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T-D-013 DON'TWORRY, BE CONSTRUCTIVE: A RANDOMIZED CONTROLLED FEASIBILITY STUDY COMPARING BEHAVIOR THERAPY SINGLY AND COMBINEDWITH CONSTRUCTIVE WORRY FOR INSOMNIA
Abstracts of 4th International Congress of WASM & 5th Conference of CSS / Sleep Medicine 12, Suppl. 1 (2011) S1–S130
T-D-010
COMPARISON OF TWO ASSESSMENT TOOLS THAT MEASURE INSOMNIA: THE INSOMNIA SEVERITY INDEX AND POLYSOMNOGRAPHY
Khosro Sadeghniiat-Haghighi 1 , Zohreh Yazdi 2 , Marjan Firoozeh 3 . 1 Center for Research on Occupational Disordere, Iran; 2 Qazvin University of Medical Sciences, Iran; 3 Shahid Beheshti University of Medical Sciences, Iran Introduction and Objectives: Insomnia is a common sleep disorder, characterized by difficulties in sleep initiation, sleep maintenance or early morning awakening. Although polysomnography is a standard method in the evaluation of sleep disorders, it is not recommended for routine use in the clinical assessment of insomnia. Instead, standard questionnaires could be used in the primary evaluation of insomnia. Objective: The main objective of this study was to compare the type and severity of patients subjective complaints of insomnia gathered from Insomnia Severity Index (ISI) questionnaire with the result of their polysomnographic evaluation. Materials and Methods: In this cross-sectional study conducted during 2006 to 2009 in Iran, all of the patients with sleep disorders were evaluated. The study consisted of self administered questionnaires completed by participants to provide information on demographic characteristics, and ISI questionnaire. After completing the questionnaire, all the participants underwent standard overnight polysomnography. Results: Subjects were 151 patients (47.2±10.8 years old). The average ISS was 6.1±4. There was significant relationship between subjective complaint of difficulty in sleep initiation and sleep onset latency in PSG (r=0.5) Conclusion: Our findings suggest that objective insomnia measured with Insomnia Severity Index is related with PSG variables and ISI could be useful tools to quantify perceived insomnia severity. Further studies are needed to determine sensitivity and specificity of this questionnaire.
T-D-011
DIFFERENCES BETWEEN GOOD SLEEPERS AND INSOMNIA SUFFERERS IN NAPPING CHARACTERISTICS AFTER A MENTALLY EXHAUSTING BATTERY OF COGNITIVE TESTING
Alexandra D. Pérusse, Isabelle Turcotte, Célyne H. Bastien. École de Psychologie, Université Laval, Canada Introduction and Objectives: It has been shown that good sleepers (GS) sleep better than insomnia sufferers (INS) while napping. The objective of this study was to examine if sleep during napping differs between GS and INS (subdivided in paradoxical ‘IPA’ and psychophysiological ‘IPS’) after individuals underwent a mentally exhausting battery of cognitive testing. Materials and Methods: 14 IPS (Mean age = 36.0), 11 IPA (Mean age = 37.2) and 14 GS (Mean age = 34.8) completed four consecutive PSG nights in the laboratory. Upon awakening on mornings 2 and 3, cognitive testing (lasting between 90 to 120 minutes) was administered and then followed by a 20 minute nap. Sleep onset latency (SOL), total sleep time (TST), total wake time (TWT) and sleep efficacy (SE) were computed for each napping session. Results: One way ANOVAs revealed significant group differences (≥0.01) for TST, SE and TWT. GS had a longer TST (Mean = 7.15, SD = 7.21) than IPS (Mean = 2.80, SD = 4.60) and IPA (Mean = 2.80, SD = 4.37) and a better SE (Mean = 34.25, SD = 34.24) than IPS (Mean = 14.46, SD = 23.51) and IPA (Mean = 13.3, SD = 20.86). Finally, INS were awake significantly longer than GS (IPS: Mean = 16.93, SD = 4.87; IPA: Mean = 17.93, SD = 4.21; and GS: Mean = 12.70, SD = 7.04). However, only a marginal significant difference was observed for SOL (p=0.307). Still, GS were seemingly falling asleep more rapidly than both groups of INS. Conclusion: Results show that GS sleep better than INS during naps following prolonged cognitive testing, suggesting that, in INS, hyper arousal predominates over exhaustion. These results may parallel what is observed at night when INS experience cognitive loading but are unable to fall asleep. Acknowledgements: Supported by the Canadian Institute of Health Research.
