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- Title
The effect of group-based cognitive behavioural therapy for insomnia in patients with rheumatoid arthritis: a randomized controlled trial.
- Authors
Latocha, Kristine M; Løppenthin, Katrine B; Østergaard, Mikkel; Jennum, Poul J; Hetland, Merete L; Røgind, Henrik; Lundbak, Tine; Midtgaard, Julie; Christensen, Robin; Esbensen, Bente A
- Abstract
Objectives The primary objective was to compare the effect of cognitive behavioural therapy for insomnia (CBT-I) to usual care on sleep efficiency, measured by polysomnography (PSG) immediately after the intervention at week 7. Secondary objectives included comparing the longer-term effect on sleep- and RA-related outcomes at week 26. Methods In a randomized controlled trial using a parallel group design, the experimental intervention was 6 weeks' nurse-led group-based CBT-I; the comparator was usual care. Analyses were based on the intention-to-treat (ITT) principle; missing data were statistically modelled using repeated-measures linear mixed effects models adjusted for the level at baseline. Results The ITT population consisted of 62 patients (89% women), with an average age of 58 years and an average sleep efficiency of 83.1%. At primary end point, sleep efficiency was 88.7% in the CBT-I group, compared with 83.7% in the control group (difference: 5.03 [95% CI −0.37, 10.43]; P = 0.068) measured by PSG at week 7. Key secondary outcomes measured with PSG had not improved at week 26. However, for all the patient-reported key secondary sleep- and RA-related outcomes, there were statistically highly significant differences between CBT-I and usual care (P < 0.0001), e.g. insomnia (Insomnia Severity Index: −9.85 [95% CI −11.77, −7.92]) and the RA impact of disease (RAID: −1.36 [95% CI −1.92, −0.80]) at week 26. Conclusion Nurse-led group-based CBT-I did not lead to an effect on sleep efficiency objectively measured with PSG. However, CBT-I showed improvement on all patient-reported key secondary sleep- and RA-related outcomes measured at week 26. Trial registration ClinicalTrials.gov, https://clinicaltrials.gov , NCT03766100.
- Subjects
INSOMNIA treatment; RHEUMATOID arthritis diagnosis; SLEEP quality; CONFIDENCE intervals; TIME; POLYSOMNOGRAPHY; REGRESSION analysis; HEALTH outcome assessment; SLEEP disorders; SLEEP duration; TREATMENT effectiveness; RANDOMIZED controlled trials; REPEATED measures design; DESCRIPTIVE statistics; RESEARCH funding; INTENTION; STATISTICAL models; DATA analysis software; COGNITIVE therapy; GROUP process; NURSING interventions; DISEASE complications
- Publication
Rheumatology, 2023, Vol 62, Issue 3, p1097
- ISSN
1462-0324
- Publication type
Article
- DOI
10.1093/rheumatology/keac448