Overall, results suggest a role for exercise as an adjunct smoking cessation treatment to specifically target sleep disturbances during early acute nicotine withdrawal. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Isabella Soreca
- Pittsburgh Veterans Administration Healthcare System, Pittsburgh PA
| | | | | | | | | | - Joel M. Mumma
- University of Pittsburgh, Department of Psychiatry, Pittsburgh PA
| | - John M. Jakicic
- University of Pittsburgh, Department of Health and Physical Activity, Pittsburgh PA
| | - David J. Kupfer
- University of Pittsburgh, Department of Psychiatry, Pittsburgh PA
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Ong JC, Crawford MR, Dawson SC, Fogg LF, Turner AD, Wyatt JK, Crisostomo MI, Chhangani BS, Kushida CA, Edinger JD, Abbott SM, Malkani RG, Attarian HP, Zee PC. A randomized controlled trial of CBT-I and PAP for obstructive sleep apnea and comorbid insomnia: main outcomes from the MATRICS study. Sleep 2020; 43:zsaa041. [PMID: 32170307 PMCID: PMC7487869 DOI: 10.1093/sleep/zsaa041] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/30/2020] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES To investigate treatment models using cognitive behavioral therapy for insomnia (CBT-I) and positive airway pressure (PAP) for people with obstructive sleep apnea (OSA) and comorbid insomnia. METHODS 121 adults with OSA and comorbid insomnia were randomized to receive CBT-I followed by PAP, CBT-I concurrent with PAP, or PAP only. PAP was delivered following standard clinical procedures for in-lab titration and home setup and CBT-I was delivered in four individual sessions. The primary outcome measure was PAP adherence across the first 90 days, with regular PAP use (≥4 h on ≥70% of nights during a 30-day period) serving as the clinical endpoint. The secondary outcome measures were the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) with good sleeper (PSQI <5), remission (ISI <8), and response (ISI reduction from baseline >7) serving as the clinical endpoints. RESULTS No significant differences were found between the concomitant treatment arms and PAP only on PAP adherence measures, including the percentage of participants who met the clinical endpoint. Compared to PAP alone, the concomitant treatment arms reported a significantly greater reduction from baseline on the ISI (p = .0009) and had a greater percentage of participants who were good sleepers (p = .044) and remitters (p = .008). No significant differences were found between the sequential and concurrent treatment models on any outcome measure. CONCLUSIONS The findings from this study indicate that combining CBT-I with PAP is superior to PAP alone on insomnia outcomes but does not significantly improve adherence to PAP.
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Affiliation(s)
- Jason C Ong
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Megan R Crawford
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Spencer C Dawson
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Louis F Fogg
- College of Nursing, Rush University Medical Center, Chicago, IL
| | - Arlener D Turner
- Center for Sleep and Brain Health, Department of Psychiatry, New York University, New York, NY
| | - James K Wyatt
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | | | | | - Clete A Kushida
- Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | - Jack D Edinger
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, CO
| | - Sabra M Abbott
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Roneil G Malkani
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Hrayr P Attarian
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Phyllis C Zee
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
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Sweetman A, Lack L, Catcheside PG, Antic NA, Smith S, Chai-Coetzer CL, Douglas J, O'grady A, Dunn N, Robinson J, Paul D, Williamson P, McEvoy RD. Cognitive and behavioral therapy for insomnia increases the use of continuous positive airway pressure therapy in obstructive sleep apnea participants with comorbid insomnia: a randomized clinical trial. Sleep 2020; 42:5546131. [PMID: 31403168 DOI: 10.1093/sleep/zsz178] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 06/04/2019] [Indexed: 11/15/2022] Open
Abstract
