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Clinical characteristics, comorbidities, and response to treatment of veterans with obstructive sleep apnea, cincinnati veterans
Samson P, Casey KR, Knepler J, Panos RJ.
University in St. Louis School of Medicine, St. Louis, Missouri. At the time of this study, Ms Samson was affiliated with the Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio.
Prev Chronic Dis. 2012 Jan;9(1):E46. Epub 2012 Jan 26.INTRODUCTION:
Obstructive sleep apnea (OSA) is a common disorder that is associated with significant morbidity. Veterans may be at an elevated risk for OSA because of increased prevalence of factors associated with the development and progression of OSA. The objective of this study was to determine the clinical characteristics, comorbidities, polysomnographic findings, and response to treatment of veterans with OSA.METHODS:
We performed a retrospective chart review of 596 patients undergoing polysomnography at the Cincinnati Veterans Affairs Medical Center from February 2005 through December 2007. We assessed potential correlations of clinical data with polysomnography findings and response to treatment.RESULTS:
Polysomnography demonstrated OSA in 76% of patients; 30% had mild OSA, 23% moderate OSA, and 47% severe OSA. Increasing body mass index, neck circumference, Epworth Sleepiness Scale score, hypertension, congestive heart failure, and type 2 diabetes correlated with increasing OSA severity. Positive airway pressure treatment was initiated in 81% of veterans with OSA, but only 59% reported good adherence to this treatment method. Of the patients reporting good adherence, a greater proportion of those with severe OSA (27%) than with mild or moderate disease (0%-12%) reported an excellent response to treatment.CONCLUSION:
The prevalence of metabolic and cardiovascular comorbidities increased with increasing OSA severity. Only 59% of treated patients reported good adherence to treatment with positive airway pressure, and response to treatment correlated with OSA severity.
Samson P, Casey KR, Knepler J, Panos RJ.
University in St. Louis School of Medicine, St. Louis, Missouri. At the time of this study, Ms Samson was affiliated with the Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio.
Prev Chronic Dis. 2012 Jan;9(1):E46. Epub 2012 Jan 26.INTRODUCTION:
Obstructive sleep apnea (OSA) is a common disorder that is associated with significant morbidity. Veterans may be at an elevated risk for OSA because of increased prevalence of factors associated with the development and progression of OSA. The objective of this study was to determine the clinical characteristics, comorbidities, polysomnographic findings, and response to treatment of veterans with OSA.METHODS:
We performed a retrospective chart review of 596 patients undergoing polysomnography at the Cincinnati Veterans Affairs Medical Center from February 2005 through December 2007. -
Birth order and narcolepsy risk among genetically susceptible individuals: A population-based case-control study
Watson NF, Ton TG, Koepsell TD, Longstreth WT Jr.
Sleep Center, Harborview Medical Center, 325 Ninth Ave, Seattle, WA 98104, United States; Department of Neurology, University of Washington Medical Center, 1959 NE Pacific, Seattle, WA 98195, United States; Neuroepidemiology Research Group, University of Washington, Seattle, WA, United States.
Sleep Med. 2012 Jan 24. [Epub ahead of print]
BACKGROUND:
Birth order may play a role in autoimmune diseases and early childhood infections, both factors implicated in the etiology of narcolepsy. We investigated the association between birth order and narcolepsy risk in a population-based case-control study in which all study subjects were HLA-DQB1*0602 positive.METHODS:
Subjects were 18-50years old, residents of King County, Washington, and positive for HLA-DQB1*0602. Birth order was obtained from administered interviews. We used logistic regression to generate odds ratios adjusted for income and African American race.RESULTS:
Analyses included 67 cases (mean age 34.3 [SD=9.1], 70.2% female) and 95 controls (mean age 35.1 [SD=8.8], 58.1% female). Associations for birth order were as follows: first born (cases 38.8% vs. controls 50.2%, OR=1.0; reference), second born (cases 29.9% vs. controls 32.9%, OR=1.6; 95% CI 0.7, 3.7), and third born or higher (cases 31.3% vs. controls 16.8%, OR=2.5; 95% CI 1.0, 6.0). A linear trend was significant (p<0.05). Sibling number, sibling gender, having children, and number of children did not differ significantly between narcolepsy cases and controls.CONCLUSIONS:
Narcolepsy risk was significantly associated with higher birth order in this population-based study of genetically susceptible individuals. This finding supports an environmental influence on narcolepsy risk through an autoimmune mechanism, early childhood infections, or both.Copyright © 2011 Elsevier B.V. All rights reserved.
