Efficacy of a Smartphone-Based Virtual Companion to Treat Insomniac Complaints in the General Population: Sleep Diary Monitoring Versus an Internet Autonomous Intervention

Pierre Philip, Lucile Dupuy, Patricia Sagaspe, Etienne de Sevin, Marc Auriacombe, Jacques Taillard, Jean-Arthur Micoulaud-Franchi, Charles M Morin, Pierre Philip, Lucile Dupuy, Patricia Sagaspe, Etienne de Sevin, Marc Auriacombe, Jacques Taillard, Jean-Arthur Micoulaud-Franchi, Charles M Morin

Abstract

(1) Background: Insomnia is the most prevalent sleep disorder worldwide and cognitive behavioral therapy is the front-line treatment. Digital health technologies have a role to play in screening and delivering interventions remotely and without the need for human intervention. The KANOPEE app, which provides a screening and behavioral intervention for insomnia symptoms through an interaction with a virtual agent, showed encouraging results in previous studies during and after the COVID-19 lockdown, but has not yet been evaluated in a controlled study. This study aims at comparing the benefits of KANOPEE, a smartphone application dealing with insomnia complaints, with another application proposing an electronic sleep diary named “My Sleep Diary”. The acceptance and potential benefits of these digital solutions are tested in real-life settings (i.e., without soliciting human medical resources) and in the general population. (2) Methods: Subjects were included if they downloaded one of the apps between December 2020 and October 2021, and were of legal age. Both apps were available on downloading platforms in France. Primary outcome was Insomnia Severity Index (ISI), and secondary outcomes were total sleep time (TST), sleep efficiency (SE) and wake time after sleep onset (WASO). (3) Results: A total of 535 users completed the intervention with KANOPEE and 489 users completed My Sleep Diary, both for 17 days. KANOPEE users improved their ISI score significantly more than sleep diary users (interaction Time*Group: F(2,2002) = 17.3, p < 0.001). Similar results were found for nocturnal sleep parameters (TST) (KANOPEE users gained 48 min of sleep after intervention, while My Sleep Diary users gained only 16 min of sleep), and particularly in the population with moderate to severe initial sleep complaints (F(4,1980) = 8.9, p < 0.001). Other sleep markers (SE and WASO) were significantly improved in the KANOPEE users compared to the sleep diary ones (p < 0.001). (4) Conclusions: KANOPEE provides significantly greater benefits than an electronic sleep diary regarding reduction of insomnia complaints and estimated nocturnal sleep characteristics in a self-selected sample of the general population. Population with the most severe initial ISI score (≥15) benefited the most from the KANOPEE App compared to filling up a simple sleep diary.

Keywords: behavioral intervention; general population; insomnia; virtual agents.

Conflict of interest statement

C.M.M. has received research grants from Idorsia and Canopy Health, served as a consultant for Eisai, Merck, Pear Therapeutics, Sunovion and Weight Watchers, and received royalties from the Mapi Research Trust. None of these are related to this manuscript. The other authors declare no competing interests.

Figures

Figure 1
Figure 1
Examples of interfaces of KANOPEE (A–D) and My Sleep Diary (E,F) apps. (A) Screenshot of Louise questioning Insomnia Severity Index. (B) Screenshot of visual feedback given after screening interview with Louise. (C) Sleep diary and visual feedback on sleep patterns in KANOPEE. (D) Screenshot of personalized sleep recommendation given by Louise during follow-up interview. (E) Insomnia Severity Index administered in My Sleep Diary. (F) Visual feedback on sleep patterns in My Sleep Diary.
Figure 2
Figure 2
Participant flow.
Figure 3
Figure 3
Insomnia severity index according to sleep diary versus KANOPEE over time. Note: Significance: **: p < 0.01; ***: p < 0.001.
Figure 4
Figure 4
Distribution of sleep diary versus KANOPEE users depending on severity of their insomnia complaints over time.

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Source: PubMed

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