STUDY OBJECTIVES Insomnia and obstructive sleep apnea (OSA) commonly co-occur which makes OSA difficult to treat with continuous positive airway pressure (CPAP). We conducted a randomized controlled trial in participants with OSA and co-occurring insomnia to test the hypothesis that initial treatment with cognitive and behavioral therapy for insomnia (CBT-i), versus treatment as usual (TAU) would improve insomnia symptoms and increase subsequent acceptance and use of CPAP. METHODS One hundred and forty-five participants with OSA (apnea-hypopnea index ≥ 15) and comorbid insomnia were randomized to either four sessions of CBT-i, or TAU, before commencing CPAP therapy until 6 months post-randomization. Primary between-group outcomes included objective average CPAP adherence and changes in objective sleep efficiency by 6 months. Secondary between-group outcomes included rates of immediate CPAP acceptance/rejection, and changes in; sleep parameters, insomnia severity, and daytime impairments by 6 months. RESULTS Compared to TAU, participants in the CBT-i group had 61 min greater average nightly adherence to CPAP (95% confidence interval [CI] = 9 to 113; p = 0.023, d = 0.38) and higher initial CPAP treatment acceptance (99% vs. 89%; p = 0.034). The CBT-i group showed greater improvement of global insomnia severity, and dysfunctional sleep-related cognitions by 6 months (both: p < 0.001), and greater improvement in sleep impairment measures immediately following CBT-i. There were no between-group differences in sleep outcomes, or daytime impairments by 6 months. CONCLUSIONS In OSA participants with comorbid insomnia, CBT-i prior to initiating CPAP treatment improves CPAP use and insomnia symptoms compared to commencing CPAP without CBT-i. OSA patients should be evaluated for co-occurring insomnia and considered for CBT-i before commencing CPAP therapy. CLINICAL TRIAL Treating comorbid insomnia with obstructive sleep apnea (COMSIA) study: A new treatment strategy for patients with combined insomnia and sleep apnea, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365184 Australian New Zealand Clinical Trials Registry: ACTRN12613001178730. Universal Trial Number: U1111-1149-4230.
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Affiliation(s)
- Alexander Sweetman
- The Adelaide Institute for Sleep Health: A Centre of Research Excellence, College of Medicine and Public Health, Flinders University of South Australia, Bedford Park, South Australia, Australia.,College of Education Psychology and Social Work, Flinders University, Bedford Park, South Australia, Australia
| | - Leon Lack
- The Adelaide Institute for Sleep Health: A Centre of Research Excellence, College of Medicine and Public Health, Flinders University of South Australia, Bedford Park, South Australia, Australia.,College of Education Psychology and Social Work, Flinders University, Bedford Park, South Australia, Australia
| | - Peter G Catcheside
- The Adelaide Institute for Sleep Health: A Centre of Research Excellence, College of Medicine and Public Health, Flinders University of South Australia, Bedford Park, South Australia, Australia
| | - Nick A Antic
- The Adelaide Institute for Sleep Health: A Centre of Research Excellence, College of Medicine and Public Health, Flinders University of South Australia, Bedford Park, South Australia, Australia.,Sleep Health Service, Repatriation General Hospital and Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Simon Smith
- Institute for Social Science Research (ISSR), University of Queensland, Brisbane, Queensland, Australia
| | - Ching Li Chai-Coetzer
- The Adelaide Institute for Sleep Health: A Centre of Research Excellence, College of Medicine and Public Health, Flinders University of South Australia, Bedford Park, South Australia, Australia.,Sleep Health Service, Repatriation General Hospital and Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - James Douglas
- Thoracic Program, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Amanda O'grady
- The Adelaide Institute for Sleep Health: A Centre of Research Excellence, College of Medicine and Public Health, Flinders University of South Australia, Bedford Park, South Australia, Australia
| | - Nicola Dunn
- Thoracic Program, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Jan Robinson
- Thoracic Program, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Denzil Paul
