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1.
PLoS One ; 17(6): e0269882, 2022.
Article in English | MEDLINE | ID: covidwho-1892328

ABSTRACT

INTRODUCTION: Coronavirus Disease 2019 (COVID-19) has made a serious public health threat worldwide. Recent evidence has indicated that COVID-19 patients in convalescence frequently experience insomnia, which reduces their quality of life and causes unknown risks. The positive effect of cognitive behavior on insomnia has been well addressed in previous studies. Given the high infectivity and epidemicity of COVID-19, Internet-delivered intervention may be safer than face-to-face treatment. However, whether Internet-delivered cognitive behavioral therapy can effectively improve the insomnia of COVID-19 patients in convalescence has not been completely determined yet. Therefore, we conducted a meta-analysis and systematic review to evaluate the effects of Internet-delivered cognitive behavioral therapy on insomnia in COVID-19 patients in convalescence, with the aim to confer some guidance for its clinical application. METHODS AND ANALYSIS: This systematic review and meta-analysis has been registered in the International Prospective Register of Systematic Reviews (PROSPERO). Two researchers will retrieve the relevant literature on Internet-delivered cognitive behavioral therapy for insomnia in convalescent patients with COVID-19 in PubMed, Web of Science, Embase, MEDLINE, Cochrane Library, Clinical Trials gov, Chinese Biomedical Literature Database (CBM), and Chinese National Knowledge Infrastructure (CNKI) from inception to 11th of December. In addition, we will review the relevant trials and references of the included literature and manually searched the grey literature. The two researchers will independently extracted data and information and evaluated the quality of the included literature. The Review Manager software (version 5.3) and Stata software (version 14.0) will be used for data analysis. The mean difference or the standardized mean difference of 95% CI will be used to calculate continuous variables to synthesize the data. In addition, I2 and Cochrane will be used for heterogeneity assessment. TRIAL REGISTRATION: PROSPERO registration number CRD42021271278.


Subject(s)
COVID-19 , Cognitive Behavioral Therapy , Sleep Initiation and Maintenance Disorders , COVID-19/complications , COVID-19/therapy , Convalescence , Humans , Internet , Meta-Analysis as Topic , Quality of Life , Research Design , Sleep Initiation and Maintenance Disorders/complications , Sleep Initiation and Maintenance Disorders/therapy , Systematic Reviews as Topic
2.
J Alzheimers Dis ; 84(4): 1539-1550, 2021.
Article in English | MEDLINE | ID: covidwho-1771006

ABSTRACT

BACKGROUND: Approximately 50% of older adults with cognitive impairment suffer from insomnia. When untreated, pre-existing cognitive problems may be exacerbated and potentially contribute to further cognitive decline. One promising approach to maintain cognitive health is to improve sleep quantity and quality. OBJECTIVE: To determine feasibility, acceptability, and preliminary efficacy of Sleep Health Using the Internet for Older Adult Sufferers of Insomnia and Sleeplessness (SHUTi OASIS), an Internet-delivered cognitive behavioral therapy for insomnia (CBT-I) program in older adults with mild cognitive impairment (MCI). METHODS: Older adults with MCI and insomnia were recruited from hospital-based memory and sleep disorders clinics and enrolled in a single-arm pilot study. Participants completed the six cores of SHUTi OASIS, over nine weeks with two-week baseline and post-assessments using self-reported sleep diaries. Feasibility and acceptability were informed by usage statistics and qualitative interviews; preliminary efficacy was informed by patient-generated sleep data. RESULTS: Twelve participants enrolled and, on average, were 75.8 years of age. Ten participants completed the study and logged in most days. Most participants reported a positive overall experience, and interviews revealed successful and independent program management and completion. There were significant changes on all baseline to post-assessment sleep measures, including clinically meaningful improvements on the Insomnia Severity Index (13.5 to 8.3, p < 0.01), sleep efficiency, wake after sleep onset, and sleep onset latency (ps < 0.02). There was no statistically significant change in cognitive measures (p > 0.05). CONCLUSION: This study supports that older adults with cognitive impairment can independently complete CBT-I via the Internet and achieve clinical sleep improvements.


