February 22, 2021
2 min read
Source / Disclosures
McCurry reports receiving grants from the National Institute of Aging during the study. Please see the study for relevant financial disclosures from other authors.
Cognitive behavioral therapy offered over the phone was effective in improving sleep, fatigue, and, to a lesser extent, pain in older adults with comorbid insomnia and osteoarthritis, data shows.
“Scalable delivery models of cognitive behavioral therapy for insomnia (CBT-I), an effective treatment, are needed for widespread implementation, particularly in rural and disadvantaged populations that do not have access to insomnia treatment,” Susan M. McCurry, PhD, a research professor at the University of Washington School of Nursing, and colleagues enrolled JAMA internal medicine.
The researchers conducted the Osteoarthritis and Therapy for Sleep (OATS) study, a randomized clinical trial they called “the largest controlled evaluation of telephone CBT-I to date.” They recruited 327 patients from Washington (mean age = 70.2 years; 74.6% women, 66% from medically underserved / health professional deficiency areas) with chronic sleep and osteoarthritis symptoms.
All patients received six 20- to 30-minute telephone sessions over 8 weeks and submitted daily sleep diaries. CBT-I participants received instruction regarding sleep restriction, stimulus control, sleep hygiene, cognitive restructuring, and homework, while participants in education-only control (EOC) were instructed on sleep and osteoarthritis. Blind assessments took place at baseline, 2 months after treatment and 12 months after completion of study.
“Interventionists were not blinded to treatment tasks; however, all outcomes were collected by blind investigators, ‘McCurry and colleagues wrote. “Results were based on self-report, but for purposes of clinical practice and possible scalability of treatment, these are important measures of effectiveness.”
McCurry and colleagues wrote that among the 136 patients in the CBT-I group and 146 patients in the EOC group who had 12 months of data available, total 2-month post-treatment Insomnia Severity Index scores 8.1 points in ‘ the CBT-I group decreased and 4.8 points in the EOC group (adjusted mean between group difference = -3.5 points; 95% CI, -4.4 to -2.6). These results were maintained at 12 months (adjusted mean difference = punten3 points; 95% CI, ,14.1 to punten2 points).
In addition, after 12 months, 67 of 119 (56.3%) patients in the CBT-I group remained in remission (Insomnia Severity Index score = 7 points) against 33 of 128 (25.8%) patients in the EOC group. Flinders Fatigue Scale scores were also significantly reduced in the CBT-I group versus the EOC group at 2 months after treatment (mean between group difference = -2 points; 95% CI, -3.1 to -0.9 points ) and 12-month follow -up (mean difference between group = -1.8 points; 95% CI, –3.1 to –0.6 points). The researchers also reported significant differences after treatment for pain; however, these differences were not maintained after 12 months.
McCurry and colleagues concluded that the results “have broad implications” because most study participants were from medically underserved / health professional deficits, “where access to individualized specialized treatment, such as CBT-I, was at its best. and is often non-existent. ”
Given much evidence that CBT-I is effective for individuals with other comorbid conditions, including older adults with chronic pain, we believe that OATS trial findings are likely to be generalizable beyond the current [osteoarthritis] study population, ”McCurry and colleagues wrote.