- The Adelaide Institute for Sleep Health: A Centre of Research Excellence, College of Medicine and Public Health, Flinders University of South Australia, Bedford Park, South Australia, Australia
| | - Paul Williamson
- College of Education Psychology and Social Work, Flinders University, Bedford Park, South Australia, Australia
| | - R Doug McEvoy
- The Adelaide Institute for Sleep Health: A Centre of Research Excellence, College of Medicine and Public Health, Flinders University of South Australia, Bedford Park, South Australia, Australia.,Sleep Health Service, Repatriation General Hospital and Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
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Roehrs T, Withrow D, Koshorek G, Verkler J, Bazan L, Roth T. Sleep and pain in humans with fibromyalgia and comorbid insomnia: double-blind, crossover study of suvorexant 20 mg versus placebo. J Clin Sleep Med 2020; 16:415-421. [PMID: 31992394 DOI: 10.5664/jcsm.8220] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The chronic pain disorder, fibromyalgia, is associated with sleep disturbance, typically sleep maintenance. No studies have evaluated the effect of sleep medication on pain sensitivity in this population. Suvorexant, an orexin antagonist approved for treatment of insomnia, was evaluated for effects on both sleep and the pain of fibromyalgia. METHODS Women age 21 to 65 years with fibromyalgia and comorbid insomnia (n = 10) were treated, double-blind, for 9 nights each with suvorexant, 20 mg and placebo in counterbalanced order. All were in good psychiatric and stable physical health and met American College of Rheumatology 2010 criteria for fibromyalgia and Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition criteria for insomnia. Screening 8-hour polysomnography (PSG) was used to rule out other sleep disorders. On nights 8 and 9 of each treatment 8-hour PSG were collected and on days 1 and 8 pain sensitivity was assessed at 1100 and 1500 hours by measuring finger withdrawal latency (FWL) to a radiant heat stimulus at 5 randomly presented intensity levels. RESULTS Suvorexant versus placebo increased total sleep time (7.2 versus 6.7 hours, P < .05) and reduced wake after sleep onset (37 versus 67 minutes, P < .04) with no night effects or interaction. Latency to persistent sleep and sleep stage measures were not altered. FWL on both am and pm tests varied as a function of intensity (P < .001). Average FWL (over 5 intensities and both days) was increased relative to placebo on both the am (13.9 versus 13.1 seconds) and pm tests (15.8 versus 14.1 seconds, P < .03) following suvorexant the previous night. CONCLUSIONS Suvorexant 20 mg in patients with fibromyalgia, improved sleep time and reduced next-day pain sensitivity on assessments of FWL to a radiant heat stimulus. CLINICAL TRIAL REGISTRY Registry: ClinicalTrials.gov; Name: A double-blind cross-over, study to compare the hypnotic, daytime sleepiness/fatigue, and pain effects of nighttime administration of suvorexant 20 mg versus placebo in patients with fibromyalgia and comorbid insomnia; Identifier: NCT02684136; URL: https://clinicaltrials.gov/ct2/show/NCT02684136.
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Affiliation(s)
- Timothy Roehrs
- Henry Ford Health System, Sleep Disorders and Research Center, Detroit, Michigan.,Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, Michigan
| | - Dana Withrow
- Henry Ford Health System, Sleep Disorders and Research Center, Detroit, Michigan
| | - Gail Koshorek
- Henry Ford Health System, Sleep Disorders and Research Center, Detroit, Michigan
| | - Jelena Verkler
- Henry Ford Health System, Sleep Disorders and Research Center, Detroit, Michigan
| | - Luisa Bazan
- Henry Ford Health System, Sleep Disorders and Research Center, Detroit, Michigan
| | - Thomas Roth
- Henry Ford Health System, Sleep Disorders and Research Center, Detroit, Michigan.,Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, Michigan