T-D-012
DOES CBT-I DECREASE CONCOMITANT ANXIETY? A META-ANALYTIC REVIEW
Geneviève Belleville 1 , Héloïse Cousineau 2 , Katia Levrier 2 , Marie-Ève St-Pierre-Delorme 2 . 1 Université Laval, Canada; 2 Université du Québec à Montréal, Canada Introduction and Objectives: Anxiety and insomnia are prevalent and
S61
frequently comorbid disorders. It is unclear whether cognitive-behavior therapy for insomnia (CBT-I) has an impact on concomitant anxiety symptoms. The impact of CBT-I on anxiety has neither been a primary focus of efficacy studies nor the subject of a review. The present systematic review and meta-analysis represents an effort to fill this gap. The objectives are (1) to assess the impact of CBT-I on associated anxiety; (2) to determine which characteristics of studies, samples, treatments, and measures influence the magnitude of the impact; and (3) to document methods of assessing anxiety in CBT-I trials. Materials and Methods: Systematic search for clinical trials of CBT-I in PsycInfo, Medline, and Proquest Dissertations and Theses. Results: Of the 216 CBT-I trials reviewed, 72 (33.3%) reported data on anxiety. The combined effect size (ES) of CBT-I on anxiety was 0.406 [95% CI 0.318 – 0.493], indicating a small to moderate effect of CBT-I on concomitant anxiety. Use of a between-group experimental design and inclusion of a hypnotic withdrawal program significantly decreased ES. Presence of a comorbid condition (including anxiety disorders) and inclusion of anxiety management strategies did not impact ES. Anxiety and anxiety-related constructs were measured with 31 different questionnaires or questionnaire subscales, the majority of which were used only once. Conclusion: Available data suggest that CBT-I has a positive moderate impact on associated anxiety. However, magnitude of this effect may be overestimated by the inclusion of findings from less rigorous research protocols. Greater consensus about the relevant aspects of anxiety and the most appropriate instruments for anxiety assessment will facilitate improved integration of research findings in this area. Further research on the impact of CBT-I on anxiety, and particularly on the impact of adding anxiety management strategies to CBT-I for populations with or without anxiety disorders, is needed.
T-D-013
DON’T WORRY, BE CONSTRUCTIVE: A RANDOMIZED CONTROLLED FEASIBILITY STUDY COMPARING BEHAVIOR THERAPY SINGLY AND COMBINED WITH CONSTRUCTIVE WORRY FOR INSOMNIA
Markus Jansson-Fröjmark, Marcus Lind, Rikard Sunnhed. Center for Health and Medical Psychology, School of Law, Psychology, and Social Work, Sweden Introduction and Objectives: Based on the lack of research on interventions targeting intrusive and worrisome thinking for insomnia, the aim was to examine whether a constructive worry intervention (Carney and Waters, 2006) adds to the effects of behavior therapy. Materials and Methods: A randomized, controlled design was used. The design included 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 two-week follow-up. Twenty-two patients with primary insomnia participated. The primary outcome was the Anxiety and Preoccupation about Sleep Questionnaire to tap sleep-related worry, and secondary endpoints were subjective sleep estimates, the Insomnia Severity Index, and the Work and Social Adjustment Scale to index dysfunction. Results: Although both conditions produced significant improvements in subjective sleep estimates, no significant group differences over time were shown for total wake time and total sleep time. Both interventions resulted in reductions over time in insomnia severity, worry, and dysfunction. Compared to BT, BT+CW led to a larger decrease in insomnia severity at all three time points (controlled d = 1.10-1.68). In comparison with BT, BT+CW resulted in a larger reduction in worry at two of the time points (controlled d = 0.76-1.64). No significant differences between the two conditions were demonstrated for dysfunction. While more participants responded positively to treatment in the BT+CW (80-100%) than in the BT condition (18-27%), none of the participants remitted. Conclusion: The findings suggest that, compared to behavior therapy alone, constructive worry might result in additional improvements in insomnia severity and worry. Given the small sample size and short follow-up, future studies are warranted. Acknowledgements: We would like to express our appreciation to Mikael Bermås and Andreas Kjellén for collaboration on recruiting the participants.
