Kathleen P O'Hora, Allison B Morehouse, Leah Freidman, Donn Posner, Maryam Ahmadi, Beatriz Hernandez, Kristen Faye Burda, Clete Kushida, Jamie M Zeitzer, Laura C Lazzeroni, Rachel Manber, Jerome Yesavage, Andrea N Goldstein-Piekarski
{"title":"老年人失眠症及其组成部分的认知行为疗法的比较有效性和预测因素：一项随机拆解试验的主要结果。","authors":"Kathleen P O'Hora, Allison B Morehouse, Leah Freidman, Donn Posner, Maryam Ahmadi, Beatriz Hernandez, Kristen Faye Burda, Clete Kushida, Jamie M Zeitzer, Laura C Lazzeroni, Rachel Manber, Jerome Yesavage, Andrea N Goldstein-Piekarski","doi":"10.5664/jcsm.11756","DOIUrl":null,"url":null,"abstract":"<p><strong>Study objectives: </strong>To determine the relative effectiveness and predictors of cognitive therapy (CT), behavioral therapy (BT), and cognitive behavioral therapy (CBT) for insomnia in older adults.</p><p><strong>Methods: </strong>In a registered clinical trial (NCT02117388), 128 older adults with insomnia disorder were randomized to receive CBT, BT, or CT. Insomnia Severity Index (ISI) score was the primary outcome. Sleep diaries, fatigue, beliefs about sleep, cognitive arousal, and stress were secondary outcomes. Split-plot linear mixed models assessed within and between subject changes in outcomes among the treatments. As a secondary analysis, we used linear regression to test predictors of insomnia symptoms improvement, including sleep diary measures, cognitive arousal, stress, beliefs about sleep, baseline ISI score, and age. Benjamini-Hochberg correction was applied.</p><p><strong>Results: </strong>All groups exhibited insomnia symptom reduction at post-treatment (CT: <i>d=</i>-2.53, <i>P</i><.001; BT: <i>d=</i>-2.39, <i>P</i><.001; CBT: <i>d</i>=-2.90, <i>P</i><.001) and 6FU (CT: <i>d=</i>-2.68, <i>P</i><.001; BT: <i>d=</i>-2.85, <i>P</i><.001; CBT: <i>d</i>=-3.14, <i>P</i><.001). There were no group differences in the magnitude of ISI improvement (<i>P<sub>adj</sub></i>=.63), response (<i>P<sub>adj</sub></i>>.63), or remission (ISI<8; <i>P<sub>adj</sub></i>>.27). All groups exhibited significant improvements in secondary outcomes at post-treatment (<i>P<sub>adj</sub></i> <.05) and 6FU (<i>P<sub>adj</sub></i><0.05). At post-treatment, the CT and CBT groups showed greater reductions in beliefs about sleep than the BT group (F<sub>Interaction</sub>(2,185)=5.99, <i>P<sub>adj</sub></i>=.03), and the CBT group showed a greater time in bed reduction than the CT group (F<sub>Interaction</sub>(2,185)=7.05, <i>P<sub>adj</sub></i>=.01). Baseline ISI was the only treatment predictor (<i>b</i>=1.95, <i>P<sub>adj</sub></i><.001).</p><p><strong>Conclusions: </strong>CBT-I and its components each independently result in significant improvements in subjective insomnia symptoms, beliefs about sleep, worry, and fatigue in older adults.</p><p><strong>Clinical trial registration: </strong>Name: Treatments for Insomnia: Mediators, Moderators and Quality of Life; Registry: ClinicalTrials.gov; Identifier: NCT02117388.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":""},"PeriodicalIF":3.5000,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Comparative effectiveness and predictors of cognitive behavioral therapy for insomnia and its components in older adults: main outcomes of a randomized dismantling trial.\",\"authors\":\"Kathleen P O'Hora, Allison B Morehouse, Leah Freidman, Donn Posner, Maryam Ahmadi, Beatriz Hernandez, Kristen Faye Burda, Clete Kushida, Jamie M Zeitzer, Laura C Lazzeroni, Rachel Manber, Jerome Yesavage, Andrea N Goldstein-Piekarski\",\"doi\":\"10.5664/jcsm.11756\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Study objectives: </strong>To determine the relative effectiveness and predictors of cognitive therapy (CT), behavioral therapy (BT), and cognitive behavioral therapy (CBT) for insomnia in older adults.</p><p><strong>Methods: </strong>In a registered clinical trial (NCT02117388), 128 older adults with insomnia disorder were randomized to receive CBT, BT, or CT. Insomnia Severity Index (ISI) score was the primary outcome. Sleep diaries, fatigue, beliefs about sleep, cognitive arousal, and stress were secondary outcomes. Split-plot linear mixed models assessed within and between subject changes in outcomes among the treatments. As a secondary analysis, we used linear regression to test predictors of insomnia symptoms improvement, including sleep diary measures, cognitive arousal, stress, beliefs about sleep, baseline ISI score, and age. Benjamini-Hochberg correction was applied.