Watson NF, Ton TG, Koepsell TD, Longstreth WT Jr.
Sleep Center, Harborview Medical Center, 325 Ninth Ave, Seattle, WA 98104, United States; Department of Neurology, University of Washington Medical Center, 1959 NE Pacific, Seattle, WA 98195, United States; Neuroepidemiology Research Group, University of Washington, Seattle, WA, United States.
Sleep Med. 2012 Jan 24. [Epub ahead of print]
BACKGROUND:
Birth order may play a role in autoimmune diseases and early childhood infections, both factors implicated in the etiology of narcolepsy. We investigated the association between birth order and narcolepsy risk in a population-based case-control study in which all study subjects were HLA-DQB1*0602 positive.METHODS:
Subjects were 18-50years old, residents of King County, Washington, and positive for HLA-DQB1*0602. Birth order was obtained from administered interviews. -
Efficacy and safety of dopamine agonists in restless legs syndrome
Hornyak M, Trenkwalder C, Kohnen R, Scholz H.
Interdisciplinary Pain Centre, University Medical Centre, Breisacher Strasse 64, 79106 Freiburg, Germany.
Sleep Med. 2012 Jan 24. [Epub ahead of print]
OBJECTIVE:
Restless legs syndrome (RLS) is a common neurological disorder causing considerable impairment to daily living. This article is an overview of a comprehensive Cochrane meta-analysis on the efficacy and safety of dopamine agonists (DAs), the first-line treatment of RLS.METHODS:
CENTRAL, MEDLINE, EMBASE, PsycINFO, and CINAHL databases were searched for double-blind randomized controlled trials (RCTs) of DAs vs placebo.RESULTS:
Thirty-five placebo-controlled RCTs (total number of patients=6954) were eligible. The likelihood of bias was considered to be low. The mean treatment duration of the RCTs was 10.3 (standard deviation 7.3) weeks, with treatment durations up to seven months. Overall, DAs showed a moderate improvement in the International RLS Severity Scale score (mean difference -5.7 points [95% confidence interval, CI, -6.7 to -4.7; P<0.00001]) and the Clinical Global Impression-Improvement response (risk ratio 1.44 [95% CI 1.34-1.54; P<0.00001]) compared with placebo. Periodic limb movements decreased by -22.38/h (95% CI -27.8 to -16.9; P<0.00001) for DAs compared with placebo. Sleep quality and disease-specific quality of life increased slightly to moderately. Safety data confirmed the established safety characteristics of DAs. Augmentation, a specific side-effect of dopaminergic treatment of RLS, was not assessed adequately.CONCLUSIONS:
This meta-analysis showed that DAs have moderate efficacy in the treatment of RLS. Actively controlled and long-term studies are still lacking. Large-scale comparative studies are needed to identify the most efficient treatments for this chronic disorder.Copyright © 2011 Elsevier B.V. All rights reserved.
Hornyak M, Trenkwalder C, Kohnen R, Scholz H.
Interdisciplinary Pain Centre, University Medical Centre, Breisacher Strasse 64, 79106 Freiburg, Germany.
Sleep Med. 2012 Jan 24. [Epub ahead of print]
OBJECTIVE:
Restless legs syndrome (RLS) is a common neurological disorder causing considerable impairment to daily living. This article is an overview of a comprehensive Cochrane meta-analysis on the efficacy and safety of dopamine agonists (DAs), the first-line treatment of RLS.METHODS:
CENTRAL, MEDLINE, EMBASE, PsycINFO, and CINAHL databases were searched for double-blind randomized controlled trials (RCTs) of DAs vs placebo.RESULTS:
Thirty-five placebo-controlled RCTs (total number of patients=6954) were eligible. The likelihood of bias was considered to be low. The mean treatment duration of the RCTs was 10.3 (standard deviation 7.3) weeks, with treatment durations up to seven months. -
Breakthrough symptoms during the daytime in patients with restless legs syndrome (Willis-Ekbom disease)
Tzonova D, Larrosa O, Calvo E, Granizo JJ, Williams AM, de la Llave Y, García-Borreguero D.
Sleep Research Institute, Madrid, Spain.
