Behavioral Sleep Medicine最新文献

Objectives: We assessed the reliability and validity of the Korean version of the Pain-related Beliefs and Attitudes about Sleep (PBAS) scale among patients with chronic pain. Furthermore, we investigated whether pan-related dysfunctional beliefs about sleep mediate the relationship between sleep severity and pain.

Methods: Overall, 100 participants with chronic pain were recruited using an anonymous online survey. Their demographic data and responses to pain severity rating scales, comprising the translated Korean version of the PBAS; Dysfunctional Beliefs and Attitudes about Sleep-16 (DBAS-16); Metacognition Questionnaire-Insomnia-6 (MCQI-6); and the Insomnia Severity Index (ISI), were collected.

Results: The Korean version of the PBAS scale has two-factor structure. The PBAS was a reliable scale which can measure pain-related dysfunctional beliefs about sleep among patients with chronic pain. It showed strong convergent validity with pain severity (r = 0.61, p < .001), DBAS-16 (r = 0.65, p < .001), MCQI-6 (r = 0.56, p < .001), and ISI (r = 0.68, p < .001) scores. Mediation analysis indicated that pain severity directly influenced insomnia severity, with PBAS, DBAS-16, and MCQI-6 scores partially mediating this association. Conversely, insomnia severity was associated with pain severity, with the PBAS score alone mediating this relationship.

Conclusions: The Korean PBAS is a reliable and valid rating scale which measures pain-specific, sleep-related dysfunctional beliefs among patients with chronic pain.

Objectives: Sleep disturbance is commonly reported by people with anxiety, depressive, and personality disorders, but longitudinal studies exploring the interplay of the three with disturbed sleep have not previously been described.

Methods: In this study, sleep disturbance was examined among 89 patients initially presenting with anxiety or depressive disorders who provided follow-up at 12- and 30-year time points in the Nottingham Study of Neurotic Disorder. Multilevel models were used to identify factors most predictive of changes in sleep quality over time.

Results: There were strong associations between poor sleep and contemporaneous severity of personality disorder and the presence of other mental disorders at 12 and 30 years follow-up, but not with disorder presence at other time points. Improvements in personality disorder were associated with improvements in sleep between time points and attenuated the positive unadjusted effects of recovery from anxiety or depressive disorders to non-significance. Relapse into further episodes of mental disorder predicted poorer sleep, whereas worsening personality disorder was not predictive of significant changes when adjusting for other factors.

Conclusions: This study demonstrates the complex interplay between anxiety, depressive, and personality disorders and sleep disturbance over a long follow-up period. Future research might look to examine the relationship between personality disorder and disturbed sleep with interventional studies and by integrating personality trait research.

Objective: The management of HIV has shifted from a focus solely on the disease to a broader perspective encompassing co-occurring medical conditions and quality of life. Mental health concerns such as depression and sleep disturbances, particularly insomnia, are often overlooked in HIV care. The aim of the study was to investigate the longitudinal impact of insomnia on depression and medication adherence among (PLWH).

Methods: This study, conducted in an urban HIV clinic, involved active patients and assessed depression, insomnia, and medication adherence at baseline, 3-month, and 6-month intervals. Hierarchical linear models were employed to analyze the fixed and random effects of time, within-person and between-person insomnia on depression, as well as the effects of time, within-person and between-person depression on ART adherence.

Results: Within-person effects revealed that each one unit increase in the Insomnia Severity Index (ISI) was associated with a b = 0.267-point rise in Patient Health Questionnaire-9 (PHQ-9) scores (p < .001). Between-person effects revealed that each one-point increase in an individual's average ISI score was associated with a 0.476-point elevation in their PHQ-9 scores (p < .001). The between-person effects of depression on medication adherence indicated significance, with each point increase in an individual's average PHQ-9 score being linked to a 0.36% decrease in adherence (p = .012).

Conclusion: The study underscores the potential impact of insomnia on mental health and treatment adherence in people living with HIV (PLWH). This study emphasizes the necessity of comprehensive care models considering the interplay between sleep quality, mental health, and medication adherence for PLWH.

Objectives: Technology has the potential to increase access to evidence-based insomnia treatment. Patient preferences/perceptions of automated digital cognitive behavior therapy for insomnia (CBTI) and telehealth-delivered CBTI remain largely unexplored among middle-aged and older adults. Using a qualitative approach, the current study describes patients' reasons for participating in the clinical trial, preferences for digital CBTI (dCBTI) versus therapist-led CBTI, patient attitudes toward dCBTI, and patient attitudes toward telehealth-delivered therapist-led CBTI.