Subject(s)
Cognitive Behavioral Therapy , Cognitive Dysfunction/complications , Internet-Based Intervention , Sleep Initiation and Maintenance Disorders/therapy , Aged , Feasibility Studies , Female , Humans , Male , Pilot Projects , Self Report , Treatment Outcome
4.
BMJ Open Gastroenterol ; 8(1)2021 12.
Article in English | MEDLINE | ID: covidwho-1597705

ABSTRACT

OBJECTIVE: Poor sleep is common in inflammatory bowel disease (IBD), associated with worse overall disease course and predominantly attributable to insomnia. While cognitive-behavioural therapy for insomnia (CBT-I) is the recommended first-line treatment for chronic insomnia, it is untested in IBD. It is unclear if CBT-I will be as effective in this group given the extent of night-time symptoms people with IBD experience. Thus, we evaluated the feasibility and preliminary efficacy of CBT-I in IBD. DESIGN: We comprehensively assessed sleep in people with mild-to-moderately active IBD using questionnaires, daily diaries and actigraphy. People with significant insomnia symptoms were allocated to a single-arm, uncontrolled pilot feasibility study of gold-standard CBT-I treatment. They were then reassessed post-treatment. RESULTS: 20 participants with IBD completed a baseline assessment. 10 were experiencing insomnia and were allocated to CBT-I. All participants who were offered CBT-I elected to complete it, and all completed 5/5 sessions. Participants rated treatment acceptability highly and daily diary and actigraphy completion rates were >95%. At baseline, participants with insomnia evidenced significantly worse sleep than participants without insomnia. Following CBT-I, participants reported significant improvements in diary and actigraphy measures of sleep continuity, dysfunctional sleep-related beliefs and IBD disease activity. CONCLUSION: CBT-I was feasible and acceptable and demonstrated a signal for efficacy in the treatment of insomnia in IBD. Importantly, the improvements in sleep continuity were consistent with the extant literature. Future fully powered randomised controlled studies should evaluate whether treatment of insomnia can improve other aspects of IBD, including pain and inflammation. TRIAL REGISTRATION NUMBER: NCT04132024.


Subject(s)
Cognitive Behavioral Therapy , Inflammatory Bowel Diseases , Sleep Initiation and Maintenance Disorders , Chronic Disease , Feasibility Studies , Humans , Inflammatory Bowel Diseases/complications , Inflammatory Bowel Diseases/therapy , Sleep Initiation and Maintenance Disorders/therapy , Treatment Outcome
6.
J Sleep Res ; 31(2): e13489, 2022 04.
Article in English | MEDLINE | ID: covidwho-1416394

ABSTRACT

Insomnia is the most frequent sleep disorder, and the COVID-19 crisis has massively increased its prevalence in the population, due to psychosocial stress or direct viral contamination. KANOPEE_2 is a smartphone-based application that provides interactions with a virtual agent to autonomously screen and alleviate insomnia symptoms through an intervention programme giving personalized advices regarding sleep hygiene, relaxation techniques and stimulus-control. In this proof-of-concept study, we tested the effects of KANOPEE_2 among users from all over the country (France) who downloaded the app between 1 June and 26 October 2020 (to focus on effects after the end of COVID-19 confinement). Outcome measures include insomnia severity (Insomnia Severity Index) and sleep/wake schedules measured by a sleep diary. One-thousand and thirty-four users answered the screening interview (Mage  = 43.76 years; SD = 13.14), and 108 completed the two-step programme (Mage  = 46.64 years; SD = 13.63). Of those who answered the screening, 42.8% did not report sleep complaints, while 57.2% presented mild-to-severe insomnia symptoms. At the end of the intervention, users reported significantly fewer sleep complaints compared with the beginning of the intervention (Insomnia Severity Indexbeginning  = 13.58; Insomnia Severity Indexend  = 11.30; p < 0.001), and significantly increased their sleep efficiency (sleep efficiencybeginning  = 76.46%; sleep efficiencyend  = 80.17%; p = 0.013). KANOPEE_2 is a promising solution both to provide autonomous evaluation of individuals' sleep hygiene and reduce insomnia symptoms over a brief and simple intervention. These results are very encouraging for addressing the issue of insomnia management in people exposed to major psychosocial stress and the consequences of COVID-19 infection.


