Psychosocial Adjunctive Treatment for Hypersomnia (PATH)

November 19, 2019 updated by: Jason Ong, Northwestern University

Psychosocial Adjunctive Treatment for Hypersomnia (PATH): A Pilot Trial

Current pharmacological treatments for chronic hypersomnia (narcolepsy, idiopathic hypersomnia) can effectively reduce excessive daytime sleepiness but a high proportion of patients experience depressive symptoms and poor health-related quality of life. Unfortunately, there are currently no psychosocial interventions that directly addresses this issue. Therefore, the overall goal of this project is to gather initial outcome data and work out methodological issues to determine if a future pragmatic clinical trial is warranted.

Study Overview

Detailed Description

Chronic hypersomnia (CH) is a serious and debilitating condition involving persistent excessive daytime sleepiness (EDS) and includes narcolepsy and idiopathic hypersomnia (IH). Currently, pharmacotherapy is the only empirically-validated treatment for reducing EDS in this patient population but the burden of long-term management and adverse effects of the medication lead to poor health-related quality of life (HRQoL) and elevations in depressive symptoms

Evidence-based psychosocial interventions have been developed in other areas to improve HRQoL related to chronic illnesses, such as cancer and chronic pain. These interventions typically involve a package of cognitive and behavioral techniques teaching coping skills (e.g., emotion-focused and problem-focused coping), behavioral management of the chronic illness symptoms (e.g., relaxation for pain management), and other strategies to improve psychosocial functioning (e.g., mindfulness). However, no such interventions have been developed or used for people with CH. Therefore, a major research gap exists for an empirically-validated psychosocial intervention which is aimed directly at improving emotional functioning and HRQoL for people with CH.

The purpose of this project is to develop a cognitive-behavioral treatment for hypersomnia (CBT-H) and conducting a feasibility trial of CBT-H. The specific aims for this project are to: 1) develop and refine a treatment protocol for CBT-H; 2) identify the optimal delivery format of CBT-H; and 3) gather feasibility data on recruitment, retention, and selection criteria for a future clinical trial. The overall significance of this project is to improve the quality of care for people with CH by using a psychosocial intervention with medical management of hypersomnia.

Study Type

Interventional

Enrollment (Actual)

35

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 Locations

    • Illinois
      • Chicago, Illinois, United States, 60611
        • Center for Circadian and Sleep Medicine, Northwestern University

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

16 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  1. Males and females age 18 and older.
  2. Meets criteria for Narcolepsy (Type I or II) or Idiopathic Hypersomnia (IH).
  3. Moderate to severe symptoms of depression.
  4. Established standard care for CH at a sleep clinic.

Exclusion Criteria:

  1. Hypersomnia not of central origin.
  2. Current suicidal ideation or intent.
  3. Uncontrolled medical conditions or physical limitations that require immediate medical treatment that would prevent ability to engage in the treatment protocol.
  4. Inability to engage in the treatment protocol due to a psychiatric or cognitive issue.
  5. Untreated moderate-to-severe sleep-related breathing disorder.
  6. Unable to attend intervention sessions due to accessibility or availability.

