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Behavior therapy singly and combined with constructive worry for insomnia: Cognitive and behavioral processes as mediators
Abstracts / Sleep Medicine 14S (2013) e93–e164
Acknowledgements: We would like to express our appreciation to Sparbankstiftelsen Nya for funding and to the two audiology clinics in Örebro and Karlstad for recruitment. http://dx.doi.org/10.1016/j.sleep.2013.11.365
Behavior therapy singly and combined with constructive worry for insomnia: Cognitive and behavioral processes as mediators R. Sunnhed, M. Jansson-Fröjmark Department of Psychology, Stockholm University, Sweden
Introduction: The purpose with the investigation was to examine whether improvements in insomnia-related worry and time in bed mediate the outcomes in in-person CBT-I. Materials and methods: A randomized, controlled design was used, including a two-week baseline, a four-week intervention phase [sleep restriction and stimulus control (BT) or sleep restriction and stimulus control plus constructive worry (BT + CW)], and a twoweek follow-up. Thirty-one patients with primary insomnia participated. At pretreatment and mid-treatment, participants completed questionnaires and sleep diaries assessing insomnia-related worry and time in bed. At pretreatment and follow-up, outcome measures (insomnia severity, dysfunction, and subjective sleep parameters) were administered. Results: The results indicated that decreases in insomnia-related worry mediated the effect on insomnia severity and sleep quality. Reductions in time in bed mediated the treatment effect on dysfunction and total wake time. Noteworthy is also that improvements in the outcomes could be attributed to reductions in the mediators (21–60% of the variance). Conclusion: These findings provide support for cognitive-behavioral models of insomnia by highlighting insomnia-related worry and time in bed as mediators in the treatment of insomnia. The results are also important for clinical work and for testing new approaches in future research. Acknowledgements: We would like to express our appreciation to Mikael Bermås and Andreas Kjellén for collaboration on recruiting the participants. http://dx.doi.org/10.1016/j.sleep.2013.11.366
Beyond sleep duration: distinct sleep dimensions are associated with obesity in children and adolescents D. Jarrin 1, J. Mcgrath 2, C. Drake 3 1 Université Laval, Canada 2 Concordia University, Canada 3 Henry Ford Hospital, Canada
Introduction: Short sleep duration is recognized as a significant risk factor in childhood obesity; however, the question as to how sleep contributes to the development of obesity remains largely unknown. The majority of pediatric studies have relied on sleep duration as the exclusive measure of sleep; this insular approach may be misleading given that sleep is a dynamic multidimensional construct beyond sleep duration, including sleep disturbances and patterns. Although these sleep dimensions partly overlap, it is necessary to determine their independent relation with obesity, which in turn, may inform a more comprehensive understanding of putative pathophysiological mechanisms linking sleep and obesity. The aim of the present study was to investigate whether sleep dimensions
e159
including sleep duration, disturbances, and patterns were individually associated with obesity, independent of multiple covariates. The second objective was to examine whether sleep disturbances and patterns were independently associated with obesity, after adjusting for sleep duration. Materials and methods: Participants included 240 healthy children and adolescents (Mage = 12.60, SD = 1.98; 45.8% females). Anthropometric measures included measured waist and hip circumference, body mass index Z-score, and percent body fat. Subjective sleep measures included sleep duration, sleep disturbances, sleep quality, and sleep patterns from youth- and parental report. Results: Youth with larger adiposity and body composition measures reported poorer sleep quality (bavg = 0.14, p < 0.01), more sleep disturbances (bavg = 0.13, p < 0.05), and showed a delayed sleep phase pattern (bavg = 0.15, p < 0.05), independent of age, sex, pubertal status, physical activity, screen time, socioeconomic status, and sleep duration. Shorter sleep duration was significantly associated with obesity; however, this link was attenuated after adjustment of covariates. Conclusion: The results suggest that sleep measures beyond duration may more precisely capture influences that drive the negative association between sleep and obesity, and thus, yield more robust associations. As such, future studies are needed to better understand how distinct sleep dimensions confer risk for childhood obesity. Acknowledgements: This work was made possible through funding support from the Canadian Institutes of Health Research (MOP89886;OCO79897; 127383) and the Fonds de la recherche en santé du Québec (16965). http://dx.doi.org/10.1016/j.sleep.2013.11.367