Subject(s)
COVID-19 , Mobile Applications , Sleep Initiation and Maintenance Disorders , Adult , Humans , Middle Aged , SARS-CoV-2 , Sleep Initiation and Maintenance Disorders/diagnosis , Sleep Initiation and Maintenance Disorders/therapy , Smartphone , Treatment Outcome
7.
Sleep Med Clin ; 16(3): 513-521, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1284259

ABSTRACT

Insomnia is an important but widely ignored health problem in modern society. Despite unequivocal evidence on its large prevalence, health and social impacts, comorbidities, and various pharmacologic and nonpharmacologic (behavioral and device-based) approaches, its effective management is still difficult and often incomplete. This article discusses the role of insomnia in modern societies, newer complicating factors, and its overall social and public health burden. Acute insomnia and sleep difficulties during pandemic and confinement are reviewed. The article also focuses on newer developments accumulating in the field of insomnia and possible future trends.


Subject(s)
Cost of Illness , Sleep Initiation and Maintenance Disorders , Forecasting , Humans , Pandemics , Prevalence , Quarantine , Sleep Initiation and Maintenance Disorders/epidemiology , Sleep Initiation and Maintenance Disorders/therapy
8.
Int J Environ Res Public Health ; 18(11)2021 May 26.
Article in English | MEDLINE | ID: covidwho-1244025

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic created significant psychological challenges worldwide, including stress, emotional distress, and insomnia. In addition, social distancing, travel restrictions, and spread of disease have resulted in unique challenges, creating barriers to healthcare access. Compared to the rate prior to the COVID-19 pandemic, a significant increase in clinical insomnia rates have been reported. With well-known limitations of currently established treatments (e.g., cognitive behavioral therapy-insomnia (CBT-I), pharmacotherapy), there is a need to explore other effective and safe treatment modalities to treat insomnia, especially those that can be used remotely. The purpose of this study is to assess the effectiveness of app-based intervention to treat insomnia in the current era of the COVID-19 pandemic (using the Yoga of Immortals (YOI) app). This prospective cohort study was approved by the Institutional Review Board. All participants in this study were asked to complete an online survey including demographic data and validated Insomnia Severity Index (ISI) at baseline (15 May 2020), 4 weeks, and 8 weeks after starting the YOI intervention. Survey data was exported using Microsoft Excel. Statistical analysis was done using the GraphPad Prism 8. YOI intervention significantly improved the mean ISI scores in all categories of insomnia (severe, moderate, and subthreshold) at each follow-up (p ≤ 0.0001). The improvement was significant among all age groups and in both genders. In our study, YOI was a novel and effective intervention for improving insomnia symptoms and may be a new addition to the armamentarium of insomnia management. Being app-based, this has potential wider applicability, especially during the current COVID-19 pandemic.


Subject(s)
COVID-19 , Mobile Applications , Sleep Initiation and Maintenance Disorders , Yoga , Female , Humans , Male , Pandemics , Prospective Studies , SARS-CoV-2 , Sleep Initiation and Maintenance Disorders/epidemiology , Sleep Initiation and Maintenance Disorders/therapy , Treatment Outcome
9.
Sleep Med ; 91: 211-218, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1201963

ABSTRACT

The sleep of millions has suffered during the global COVID-19 pandemic. Prevalence rates of 20-45% are reported globally for insomnia symptoms during the pandemic. Affected populations include the public and health care workers. A sleep deprived society faces the increased burden of COVID-related economic disruption, psychosocial problems, substance abuse, and suicide. Disordered sleep is not expected to disappear with control of infection, making interventions acutely necessary. The question becomes how to manage the sleep dysfunction during and after the pandemic. Depression and anxiety are prominent complaints during pandemic restrictions. Insomnia symptoms and fatigue continue even as mood improves in those who are in recovery from COVID-19 infection. Management of disturbed sleep and mental health is particularly needed in frontline health care workers. This overview describes 53 publications, as of February 2021, on disturbed sleep during the pandemic, treatment studies on COVID-related sleep disturbance, and need to rely on current treatment guidelines for common sleep disorders. The available research during the first year of COVID-19 has generally described symptoms of poor sleep rather than addressing treatment strategies. It covers digital cognitive behavioral therapy for insomnia (CBT-i) for the public and frontline workers, recognizing the need of greater acceptance and efficacy of controlled trials of CBT for affected groups. Recommendations based on a tiered public health model are discussed.


