- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03109210
Therapist-Directed VS Online Therapy for Insomnia Co-Occuring With Sleep Apnea
November 3, 2023 updated by: National Jewish Health
This two-site randomized clinical trial will investigate and compare three treatments for insomnia in patients who have been diagnosed with and treated for sleep apnea: online cognitive behavioral therapy (OCBT), therapist-directed cognitive behavioral therapy (TCBT), and standard clinical care.
384 patients will be recruited and will attend up to 15 visits over 10 months.
Visits will include baseline assessment, treatment visits, and post-treatment follow-up visits.
Visits will involve completion of questionnaires, meeting with therapists, and a physical exam.
Study Overview
Status
Active, not recruiting
Conditions
Detailed Description
This dual-site randomized clinical trial will use a "SMART" design to test a stepped care model relative to standard positive airway pressure (PAP) therapy and determine if (1) augmentation of PAP therapy with online Cognitive Behavioral Therapy improves short-term outcomes of comorbid obstructive sleep apnea(OSA)/insomnia; and (2) providing a higher intensity 2nd-stage cognitive behavioral therapy (CBT) to patients who show sub-optimal short-term outcomes with OCBT+PAP improves short and longer-term outcomes.
After completing baseline assessment, the 384 comorbid OSA\insomnia patients enrolled will be randomized to a 1st-stage therapy that includes usual care PAP + OCBT (n=288) or UC (usual care PAP + sleep hygiene education; n=96).
Insomnia and OSA will be reassessed after 8 weeks.
OCBT recipients who meet "remission" criteria will continue PAP but be offered no additional insomnia intervention and will complete study outcome measures again after an additional 8-weeks and at 3 and 6 month follow-ups.
OCBT recipients classified as "unremitted" after 8 weeks of treatment will be re-randomized to a 2nd-stage treatment consisting of continued, expanded engagement in OCBT or a switch to therapist-directed CBT (TCBT).
Those receiving the 2nd-stage intervention as well as the UC group will be reassessed after another 8 weeks and at 3- and 6-month follow-up time points.
Study Type
Interventional
Enrollment (Estimated)
384
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Rachel Johnson, MA
- Phone Number: 303-398-1058
- Email: johnsonr@njhealth.org
Study Locations
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California
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Palo Alto, California, United States, 94304
- Stanford Univeristy
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Colorado
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Denver, Colorado, United States, 80206
- National Jewish Health
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Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
21 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
To be included participants must > 21 years old and:
- have a diagnosis of OSA with an AHI > 5 on a diagnostic polysomnogram;
- accept PAP as primary/sole OSA therapy, been given a prescription for PAP and filled it within the last 3 months, have had an opportunity to use PAP for at least one month, and show mean use of > 1 hour per night;
- have a complaint of persistent (i.e., > 3 months) sleep onset or sleep maintenance difficulties despite having adequate opportunity for sleep and accompanied by significant daytime impairment or distress about poor sleep;
- an Insomnia Severity Index (ISI) score > 10 indicating at least "mild" insomnia; and
- a sleep onset latency or wake time after sleep onset > 30 minutes 3 or more nights per week during two weeks of sleep diary monitoring.
Exclusion Criteria:
- an untreated psychiatric disorder (e.g., major depression) found on structured interviews as these conditions have specific treatments and it would be inappropriate not to offer those treatments;
- a lifetime diagnosis of any psychotic or bipolar disorder as sleep restriction for insomnia may precipitate hallucinations and mania;
- an imminent risk for suicide;
- alcohol or drug abuse within the past year;
- terminal illness (e.g., cancer), or neurological degenerative disease (e.g., dementia);
- current use of medications known to cause insomnia (e.g., stimulants);
- comorbid narcolepsy, idiopathic hypersomnia, restless legs syndrome (score of >11 in the IRLS), periodic limb movement during sleep (known PLMS with arousal > 15 per hour), or a circadian rhythm sleep disorder if habitual bedtimes are later than 3:00 AM or rising times are later than 11:00 AM; or
- consuming > 2 alcoholic beverages per day on a regular basis; or
- consuming more than 10 caffeinated beverages per day on a regular basis; or
- consuming marijuana in any form on a regular basis >1 time per week, or if used after 4:00 p.m; or
- change in thyroid medication dosage or received a new prescription for thyroid medication 3 months before the screening visit; or
- physician-diagnosed or self-reported seizure disorder.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Factorial Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
No Intervention: Standard Care
Participants randomized to standard care will receive normal follow-up care with their health care provider.