Does vulnerability to stress-related insomnia predict future incident and persistent insomnia among good sleepers? D. Jarrin, I. Chen, H. Ivers, C. Morin Université Laval, Canada
Introduction: Clinical and research evidence suggest that individuals who are more prone to experience situational insomnia under stressful conditions may also be at greater risk to eventually develop chronic insomnia. While there is substantial cross-sectional data on the association between heightened vulnerability to stress-related insomnia and sleep disturbances (i.e., low sleep efficiency, sleep fragmentation), there is limited data on its predictive value. The aim of the present study was to prospectively evaluate whether heightened vulnerability to stress-related insomnia was associated with increased risk of incident and persistent insomnia in a population-based sample of good sleepers. Materials and methods: Data were derived from a larger epidemiological study conducted in Québec, Canada. Participants were 1449 adults (Mage = 47.4 yrs, SD = 15.1; 41.2% male) without insomnia at baseline and evaluated four times over 3-years. Vulnerability to stress-related insomnia was measured using the Ford Insomnia Response to Stress Test (FIRST). The Life Experience Survey was used to assess the frequency and perceived impact of positive and negative events that occurred in the past year. Incident insomnia was defined as a case reporting insomnia symptoms or syndrome at any of the follow-up evaluations (non-cumulative). Persistent insomnia was defined as a case reporting insomnia symptoms or syndrome at least twice during the follow-up evaluations. Results: Of the sample, 91.7% completed the 6-month follow-up, 87.8% completed the 1-year follow-up, 84.1% completed the 2-year follow-up, and 71.5% completed the 3-year follow-up. After controlling for age, sex, depressive symptoms, and stressful events and per-
Acknowledgements: We would like to express our appreciation to Sparbankstiftelsen Nya for funding and to the two audiology clinics in Örebro and Karlstad for recruitment. http://dx.doi.org/10.1016/j.sleep.2013.11.365
Behavior therapy singly and combined with constructive worry for insomnia: Cognitive and behavioral processes as mediators R. Sunnhed, M. Jansson-Fröjmark Department of Psychology, Stockholm University, Sweden
Introduction: The purpose with the investigation was to examine whether improvements in insomnia-related worry and time in bed mediate the outcomes in in-person CBT-I. Materials and methods: A randomized, controlled design was used, including a two-week baseline, a four-week intervention phase [sleep restriction and stimulus control (BT) or sleep restriction and stimulus control plus constructive worry (BT + CW)], and a twoweek follow-up. Thirty-one patients with primary insomnia participated. At pretreatment and mid-treatment, participants completed questionnaires and sleep diaries assessing insomnia-related worry and time in bed. At pretreatment and follow-up, outcome measures (insomnia severity, dysfunction, and subjective sleep parameters) were administered. Results: The results indicated that decreases in insomnia-related worry mediated the effect on insomnia severity and sleep quality. Reductions in time in bed mediated the treatment effect on dysfunction and total wake time. Noteworthy is also that improvements in the outcomes could be attributed to reductions in the mediators (21–60% of the variance). Conclusion: These findings provide support for cognitive-behavioral models of insomnia by highlighting insomnia-related worry and time in bed as mediators in the treatment of insomnia. The results are also important for clinical work and for testing new approaches in future research. Acknowledgements: We would like to express our appreciation to Mikael Bermås and Andreas Kjellén for collaboration on recruiting the participants. http://dx.doi.org/10.1016/j.sleep.2013.11.366
Beyond sleep duration: distinct sleep dimensions are associated with obesity in children and adolescents D. Jarrin 1, J. Mcgrath 2, C. Drake 3 1 Université Laval, Canada 2 Concordia University, Canada 3 Henry Ford Hospital, Canada