Subject(s)
COVID-19 , Sleep Initiation and Maintenance Disorders , Sleep Wake Disorders , Anxiety/epidemiology , Depression/epidemiology , Humans , Pandemics , SARS-CoV-2 , Sleep , Sleep Initiation and Maintenance Disorders/epidemiology , Sleep Initiation and Maintenance Disorders/therapy , Sleep Wake Disorders/epidemiology , Sleep Wake Disorders/therapy
10.
Asian J Psychiatr ; 60: 102656, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1184783

ABSTRACT

BACKGROUND AND AIM: Recently, the availability and usefulness of mobile self-help mental health applications have increased, but few applications deal with COVID-19-related psychological problems. This study explored the intervention efficacy of a mobile application on addressing psychological problems related to COVID-19. METHODS: A longitudinal control trial involving 129 Chinese participants with depression symptoms was conducted through the mobile application "Care for Your Mental Health and Sleep during COVID-19" (CMSC) based on WeChat. Participants were divided into two groups: mobile internet cognitive behavioral therapy (MiCBT) and wait-list. The primary outcome was improvement in depression symptoms. Secondary outcomes included improvement in anxiety and insomnia. The MiCBT group received three self-help CBT intervention sessions in one week via CMSC. RESULTS: The MiCBT group showed significant improvement in depression and insomnia (allP < 0.05) compared with the wait-list group. Although both groups showed significant improvement in anxiety at the intervention's end, compared with the wait-list group, the MiCBT group had no significant advantage. Correlation analysis showed that improvement in depression and anxiety had a significant positive association with education level. Changes in insomnia were significantly negatively correlated with anxiety of COVID-19 at the baseline. CMSC was considered helpful (n=68, 81.9 %) and enjoyable (n=54, 65.9 %) in relieving depression and insomnia during the COVID-19 outbreak. CONCLUSIONS: CMSC is verified to be effective and convenient for improving COVID-19-related depression and insomnia symptoms. A large study with sufficient evidence is required to determine its continuous effect on reducing mental health problems during the pandemic.


Subject(s)
Anxiety/therapy , COVID-19/psychology , Cognitive Behavioral Therapy/methods , Depression/therapy , Sleep Initiation and Maintenance Disorders/psychology , Sleep Initiation and Maintenance Disorders/therapy , Anxiety/psychology , COVID-19/epidemiology , Depression/psychology , Female , Humans , Male , Mental Health , Pandemics , SARS-CoV-2 , Sleep Initiation and Maintenance Disorders/diagnosis , Treatment Outcome
11.
Sleep Breath ; 25(4): 2213-2219, 2021 12.
Article in English | MEDLINE | ID: covidwho-1146508

ABSTRACT

BACKGROUND: The outbreak of Coronavirus Disease-2019 (COVID-19) caused great psychological distress often with comorbid insomnia. Insomnia is common in patients with COVID-19 admitted to mobile cabin hospitals. Insomnia may lead to immune dysfunction, a condition not conducive to recovery from COVID-19. The use of sedative-hypnotic drugs is limited by their inhibitory effect on the respiratory system. A paucity of research is available regarding psychotherapy interventions to improve insomnia symptoms among  patients with COVID-19. In the general population, sleep problems are more common in women than in men; insomnia in women patients requires special attention. The aim of this study was to develop simplified-cognitive behavioral therapy for insomnia (S-CBTI) for patients with COVID-19 and comorbid insomnia symptoms and to verify its effectiveness through a self-control trial. A second aim was to compare the effectiveness of S-CBTI between acute and chronic insomnia among women with COVID-19 and comorbid insomnia symptoms in Wuhan Jianghan Cabin Hospital. METHODS: S-CBTI consisted of education on COVID-19 and sleep hygiene, stimulus control, sleep restriction, and self-suggestion relaxation training over a period of two consecutive weeks. Of 67 women, 66 completed psychological intervention and baseline and post-intervention assessments. There were 31 women with acute insomnia and 35 with chronic insomnia. The Insomnia Severity Index (ISI) score and self-compiled sleep data were assessed at baseline and post-intervention, and subjective sleep evaluations were assessed at days 4, 7, 12, and 14. RESULTS: The ISI score, sleep latency, night sleep time, and sleep efficiency were statistically significantlly improved from baseline to post-intervention by paired T-test. After the intervention, the mean ISI score of the acute insomnia group was lower than that of the chronic insomnia group. The reduction of the ISI score and the improvement of sleep time from baseline to post-intervention in the acute insomnia group were greater than those in the chronic insomnia group. Utilization of sedative-hypnotic drugs in the acute insomnia group was less than that in the chronic insomnia group, and the difference was statistically significant. CONCLUSIONS: S-CBTI can improve the insomnia symptoms of women with COVID-19 in mobile cabin hospitals, especially for stress-related acute insomnia.


