Night-to-Night Sleep Variability in Older Adults With Chronic Insomnia: Mediators and Moderators in a Randomized Controlled Trial of Brief Behavioral Therapy (BBT-I)

被引:24
作者
Chan, Wai Sze [1 ]
Williams, Jacob [2 ]
Dautovich, Natalie D. [3 ]
McNamara, Joseph P. H. [4 ]
Stripling, Ashley [5 ]
Dzierzewski, Joseph M. [3 ]
Berry, Richard B. [6 ]
McCoy, Karin J. M. [7 ]
McCrae, Christina S. [8 ]
机构
[1] Dartmouth Coll, Geisel Sch Med, Dept Psychiat, Hanover, NH 03755 USA
[2] TIRR Mem Hermann, Houston, TX USA
[3] Virginia Commonwealth Univ, Dept Psychol, Box 2018, Richmond, VA 23284 USA
[4] Univ Florida, Dept Psychiat, Gainesville, FL 32611 USA
[5] Nova Southeastern Univ, Coll Psychol, Ft Lauderdale, FL 33314 USA
[6] Univ Florida, Coll Med, Gainesville, FL USA
[7] South Texas Vet Hlth Care Syst, Neuropsychol Serv, San Antonio, TX USA
[8] Univ Missouri Columbia, Dept Hlth Psychol, Columbia, MO USA
来源
JOURNAL OF CLINICAL SLEEP MEDICINE | 2017年 / 13卷 / 11期
关键词
CBT-I; insomnia; mechanisms of change; older adults; sleep variability; treatment efficacy moderator; CLINICAL-SIGNIFICANCE; DEPRESSION; MODELS; IMPACT;
D O I
10.5664/jcsm.6790
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Study Objectives: Sleep variability is a clinically significant variable in understanding and treating insomnia in older adults. The current study examined changes in sleep variability in the course of brief behavioral therapy for insomnia (BBT-I) in older adults who had chronic insomnia. Additionally, the current study examined the mediating mechanisms underlying reductions of sleep variability and the moderating effects of baseline sleep variability on treatment responsiveness. Methods: Sixty-two elderly participants were randomly assigned to either BBT-I or self-monitoring and attention control (SMAC). Sleep was assessed by sleep diaries and actigraphy from baseline to posttreatment and at 3-month follow-up. Mixed models were used to examine changes in sleep variability (within-person standard deviations of weekly sleep parameters) and the hypothesized mediation and moderation effects. Results: Variabilities in sleep diary-assessed sleep onset latency (SOL) and actigraphy-assessed total sleep time (TST) significantly decreased in BBT-I compared to SMAC (Pseudo R-2 =.12,.27; P =.018,.008). These effects were mediated by reductions in bedtime and wake time variability and time in bed. Significant time x group x baseline sleep variability interactions on sleep outcomes indicated that participants who had higher baseline sleep variability were more responsive to BBT-I; their actigraphy-assessed TST, SOL, and sleep efficiency improved to a greater degree (Pseudo R-2 =.15 to .66; P <.001 to .044). Conclusions: BBT-I is effective in reducing sleep variability in older adults who have chronic insomnia. Increased consistency in bedtime and wake time and decreased time in bed mediate reductions of sleep variability. Baseline sleep variability may serve as a marker of high treatment responsiveness to BBT-I.
引用
收藏
页码:1243 / 1254
页数:12
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