Introduction: Short sleep duration is recognized as a significant risk factor in childhood obesity; however, the question as to how sleep contributes to the development of obesity remains largely unknown. The majority of pediatric studies have relied on sleep duration as the exclusive measure of sleep; this insular approach may be misleading given that sleep is a dynamic multidimensional construct beyond sleep duration, including sleep disturbances and patterns. Although these sleep dimensions partly overlap, it is necessary to determine their independent relation with obesity, which in turn, may inform a more comprehensive understanding of putative pathophysiological mechanisms linking sleep and obesity. The aim of the present study was to investigate whether sleep dimensions
e159
including sleep duration, disturbances, and patterns were individually associated with obesity, independent of multiple covariates. The second objective was to examine whether sleep disturbances and patterns were independently associated with obesity, after adjusting for sleep duration. Materials and methods: Participants included 240 healthy children and adolescents (Mage = 12.60, SD = 1.98; 45.8% females). Anthropometric measures included measured waist and hip circumference, body mass index Z-score, and percent body fat. Subjective sleep measures included sleep duration, sleep disturbances, sleep quality, and sleep patterns from youth- and parental report. Results: Youth with larger adiposity and body composition measures reported poorer sleep quality (bavg = 0.14, p < 0.01), more sleep disturbances (bavg = 0.13, p < 0.05), and showed a delayed sleep phase pattern (bavg = 0.15, p < 0.05), independent of age, sex, pubertal status, physical activity, screen time, socioeconomic status, and sleep duration. Shorter sleep duration was significantly associated with obesity; however, this link was attenuated after adjustment of covariates. Conclusion: The results suggest that sleep measures beyond duration may more precisely capture influences that drive the negative association between sleep and obesity, and thus, yield more robust associations. As such, future studies are needed to better understand how distinct sleep dimensions confer risk for childhood obesity. Acknowledgements: This work was made possible through funding support from the Canadian Institutes of Health Research (MOP89886;OCO79897; 127383) and the Fonds de la recherche en santé du Québec (16965). http://dx.doi.org/10.1016/j.sleep.2013.11.367
Does vulnerability to stress-related insomnia predict future incident and persistent insomnia among good sleepers? D. Jarrin, I. Chen, H. Ivers, C. Morin Université Laval, Canada
Introduction: Clinical and research evidence suggest that individuals who are more prone to experience situational insomnia under stressful conditions may also be at greater risk to eventually develop chronic insomnia. While there is substantial cross-sectional data on the association between heightened vulnerability to stress-related insomnia and sleep disturbances (i.e., low sleep efficiency, sleep fragmentation), there is limited data on its predictive value. The aim of the present study was to prospectively evaluate whether heightened vulnerability to stress-related insomnia was associated with increased risk of incident and persistent insomnia in a population-based sample of good sleepers. Materials and methods: Data were derived from a larger epidemiological study conducted in Québec, Canada. Participants were 1449 adults (Mage = 47.4 yrs, SD = 15.1; 41.2% male) without insomnia at baseline and evaluated four times over 3-years. Vulnerability to stress-related insomnia was measured using the Ford Insomnia Response to Stress Test (FIRST). The Life Experience Survey was used to assess the frequency and perceived impact of positive and negative events that occurred in the past year. Incident insomnia was defined as a case reporting insomnia symptoms or syndrome at any of the follow-up evaluations (non-cumulative). Persistent insomnia was defined as a case reporting insomnia symptoms or syndrome at least twice during the follow-up evaluations. Results: Of the sample, 91.7% completed the 6-month follow-up, 87.8% completed the 1-year follow-up, 84.1% completed the 2-year follow-up, and 71.5% completed the 3-year follow-up. After controlling for age, sex, depressive symptoms, and stressful events and per-