Effects of a Triage Checklist to optimize insomnia treatment outcomes and reduce hypnotic use: the RCT of the effectiveness of stepped-care sleep therapy in general practice study.

IF 5.6 2区医学 Q1 Medicine

Sleep Pub Date : 2025-01-13 DOI:10.1093/sleep/zsae182

Rachel Manber, Nicole B Gumport, Isabelle A Tully, Jane P Kim, Bohye Kim, Norah Simpson, Lisa G Rosas, Donna M Zulman, Jeremy D Goldhaber-Fiebert, Elizabeth Rangel, Jessica R Dietch, Joshua Tutek, Latha Palaniappan

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Abstract

Study objectives: Evaluate a triaged stepped-care strategy among adults 50 and older with insomnia disorder.

Methods: Participants (N = 245) were classified at baseline by a Triage Checklist. Those projected to do better if they start treatment with therapist versus digitally delivered CBT-I (tCBT-I vs dCBT-I) constituted the YES stratum (n = 137); the rest constituted the NO stratum (n = 108). Participants were randomized within stratum to a strategy that utilized only dCBT-I (ONLN) or to a strategy that prospectively allocated the first step of care to dCBT-I or tCBT-I based on the Triage Checklist and switched dCBT-I nonresponders at 2-months to tCBT-I (STEP). Co-primary outcomes were the insomnia severity index (ISI) and the average nightly amount of prescription hypnotic medications used (MEDS), assessed at 2, 4, 6, 9, and 12 months postrandomization.

Results: Mixed effects models revealed that, compared to ONLN, participants in STEP had greater reductions in ISI (p = .001; η2 = 0.01) and MEDS (p = .019, η2 = 0.01). Within the YES stratum, compared to ONLN, those in STEP had greater reductions in ISI (p = .0001, η2 = 0.023) and MEDS (p = .018, η2 = 0.01). Within the ONLN arm, compared to the YES stratum, those in the NO stratum had greater reductions in ISI (p = .015, η2 = 0.01) but not in MEDS. Results did not change with treatment-dose covariate adjustment.

Conclusions: Triaged-stepped care can help guide the allocation of limited CBT-I treatment resources to promote effective and safe treatment of chronic insomnia among middle-aged and older adults. Further refinement of the Triage Checklist and optimization of the timing and switching criteria may improve the balance between effectiveness and use of resources.

Clinical trial information: Name: The RESTING Insomnia Study: Randomized Controlled Study on Effectiveness of Stepped-Care Sleep Therapy.

Trial registration id: NCT03532282. URL: https://clinicaltrials.gov/study/NCT03532282.

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分诊核对表对优化失眠治疗效果和减少催眠药使用的影响：RESTING 研究。

研究目的评估针对 50 岁及以上失眠症成人的分诊阶梯护理策略：参与者（N=245）在基线时根据分诊检查表进行分类。预计开始接受治疗师提供的CBT-I（tCBT-I与dCBT-I）与数字提供的CBT-I（tCBT-I与dCBT-I）治疗效果会更好的人构成 "是 "层（人数=137）；其余的人构成 "否 "层（人数=108）。参与者在分层内被随机分配到仅使用 dCBT-I 的策略（ONLN）或根据 "三联检查表 "将第一步护理前瞻性地分配给 dCBT-I 或 tCBT-I，并在 2 个月后将 dCBT-I 未应答者转为 tCBT-I 的策略（STEP）。共同主要结果是失眠严重程度指数（ISI）和每晚平均使用的处方催眠药量（MEDS），分别在随机后的2、4、6、9和12个月进行评估：混合效应模型显示，与 ONLN 相比，STEP 参与者的 ISI（p=0.001；η2=0.01）和 MEDS（p=0.019；η2=0.01）降低幅度更大。在 "YES "分层中，与 ONLN 相比，STEP 患者的 ISI（p=0.0001，η2=0.023）和 MEDS（p=0.018，η2=0.01）降低幅度更大。在 ONLN 治疗组中，与 "YES "层相比，"NO "层的患者 ISI 下降幅度更大（p=0.015，η2=0.01），但 MEDS 下降幅度不大。治疗剂量协变量调整后，结果没有变化：分诊-分步治疗有助于指导有限的 CBT-I 治疗资源的分配，从而促进中老年人慢性失眠症的有效、安全治疗。进一步完善分诊检查表、优化时间和转换标准可能会提高疗效和资源利用之间的平衡。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Sleep Medicine-Neurology (clinical)

CiteScore

8.70

自引率

10.70%

发文量

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