Method: Middle-aged and older adults (N = 80) completed a semi-structured interview before CBTI exposure. Qualitative responses were coded, and themes were inductively extracted.

Results: Most (62.5%) of the participants expressed a preference for therapist-led CBTI to dCBTI. Convenience was the most commonly reported advantage of dCBTI (n = 55) and telehealth-delivered CBTI (n = 65). Decreasing transit time and pandemic-related health concerns were identified as advantages to dCBTI and telehealth-delivered CBTI. Lack of human connection and limited personalization were perceived as disadvantages of dCBTI. Only three participants reported technological barriers to dCBTI and telehealth-delivered CBTI.

Conclusion: Findings suggest that, despite an overall preference for therapist-led treatment, most middle-aged and older adults are open to dCBTI. As both dCBTI and telehealth-delivered CBTI are perceived as convenient, these modalities offer the potential to increase access to insomnia care.

Objectives: This study aimed to validate the Korean version of the sleep hygiene practice scale (SHPS-K) and determine its effectiveness in screening poor sleepers with insomnia.

Methods: Online survey was conducted using translated SHPS in Korean, the Korean versions of the Pittsburgh Sleep Quality Index (PSQI-K), Insomnia Severity Index (ISI-K), and Epworth Sleepiness Scale (KESS) in a non-clinical population. The internal consistency and test-retest reliability of the SHPS-K were assessed using Cronbach's alpha and intraclass correlation coefficients (ICC), respectively. Construct validity was evaluated using correlation analyses with other questionnaires and confirmatory factor analysis. We determined the cutoff values that could identify poor sleepers with insomnia symptoms (PSQI-K > 5 and ISI-K ≥ 15) using receiver operating characteristic analysis.

Results: A total of 484 participants (242 women, mean age of 43.8 years) were enrolled. The average SHPS-K score was 71.2, with no significant sex differences. Women had poorer sleep scheduling and timing behaviors, and men had poorer eating and drinking behaviors. Good internal consistency (Cronbach's alpha = 0.88) and test-retest reliability (ICC = 0.80) were observed. The SHPS-K was positively correlated with the PSQI-K (r = 0.55), ISI-K (r = 0.54), and KESS (r = 0.42). A cutoff value of 73 identified poor sleepers with insomnia (area under the curve = 0.828).

Conclusions: The SHPS-K is a reliable instrument for evaluating sleep hygiene in non-clinical Korean populations.

Objectives: Cognitive Behavioral Therapy for Insomnia (CBTi) is a first-line treatment for a prevalent and impairing disorder. Digital CBTi programs increase access to internet-based self-directed care. However, the clinical effect of offering different forms of CBTi in a healthcare setting is not clearly understood. This study examines treatment engagement and clinical outcomes for individuals referred to either digital or provider-led CBTi.

Methods: Over two years, providers at a Veterans Health Administration (VHA) facility referred patients to digital CBTi with telephone coaching support or traditional provider-led CBTi. Characteristics of those referred, proportions engaging in and completing treatment, as well as insomnia severity were compared among those referred to each format.

Results: Providers referred 139 individuals to digital CBTi, 340 to provider-led CBTi, and 14 to both formats. Individuals referred to digital CBTi were older with less severe insomnia. Despite lower levels of program engagement and completion in the digital CBTi cohort, measures of insomnia symptom change were similar between the groups.

Conclusions: This is the first study to evaluate both digital and provider-led evidence-based treatments for insomnia disorder simultaneously deployed in a healthcare setting. While engagement in digital CBTi lagged that for provider-led CBTi, offering both formats may expand access to different groups, while fostering similar outcomes.

Objective: This study aims to explore the perspectives and experiences of Australian caregivers and community pharmacists about pediatric melatonin use.

Methods: A convenience sample of caregivers with children (aged 11-16 years) using melatonin as a sleep aid and community pharmacists (including pharmacist interns) were recruited. Participants first completed an online survey followed by an online semi-structured interview. Interviews were guided by a schedule of questions for the respective participant groups, broadly exploring their beliefs about melatonin, experiences in using/supplying melatonin, and perceived facilitators/barriers for melatonin use. Interviews were digitally recorded, transcribed verbatim, and analyzed using the Framework Approach.

