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Improving sleep after stroke: A randomised controlled trial of digital cognitive behavioural therapy for insomnia.
Fleming, Melanie K; Smejka, Tom; Macey, Ellie; Luengo-Fernandez, Ramon; Henry, Alasdair L; Robinson, Barbara; Kyle, Simon D; Espie, Colin A; Johansen-Berg, Heidi.
Afiliación
  • Fleming MK; Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
  • Smejka T; Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
  • Macey E; Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
  • Luengo-Fernandez R; Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
  • Henry AL; Big Health Ltd, London, UK.
  • Robinson B; Sir Jules Thorn Sleep & Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
  • Kyle SD; Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
  • Espie CA; Sir Jules Thorn Sleep & Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
  • Johansen-Berg H; Big Health Ltd, London, UK.
J Sleep Res ; 33(2): e13971, 2024 Apr.
Article en En | MEDLINE | ID: mdl-37407096
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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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Trastornos del Sueño-Vigilia / Terapia Cognitivo-Conductual / Accidente Cerebrovascular / Trastornos del Inicio y del Mantenimiento del Sueño Tipo de estudio: Clinical_trials Aspecto: Patient_preference Límite: Female / Humans / Male / Middle aged Idioma: En Revista: J Sleep Res Asunto de la revista: PSICOFISIOLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Reino Unido

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Trastornos del Sueño-Vigilia / Terapia Cognitivo-Conductual / Accidente Cerebrovascular / Trastornos del Inicio y del Mantenimiento del Sueño Tipo de estudio: Clinical_trials Aspecto: Patient_preference Límite: Female / Humans / Male / Middle aged Idioma: En Revista: J Sleep Res Asunto de la revista: PSICOFISIOLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Reino Unido