JAMA: Cognitive behavioral therapy for insomnia based on short phone calls reduce chronic insomnia symptoms

JAMA: Cognitive behavioral therapy for insomnia based on short phone calls reduce chronic insomnia symptoms.  Interpretation of JAMA Intern Med papers! Can cognitive behavioral therapy for insomnia based on short phone calls reduce chronic insomnia symptoms in elderly patients suffering from moderate to severe osteoarthritis pain?

Osteoarthritis (OA) is a chronic, non-inflammatory degenerative disease. It is estimated that there are 360 ​​million people suffering from osteoarthritis in the world. There is no cure for osteoarthritis, and the cause is still unclear. Its occurrence is related to age, obesity, inflammation, trauma, and genetic factors.

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Osteoarthritis patients face a huge burden-due to the physical pain they experience, all aspects of life will be affected, including sleep and daily social interaction. When osteoarthritis is severe, rest cannot be relieved, and nighttime pain may increase, which will cause severe insomnia.

For insomnia, Cognitive Behavioral Therapy for Insomnia (CBT-I) is recognized worldwide as the best non-drug treatment for insomnia disorders. It mainly includes five aspects: sleep hygiene education, stimulation control, sleep restriction, relaxation therapy, and cognitive therapy. Tests have proved that cognitive behavioral therapy for insomnia will benefit insomnia groups of any age, as well as other chronic disease patients and insomnia-susceptible groups. As an effective treatment, it needs to expand more models to be widely implemented, especially in rural areas lacking insomnia treatment and people with insufficient medical services.

So what is the effect of cognitive behavioral therapy for insomnia on reducing chronic insomnia symptoms in elderly patients with moderate to severe osteoarthritis pain? In a study, from the University of Washington, the University of Washington, Seattle Kaiser State Institute of Health and Health, Laval University, Canada and Researchers at the University of Massachusetts Boston conducted a randomized clinical trial to study the effectiveness of telephone CBT-I and education-only control (EOC) in elderly people with moderate to severe osteoarthritis pain.

The relevant research results were published online in Jama Internal Medine on February 22, 2021, under the title Effect of Telephone Cognitive Behavioral Therapy for Insomnia in Older Adults With Osteoarthritis Pain: A Randomized Clinical Trial.

This is a randomized clinical trial involving 327 participants 60 years and older, with an average age of 70.2 years, of which 244 (74.6%) were women. They were recruited in Washington State from September 2016 to December 2018. Participants underwent dual screening for moderate to severe insomnia and osteoarthritis (OA) pain symptoms within 3 weeks, and blinded assessments at baseline, 2 months after treatment, and 12 months follow-up.

The researchers provided 6 conference calls of 20 to 30 minutes in 8 weeks. Participants need to submit a diary every day. And will receive different educational materials according to the group. The guidance received by the CBT-I group included sleep restriction, stimulus control, sleep hygiene, cognitive reconstruction, and homework. The EOC group only received information about sleep and osteoarthritis.

The main result of the study was the Insomnia Severity Index (ISI) score at 2 and 12 months of follow-up after treatment. Secondary outcomes include pain (scores on the brief pain scale), depression (scores on the 8-item patient health questionnaire), and fatigue (scores on the Flinders Fatigue Scale).

The results showed that among the 282 participants with follow-up ISI data, the total ISI score of the CBT-I group dropped by 8.1 points and the EOC group dropped by 4.8 points after 2 months of treatment. The average difference between the groups after adjustment was −3.5 points (95% CI, −4.4 -−2.6 points; P < .001)). This result was maintained at follow-up time after months of treatment (adjusted mean difference was −3.0 points; 95% CI, −4.1 to −2.0 points; P < .001). At the 12-month follow-up, 67 (56.3%) of the 119 participants who received CBT-I were in remission (ISI score ≤7), while 33 of the 128 participants who received EOC treatment People (25.8%) are in remission.

Compared with the EOC group, the CBT-I group was 2 months after treatment (mean difference between groups was −2.0 points; 95% CI, −3.1 to −0.9 points; P = <.001) and 12 months (between groups) The average difference was −1.8 points; 95% CI, −3.1 to −0.6 points; P = .003) and fatigue was also significantly reduced during follow-up. In terms of pain, the researchers also observed significant differences after treatment, but these differences did not persist during the 12-month follow-up.

These results show that in the elderly with comorbid insomnia and osteoarthritis, telephone CBT-I can effectively improve sleep and fatigue, and to a lesser extent pain. These results confirm that the telephone CBT-I is an available, personalized, effective and scalable treatment for insomnia. It can make the elderly suffering from osteoarthritis pain, especially those in rural areas and areas with insufficient medical services, more effectively obtain individualized and effective treatment opportunities for chronic insomnia.

(source:internet, reference only)

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