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: Non-Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: CBT-H (Individual format)
Individual CBT-H consists of 6 weekly sessions that are conducted one-on-one with a study therapist using live videoconferencing or in-person. Each session is expected to last about 45 to 60 minutes.
The CBT-H intervention consists of 6 weekly sessions that are conducted either individually or in small groups. Each session is expected to last about 45 to 60 minutes and will be delivered a study therapist using live videoconferencing or in-person. The treatment package consists of cognitive and behavioral modules that include education about hypersomnia, coping skills training, emotion regulation regarding the perceived limitations of living with chronic hypersomnia (e.g., "I cannot live a full life because of my illness"), and behavioral techniques using scheduled naps, sleep hygiene, and regularizing sleep schedules at night which are on the current optional recommendations for hypersomnia.
Experimental: CBT-H (Group format)
Group-based CBT-H consists of 6 weekly sessions that are conducted in groups with a study therapist using live videoconferencing or in-person. Each session is expected to last about 45 to 60 minutes. The treatment package consists of the same cognitive and behavioral modules as the individual CBT-H. However, participants are also provided the opportunity to share their experiences and provide peer support in the group format.
The CBT-H intervention consists of 6 weekly sessions that are conducted either individually or in small groups. Each session is expected to last about 45 to 60 minutes and will be delivered a study therapist using live videoconferencing or in-person. The treatment package consists of cognitive and behavioral modules that include education about hypersomnia, coping skills training, emotion regulation regarding the perceived limitations of living with chronic hypersomnia (e.g., "I cannot live a full life because of my illness"), and behavioral techniques using scheduled naps, sleep hygiene, and regularizing sleep schedules at night which are on the current optional recommendations for hypersomnia.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Patient Health Questionnaire (PHQ)
Time Frame: Change from Baseline PHQ at 6 weeks (Post-treatment)
The PHQ is a 9-item self-report scale of depressive symptoms that has been validated to assess the severity of depression in clinical practice. PHQ-9 cut scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively.
Change from Baseline PHQ at 6 weeks (Post-treatment)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Patient Reported Outcomes Measurement Information System (PROMIS) Self Efficacy Scale
Time Frame: Baseline to post-treatment (6 weeks)
Measures general self-efficacy, self-efficacy for managing emotions, self-efficacy for managing social interactions, self-efficacy for managing symptoms using Computer Adaptive Testing (CAT) with higher scores reflecting better self-efficacy.
Baseline to post-treatment (6 weeks)
Patient Reported Outcomes Measurement Information System (PROMIS) Depression Scale
Time Frame: Baseline to post-treatment (6 weeks)
Measures depressive symptoms using Computer Adaptive Testing (CAT) with higher scores reflecting more anxiety symptoms.
Baseline to post-treatment (6 weeks)
Patient Reported Outcomes Measurement Information System (PROMIS) Anxiety Scale
Time Frame: Baseline to post-treatment (6 weeks)
Measures anxiety symptoms using Computer Adaptive Testing (CAT) with higher scores reflecting more anxiety symptoms.
Baseline to post-treatment (6 weeks)
Patient Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance Scale
Time Frame: Baseline to post-treatment (6 weeks)
Measures sleep disturbances using Computer Adaptive Testing (CAT) with higher scores reflecting more sleep disturbance.
Baseline to post-treatment (6 weeks)
Patient Reported Outcomes Measurement Information System (PROMIS) Sleep-Related Impairment Scale
Time Frame: Baseline to post-treatment (6 weeks)
Measures sleep-related impairment using Computer Adaptive Testing (CAT) with higher scores reflecting worse outcomes.
Baseline to post-treatment (6 weeks)
Patient Reported Outcomes Measurement Information System (PROMIS) Fatigue Scale
Time Frame: Baseline to post-treatment (6 weeks)
Measures fatigue using Computer Adaptive Testing (CAT) with higher scores reflecting worse outcomes.
Baseline to post-treatment (6 weeks)
Patient Reported Outcomes Measurement Information System (PROMIS) Phyiscal Function Scale
Time Frame: Baseline to post-treatment (6 weeks)
Measures physical function using Computer Adaptive Testing (CAT) with higher scores reflecting better physical function.
Baseline to post-treatment (6 weeks)
Epworth Sleepiness Scale (ESS)
Time Frame: Baseline to post-treatment (6 weeks)
The ESS consists of eight questions rated from 0 to 3, with higher scores indicating greater likelihood of falling asleep. Total scores of 10 or greater reflect excessive daytime sleepiness.
Baseline to post-treatment (6 weeks)
Functional Outcomes of Sleep Questionaire (FOSQ)
Time Frame: Baseline to post-treatment (6 weeks)
The FOSQ assesses the impact of sleepiness on daily behaviors and quality of life. It is comprised of 30 items divided into five subscales: activity level, vigilance, intimate and sexual relationships, general productivity, and social outcome. Items are rated from 1 to 4, with higher score reflecting better functioning.
Baseline to post-treatment (6 weeks)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

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)

December 10, 2018

Primary Completion (Actual)

September 30, 2019

Study Completion (Actual)

October 7, 2019

Study Registration Dates

First Submitted

April 3, 2019

First Submitted That Met QC Criteria

April 3, 2019

First Posted (Actual)

April 5, 2019

Study Record Updates

Last Update Posted (Actual)

November 21, 2019

Last Update Submitted That Met QC Criteria

November 19, 2019

Last Verified

November 1, 2019

More Information

Terms related to this study

Other Study ID Numbers

  • STU00207253
  • 185-SR-17 (Other Grant/Funding Number: American Academy of Sleep Medicine Foundation)

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.

Clinical Trials on Narcolepsy

Clinical Trials on Cognitive-Behavior Therapy for Hypersomnia (CBT-H)

Subscribe