Subject(s)
COVID-19/complications , Cognitive Behavioral Therapy , Outcome Assessment, Health Care , Sleep Initiation and Maintenance Disorders/etiology , Sleep Initiation and Maintenance Disorders/therapy , Acute Disease , Adolescent , Adult , China , Chronic Disease , Female , Humans , Middle Aged , Mobile Health Units , Patient Education as Topic , Relaxation Therapy , Severity of Illness Index , Young Adult
13.
J Med Internet Res ; 22(12): e24268, 2020 12 18.
Article in English | MEDLINE | ID: covidwho-993081

ABSTRACT

BACKGROUND: The COVID-19 crisis and consequent confinement restrictions have caused significant psychosocial stress and reports of sleep complaints, which require early management, have increased during recent months. To help individuals concerned about their sleep, we developed a smartphone-based app called KANOPEE that allows users to interact with a virtual agent dedicated to autonomous screening and delivering digital behavioral interventions. OBJECTIVE: Our objective was to assess the feasibility of this app, in terms of inclusion rate, follow-up rate, perceived trust and acceptance of the virtual agent, and effects of the intervention program, in the context of COVID-19 confinement in France. METHODS: The virtual agent is an artificial intelligence program using decision tree architecture and interacting through natural body motion and natural voice. A total of 2069 users aged 18 years and above downloaded the free app during the study period (April 22 to May 5, 2020). These users first completed a screening interview based on the Insomnia Severity Index (ISI) conducted by the virtual agent. If the users were positive for insomnia complaints (ISI score >14), they were eligible to join the 2-stage intervention program: (1) complete an electronic sleep diary for 1 week and (2) follow personalized sleep recommendations for 10 days. We collected and analyzed the following measures: sociodemographic information, ISI scores and sleep/wake schedules, and acceptance and trust of the agent. RESULTS: Approximately 76% (1574/2069) of the app users completed the screening interview with the virtual agent. The virtual agent was well accepted by 27.4% (431/1574) of the users who answered the acceptance and trust questionnaires on its usability, satisfaction, benevolence, and credibility. Of the 773 screened users who reported sleep complaints (ISI score >14), 166 (21.5%) followed Step 1 of the intervention, and only 47 of those (28.3%) followed Step 2. Users who completed Step 1 found that their insomnia complaints (baseline mean ISI score 18.56, mean ISI score after Step 1 15.99; P<.001) and nocturnal sleep quality improved significantly after 1 week. Users who completed Step 2 also showed an improvement compared to the initial measures (baseline mean ISI score 18.87, mean ISI score after Step 2 14.68; P<.001). Users that were most severely affected (ISI score >21) did not respond to either intervention. CONCLUSIONS: These preliminary results suggest that the KANOPEE app is a promising solution to screen populations for sleep complaints and that it provides acceptable and practical behavioral advice for individuals reporting moderately severe insomnia.


Subject(s)
COVID-19/epidemiology , Cognitive Behavioral Therapy/methods , Sleep Initiation and Maintenance Disorders/therapy , Smartphone , Social Isolation/psychology , Adolescent , Adult , Aged , Artificial Intelligence , Decision Trees , Feasibility Studies , Female , France , Humans , Male , Middle Aged , Mobile Applications , Proof of Concept Study , Quarantine , Sleep , Stress, Psychological/complications , Surveys and Questionnaires , Telemedicine , Young Adult
14.
Riv Psichiatr ; 55(6): 337-341, 2020.
Article in Italian | MEDLINE | ID: covidwho-992941

ABSTRACT

Insomnia symptoms might affect about 60% of the Italian population. Insomnia is a "24 hours syndrome" and a risk factor for medical and mental disorders. It should always be assessed and treated in the clinical practice. Cognitive Behavioral Therapy for Insomnia is the first line treatment but its availability in Italy is scarce. Pharmacological options in Italy are: melatonin 2 mg prolonged release that should be the first choice in subjects ≥55 years old and used until 13 weeks; and for a short term use (≤4 weeks) Z-drugs or short-acting benzodiazepines (in subjects <65 years old) or a sedating antidepressant.


