Sleeping for two: a randomized controlled trial of cognitive behavioral therapy for insomnia in pregnancy.

IF 3.5 3区 医学 Q1 CLINICAL NEUROLOGY Journal of Clinical Sleep Medicine Pub Date : 2024-10-22 DOI:10.5664/jcsm.11396
Anna L MacKinnon, Katherine Silang, Dana Watts, Jasleen Kaur, Makayla Freeman, Kyle Dewsnap, Elizabeth Keys, Joshua W Madsen, Gerald F Giesbrecht, Tyler Williamson, Amy Metcalfe, Tavis Campbell, Kelly J Mrklas, Lianne M Tomfohr-Madsen
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Abstract

Study objectives: Insomnia and sleep problems are common in pregnancy and have potentially negative impacts on both parental and infant health. This study examined the sleeping for two adaptation of cognitive behavioral therapy for insomnia (CBT-I) in pregnancy.

Methods: A parallel (1:1) randomized controlled trial evaluated CBT-I (n=32) compared to a treatment as usual (TAU) waitlist (n=32) among pregnant individuals from Alberta, Canada experiencing insomnia. Five weekly individual sessions of CBT-I pivoted from in-person delivery to telehealth due to COVID-19 pandemic physical distancing regulations. Insomnia symptom severity (primary outcome), insomnia diagnosis by structured interview, self-reported sleep problems, as well as sleep parameters measured by diary and actigraphy, were assessed pre-treatment at 12-28 weeks gestation (T1), one-week post-treatment (T2), and six months postpartum (T3). Birth information (secondary outcomes) were collected via delivery record and parent report of infant sleep (exploratory outcome) was taken at T3.

Results: Multilevel modeling using an intention-to-treat approach showed that CBT-I was associated with a decrease in insomnia symptoms and improved sleep quality across time compared to TAU. The CBT-I group had fewer diagnoses of insomnia post-treatment, but the difference did not reach statistical significance until 6-months postpartum. Participants with worse sleep quality at baseline benefitted substantially more from CBT-I vs. TAU waitlist.

Conclusions: CBT-I delivered in pregnancy can reduce symptoms of insomnia and improve sleep quality, which could in turn minimize risk of negative consequences for birthing parent and infant health.

Clinical trial registration: Registry: ClinicalTrials.gov; Identifier: NCT03918057; Name: Sleeping for Two: RCT of CBT-Insomnia in Pregnancy; URL: https://www.clinicaltrials.gov/study/NCT03301727.

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两个人的睡眠:针对孕期失眠的认知行为疗法随机对照试验。
研究目的失眠和睡眠问题在孕期很常见,对父母和婴儿的健康都有潜在的负面影响。本研究考察了两种孕期失眠认知行为疗法(CBT-I)的睡眠情况:一项平行(1:1)随机对照试验评估了 CBT-I(32 人)与照常治疗(TAU)候补名单(32 人)对加拿大艾伯塔省失眠孕妇的治疗效果。由于 COVID-19 大流行的物理距离规定,每周五次的 CBT-I 个人疗程从面对面提供转为远程医疗。在妊娠 12-28 周(T1)、治疗后一周(T2)和产后六个月(T3)分别对治疗前、治疗后一周和产后六个月的失眠症状严重程度(主要结果)、通过结构化访谈进行的失眠诊断、自我报告的睡眠问题,以及通过日记和动图测量的睡眠参数进行了评估。出生信息(次要结果)通过分娩记录收集,父母对婴儿睡眠的报告(探索性结果)在 T3 进行:采用意向治疗法建立的多层次模型显示,与 TAU 相比,CBT-I 与失眠症状的减少和睡眠质量的改善相关。CBT-I组在治疗后的失眠诊断率较低,但这一差异在产后6个月才达到统计学意义。基线睡眠质量较差的参试者从CBT-I治疗中获益明显多于等待TAU治疗的参试者:结论:妊娠期接受 CBT-I 治疗可减轻失眠症状,改善睡眠质量,从而最大限度地降低对分娩父母和婴儿健康造成负面影响的风险:临床试验注册:注册表:临床试验注册:ClinicalTrials.gov; Identifier:NCT03918057;名称:双人睡眠:妊娠期失眠的 CBT RCT;URL:https://www.clinicaltrials.gov/study/NCT03301727。
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来源期刊
CiteScore
6.20
自引率
7.00%
发文量
321
审稿时长
1 months
期刊介绍: Journal of Clinical Sleep Medicine focuses on clinical sleep medicine. Its emphasis is publication of papers with direct applicability and/or relevance to the clinical practice of sleep medicine. This includes clinical trials, clinical reviews, clinical commentary and debate, medical economic/practice perspectives, case series and novel/interesting case reports. In addition, the journal will publish proceedings from conferences, workshops and symposia sponsored by the American Academy of Sleep Medicine or other organizations related to improving the practice of sleep medicine.
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