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Luyster FS, Ritterband LM, Sereika SM, Buysse DJ, Wenzel SE, Strollo PJ. Internet-Based Cognitive-Behavioral Therapy for Insomnia in Adults With Asthma: A Pilot Study. Behav Sleep Med 2020; 18:10-22. [PMID: 30252506 PMCID: PMC6433549 DOI: 10.1080/15402002.2018.1518229] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background/Objective: Insomnia is common among adults with asthma and is associated with worse asthma control. Cognitive-behavioral therapy for insomnia (CBT-I) is an effective treatment for insomnia with medical comorbidities, but it has not been tested in asthma. The purpose of this study was to assess the feasibility and acceptability of an Internet-based CBT-I intervention, called Sleep Healthy Using the Internet (SHUTi), among adults with asthma and comorbid insomnia, and to gather preliminary efficacy data on changes in insomnia severity, sleep quality, asthma control, and asthma-related quality of life. Methods: A single-group, pretest-posttest design was employed, where all participants completed the SHUTi program. Online questionnaires were completed pre- and postintervention. Individual telephone interviews were conducted after posttreatment data collection to obtain participants' experiences with SHUTi and suggestions for improvement. Results: The sample (N = 23) comprised men and women aged 18-75 years with moderate to severe, not well-controlled asthma, and comorbid insomnia. Nineteen (83%) completed postintervention assessments. Improvements on the Insomnia Severity Index, Pittsburgh Sleep Quality Index, Asthma Control Test, and Asthma Quality of Life Questionnair-Marks were observed at postintervention. Data from the telephone interviews suggest that most participants had a positive experience with SHUTi. Participants suggested incorporating asthma-specific content into future versions of the intervention. Conclusions: Internet-based CBT-I is a potential treatment option for adults with asthma and comorbid insomnia.
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Affiliation(s)
- Faith S. Luyster
- University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
| | - Lee M. Ritterband
- Center for Behavioral Health & Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Susan M. Sereika
- University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
| | - Daniel J. Buysse
- Department of Psychiatry and Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Sally E. Wenzel
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Patrick J. Strollo
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
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Ayappa I, Chen Y, Bagchi N, Sanders H, Black K, Twumasi A, Rapoport DM, Lu SE, Sunderram J. The Association between Health Conditions in World Trade Center Responders and Sleep-Related Quality of Life and Sleep Complaints. Int J Environ Res Public Health 2019; 16:E1229. [PMID: 30959865 DOI: 10.3390/ijerph16071229] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 03/22/2019] [Accepted: 04/03/2019] [Indexed: 01/11/2023]
Abstract
Background: World Trade Center (WTC) dust-exposed subjects have multiple comorbidities that affect sleep. These include obstructive sleep apnea (OSA), chronic rhinosinusitis (CRS), gastroesophageal-reflux disorder (GERD) and post-traumatic stress disorder (PTSD). We examined the impact of these conditions to sleep-related outcomes. Methods: Demographics, co-morbidities and symptoms were obtained from 626 WTC (109F/517M), 33⁻87years, BMI = 29.96 ± 5.53 kg/m²) subjects. OSA diagnosis was from a 2-night home sleep test (ARESTM). Subjective sleep quality, sleep-related quality of life (QOL, Functional Outcomes of Sleep Questionnaire), excessive daytime sleepiness (Epworth Sleepiness Scale), sleep duration and sleep onset and maintenance complaints were assessed. Results: Poor sleep quality and complaints were reported by 19⁻70% of subjects and average sleep duration was 6.4 h. 74.8% of subjects had OSA. OSA diagnosis/severity was not associated with any sleep-related outcomes. Sleep duration was lower in subjects with all conditions (p < 0.05) except OSA. CRS was a significant risk factor for poor sleep-related QOL, sleepiness, sleep quality and insomnia; PTSD for poor sleep-related QOL and insomnia; GERD for poor sleep quality. These associations remained significant after adjustment for, age, BMI, gender, sleep duration and other comorbidities. Conclusions: Sleep complaints are common and related to several health conditions seen in WTC responders. Initial interventions in symptomatic patients with both OSA and comorbid conditions may need to be directed at sleep duration, insomnia or the comorbid condition itself, in combination with intervention for OSA.