Subject(s)
COVID-19/epidemiology , Consensus , Epidemics , SARS-CoV-2 , Sleep Aids, Pharmaceutical/therapeutic use , Sleep Initiation and Maintenance Disorders/drug therapy , Aged , Antidepressive Agents/therapeutic use , COVID-19/complications , Cognitive Behavioral Therapy , GABA Agonists/therapeutic use , Humans , Hypnotics and Sedatives/therapeutic use , Italy/epidemiology , Middle Aged , Receptors, Melatonin/agonists , Sleep Initiation and Maintenance Disorders/etiology , Sleep Initiation and Maintenance Disorders/therapy , Societies, Scientific
15.
Sleep ; 44(4)2021 04 09.
Article in English | MEDLINE | ID: covidwho-949456

ABSTRACT

STUDY OBJECTIVES: Stressful life events contribute to insomnia, psychosocial functioning, and illness. Though individuals with a history of insomnia may be especially vulnerable during stressful life events, risk may be mitigated by prior intervention. This study evaluated the effect of prior digital cognitive-behavioral therapy for insomnia (dCBT-I) versus sleep education on health resilience during the COVID-19 pandemic. METHODS: COVID impact, insomnia, general- and COVID-related stress, depression, and global health were assessed in April 2020 in adults with a history of insomnia who completed a randomized controlled trial of dCBT-I (n = 102) versus sleep education control (n = 106) in 2016-2017. Regression analyses were used to evaluate the effect of intervention conditions on subsequent stress and health during the pandemic. RESULTS: Insomnia symptoms were significantly associated with COVID-19 related disruptions, and those who previously received dCBT-I reported less insomnia symptoms, less general stress and COVID-related cognitive intrusions, less depression, and better global health than those who received sleep education. Moreover, the odds for resurgent insomnia was 51% lower in the dCBT-I versus control condition. Similarly, odds of moderate to severe depression during COVID-19 was 57% lower in the dCBT-I condition. CONCLUSIONS: Those who received dCBT-I had increased health resilience during the COVID-19 pandemic in adults with a history of insomnia and ongoing mild to moderate mental health symptoms. These data provide evidence that dCBT-I is a powerful tool to promote mental and physical health during stressors, including the COVID-19 pandemic. CLINICAL TRIAL REGISTRATION: NCT02988375.


Subject(s)
COVID-19 , Cognitive Behavioral Therapy , Sleep Initiation and Maintenance Disorders , Adult , Depression/epidemiology , Depression/therapy , Humans , Pandemics , SARS-CoV-2 , Sleep Initiation and Maintenance Disorders/epidemiology , Sleep Initiation and Maintenance Disorders/therapy , Treatment Outcome
17.
Sleep Med Clin ; 15(3S): e1-e7, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-739928

ABSTRACT

Prior to the COVID-19 pandemic, few pediatric sleep medicine clinicians routinely engaged in telemedicine visits because thorough examinations were difficult to perform; there was lack of consistent reimbursement; and many clinicians were busy with their in-office practices. This article reviews how telemedicine has been explored in pediatric sleep medicine prior to the pandemic, current applications of telemedicine, challenges, and reimagining pediatric sleep within the realm of telemedicine.


Subject(s)
Pediatrics , Sleep Medicine Specialty , Sleep Wake Disorders/diagnosis , Sleep Wake Disorders/therapy , Telemedicine/methods , Betacoronavirus , COVID-19 , Child , Continuous Positive Airway Pressure , Coronavirus Infections , Humans , Otolaryngology , Pandemics , Pneumonia, Viral , Polysomnography , Referral and Consultation , Restless Legs Syndrome/diagnosis , Restless Legs Syndrome/therapy , SARS-CoV-2 , Sleep , Sleep Apnea, Obstructive/diagnosis , Sleep Apnea, Obstructive/therapy , Sleep Disorders, Circadian Rhythm/diagnosis , Sleep Disorders, Circadian Rhythm/therapy , Sleep Initiation and Maintenance Disorders/diagnosis , Sleep Initiation and Maintenance Disorders/therapy
18.
Trials ; 21(1): 704, 2020 Aug 08.
Article in English | MEDLINE | ID: covidwho-705118

