Sommeil profond chez les personnes âgées
Une Thérapie Cognitivo-Comportementale Automatisée par Internet des Objets pour l'Insomnie qui Améliore la Cognition chez les Personnes Âgées
This double blind randomized clinical trial on older independent-living healthy individuals with symptoms of insomnia will harness Cognitive Behavioral Therapy for Insomnia (CBT-I) and augment it with ambulatory data collection devices, personalized digital content, and smart sound and light cues (CBT-I +Internet of Things [IoT]+Artificial Intelligence [AI]). With this approach, the investigators aim to overcome many of the limitations that CBT-I in the clinic faces: the investigators can implement it in ambulatory settings while providing increased (remote) accessibility to therapy. The investigators will compare the CBT-I +IoT+AI to active controls that also integrate with smart phone devices, including SleepEZ, which is also based on CBT-I, and sleep hygiene education. These active controls will help determine whether CBT-I +IoT+AI is effective at treating insomnia based on the Insomnia Severity Index (ISI) (primary outcome), sleep metrics (secondary outcome), cognitive performance (secondary outcome), and additional outcomes like therapeutic adherence and other mental health assessments. Participants will be asked to track sleep with wearable and nearable devices, complete surveys, and complete cognitive assessments.
Aperçu de l'étude
Statut
Les conditions
Intervention / Traitement
Description détaillée
Insomnia is highly prevalent in older adults and is associated with impaired daytime functioning and increased risk for cognitive decline. Cognitive Behavioral Therapy for Insomnia (CBT-I) is the recommended first-line treatment, yet access, adherence, and scalability remain persistent barriers, particularly for older populations. Digital CBT-I programs address some access challenges but often demonstrate reduced adherence and diminished effectiveness in real-world use.
This study evaluates a fully remote, automated digital CBT-I system that integrates mobile software with Internet of Things (IoT)-enabled environmental cues and artificial intelligence-driven personalization. The intervention is designed to promote adherence to CBT-I principles by passively supporting sleep-wake routines using adaptive sound, light, and behavioral prompts delivered through consumer electronic devices in the participant's home environment.
The study is a randomized, double-blind, controlled trial conducted entirely remotely in community-dwelling older adults with clinically significant insomnia symptoms. Following screening and baseline assessment, participants are randomly assigned in a 1:2:2 allocation to one of three study arms: 1) SleepSpaceRx CBT-I-IoT-AI (n=72), 2) Sleep-EZ CBT-I-based active comparator (n=72), or 3) Sleep Hygiene + IoT active comparator (n=36). All participants receive comparable study devices and interaction time to maintain blinding and control for expectancy effects.
The intervention period lasts six weeks and is preceded by a baseline assessment phase and followed by post-intervention and follow-up assessments. Throughout the study, participants complete standardized self-report measures of insomnia severity and engage in repeated, brief cognitive assessments administered via mobile devices. Objective sleep data are collected using non-invasive, ambulatory sensing technologies that operate passively in the home environment.
The primary objective of the study is to compare changes in insomnia severity across study arms. Secondary objectives include evaluation of sleep characteristics, adherence to behavioral recommendations, and performance on cognitive tasks sensitive to sleep-related changes in older adults. The study is designed to assess feasibility, usability, and preliminary efficacy of an automated, home-based digital CBT-I approach that emphasizes adherence support and sleep quality enhancement.
This trial will contribute evidence on whether an integrated digital and IoT-based behavioral intervention can improve insomnia outcomes and support cognitive functioning in older adults, informing future large-scale trials and potential clinical implementation.
Type d'étude
Inscription (Estimé)
Phase
- Phase 2
Contacts et emplacements
Coordonnées de l'étude
- Nom: Daniel Gartenberg, PhD
- Numéro de téléphone: 732-668-1250
- E-mail: dan@sleepspace.com
Sauvegarde des contacts de l'étude
- Nom: Octavian Geagla
- Numéro de téléphone: 9177571660
- E-mail: octavian@sleepspace.com
Lieux d'étude
-
-
New York
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New York, New York, États-Unis, 10012
- Recrutement
- SleepSpace
-
Contact:
- Daniel Gartenberg, PhD
- Numéro de téléphone: 732-668-1250
- E-mail: dan@sleepspace.com
-
Contact:
- Daniel Gartenberg, PhD
- Numéro de téléphone: 7326681250
- E-mail: dan@sleepspace.com
-
Contact:
- Octavian Geagla, MA
- Numéro de téléphone: 5712430233
- E-mail: octavian@sleepspace.com
-
-
Critères de participation
Critère d'éligibilité
Âges éligibles pour étudier
Accepte les volontaires sains
Sexes éligibles pour l'étude
La description
Inclusion Criteria
-
Fluent English speaker and reader.
-
Capable of providing one's own informed consent.
- As determined by validated, abbreviated phone-based remote Montreal Cognitive Assessment (MoCA) testing score of ≥18, which is the score that separates Mild Cognitive Impairment (MCI) from Alzheimer's Disease and Related Dementia (ADRD).