Results: Fourteen caregivers of predominantly neurodiverse adolescents and 24 community pharmacists were interviewed. While melatonin was perceived by caregivers of both typically developing and neurodiverse dependants as safer than pharmacological sleep aids, treatment was only initiated after trialling non-pharmacological strategies first. Pharmacists expressed concerns around the ambiguities in practice and the limited scope of existing resources for guiding pediatric melatonin use. Caregivers frequently deferred to the information available online to procure products or self-adjust doses and dosing schedules. Both pharmacists and caregivers emphasized the need for more affordable and age-appropriate proprietary formulations that are readily accessible.

Conclusion: Melatonin is administered predominantly by caregivers of neurodiverse adolescents to address their sleep disturbances. The findings underscore the need for reliable, evidence-based information to guide safe and appropriate use of melatonin in pediatric populations. Patient education is also warranted to address maladaptive medication-administration practices. Lastly, there is a need for stronger regulatory oversight of melatonin products to ensure their quality and safety of use.

Objectives: Approximately 70% of the military personnel experience chronic sleep insufficiency, which negatively impacts military readiness and health. Military sleep health does not appear to be improving despite targeted programs to optimize sleep. The present quasi-experimental study aims to evaluate a single-session sleep intervention in United States Air Force (USAF) Technical Training.

Method: A group-based Brief Sleep Intervention (BSI) was developed for the target population. Participants included 321 technical school students (Mean age = 21; 82% male; 67% White) who were assigned to the BSI (n = 203) or a control group (n = 118). Propensity-score-weighted multivariable logistic regression was employed to compare outcomes.

Results: At the 2-week follow-up, students in the BSI were significantly more likely to report sleeping 6 or more hours on weekdays (OR = 1.49, p < .001) and "Good/Very Good" sleep quality (OR = 1.50, p = .032) than those in the control group. In addition, 69.2% of the students in BSI reported having engaged in the self-selected "Action Step" chosen during the intervention.

Conclusions: To our knowledge, this is the first study to test a preventative sleep intervention in USAF Technical Training. Results suggest that a single-session group intervention can promote behavioral changes and improve sleep health.

Background: Athletes display a high prevalence of undesired sleep characteristics that may affect both performance and wellbeing.

Objectives: This scoping review aimed to identify and map the existing evidence of behavioral sleep interventions and their effects on sleep outcomes in athletes, and retrospectively code the behavior change techniques (BCTs) implemented using the Behavior Change Technique Taxonomy (BCTTv1).

Methods: Conducted following the JBI methodology for scoping reviews, four online databases were used to identify prospective interventions with at least one behavioral component in competitive athletes, and reporting a sleep outcome pre- and post-intervention.

Results: Thirty-three studies met the inclusion criteria, encompassing 892 participants with a median age of 23. Five intervention categories were identified (education, mind-body practices, direct, multi-component, and other), with each demonstrating mixed efficacy but the potential to improve sleep outcomes. The BCTs varied in type and frequency between each category, with only 18 unique BCTs identified across all studies.

Conclusions: The varied efficacy of previous studies at improving sleep outcomes may be attributed to the lack of behavior change theory applied during intervention development. Designing interventions following a targeted specification of the behavioral problem, and the integration of corresponding BCTs should be considered in future research.

Objectives: Insomnia and chronic pain are common symptoms in people with HIV. Poor sleep has been associated with chronic pain. While cognitive behavioral therapy for insomnia improves insomnia in clinical populations, there are barriers to people with HIV accessing treatment including the lack of trained providers and lengthy sessions. Only one study has examined the efficacy of brief behavioral treatment for insomnia (BBTI) in people with HIV. This study examined BBTI effects on sleep and pain in people with HIV.

Methods: Ten adults with HIV and chronic pain completed a 4-week, telephone-delivered BBTI treatment. A control group (n = 10) completed a brief mindfulness training (BMT). The Insomnia Severity Index and Brief Pain Inventory were used to assess insomnia severity and pain outcomes, respectively.

Results: There was a significant interaction between intervention and time on insomnia severity, F (2,14) = 5.7, p = .02, partial η² = 0.45). The BBTI group demonstrated significant improvements in insomnia severity from pre- to post-intervention (p < .001) and from pre-intervention to one-month post-intervention (p = .001) compared to the BMT group. There was a significant interaction between intervention and time on pain interference, F (1,18) = 4.9, p = .02, partial η² = 0.27). The BBTI group demonstrated a significant decrease in pain interference from pre- to post-intervention (p < .001) compared to the BMT group.

Conclusions: This pilot study demonstrated that BBTI improved insomnia in people with HIV for up to one-month post-treatment. Novel preliminary evidence suggests that BBTI may also improve pain outcomes in people with HIV.