T-D-010
COMPARISON OF TWO ASSESSMENT TOOLS THAT MEASURE INSOMNIA: THE INSOMNIA SEVERITY INDEX AND POLYSOMNOGRAPHY
Khosro Sadeghniiat-Haghighi 1 , Zohreh Yazdi 2 , Marjan Firoozeh 3 . 1 Center for Research on Occupational Disordere, Iran; 2 Qazvin University of Medical Sciences, Iran; 3 Shahid Beheshti University of Medical Sciences, Iran Introduction and Objectives: Insomnia is a common sleep disorder, characterized by difficulties in sleep initiation, sleep maintenance or early morning awakening. Although polysomnography is a standard method in the evaluation of sleep disorders, it is not recommended for routine use in the clinical assessment of insomnia. Instead, standard questionnaires could be used in the primary evaluation of insomnia. Objective: The main objective of this study was to compare the type and severity of patients subjective complaints of insomnia gathered from Insomnia Severity Index (ISI) questionnaire with the result of their polysomnographic evaluation. Materials and Methods: In this cross-sectional study conducted during 2006 to 2009 in Iran, all of the patients with sleep disorders were evaluated. The study consisted of self administered questionnaires completed by participants to provide information on demographic characteristics, and ISI questionnaire. After completing the questionnaire, all the participants underwent standard overnight polysomnography. Results: Subjects were 151 patients (47.2±10.8 years old). The average ISS was 6.1±4. There was significant relationship between subjective complaint of difficulty in sleep initiation and sleep onset latency in PSG (r=0.5) Conclusion: Our findings suggest that objective insomnia measured with Insomnia Severity Index is related with PSG variables and ISI could be useful tools to quantify perceived insomnia severity. Further studies are needed to determine sensitivity and specificity of this questionnaire.
T-D-011
DIFFERENCES BETWEEN GOOD SLEEPERS AND INSOMNIA SUFFERERS IN NAPPING CHARACTERISTICS AFTER A MENTALLY EXHAUSTING BATTERY OF COGNITIVE TESTING
Alexandra D. Pérusse, Isabelle Turcotte, Célyne H. Bastien. École de Psychologie, Université Laval, Canada Introduction and Objectives: It has been shown that good sleepers (GS) sleep better than insomnia sufferers (INS) while napping. The objective of this study was to examine if sleep during napping differs between GS and INS (subdivided in paradoxical ‘IPA’ and psychophysiological ‘IPS’) after individuals underwent a mentally exhausting battery of cognitive testing. Materials and Methods: 14 IPS (Mean age = 36.0), 11 IPA (Mean age = 37.2) and 14 GS (Mean age = 34.8) completed four consecutive PSG nights in the laboratory. Upon awakening on mornings 2 and 3, cognitive testing (lasting between 90 to 120 minutes) was administered and then followed by a 20 minute nap. Sleep onset latency (SOL), total sleep time (TST), total wake time (TWT) and sleep efficacy (SE) were computed for each napping session. Results: One way ANOVAs revealed significant group differences (≥0.01) for TST, SE and TWT. GS had a longer TST (Mean = 7.15, SD = 7.21) than IPS (Mean = 2.80, SD = 4.60) and IPA (Mean = 2.80, SD = 4.37) and a better SE (Mean = 34.25, SD = 34.24) than IPS (Mean = 14.46, SD = 23.51) and IPA (Mean = 13.3, SD = 20.86). Finally, INS were awake significantly longer than GS (IPS: Mean = 16.93, SD = 4.87; IPA: Mean = 17.93, SD = 4.21; and GS: Mean = 12.70, SD = 7.04). However, only a marginal significant difference was observed for SOL (p=0.307). Still, GS were seemingly falling asleep more rapidly than both groups of INS. Conclusion: Results show that GS sleep better than INS during naps following prolonged cognitive testing, suggesting that, in INS, hyper arousal predominates over exhaustion. These results may parallel what is observed at night when INS experience cognitive loading but are unable to fall asleep. Acknowledgements: Supported by the Canadian Institute of Health Research.