ABSTRACT

OBJECTIVES: The primary aim of the present study is to examine the efficacy of an online intervention for poor sleep in the context of an ongoing stressful major life event, by assessing if this intervention can reduce insomnia severity at short-term (one week post-intervention) and long-term (one and three months post-intervention) follow-up time points. It is hypothesised that the intervention will: 1) reduce insomnia severity in poor sleepers, compared to wait-list control poor sleepers, and good sleepers; 2) reduce subjective symptoms of anxiety and depression in all groups, and 3) prevent the transition to acute insomnia in good sleepers. TRIAL DESIGN: This study is a cluster randomised controlled trial. PARTICIPANTS: Both healthy good sleepers, who do not report having any current sleep problems, and individuals who report having sleep problems, will be recruited for the present study. This is a single-site study (Northumbria University). This study will be delivered using the internet and there are no geographic restrictions. Individuals who self-report as poor sleepers will meet DSM-5 criteria for acute insomnia, which is where individuals: 1) have difficulties in falling asleep, staying asleep, or awakening too early for at least three nights per week, for a time period of between two weeks and three months; and 2) report experiencing distress or impairment caused by sleep loss. Both 1) and 2) must have occurred despite the individual having had an adequate opportunity for sleep during this time period. Good sleepers will be individuals who do not have current sleep problems. All participants must have a sufficient level of English comprehension to understand and complete study measures. Individuals cannot participate if they report having chronic sleep problems (where they have existed for more than three months immediately prior to providing consent), nor will individuals who are actively seeking treatment for their sleep problems irrespective of how long they have had the sleep problem. Individuals also cannot participate if they have a self-reported history of head injuries, or if they have a self-reported diagnosis of schizophrenia, epilepsy or personality disorder, as the distraction techniques involved in the insomnia intervention may increase rumination in individuals with these conditions, and influence the effectiveness of the intervention. INTERVENTION AND COMPARATOR: Participants who receive the intervention will be provided with an online version of a self-help leaflet. A printed version of this leaflet has been successfully used in previous treatment studies, which have been conducted by our research group. Participants will be encouraged to download, save or print out this leaflet, which will be provided in PDF format. There will be no restrictions on use and participants will be encouraged to refer to this leaflet as often as they wish to. Briefly, this self-help leaflet aims to improve sleep by identifying and addressing sleep-related dysfunctional thinking by providing education about sleep, providing techniques to distract from intrusive worrisome thoughts at night, and providing guidelines for sleep-related stimulus control. The comparator is a wait-list control (i.e. where they will receive the intervention after a one month delay) group. MAIN OUTCOMES: The primary outcome measure will be insomnia severity, as measured using the Insomnia Severity Index (Bastien, Vallières, & Morin, 2001), assessed immediately prior to the intervention and at one week, one month and three months post-intervention, compared to baseline. Secondary outcome measures will include subjective mood, measured using the 7-item Generalised Anxiety Disorder Questionnaire (GAD-7; Spitzer, Kroenke, Williams, & Lowe, 2006)) and 9-item Patient Health Questionnaire (PHQ-9; Kroenke, Spitzer, & Williams, 2001), assessed immediately prior to the intervention, and one week, one month and three months post-intervention, compared to baseline. Additionally, subjective sleep continuity, derived from sleep diaries (Carney et al., 2012), will be compared pre and post-intervention. RANDOMISATION: This study will operate as a cluster randomised controlled trial. Good sleepers will be randomised into an intervention or a no-intervention group, with a 1:1 allocation. Poor sleepers will be randomised into an intervention or wait-list control group, with a 1:1 allocation. Randomisation will be conducted automatically using Qualtrics study software, where block sizes will be equal and randomisation will be computer-generated. BLINDING (MASKING): Participants will not be blinded to group assignment. The outcomes will be assessed by a blinded investigator. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): The minimum sample size is 60. A total of 30 poor sleepers will be randomised to the intervention or wait-list control group. A total of 30 good sleepers will be randomised to the intervention or no intervention group. TRIAL STATUS: Recruitment for this study has yet to start. It is anticipated that recruitment will begin in August 2020 and end in April 2022. The current study protocol is version 1.0 (20 July 2020) TRIAL REGISTRATION: This study was prospectively registered in the ISRCTN registry (registration number ISRCTN43900695 , date of registration: 8 April 2020). FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2).