Sleep Med. 2012 Jan 24. [Epub ahead of print]
BACKGROUND:
It is often assumed that most patients with restless legs syndrome (RLS) only experience symptoms at night. However, previous studies have estimated the prevalence of daytime symptoms to be 10-60%. This study sought to investigate the prevalence and pattern of daytime symptoms in patients with moderate-to-severe RLS.METHODS:
Observational, cross-sectional investigation. A self-administered questionnaire was sent out, on a random basis, to 310 patients with RLS by the Spanish RLS patient support group. Only individuals with a confirmed diagnosis of RLS were included in the final survey.RESULTS:
In total, 224 individuals were included in the survey (response rate 72%). Over 55% of patients reported daytime crises on most (>3) days of the week, and 41% suffered daytime symptoms on a daily basis. These breakthrough crises were characterized by unexpected and sudden symptoms and were frequently precipitated by a reduction in daytime activity. The mean severity of these crises on a visual analogue scale (range 0-10) was 6.8 (standard deviation 2.1), and they had a major impact on quality of life. The prevalence of breakthrough crises was related to duration of illness but not to duration of treatment.CONCLUSION:
This study suggests that breakthrough crises are common in moderate-to-severe RLS and have a negative effect on quality of life. More studies are needed to investigate whether breakthrough crises reflect disease progression or, at least for those patients undergoing dopaminergic treatment, whether they represent an early indication of RLS augmentation.Copyright © 2011 Elsevier B.V. All rights reserved.
Tzonova D, Larrosa O, Calvo E, Granizo JJ, Williams AM, de la Llave Y, García-Borreguero D.
Sleep Research Institute, Madrid, Spain.
Sleep Med. 2012 Jan 24. [Epub ahead of print]
BACKGROUND:
It is often assumed that most patients with restless legs syndrome (RLS) only experience symptoms at night. However, previous studies have estimated the prevalence of daytime symptoms to be 10-60%. This study sought to investigate the prevalence and pattern of daytime symptoms in patients with moderate-to-severe RLS.METHODS:
Observational, cross-sectional investigation. A self-administered questionnaire was sent out, on a random basis, to 310 patients with RLS by the Spanish RLS patient support group. Only individuals with a confirmed diagnosis of RLS were included in the final survey.RESULTS:
In total, 224 individuals were included in the survey (response rate 72%). -
Obesity, diabetes and OSAS induce of sleep disorders: exercise as therapy
Alves ES, Lira FS, Santos RV, Tufik S, de Mello MT.
Departamento de Psicobiologia, Universidade Federal de São Paulo, Brazil.
Lipids Health Dis. 2011 Aug 23;10:148.
Abstract
Sleep is an integral part of good health. Sleep disorders and variations in sleep habits are associated with a low-grade inflammatory status, which may be either a cause or consequence of other conditions, including obesity, diabetes and cardiovascular disease. Several strategies are available to counteract these conditions including continuous positive airway pressure (CPAP), pharmacological and nutritional interventions, and even surgery. At present, our group is investigating the effect of chronic endurance exercise on sleep alterations.
Alves ES, Lira FS, Santos RV, Tufik S, de Mello MT.
Departamento de Psicobiologia, Universidade Federal de São Paulo, Brazil.
Lipids Health Dis. 2011 Aug 23;10:148.
Abstract
Sleep is an integral part of good health. Sleep disorders and variations in sleep habits are associated with a low-grade inflammatory status, which may be either a cause or consequence of other conditions, including obesity, diabetes and cardiovascular disease. Several strategies are available to counteract these conditions including continuous positive airway pressure (CPAP), pharmacological and nutritional interventions, and even surgery. At present, our group is investigating the effect of chronic endurance exercise on sleep alterations. -
Does inadequate sleep play a role in vulnerability to obesity?
Knutson KL.
Section of Pulmonary/Critical Care, Department of Medicine, University of Chicago, 5841 S Maryland Ave MC 6076, Chicago, Illinois 60622. kknutson@medicine.bsd.uchicago.edu.