T-D-012
DOES CBT-I DECREASE CONCOMITANT ANXIETY? A META-ANALYTIC REVIEW
Geneviève Belleville 1 , Héloïse Cousineau 2 , Katia Levrier 2 , Marie-Ève St-Pierre-Delorme 2 . 1 Université Laval, Canada; 2 Université du Québec à Montréal, Canada Introduction and Objectives: Anxiety and insomnia are prevalent and
S61
frequently comorbid disorders. It is unclear whether cognitive-behavior therapy for insomnia (CBT-I) has an impact on concomitant anxiety symptoms. The impact of CBT-I on anxiety has neither been a primary focus of efficacy studies nor the subject of a review. The present systematic review and meta-analysis represents an effort to fill this gap. The objectives are (1) to assess the impact of CBT-I on associated anxiety; (2) to determine which characteristics of studies, samples, treatments, and measures influence the magnitude of the impact; and (3) to document methods of assessing anxiety in CBT-I trials. Materials and Methods: Systematic search for clinical trials of CBT-I in PsycInfo, Medline, and Proquest Dissertations and Theses. Results: Of the 216 CBT-I trials reviewed, 72 (33.3%) reported data on anxiety. The combined effect size (ES) of CBT-I on anxiety was 0.406 [95% CI 0.318 – 0.493], indicating a small to moderate effect of CBT-I on concomitant anxiety. Use of a between-group experimental design and inclusion of a hypnotic withdrawal program significantly decreased ES. Presence of a comorbid condition (including anxiety disorders) and inclusion of anxiety management strategies did not impact ES. Anxiety and anxiety-related constructs were measured with 31 different questionnaires or questionnaire subscales, the majority of which were used only once. Conclusion: Available data suggest that CBT-I has a positive moderate impact on associated anxiety. However, magnitude of this effect may be overestimated by the inclusion of findings from less rigorous research protocols. Greater consensus about the relevant aspects of anxiety and the most appropriate instruments for anxiety assessment will facilitate improved integration of research findings in this area. Further research on the impact of CBT-I on anxiety, and particularly on the impact of adding anxiety management strategies to CBT-I for populations with or without anxiety disorders, is needed.
T-D-013
DON’T WORRY, BE CONSTRUCTIVE: A RANDOMIZED CONTROLLED FEASIBILITY STUDY COMPARING BEHAVIOR THERAPY SINGLY AND COMBINED WITH CONSTRUCTIVE WORRY FOR INSOMNIA
Markus Jansson-Fröjmark, Marcus Lind, Rikard Sunnhed. Center for Health and Medical Psychology, School of Law, Psychology, and Social Work, Sweden Introduction and Objectives: Based on the lack of research on interventions targeting intrusive and worrisome thinking for insomnia, the aim was to examine whether a constructive worry intervention (Carney and Waters, 2006) adds to the effects of behavior therapy. Materials and Methods: A randomized, controlled design was used. The design included 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 two-week follow-up. Twenty-two patients with primary insomnia participated. The primary outcome was the Anxiety and Preoccupation about Sleep Questionnaire to tap sleep-related worry, and secondary endpoints were subjective sleep estimates, the Insomnia Severity Index, and the Work and Social Adjustment Scale to index dysfunction. Results: Although both conditions produced significant improvements in subjective sleep estimates, no significant group differences over time were shown for total wake time and total sleep time. Both interventions resulted in reductions over time in insomnia severity, worry, and dysfunction. Compared to BT, BT+CW led to a larger decrease in insomnia severity at all three time points (controlled d = 1.10-1.68). In comparison with BT, BT+CW resulted in a larger reduction in worry at two of the time points (controlled d = 0.76-1.64). No significant differences between the two conditions were demonstrated for dysfunction. While more participants responded positively to treatment in the BT+CW (80-100%) than in the BT condition (18-27%), none of the participants remitted. Conclusion: The findings suggest that, compared to behavior therapy alone, constructive worry might result in additional improvements in insomnia severity and worry. Given the small sample size and short follow-up, future studies are warranted. Acknowledgements: We would like to express our appreciation to Mikael Bermås and Andreas Kjellén for collaboration on recruiting the participants.