This will include routine assessment and adjustment of PAP therapy, and instruction in proper sleep hygiene.
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|
Experimental: Intervention
In addition to standard care procedures, participants randomized to the intervention arm will receive up to two sequential treatments.
First, participants will receive Online Cognitive Behavioral Therapy (OCBT).
Those who meet criteria for remission after this first treatment will continue through follow-up without further treatment.
Those who do not will be randomized again to either extended OCBT, or Therapist-directed Cognitive Behavioral Therapy (TCBT).
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Cognitive behavioral therapy delivered via commercial online software.
Other Names:
Cognitive Behavioral Therapy delivered via traditional, in-person interaction with a licensed mental health professional.
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Insomnia Severity Index (ISI) score change
Time Frame: Symptom remission will be measured at post-treatment visits one and two, approximately 18 and 28 weeks following enrollment.
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Change in participants' score on the ISI will be measured over baseline, post-treatment, and follow-up visits.
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Symptom remission will be measured at post-treatment visits one and two, approximately 18 and 28 weeks following enrollment.
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Quebec Sleep Questionnaire (QSQ) score change
Time Frame: Participants will be asked to complete the QSQ at baseline, post-treatment, and follow-up visits, at approximately weeks 1, 18, and 28.
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Change in participants' score on the QSQ will be measured over baseline, post-treatment, and follow-up visits.
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Participants will be asked to complete the QSQ at baseline, post-treatment, and follow-up visits, at approximately weeks 1, 18, and 28.
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in subjective measurement of total sleep time
Time Frame: Participants will be asked to complete two weeks of sleep diaries at baseline (week 1), post-treatment (weeks 8 and 18), and follow-up visits (months 9 and 12) to measure change in these assessments over time.
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Participants will be asked to fill out a sleep diary throughout the study.
Study personnel will use these diaries to calculate subjective assessment of total sleep time.
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Participants will be asked to complete two weeks of sleep diaries at baseline (week 1), post-treatment (weeks 8 and 18), and follow-up visits (months 9 and 12) to measure change in these assessments over time.
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Change in subjective measurement of sleep efficiency
Time Frame: Participants will be asked to complete two weeks of sleep diaries at baseline (week 1), post-treatment (weeks 8 and 18), and follow-up visits (months 9 and 12) to measure change in these assessments over time.
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Participants will be asked to fill out a sleep diary throughout the study.
Study personnel will use these diaries to calculate subjective assessment of sleep efficiency.
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Participants will be asked to complete two weeks of sleep diaries at baseline (week 1), post-treatment (weeks 8 and 18), and follow-up visits (months 9 and 12) to measure change in these assessments over time.
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Positive Airway Pressure (PAP) Therapy Adherence
Time Frame: Adherence data will be collected through study completion, an average of one year.
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Participants' adherence to PAP therapy will be passively monitored during their participation in the study.
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Adherence data will be collected through study completion, an average of one year.
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
April 15, 2017
Primary Completion (Actual)
April 14, 2022
Study Completion (Estimated)
June 30, 2024
Study Registration Dates
First Submitted
March 27, 2017
First Submitted That Met QC Criteria
April 5, 2017
First Posted (Actual)
April 12, 2017
Study Record Updates
Last Update Posted (Actual)
November 7, 2023
Last Update Submitted That Met QC Criteria
November 3, 2023
Last Verified
November 1, 2023
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- HS2989
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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