Am J Hum Biol. 2012 Jan 24. doi: 10.1002/ajhb.22219. [Epub ahead of print]
Abstract
The prevalence of obesity is increasing rapidly worldwide, which is cause for concern because obesity increases the risk of cardiovascular disease and diabetes, reduces life expectancy, and impairs quality of life. A better understanding of the risk factors for obesity is therefore a critical global health concern, and human biologists can play an important role in identifying these risk factors in various populations. The objective of this review is to present the evidence that inadequate sleep may be a novel risk factor associated with increased vulnerability to obesity and associated cardiometabolic disease. Experimental studies have found that short-term sleep restriction is associated with impaired glucose metabolism, dysregulation of appetite, and increased blood pressure. Observational studies have observed cross-sectional associations between short sleep duration (generally <6 h per night) and increased body mass index or obesity, prevalent diabetes, and prevalent hypertension. Some studies also reported an association between self-reported long sleep duration (generally >8 h per night) and cardiometabolic disease. A few prospective studies have found a significant increased risk of weight gain, incident diabetes, and incident hypertension associated with inadequate sleep. Given the potential link between inadequate sleep and obesity, a critical next step is to identify the social, cultural, and environmental determinants of sleep, which would help to identify vulnerable populations. Future human biology research should consider variation in sleep characteristics among different populations and determine whether the associations between sleep and obesity observed in Western populations persist elsewhere. © 2012 Wiley Periodicals, Inc.
Knutson KL.
Section of Pulmonary/Critical Care, Department of Medicine, University of Chicago, 5841 S Maryland Ave MC 6076, Chicago, Illinois 60622. kknutson@medicine.bsd.uchicago.edu.
Am J Hum Biol. 2012 Jan 24. doi: 10.1002/ajhb.22219. [Epub ahead of print]
Abstract
The prevalence of obesity is increasing rapidly worldwide, which is cause for concern because obesity increases the risk of cardiovascular disease and diabetes, reduces life expectancy, and impairs quality of life. A better understanding of the risk factors for obesity is therefore a critical global health concern, and human biologists can play an important role in identifying these risk factors in various populations. The objective of this review is to present the evidence that inadequate sleep may be a novel risk factor associated with increased vulnerability to obesity and associated cardiometabolic disease. -
Excessive daytime sleepiness and vascular events: The Three City Study
Blachier M, Dauvilliers Y, Jaussent I, Helmer C, Ritchie K, Jouven X, Tzourio C, Amouyel P, Besset A, Ducimetiere P, Empana JP.
Paris Cardiovascular Research Centre (PARCC), University Paris Descartes, Sorbonne Paris Cité, UMR-S970, Paris, France.
Ann Neurol. 2011 Oct 31. doi: 10.1002/ana.22656. [Epub ahead of print]
OBJECTIVE:
We assessed whether excessive daytime sleepiness (EDS) at baseline was associated with subsequent coronary heart disease (CHD) and stroke events.METHODS:
The Three City Study, a French population-based multicenter prospective study, included 7,007 subjects aged ≥65 years with no personal history of CHD, stroke, or dementia, and self-rated EDS as never, rare, regular, or frequent in response to a face-to-face questionnaire. Hazard ratios (HRs) for the first episode of stroke and CHD over 6 years were estimated using a Cox proportional hazards model with age as the time scale.RESULTS:
The mean age of the cohort was 73.7 years (standard deviation, 5.37), 63% were women, and 13.3% and 4.3% reported regular and frequent EDS, respectively. After a median follow-up period of 5.1 years, 372 subjects experienced a first event, either stroke (122 subjects) or a CHD event (250 subjects). The increased risk of CHD and stroke was confined to the group with frequent EDS, and was 1.73× as much as in the group that reported never having EDS (HR, 1.73; 95% confidence interval [CI], 1.15-2.60), after adjustment for confounding and mediating factors. This association was seen in those without hypertension but not in those with hypertension at baseline (p for interaction = 0.01). Moreover, the association with frequent EDS was statistically significant for stroke (HR, 2.10; 95% CI, 1.13-3.89) but not for CHD (HR, 1.51; 95% CI, 0.87-2.61).INTERPRETATION:
The current study suggests that frequent EDS is independently associated with future vascular events and stroke in particular in healthy community-dwelling elderly subjects. ANN NEUROL 2011.Copyright © 2011 American Neurological Association.
Blachier M, Dauvilliers Y, Jaussent I, Helmer C, Ritchie K, Jouven X, Tzourio C, Amouyel P, Besset A, Ducimetiere P, Empana JP.
Paris Cardiovascular Research Centre (PARCC), University Paris Descartes, Sorbonne Paris Cité, UMR-S970, Paris, France.