</p><p><strong>Results: </strong>All groups exhibited insomnia symptom reduction at post-treatment (CT: <i>d=</i>-2.53, <i>P</i><.001; BT: <i>d=</i>-2.39, <i>P</i><.001; CBT: <i>d</i>=-2.90, <i>P</i><.001) and 6FU (CT: <i>d=</i>-2.68, <i>P</i><.001; BT: <i>d=</i>-2.85, <i>P</i><.001; CBT: <i>d</i>=-3.14, <i>P</i><.001). There were no group differences in the magnitude of ISI improvement (<i>P<sub>adj</sub></i>=.63), response (<i>P<sub>adj</sub></i>>.63), or remission (ISI<8; <i>P<sub>adj</sub></i>>.27). All groups exhibited significant improvements in secondary outcomes at post-treatment (<i>P<sub>adj</sub></i> <.05) and 6FU (<i>P<sub>adj</sub></i><0.05). At post-treatment, the CT and CBT groups showed greater reductions in beliefs about sleep than the BT group (F<sub>Interaction</sub>(2,185)=5.99, <i>P<sub>adj</sub></i>=.03), and the CBT group showed a greater time in bed reduction than the CT group (F<sub>Interaction</sub>(2,185)=7.05, <i>P<sub>adj</sub></i>=.01). Baseline ISI was the only treatment predictor (<i>b</i>=1.95, <i>P<sub>adj</sub></i><.001).</p><p><strong>Conclusions: </strong>CBT-I and its components each independently result in significant improvements in subjective insomnia symptoms, beliefs about sleep, worry, and fatigue in older adults.</p><p><strong>Clinical trial registration: </strong>Name: Treatments for Insomnia: Mediators, Moderators and Quality of Life; Registry: ClinicalTrials.gov; Identifier: NCT02117388.</p>\",\"PeriodicalId\":50233,\"journal\":{\"name\":\"Journal of Clinical Sleep Medicine\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.5000,\"publicationDate\":\"2025-06-06\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Clinical Sleep Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.5664/jcsm.11756\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Sleep Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5664/jcsm.11756","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Comparative effectiveness and predictors of cognitive behavioral therapy for insomnia and its components in older adults: main outcomes of a randomized dismantling trial.
Study objectives: To determine the relative effectiveness and predictors of cognitive therapy (CT), behavioral therapy (BT), and cognitive behavioral therapy (CBT) for insomnia in older adults.
Methods: In a registered clinical trial (NCT02117388), 128 older adults with insomnia disorder were randomized to receive CBT, BT, or CT. Insomnia Severity Index (ISI) score was the primary outcome. Sleep diaries, fatigue, beliefs about sleep, cognitive arousal, and stress were secondary outcomes. Split-plot linear mixed models assessed within and between subject changes in outcomes among the treatments. As a secondary analysis, we used linear regression to test predictors of insomnia symptoms improvement, including sleep diary measures, cognitive arousal, stress, beliefs about sleep, baseline ISI score, and age. Benjamini-Hochberg correction was applied.
Results: All groups exhibited insomnia symptom reduction at post-treatment (CT: d=-2.53, P<.001; BT: d=-2.39, P<.001; CBT: d=-2.90, P<.001) and 6FU (CT: d=-2.68, P<.001; BT: d=-2.85, P<.001; CBT: d=-3.14, P<.001). There were no group differences in the magnitude of ISI improvement (Padj=.63), response (Padj>.63), or remission (ISI<8; Padj>.27). All groups exhibited significant improvements in secondary outcomes at post-treatment (Padj <.05) and 6FU (Padj<0.05). At post-treatment, the CT and CBT groups showed greater reductions in beliefs about sleep than the BT group (FInteraction(2,185)=5.99, Padj=.03), and the CBT group showed a greater time in bed reduction than the CT group (FInteraction(2,185)=7.05, Padj=.01). Baseline ISI was the only treatment predictor (b=1.95, Padj<.001).
Conclusions: CBT-I and its components each independently result in significant improvements in subjective insomnia symptoms, beliefs about sleep, worry, and fatigue in older adults.
Clinical trial registration: Name: Treatments for Insomnia: Mediators, Moderators and Quality of Life; Registry: ClinicalTrials.gov; Identifier: NCT02117388.
期刊介绍：
Journal of Clinical Sleep Medicine focuses on clinical sleep medicine. Its emphasis is publication of papers with direct applicability and/or relevance to the clinical practice of sleep medicine. This includes clinical trials, clinical reviews, clinical commentary and debate, medical economic/practice perspectives, case series and novel/interesting case reports. In addition, the journal will publish proceedings from conferences, workshops and symposia sponsored by the American Academy of Sleep Medicine or other organizations related to improving the practice of sleep medicine.
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