Effectiveness of an App-Based Short Intervention to Improve Sleep: Randomized Controlled Trial.
cognitive behavioral treatment for insomnia
eHealth
insomnia
mobile app
sleep
Journal
JMIR mental health
ISSN: 2368-7959
Titre abrégé: JMIR Ment Health
Pays: Canada
ID NLM: 101658926
Informations de publication
Date de publication:
21 Mar 2023
21 Mar 2023
Historique:
received:
30
05
2022
accepted:
30
09
2022
revised:
15
09
2022
entrez:
21
3
2023
pubmed:
22
3
2023
medline:
22
3
2023
Statut:
epublish
Résumé
A growing body of evidence for digital interventions to improve sleep shows promising effects. The interventions investigated so far have been primarily web-based; however, app-based interventions may reach a wider audience and be more suitable for daily use. This study aims to evaluate the intervention effects, adherence, and acceptance of an unguided app-based intervention for individuals who wish to improve their sleep. In a randomized controlled trial, we evaluated the effects of an app-based short intervention (Refresh) to improve sleep compared with a waitlist condition. Refresh is an 8-week unguided intervention covering the principles of cognitive behavioral therapy for insomnia (CBT-I) and including a sleep diary. The primary outcome was sleep quality (insomnia symptoms) as self-assessed by the Regensburg Insomnia Scale (RIS). The secondary outcomes were depression (9-item Patient Health Questionnaire [PHQ-9] score) and perceived insomnia-related impairment. We included 371 participants, of which 245 reported poor sleep at baseline. About 1 in 3 participants who were allocated to the intervention group never accessed the intervention. Active participants completed on average 4 out of 8 chapters. Retention rates were 67.4% (n=250) at postassessment and 57.7% (n=214) at the 6-month follow-up. At postintervention, insomnia symptoms in the intervention group had improved more than those in the waitlist group, with a small effect (d=0.26) in the whole sample and a medium effect (d=0.45) in the subgroup with poor sleep. Effects in the intervention group were maintained at follow-up. Perceived insomnia-related impairment also improved from pre- to postassessment. No significant intervention effect on depression was detected. Working alliance and acceptance were moderate to good. An app-based, unguided intervention is a feasible and effective option to scale-up CBT-I-based treatment, but intervention uptake and adherence need to be carefully addressed. ISRCTN Registry ISRCTN53553517; https://www.isrctn.com/ISRCTN53553517.
Sections du résumé
BACKGROUND
BACKGROUND
A growing body of evidence for digital interventions to improve sleep shows promising effects. The interventions investigated so far have been primarily web-based; however, app-based interventions may reach a wider audience and be more suitable for daily use.
OBJECTIVE
OBJECTIVE
This study aims to evaluate the intervention effects, adherence, and acceptance of an unguided app-based intervention for individuals who wish to improve their sleep.
METHODS
METHODS
In a randomized controlled trial, we evaluated the effects of an app-based short intervention (Refresh) to improve sleep compared with a waitlist condition. Refresh is an 8-week unguided intervention covering the principles of cognitive behavioral therapy for insomnia (CBT-I) and including a sleep diary. The primary outcome was sleep quality (insomnia symptoms) as self-assessed by the Regensburg Insomnia Scale (RIS). The secondary outcomes were depression (9-item Patient Health Questionnaire [PHQ-9] score) and perceived insomnia-related impairment.
RESULTS
RESULTS
We included 371 participants, of which 245 reported poor sleep at baseline. About 1 in 3 participants who were allocated to the intervention group never accessed the intervention. Active participants completed on average 4 out of 8 chapters. Retention rates were 67.4% (n=250) at postassessment and 57.7% (n=214) at the 6-month follow-up. At postintervention, insomnia symptoms in the intervention group had improved more than those in the waitlist group, with a small effect (d=0.26) in the whole sample and a medium effect (d=0.45) in the subgroup with poor sleep. Effects in the intervention group were maintained at follow-up. Perceived insomnia-related impairment also improved from pre- to postassessment. No significant intervention effect on depression was detected. Working alliance and acceptance were moderate to good.