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Age 55+ years old (inclusive) at enrollment. a. As self-reported on screening survey and later verified in video appointment (e.g. Zoom Health)
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If residing in a community residence (such as a retirement community) in which a Medical Director designates living status categories, then the participant must be Independent Living status (or equivalent).
- As self-reported on screening survey
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Insomnia Severity Index score ≥15 (i.e., at least "clinical insomnia," that is "moderate-to-severe") - but if recruitment is slow then the investigators will recruit with ISI score ≥11 "mild-to-severe").
a. As self-reported on the ISI screening survey
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Willing to refrain from initiating new therapeutic interventions (e.g. medication; behavioral) that are not a part of this study protocol for issues pertaining to sleep for the duration of study participation.
a. By self-report
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Willing to maintain any existing physician-directed pharmacologic intervention for issues pertaining to sleep for the duration of study participation.
a. By self-report
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Has a residence with WIFI.
a. By self-report
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Normal hearing with or without a hearing aid.
a. By self-report
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Difficulty falling asleep, staying asleep, or waking too early, occurring at least 3 nights/week for 3+months, causing significant daytime distress/impairment (e.g., fatigue, poor focus, mood issues), despite adequate sleep opportunity, and not better explained by another sleep disorder or substance.
- By Sleep Condition Indicator [SCI]
Exclusion Criteria
-
Illicit drug use in the past month (except for marijuana because it is legal in many States, and the investigators are recruiting nationwide).
a. As self-reported on screening survey. Marijuana usage will be tracked via self-report and examined as a moderator.
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Diagnosed serious mental health disorder.
- Specifically, psychosis or bipolar depression, severe major depression, moderate to high risk of suicide, dementia
- As self-reported on screening survey
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Currently or recent engaged (past 1-year) in evidence-based psychotherapy for Insomnia (e.g., CBTi), in addition to ever receiving a full course of CBTi:
a. By self-report
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Cohabitating with a current or previous participant in this study.
a. This criterion is to avoid cross-contamination of study condition awareness, if two cohabitating individuals are randomized into different study arms.
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Initiation of any psychological treatment in the last 3-months.
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A highly irregular schedule (e.g. shift work) that would prevent adoption of intervention strategies, as evaluated through the Shift Work Disorder Index.
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Previous exposure to the SleepSpace software.
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Medical conditions that are exacerbated by sleep restriction.
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Planned major surgery during the trial.
Plan d'étude
Comment l'étude est-elle conçue ?
Détails de conception
- Objectif principal: Traitement
- Répartition: Randomisé
- Modèle interventionnel: Affectation parallèle
- Masquage: Quadruple
Armes et Interventions
Groupe de participants / Bras |
Intervention / Traitement |
|---|---|
|
Expérimental: SleepSpaceRx CBT-I-IoT-AI
Participants randomized to this study arm will experience an attempted enhancement of standard video based digital CBT-I, that is facilitated with electronic device-based interventions (Internet of Things) and artificial intelligence (AI) customizations of content. Noninvasive ambulatory worn + bedside devices deliver real-time feedback of objective data to the participant on an application interface and this data is used to customize the software and promote healthy sleep routines. In addition, daily animated videos are customized to the users' challenges. Subjective data collected using the application are available live to the participant, when appropriate. Environmental cues and notifications are programmed into IoT devices to remind patients of their behavioral prescription and to create a living-space environment that is conducive to effective therapy. This will include smart lights and sounds that cue the participant. |
What distinguishes this condition is increased customization of the CBT-I content and increased usage of the Internet of Things (IoT) devices used to promote CBT-I directives. |
|
Comparateur actif: Sleep-EZ CBT-I Based Solution
Participants randomized to this study arm will experience standard digital-based CBT-I that is delivered via the Path to Better Sleep program called SleepEZ that was created by Veteran Affairs (VA). The program will be administered within the SleepSpace software, which will be used to track adherence and deliver sham interventions. Users will have access to a pared-down version of the SleepSpace electronic application that enables them to track sleep in a sleep diary, access the content found in SleepEZ, and integrate with smart light bulbs and sounds to receive certain sound and light interventions. For example, the lights will brighten during the users expected circadian dip. |
This condition includes interactive videos about CBT-I and leverages some IoT interventions. |
|
Comparateur actif: Sleep Hygiene + IoT
Participants randomized to this study arm will experience sleep hygiene education and training, a component of CBT-I, which will also occur within the SleepSpace software to ensure all participants receive the same software platform and adherence is tracked uniformly across solutions. Users will have access to a version of our electronic application that enables them to track sleep in a sleep diary, access the animated Sleep Hygiene content created in the same way as the videos in the CBTi-IoT-AI condition, and integrate with smart light bulbs and sounds to receive certain sound and light interventions. |
This intervention includes interactive videos regarding sleep hygiene, a component of CBT-I and leverages some IoT interventions. |
Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
|
Insomnia Severity Index (ISI)
Délai: Weekly for the first 8 weeks, then at week 10 and week 12
|
Subjective patient completion of the Insomnia Severity Index survey. Sum of survey item responses; Minimum score: 0; Maximum score: 28. Higher sum score indicates a greater number of, or more severe, insomnia symptoms; reduction in sum score suggests improvement of insomnia. |
Weekly for the first 8 weeks, then at week 10 and week 12
|
Mesures de résultats secondaires
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
|
Change in cognitive test battery performance
Délai: M2C2 is Daily during Baseline Weeks 1-2 and post-intervention Weeks 9-10. and Dana is Daily during Baseline Week 2 and post-intervention Week 10.