Ann Neurol. 2011 Oct 31. doi: 10.1002/ana.22656. [Epub ahead of print]
OBJECTIVE:
We assessed whether excessive daytime sleepiness (EDS) at baseline was associated with subsequent coronary heart disease (CHD) and stroke events.METHODS:
The Three City Study, a French population-based multicenter prospective study, included 7,007 subjects aged ≥65 years with no personal history of CHD, stroke, or dementia, and self-rated EDS as never, rare, regular, or frequent in response to a face-to-face questionnaire. Hazard ratios (HRs) for the first episode of stroke and CHD over 6 years were estimated using a Cox proportional hazards model with age as the time scale. -
Residual sleepiness in obstructive sleep apnoea: phenotype and related symptoms
Vernet C, Redolfi S, Attali V, Konofal E, Brion A, Frija-Orvoen E, Pottier M, Similowski T, Arnulf I.
Sleep Disorders Unit, UMR 975, National Reference Centre for Narcolepsy and Hypersomnia, Paris, France.
Eur Respir J. 2011 Jul;38(1):98-105. Epub 2011 Mar 15.
Abstract
The characteristics of residual excessive sleepiness (RES), defined by an Epworth score >10 in adequately treated apnoeic patients, are unknown. 40 apnoeic patients, with (n = 20) and without (n = 20) RES, and 20 healthy controls underwent clinical interviews, cognitive and biological tests, polysomnography, a multiple sleep latency test, and 24-h sleep monitoring. The marked subjective sleepiness in the RES group (mean ± sd score 16.4 ± 3) contrasted with moderately abnormal objective measures of sleepiness (90% of patients with RES had daytime sleep latencies >8 min). Compared with patients without RES, the patients with RES had more fatigue, lower stage N3 percentages, more periodic leg movements (without arousals), lower mean sleep latencies and longer daytime sleep periods. Most neuropsychological dimensions (morning headaches, memory complaints, spatial memory, inattention, apathy, depression, anxiety and lack of self-confidence) were not different between patients with and without RES, but gradually altered from controls to apnoeic patients without and then with RES. RES in apnoeic patients differs markedly from sleepiness in central hypersomnia. The association between RES, periodic leg movements, apathy and depressive mood parallels the post-hypoxic lesions in noradrenaline, dopamine and serotonin systems in animals exposed to intermittent hypoxia.
Vernet C, Redolfi S, Attali V, Konofal E, Brion A, Frija-Orvoen E, Pottier M, Similowski T, Arnulf I.
Sleep Disorders Unit, UMR 975, National Reference Centre for Narcolepsy and Hypersomnia, Paris, France.
Eur Respir J. 2011 Jul;38(1):98-105. Epub 2011 Mar 15.
Abstract
The characteristics of residual excessive sleepiness (RES), defined by an Epworth score >10 in adequately treated apnoeic patients, are unknown. 40 apnoeic patients, with (n = 20) and without (n = 20) RES, and 20 healthy controls underwent clinical interviews, cognitive and biological tests, polysomnography, a multiple sleep latency test, and 24-h sleep monitoring. The marked subjective sleepiness in the RES group (mean ± sd score 16.4 ± 3) contrasted with moderately abnormal objective measures of sleepiness (90% of patients with RES had daytime sleep latencies >8 min). -
Effects of 8 weeks of CPAP on abdominal adiposity in obstructive sleep apnoea.
Sivam S, Phillips CL, Trenell MI, Yee BJ, Liu PY, Wong KK, Grunstein RR.
Woolcock Institute of Medical Research, PO Box M77, Missenden Road, NSW 2050, Australia.
Eur Respir J. 2012 Jan 20. [Epub ahead of print]
Abstract
To investigate the effect of Continuous Positive Airway Pressure treatment on regional adipose tissue distribution in patients with moderate or severe obstructive sleep apnoea.Patients received both therapeutic and sham CPAP in random order for 2 months each with an intervening one month washout. Abdominal subcutaneous, visceral and liver fat were quantified using magnetic resonance imaging (MRI) and spectroscopy (MRS). Liver enzymes and plasma glucose were also determined. Measurements were obtained at baseline and at the end of both treatment arms.38 eligible patients were randomly assigned to a treatment order with 27 patients having complete MRI/MRS data. No significant difference was observed in subcutaneous (-28.6 cm(3), p=0.49) and visceral adipose tissue (-16.8 cm(3), p=0.59), intra-hepatic lipid (-0.2(% ), p=0.21) and fasting glucose measurements (-0.1 mmol·L(-1), p=0.46) between treatment modalities. Alkaline phosphatase decreased (-3.1 U·L(-1), p=0.02) while on therapeutic CPAP compared with sham CPAP but other liver enzymes including aspartate aminotransferase (0.3 U·L(-1), p=0.82), alanine aminotransferase (1.34 U·L(-1), p=0.59) and gamma-glutamyltransferase (-2.3 U·L(-1), p=0.33) remained unchanged.In this first randomized sham controlled trial, there was no change in adipose tissue distribution after 8 weeks of therapeutic CPAP compared with 8 weeks of sham CPAP. Longer duration of CPAP use may be necessary to demonstrate a difference.