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Randomized Controlled Trials as Topic , Sleep Initiation and Maintenance Disorders/therapy , COVID-19 , Humans , Outcome Assessment, Health Care , Pandemics , SARS-CoV-2 , Self Report
19.
Sleep Med ; 74: 81-85, 2020 10.
Article in English | MEDLINE | ID: covidwho-654393

ABSTRACT

BACKGROUND: Due to the 2019 novel coronavirus (COVID-19) disease outbreak, social distancing measures were imposed to control the spread of the pandemic. However, isolation may affect negatively the psychological well-being and impair sleep quality. Our aim was to evaluate the sleep quality of respiratory patients during the COVID-19 pandemic lockdown. METHODS: All patients who underwent a telemedicine appointment from March 30 to April 30 of 2020 were asked to participate in the survey. Sleep difficulties were measured using Jenkins Sleep Scale. RESULTS: The study population consisted of 365 patients (mean age 63.9 years, 55.6% male, 50.1% with sleep-disordered breathing [SDB]). During the lockdown, 78.9% of participants were confined at home without working. Most patients (69.6%) reported at least one sleep difficulty and frequent awakenings was the most prevalent problem. Reporting at least one sleep difficulty was associated with home confinement without working, female gender and diagnosed or suspected SDB, after adjustment for cohabitation status and use of anxiolytics. Home confinement without working was associated with difficulties falling asleep and waking up too early in the morning. Older age was a protective factor for difficulties falling asleep, waking up too early and non-restorative sleep. Notably, SDB patients with good compliance to positive airway pressure therapy were less likely to report sleep difficulties. CONCLUSIONS: Home confinement without working, female gender and SDB may predict a higher risk of reporting sleep difficulties. Medical support during major disasters should be strengthened and potentially delivered through telemedicine, as this comprehensive approach could reduce psychological distress and improve sleep quality.


Subject(s)
Betacoronavirus , Coronavirus Infections/psychology , Pandemics , Pneumonia, Viral/psychology , Sleep Apnea Syndromes/psychology , Sleep Initiation and Maintenance Disorders/psychology , Social Isolation/psychology , Aged , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Female , Humans , Male , Middle Aged , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Portugal/epidemiology , SARS-CoV-2 , Sleep/physiology , Sleep Apnea Syndromes/epidemiology , Sleep Apnea Syndromes/therapy , Sleep Initiation and Maintenance Disorders/epidemiology , Sleep Initiation and Maintenance Disorders/therapy , Surveys and Questionnaires , Telemedicine/methods
20.
Behav Sleep Med ; 18(4): 570-572, 2020.
Article in English | MEDLINE | ID: covidwho-597048

ABSTRACT

OBJECTIVE/BACKGROUND: As a response to clinical observations that the pervasive stress and social/environmental disruptions from the 2020 COVID-19 pandemic have also impacted sleep, the Society of Behavioral Sleep Medicine (SBSM) convened the COVID-19 Task Force with goals to identify and disseminate information that could be useful in addressing sleep concerns during this crisis. Participants Members of the SBSM COVID-19 Task Force. Results/Conclusions Herein is a summary of the resources developed by the SBSM COVID-19 Task force, which includes links to online materials developed for use by providers and patients, as well as brief descriptions of key recommendations by the Task Force for specific sleep conditions (e.g., acute insomnia, nightmares) and vulnerable populations (e.g., parents, essential/healthcare workers, older adults).


Subject(s)
Advisory Committees/organization & administration , COVID-19 , Dreams , Pandemics , Sleep Initiation and Maintenance Disorders/therapy , Sleep Medicine Specialty , Societies, Medical/organization & administration , Adolescent , Adult , Aged , COVID-19/epidemiology , Child , Goals , Health Personnel/psychology , Humans , Practice Guidelines as Topic , Sleep , Sleep Initiation and Maintenance Disorders/epidemiology , Stress, Psychological/complications , Stress, Psychological/epidemiology
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