Telehealth-delivered cognitive behavioral therapy - a potential solution to improve sleep quality and normalize the salience network in fibromyalgia: a pilot randomized trial.

Our study investigated the associations between the clinical benefits of telehealth-delivered cognitive behavioral therapy for insomnia (tele-CBT-I) and the salience network in fibromyalgia (FM). Thirty-five FM patients with comorbid insomnia were recruited and assigned into two groups: the tele-CBT-I group (n = 17) or the treatment-as-usual (TAU) group (n = 18). At baseline and post-treatment, clinical status was assessed using standardized scales, including the Insomnia Severity Index (ISI), Brief Pain Inventory, Numeric Pain Rating scale, Beck Depression Intervention version II, Beck Anxiety Intervention, Situational Fatigue Scale, and Fibromyalgia Impact Questionnaires. Resting-state functional magnetic resonance imaging was collected. We compared within- and between-group differences in clinical changes and functional connectivity (FC) of the salience network. A factor analysis of significant FCs was performed. Correlation analyses between clinical symptoms and salience FCs were conducted. The tele-CBT-I group showed sleep quality improvements after treatment that were greater than those in the TAU group (p-value = 0.038). After treatment, tele-CBT-I decreased FCs of cortical regions and increased FCs of subcortical regions compared to the TAU group. Additionally, factor analysis grouped the significant FCs into cortical factors and subcortical factors. The cortical factor value, representing the involvement of specific cortical regions of the salience network by the factor analysis, was significantly associated with ISI scores in the tele-CBT-I group (p-value = 0.0002). In conclusion, tele-CBT-I might be an adjuvant approach to improve sleep quality and normalize cortical and subcortical functions of the salience network in FM patients with comorbid insomnia.

Psychometric and structural properties of the traditional Chinese version of the sleep condition indicator for patients undergoing hemodialysis.

PURPOSE: Insomnia is a prevalent sleep disorder among patients undergoing hemodialysis for chronic kidney disease. This study aimed to translate the sleep condition indicator (SCI), an insomnia screening tool based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), into a traditional Chinese version (SCI-TC) and evaluate the reliability and validity of this version for patients undergoing hemodialysis. METHODS: This cross-sectional study conducted from November 2022 to June 2023 involved 200 patients on hemodialysis (mean age, 65.56 years; 61.5% men). Participants completed a series of questionnaires, with insomnia diagnosed according to DSM-5 criteria as the gold standard. A receiver operating characteristic (ROC) curve analysis was conducted to examine the sensitivity and specificity of the SCI-TC. RESULTS: According to the DSM-5 criteria, 38% of the participants had insomnia. Cronbach's alpha for the SCI-TC was 0.92. The SCI-TC exhibited a good fit as a two-factor model, and its scores were significantly associated with those of the traditional Chinese versions of the Insomnia Severity Index, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, EuroQol 5-Dimensions scale, and EuroQol Visual Analogue Scale (r = - 0.94, - 0.53, - 0.38, 0.27, and 0.30, respectively; all p < 0.05). The ROC curve analysis revealed an optimal cutoff of 16 points, with the sensitivity, specificity, and area under curve of 88.2%, 84.7%, and 0.91(95% confidence interval, 0.87-0.95), respectively. CONCLUSION: The SCI-TC demonstrates robust reliability and validity in detecting insomnia among patients undergoing hemodialysis. These findings suggest that health-care providers should considering using the SCI as an easy-to-use tool for the timely detection of insomnia in this population.

Effects of nurse-led brief behavioral treatment for insomnia in adults: a randomized controlled trial.

STUDY OBJECTIVES: To examine the effects of nurse-led brief behavioral treatment for insomnia (BBTI) on insomnia severity, sleep status, daytime function, quality of life (QoL), psychological distress levels, treatment response, and insomnia remission in young and middle-aged Asian adults with insomnia symptoms. METHODS: This two-parallel, randomized controlled trial recruited 42 participants with insomnia symptoms randomly allocated to the nurse-led BBTI group or sleep hygiene (SH) group. The outcome measurements included the Insomnia Severity Index, sleep diary, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Brief Fatigue Inventory, RAND-36 Health Status Inventory, and the Depression, Anxiety and Stress Scale-21. The measurement time points included baseline, the end of each week of the intervention period, and one-month follow-up. RESULTS: Compared with the SH group, participants in the BBTI group significantly improved insomnia severity, sleep onset latency, sleep efficiency, sleep quality, daytime sleepiness, and the mental components of QoL after completing nurse-led BBTI immediately and one month later (p < 0.05). In addition, 52.4% and 71.4% of the participants achieved remission after completing nurse-led BBTI immediately and one month later, which were significantly higher than the SH group (14.3%, p = 0.02; 14.3%, p < 0.001, respectively). CONCLUSIONS: We suggested the relative effects of BBTI on declined insomnia severity and improved sleep status among young and middle-aged Asian adults with insomnia symptoms and confirmed the benefits of nurse-led BBTI in alleviating insomnia. Nurses should incorporate BBTI into insomnia care further to enhance the daytime function and quality of life of the population with insomnia symptoms. CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov; Name: Effects of Nurse-led Brief Behavioral Treatment for Insomnia: A Feasibility Randomized Controlled Trial; URL: https://clinicaltrials.gov/study/NCT05310136; Identifier: NCT05310136.

Are the Insomnia Severity Index and Pittsburgh Sleep Quality Index valid outcome measures for Cognitive Behavioral Therapy for Insomnia? Inquiry from the perspective of response shifts and longitudinal measurement invariance in their Chinese versions.

OBJECTIVE: The purpose of this study was to examine whether the Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) are valid outcome measures for Cognitive Behavioral Therapy for Insomnia (CBT-I). Specifically, we tested whether the factorial parameters of the ISI and the PSQI could remain invariant against CBT-I, which is a prerequisite to using their change scores as an unbiased measure of the treatment outcome of CBT-I. METHODS: A clinical data set including scores on the Chinese versions of the ISI and the PSQI obtained from 114 insomnia patients prior to and after a 6-week CBT-I program in Taiwan was analyzed. A series of measurement invariance (MI) tests were conducted to compare the factorial parameters of the ISI and the PSQI before and after the CBT-I treatment program. RESULTS: Most factorial parameters of the ISI remained invariant after CBT-I. However, the factorial model of the PSQI changed after CBT-I treatment. An extra loading with three residual correlations was added into the factorial model after treatment. CONCLUSIONS: The partial strong invariance of the ISI supports that it is a valid outcome measure for CBT-I. In contrast, various changes in the factor model of the PSQI indicate that it may not be an appropriate outcome measure for CBT-I. Some possible causes for the changes of the constructs of the PSQI following CBT-I are discussed.

Comorbidity and confounding factors in attention-deficit/hyperactivity disorder and sleep disorders in children.

Sleep problems are commonly reported in children with attention-deficit/hyperactivity disorder (ADHD) symptoms. Research data regarding the complex and reciprocal relationship between ADHD and sleep disturbances has now accumulated. This paper is focused on the types of sleep problems that are associated with ADHD symptomatology, and attempts to untangle confounding factors and overlapping symptoms. The goal is also to present an updated overview of the pathophysiology of and treatment strategies for sleep problems in children with ADHD. The review also points out that future research will be needed to clarify further the other psychiatric comorbidities and side effects of medication in order to improve treatment outcomes and prevent misdiagnosis in clinical practice.