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Cho YW, Kim KT, Moon HJ, Korostyshevskiy VR, Motamedi GK, Yang KI. Comorbid Insomnia With Obstructive Sleep Apnea: Clinical Characteristics and Risk Factors. J Clin Sleep Med 2018; 14:409-417. [PMID: 29458695 DOI: 10.5664/jcsm.6988] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 11/28/2017] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) and chronic insomnia are two common sleep disorders and both are considered independent risk factors for heart disease. The aim of this study was to investigate the prevalence of comorbid insomnia with OSA and to compare its clinical characteristics with those of OSA without insomnia. METHODS Patients who visited two tertiary university hospital sleep centers were screened. Those with a diagnosis of OSA using polysomnography were divided into two groups based on their scores on the Korean version of the Insomnia Severity Index (ISI-K): OSA with insomnia (OSA+I) (ISI-K score ≥ 15) and OSA without insomnia (OSA-I) (ISI-K score < 15). Subjective symptoms were evaluated using sleep questionnaires including ISI-K. Demographic and clinical characteristics of OSA+I and OSA-I were compared. RESULTS Out of 476 patients with OSA, 139 (29.2%) had significant insomnia. Patients in the OSA+I group had a higher percentage of females (35.3% versus 19.6%, P < .001) and have higher rates of heart disease (19.4% versus 8.6%, P < .001). OSA+I group showed lower quality of life, lower quality of sleep, higher sleep propensity, and higher depression as measured by the Korean versions of the Short-Form 36-Item Health Survey, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and Beck Depression Inventory, respectively. There were no significant differences in adherence to continuous positive airway pressure between the groups. CONCLUSIONS There is a high prevalence of comorbid insomnia with OSA (29.2%), consistent with previous findings in Western studies. Comorbid insomnia with OSA may constitute a cumulative risk factor for cardiovascular disease. These findings warrant further investigation into the mechanisms involved in its pathogenesis and devising more efficient treatments.
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Affiliation(s)
- Yong Won Cho
- Department of Neurology, Keimyung University School of Medicine, Dongsan Medical Center, Daegu, South Korea
| | - Keun Tae Kim
- Department of Neurology, Keimyung University School of Medicine, Dongsan Medical Center, Daegu, South Korea
| | - Hye-Jin Moon
- Department of Neurology, Keimyung University School of Medicine, Dongsan Medical Center, Daegu, South Korea.,Department of Neurology, School of Medicine, Soonchunhyang University, Bucheon, South Korea
| | - Valeriy R Korostyshevskiy
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC
| | - Gholam K Motamedi
- Department of Neurology, Georgetown University Hospital, Washington, DC
| | - Kwang Ik Yang
- Sleep Disorders Center, Department of Neurology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, South Korea
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O'Sullivan M, Rahim M, Hall C. The prevalence and management of poor sleep quality in a secondary care mental health population. J Clin Sleep Med 2015; 11:111-6. [PMID: 25348241 DOI: 10.5664/jcsm.4452] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 10/06/2014] [Indexed: 12/19/2022]
Abstract
STUDY OBJECTIVES Poor sleep quality, particularly insomnia, has been identified as a frequent problem among individuals with mental health difficulties. Comorbid sleep difficulties adversely affect quality of life and functioning, and have been associated with the causation and maintenance of a number of psychiatric disorders, as well as increasing the risk of relapse. The study objectives were to ascertain clinician knowledge related to insomnia, investigate sleep quality among service users in a community mental health setting in the UK, and evaluate service provision of evidence-based interventions for sleep difficulties. METHODS A cross-sectional design was used. Nineteen clinicians completed a questionnaire on their clinical practice. Seventy-three service users completed the Pittsburgh Sleep Quality Index and provided self-report data on interventions received and associated satisfaction. RESULTS Clinical staff demonstrated deficits in knowledge of insomnia symptomatology. Sixty-four percent (95% CI 54% to 74%) of service users were identified as poor sleepers on the PSQI. Sixty-one percent of poor sleepers had not been offered support for sleep difficulties. The most common support received was prescribed psychotropic medication (32%). Cognitive behavioral therapy was the intervention rated as most helpful but was only received by 6%. CONCLUSIONS This study highlights inadequaciesin providing evidence-based interventions for sleep difficulties. Key recommendations include training clinicians in the identification of sleep difficulties and provision of evidence-based interventions, provision of cost-effective transdiagnostic group interventions, and formalizing assessment and treatment pathways for service users with sleep difficulties.