Sivam S, Phillips CL, Trenell MI, Yee BJ, Liu PY, Wong KK, Grunstein RR.
Woolcock Institute of Medical Research, PO Box M77, Missenden Road, NSW 2050, Australia.
Eur Respir J. 2012 Jan 20. [Epub ahead of print]
Abstract
To investigate the effect of Continuous Positive Airway Pressure treatment on regional adipose tissue distribution in patients with moderate or severe obstructive sleep apnoea.Patients received both therapeutic and sham CPAP in random order for 2 months each with an intervening one month washout. Abdominal subcutaneous, visceral and liver fat were quantified using magnetic resonance imaging (MRI) and spectroscopy (MRS). Liver enzymes and plasma glucose were also determined. Measurements were obtained at baseline and at the end of both treatment arms.38 eligible patients were randomly assigned to a treatment order with 27 patients having complete MRI/MRS data. No significant difference was observed in subcutaneous (-28. -
Efficacy of a behavioral self-help treatment with or without therapist guidance for co-morbid and primary insomnia - a randomize
Jernelov S, Lekander M, Blom K, Rydh S, Ljotsson B, Axelsson J, Kaldo V.
BMC Psychiatry. 2012 Jan 22;12(1):5. [Epub ahead of print]
BACKGROUND:
Cognitive behavioral therapy is treatment of choice for insomnia, but availability is scarce. Self-help can increase availability at low cost, but evidence for its efficacy is limited, especially for the typical insomnia patient with co-morbid problems. We hypothesized that a cognitive behaviorally based self-help book is effective to treat insomnia in individuals, also with co-morbid problems, and that the effect is enhanced by adding brief therapist telephone support.METHODS:
Volunteer sample; 133 media-recruited adults with insomnia. History of sleep difficulties (mean [SD]) 11.8 [12.0] years. 92.5% had co-morbid problems (e.g. allergy, pain, and depression). Parallel randomized (block-randomization, n>21) controlled "open label" trial; three groups - bibliotherapy with (n=44) and without (n=45) therapist support, and waiting list control (n=44). Assessments before and after treatment, and at three-month follow-up. Intervention was six weeks of bibliotherapeutic self-help, with established cognitive behavioral methods including sleep restriction, stimulus control, and cognitive restructuring. Therapist support was a 15-minute structured telephone call scheduled weekly. Main outcome measures were sleep diary data, and the Insomnia Severity Index.RESULTS:
Intention-to-treat analyses of 133 participants showed significant improvements in both self-help groups from pre to post treatment compared to waiting list. For example, treatment with and without support gave shorter sleep onset latency (improvement minutes [95% Confidence Interval], 35.4 [24.2 to 46.6], and 20.6 [10.6 to 30.6] respectively), and support gave a higher remission rate (defined as ISI score below 8; 61.4%), than bibliotherapy alone (24.4%, p's<.001). Improvements were not seen in the control group (sleep onset latency 4.6 minutes shorter [-1.5 to 10.7], and remission rate 2.3%). Self-help groups maintained gains at three-month follow-up.CONCLUSIONS:
Participants receiving self-help for insomnia benefited markedly. Self-help, especially if therapist-supported, has considerable potential to be as effective as individual treatment at lower cost, also for individuals with co-morbid problems. Trial registration ClinicalTrials.gov, NCT01105052.
Jernelov S, Lekander M, Blom K, Rydh S, Ljotsson B, Axelsson J, Kaldo V.
BMC Psychiatry. 2012 Jan 22;12(1):5. [Epub ahead of print]
BACKGROUND:
Cognitive behavioral therapy is treatment of choice for insomnia, but availability is scarce. Self-help can increase availability at low cost, but evidence for its efficacy is limited, especially for the typical insomnia patient with co-morbid problems. We hypothesized that a cognitive behaviorally based self-help book is effective to treat insomnia in individuals, also with co-morbid problems, and that the effect is enhanced by adding brief therapist telephone support.METHODS:
Volunteer sample; 133 media-recruited adults with insomnia. History of sleep difficulties (mean [SD]) 11.8 [12.0] years. 92.5% had co-morbid problems (e.g. allergy, pain, and depression).
