Dataset Information

Change in Dysfunctional Sleep-Related Beliefs is Associated with Changes in Sleep and Other Health Outcomes Among Older Veterans With Insomnia: Findings From a Randomized Controlled Trial.

ABSTRACT:

Background

Cognitive behavioral therapy for insomnia (CBTI) targets changing dysfunctional sleep-related beliefs. The impact of these changes on daytime functioning in older adults is unknown.

Purpose

We examined whether changes in sleep-related beliefs from pre- to post-CBTI predicted changes in sleep and other outcomes in older adults.

Method

Data included 144 older veterans with insomnia from a randomized controlled trial testing CBTI. Sleep-related beliefs were assessed with the Dysfunctional Beliefs and Attitudes about Sleep-16 (DBAS-16, subscales: Consequences, Worry/Helplessness, Sleep Expectations, Medication). Outcomes included sleep diary variables, actigraphy-measured sleep efficiency, Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Flinders Fatigue Scale (FFS), Patient Health Questionnaire-9, and health-related quality of life. Analyses compared slope of change in DBAS subscales from baseline to posttreatment between CBTI and control, and assessed the relationship between DBAS change and the slope of change in outcomes from baseline to 6 months.

Results

Compared to controls, the CBTI group demonstrated stronger associations between improvement in DBAS-Consequences and subsequent improvement in PSQI, ISI, ESS, and FFS. The CBTI group also demonstrated stronger associations between improvement in DBAS-Worry/Helplessness and subsequent improvements in PSQI, ISI, and FFS; improvements in DBAS-Medication and PSQI; and improvements in DBAS-Sleep Expectations and wake after sleep onset (sleep diary) and FFS (all p < .05).

Conclusions

Significant reduction in dysfunctional sleep-related beliefs following CBTI in older adults predicted improvement in several outcomes of sleep and daytime functioning. This suggests the importance of addressing sleep-related beliefs for sustained improvement with CBTI in older veterans.

Trial registration

ClinicalTrials.gov Identifier: NCT00781963.

SUBMITTER: Song Y

PROVIDER: S-EPMC8691391 | biostudies-literature | 2022 Jan

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Change in Dysfunctional Sleep-Related Beliefs is Associated with Changes in Sleep and Other Health Outcomes Among Older Veterans With Insomnia: Findings From a Randomized Controlled Trial.

Song Yeonsu Y Kelly Monica R MR Fung Constance H CH Dzierzewski Joseph M JM Grinberg Austin M AM Mitchell Michael N MN Josephson Karen K Martin Jennifer L JL Alessi Cathy A CA

Annals of behavioral medicine : a publication of the Society of Behavioral Medicine 20220101 1

<h4>Background</h4>Cognitive behavioral therapy for insomnia (CBTI) targets changing dysfunctional sleep-related beliefs. The impact of these changes on daytime functioning in older adults is unknown.<h4>Purpose</h4>We examined whether changes in sleep-related beliefs from pre- to post-CBTI predicted changes in sleep and other outcomes in older adults.<h4>Method</h4>Data included 144 older veterans with insomnia from a randomized controlled trial testing CBTI. Sleep-related beliefs were assessed ...[more]

PMID: 33944909

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Project description:BackgroundSleep disturbance is a major health concern among US veterans who have served since 2001 in a combat theater in Iraq or Afghanistan. We report subjective and objective sleep results from a pilot trial assessing self-management-guided use of a mobile app (CBT-i Coach, which is based on cognitive behavioral therapy for insomnia) as an intervention for insomnia in military veterans.ObjectiveThe primary aim of this study was to evaluate changes in subjective and objective sleep outcomes from pre to postintervention.MethodsSubjective outcomes included the Insomnia Severity Index, the Pittsburgh Sleep Quality Inventory, and sleep-related functional status. A wearable sleep monitor (WatchPAT) measured objective sleep outcomes, including sleep efficiency, percent rapid eye movement (REM) during sleep, sleep time, and sleep apnea. A total of 38 participants were enrolled in the study, with 18 participants being withdrawn per the protocol because of moderate or severe sleep apnea and 9 others who dropped out or withdrew. Thus, 11 participants completed the full 6-week CBT-i Coach self-management intervention (ie, completers).ResultsCompleter results indicated significant changes in subjective sleep measures, including reduced reports of insomnia (Z=-2.68, P=.007) from pre (mean 16.63, SD 5.55) to postintervention (mean 12.82, SD 3.74), improved sleep quality (Z=-2.37, P=.02) from pre (mean 12.82, SD 4.60) to postintervention (mean 10.73, SD 3.32), and sleep-related functioning (Z=2.675, P=.007) from pre (mean 13.86, SD 3.69) to postintervention (mean 15.379, SD 2.94). Among the objective measures, unexpectedly, objective sleep time significantly decreased from pre to postintervention (χ22=7.8, P=.02). There were no significant changes in percent REM sleep or sleep efficiency.ConclusionsThese findings suggest that the CBT-i Coach app can improve subjective sleep and that incorporating objective sleep measures into future, larger clinical trials or clinical practice may yield important information, particularly by detecting previously undetected sleep apnea.Trial registrationClinicalTrials.gov NCT02392000; http://clinicaltrials.gov/ct2/show/NCT02392000.

Project description:Sleep irregularity has been linked to multiple deleterious consequences in clinical populations or community adults and adolescents, but little is known about young adults. In this study, we explored the relationships between two measures of sleep regularity and a wide range of factors (lifestyle behaviors, subjective sleep, clinical outcomes, and academic performance) in a sample of female, university students in the United Arab Emirates. A total of 176 participants were recruited. Objective estimates of sleep-wake patterns were obtained using seven-day wrist actigraphy and data were used to calculate daily sleep regularity with the Sleep Regularity Index (SRI) and weekly sleep regularity with the social jetlag (SJL). Subjective sleep measures were also acquired using the Pittsburgh Sleep Quality Index (PSQI), Dysfunctional Beliefs and Attitudes about Sleep (DBAS), and daytime napping frequency. Self-reported night-time technology use frequency was ascertained using the Technology Use Questionnaire (TUQ). Psychological health was assessed using the Hospital Anxiety and Depression Scale. Objective physical health measurements for body mass index, fasting blood glucose and blood pressure were obtained. No significant associations emerged between sleep regularity and psychological physical health, or academic performance. However, significant relationships were detected between SRI and daytime napping frequency (p-value = 0.0017), PSQI (p-value = 0.0337), and DBAS (p-value = 0.0176), suggesting that daily irregular sleep patterns are associated with more frequent daytime napping, greater dysfunctional sleep beliefs, and poorer subjective sleep quality. Conversely, SJL was significantly associated with the DBAS (p-value = 0.0253), and the TUQ (p-value = 0.0208), indicating that weekly irregular sleep patterns are linked to greater dysfunctional sleep beliefs and increased nighttime technology use. In conclusion, efforts to educate and cultivate sustainable and consistent sleep-wake patterns amongst university students are needed, which can be achieved by raising awareness, promoting good sleep health habits, and minimizing excessive bedtime technology.

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Dataset Information

Change in Dysfunctional Sleep-Related Beliefs is Associated with Changes in Sleep and Other Health Outcomes Among Older Veterans With Insomnia: Findings From a Randomized Controlled Trial.

Background

Purpose

Method

Results

Conclusions

Trial registration

Publications

Change in Dysfunctional Sleep-Related Beliefs is Associated with Changes in Sleep and Other Health Outcomes Among Older Veterans With Insomnia: Findings From a Randomized Controlled Trial.

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