Abstract | OBJECTIVE/BACKGROUND: Discrepancies between sleep diaries and actigraphy occur among individuals with insomnia. Cognitive behavioural therapy for insomnia (CBT-I) improves insomnia but the impact on discrepancy is unclear. This study examined CBT-I's effects on actigraphy-diary discrepancy and explored sleep-related beliefs and attitudes as a mediator. PATIENTS/METHODS: Participants were 108 (age M±SD = 47.23 ± 12.42, 67.60 % female) adults with insomnia and major depressive disorder from the Treatment of Insomnia and Depression study. They were randomized to 7 sessions of CBT-I or sham Quasi-Desensitization Therapy for Insomnia (DTI), plus 16 weeks of antidepressants. Two weeks of actigraphy and sleep diary were collected at baseline, mid-treatment, end-treatment. Differences between sleep diary and actigraphy total sleep time (TST), sleep onset latency ( SOL), wake after sleep onset (WASO), and sleep efficiency (SE) were calculated. Participants completed Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS) at baseline and mid-treatment. RESULTS: At baseline, diary (versus actigraphy) TST was shorter (1.1 ± 1.41h), whilst SOL (21.64 ± 41.25min) and WASO (17.45 ± 61.99min) were longer. Mixed effects models using daily data showed that after adjusting for age and sex, participants in the CBT-I group (versus DTI) showed greater reduction in all actigraphy-diary discrepancy domains (all p-values<.01), reductions evident from mid-treatment. Group differences on actigraphy-diary discrepancy reductions in TST, SOL, and SE (not WASO) were mediated by changes in DBAS from baseline to mid-treatment (all p-values<.05). Changes in discrepancy did not mediate insomnia symptom changes (p-values>.39). CONCLUSIONS: CBT-I reduced actigraphy-diary discrepancy in individuals with comorbid insomnia and depression; this reduction was associated with improved sleep-related attitudes, a therapeutic target of CBT-I. CLINICAL TRIAL REGISTRATION: SUPPORT (IF ANY): MH078924, MH078961, MH079256.
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Authors | Marie-Antoinette Spina, Bei Bei, Shanthakumar W Rajaratnam, Andrew Krystal, Jack D Edinger, Daniel J Buysse, Michael Thase, Rachel Manber |
Journal | Sleep medicine
(Sleep Med)
Vol. 114
Pg. 137-144
(Feb 2024)
ISSN: 1878-5506 [Electronic] Netherlands |
PMID | 38183804
(Publication Type: Randomized Controlled Trial, Journal Article)
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Copyright | Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved. |
Chemical References |
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Topics |
- Adult
- Humans
- Female
- Male
- Sleep Initiation and Maintenance Disorders
(therapy)
- Actigraphy
- Depressive Disorder, Major
(complications, therapy)
- Treatment Outcome
- Sleep
- Cognitive Behavioral Therapy
- Antidepressive Agents
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