|
Objective test performance metrics on an ambulatory cognitive test battery delivered with a smartphone device that includes validated assessments: the Mobile Monitoring of Cognitive Change (M2C2) and DANA Brain Vitals. |
M2C2 is Daily during Baseline Weeks 1-2 and post-intervention Weeks 9-10. and Dana is Daily during Baseline Week 2 and post-intervention Week 10.
|
|
Consensus Sleep Diary
Délai: Time Frame: Daily during Baseline Weeks 1-2, Intervention Weeks 3-8, and post-intervention Weeks 9-10.
|
Subjective sleep diary data will be used to determine perceived sleep features (duration, quality, time in bed, etc). |
Time Frame: Daily during Baseline Weeks 1-2, Intervention Weeks 3-8, and post-intervention Weeks 9-10.
|
Autres mesures de résultats
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
|
Nearable Sleep Sensing (Motion)
Délai: Daily from week two to week eight
|
Motion (up to 50 hertz x, y, z actigraphy) from the iPhone will be used to estimate time in bed, sleep/wake, sleep onset latency, wake after sleep onset, and other sleep related metrics. |
Daily from week two to week eight
|
|
Nearable Sleep Sensing (Sound)
Délai: Daily from week two to week eight
|
Sound data (decibels) from the iPhone will be used to estimate time in bed, sleep/wake, sleep onset latency, wake after sleep onset, and other sleep related metrics. |
Daily from week two to week eight
|
|
Wearable Sleep Sensing (Motion)
Délai: Daily during Baseline to Week 2 (randomization) and the post-intervention assessment period (Weeks 9-10).
|
Motion (up to 50 hertz x, y, z actigraphy) from the Apple Watch or Sensor Bio wearable will be used to estimate time in bed, sleep/wake, sleep onset latency, wake after sleep onset, and other sleep related metrics. |
Daily during Baseline to Week 2 (randomization) and the post-intervention assessment period (Weeks 9-10).
|
|
Wearable Sleep Sensing (Heart Rate)
Délai: Daily during Baseline to Week 2 (randomization) and the post-intervention assessment period (Weeks 9-10).
|
Heart rate (up to .2 hertz) from the Apple Watch or Sensor Bio wearable will be used to estimate time in bed, sleep/wake, sleep onset latency, wake after sleep onset, and other sleep related metrics. |
Daily during Baseline to Week 2 (randomization) and the post-intervention assessment period (Weeks 9-10).
|
|
Adherence
Délai: Daily during the intervention: Week three to Week eight
|
The frequency and duration of engagement with the content or other active aspects of the intervention |
Daily during the intervention: Week three to Week eight
|
|
Generalized Anxiety Symptoms
Délai: Baseline (Week 1) to post treatment (Week 12)
|
Change in anxiety symptoms measured by the Generalized Anxiety Disorder 7 item scale (GAD 7). |
Baseline (Week 1) to post treatment (Week 12)
|
|
Depressive Symptoms
Délai: Baseline (Week 1) to post treatment (Week 12)
|
Change in depressive symptoms measured by the Patient Health Questionnaire 8 item scale (PHQ 8). |
Baseline (Week 1) to post treatment (Week 12)
|
|
Post Traumatic Stress Symptoms
Délai: Baseline (Week 1) to post treatment (Week 12)
|
Change in post traumatic stress symptoms measured by the Primary Care PTSD Screen (PC PTSD). |
Baseline (Week 1) to post treatment (Week 12)
|
|
Social Connectedness From Voice Features
Délai: Baseline (Week 1) to post treatment (Week 12)
|
Exploratory changes in social connectedness metrics derived from speech and voice features collected during study interactions. |
Baseline (Week 1) to post treatment (Week 12)
|
Collaborateurs et enquêteurs
Parrainer
Collaborateurs
Les enquêteurs
- Directeur d'études: Daniel Taylor, PhD, University of Arizona
Publications et liens utiles
Liens utiles
Dates d'enregistrement des études
Dates principales de l'étude
Début de l'étude (Estimé)
Achèvement primaire (Estimé)
Achèvement de l'étude (Estimé)
Dates d'inscription aux études
Première soumission
Première soumission répondant aux critères de contrôle qualité
Première publication (Réel)
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Réel)
Dernière mise à jour soumise répondant aux critères de contrôle qualité
Dernière vérification
Plus d'information
Termes liés à cette étude
Mots clés
Termes MeSH pertinents supplémentaires
Autres numéros d'identification d'étude
- 1R43AG097205-01 (Subvention/contrat des NIH des États-Unis)
Plan pour les données individuelles des participants (IPD)
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Informations sur les médicaments et les dispositifs, documents d'étude
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