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Affiliation(s)
- Michelle O'Sullivan
- School of Psychology, University of Surrey, Surrey, UK: Surrey & Borders Partnership Mental Health NHS Foundation Trust, Surrey, UK
| | - Masuma Rahim
- School of Psychology, University of Surrey, Surrey, UK: Surrey & Borders Partnership Mental Health NHS Foundation Trust, Surrey, UK
| | - Christopher Hall
- South-West London & St George's Mental Health NHS Trust, London, UK
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12
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Fung CH, Martin JL, Dzierzewski JM, Jouldjian S, Josephson K, Park M, Alessi C. Prevalence and symptoms of occult sleep disordered breathing among older veterans with insomnia. J Clin Sleep Med 2013; 9:1173-8. [PMID: 24235899 DOI: 10.5664/jcsm.3162] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
STUDY OBJECTIVES To determine the prevalence of occult sleep disordered breathing (SDB) and describe the relationship between classic SDB symptoms (e.g., loud snoring) and occult SDB in older veterans with insomnia. METHODS We analyzed baseline survey and in-home sleep study data for 435 veterans (mean age = 72.0 years [SD 8.0]) who had no known history of SDB, met International Classification of Sleep Disorders 2(nd) Edition criteria for insomnia, and were enrolled in a behavioral intervention trial for insomnia. Variables of interest included apnea-hypopnea index (AHI) ≥ 15, age, race/ethnicity, marital status, body mass index (BMI), insomnia subtype (i.e., onset, maintenance, or terminal), self-reported excessive daytime sleepiness, snoring, and witnessed breathing pause items from the Berlin Questionnaire. We computed the frequency of AHI ≥ 15 and assessed whether each classic SDB symptom was associated with an AHI ≥ 15 in 4 separate multivariate logistic regression models. RESULTS Prevalence of AHI ≥ 15 was 46.7%. Excessive daytime sleepiness (adjusted odds ratio 1.63, 95% CI 1.02, 2.60, p = 0.04), but not snoring loudness, snoring frequency, or witnessed breathing pauses was associated with occult SDB (AHI ≥ 15). Insomnia subtypes were not significantly associated with occult SDB (p > 0.38). CONCLUSIONS In our sample of older veterans with insomnia, nearly half had occult SDB, which was characterized by reported excessive daytime sleepiness, but not loud or frequent snoring or witnessed breathing pauses. Insomnia subtype was unrelated to the presence of occult SDB.
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Affiliation(s)
- Constance H Fung
- Geriatric Research, Education and Clinical Center (GRECC): Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, CA ; David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
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Abstract
Insomnia is a prevalent disorder that greatly impacts military personnel, especially those deployed in support of combat efforts. Deployment-related stressors like combat exposure, mild traumatic brain injury (mTBI) irregular sleep-wake schedules, and adjustment to the return home all contribute to insomnia. However, insomnia can also exacerbate the deployment experience and is a risk factor for traumatic stress reactions such as PTSD, depression, and suicide. Military personnel with mTBI are significantly impacted by insomnia; the majority experience sleep disruption and this can impede recovery and rehabilitation. As more service members return home from deployment, treatment is vital to reduce the impact of insomnia. Preliminary outcome data, showing positive results for reduction of sleep disruption, has been found with treatments such as combined cognitive behavioral treatment of insomnia (CBTI) and imagery rehearsal therapy (IRT), preference-based interventions, as well as efforts to broadly disseminate CBTI. The recent literature on the impact and treatment of deployment-related insomnia is reviewed.
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