CONCLUSIONS
CONCLUSIONS
An app-based, unguided intervention is a feasible and effective option to scale-up CBT-I-based treatment, but intervention uptake and adherence need to be carefully addressed.
TRIAL REGISTRATION
BACKGROUND
ISRCTN Registry ISRCTN53553517; https://www.isrctn.com/ISRCTN53553517.
Identifiants
pubmed: 36943337
pii: v10i1e39052
doi: 10.2196/39052
pmc: PMC10131838
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e39052Informations de copyright
©Bianka Vollert, Luise Müller, Corinna Jacobi, Mickey Trockel, Ina Beintner. Originally published in JMIR Mental Health (https://mental.jmir.org), 21.03.2023.
Références
Behav Cogn Psychother. 2019 May;47(3):287-302
pubmed: 30185239
J Abnorm Psychol. 2005 Feb;114(1):111-8
pubmed: 15709817
Sleep. 1999 May 1;22 Suppl 2:S354-8
pubmed: 10394607
Arch Intern Med. 2009 Mar 9;169(5):447-53
pubmed: 19273774
J Clin Sleep Med. 2019 Jan 15;15(1):11-13
pubmed: 30621849
Sleep. 2012 Jun 01;35(6):769-81
pubmed: 22654196
J Gen Intern Med. 2001 Sep;16(9):606-13
pubmed: 11556941
Behav Res Ther. 2012 Jan;50(1):22-9
pubmed: 22055281
Sleep. 2006 Sep;29(9):1155-73
pubmed: 17040003
BJPsych Open. 2017 Sep 25;3(5):228-235
pubmed: 28959453
J Biomed Inform. 2009 Apr;42(2):377-81
pubmed: 18929686
J Clin Psychiatry. 2012 Dec;73(12):e1478-84
pubmed: 23290331
J Clin Sleep Med. 2021 Feb 1;17(2):263-298
pubmed: 33164741
Int J Environ Res Public Health. 2021 Dec 24;19(1):
pubmed: 35010445
J Clin Sleep Med. 2019 Jan 15;15(1):101-110
pubmed: 30621837
Neuropsychiatr Dis Treat. 2010 Dec 20;7:1-18
pubmed: 21326650
Hum Neurobiol. 1982;1(3):195-204
pubmed: 7185792
Eur J Prev Cardiol. 2014 Jan;21(1):57-64
pubmed: 22942213
BMC Fam Pract. 2012 May 25;13:40
pubmed: 22631616
J Med Internet Res. 2020 Jan 7;22(1):e13346
pubmed: 31909725
Sleep Med Rev. 2016 Dec;30:1-10
pubmed: 26615572
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2013 May;56(5-6):740-8
pubmed: 23703493
Behav Res Ther. 2007 Mar;45(3):511-21
pubmed: 16759637
Sleep. 2009 Dec;32(12):1549-58
pubmed: 20041590
Hypertens Res. 2013 Nov;36(11):985-95
pubmed: 24005775
Sleep Med Rev. 2009 Feb;13(1):61-71
pubmed: 18952469
Behav Sleep Med. 2016;14(3):235-66
pubmed: 26240937
J Med Internet Res. 2020 Apr 1;22(4):e15841
pubmed: 32234700
Nervenarzt. 2014 Jan;85(1):43-9
pubmed: 24346426
BMC Psychiatry. 2016 Nov 5;16(1):375
pubmed: 27816065
Sleep Med. 2019 Mar;55:124-134
pubmed: 30785053
BMC Public Health. 2012 Jul 28;12:565
pubmed: 22839359
Sleep Med Rev. 2015 Feb;19:17-28
pubmed: 25104471
Sleep Med Rev. 2010 Feb;14(1):69-82
pubmed: 19962922
Int J Med Inform. 2016 Dec;96:71-85
pubmed: 27117057
J Affect Disord. 2004 Jul;81(1):61-6
pubmed: 15183601
World Psychiatry. 2014 Feb;13(1):4-11
pubmed: 24497236
Sleep Med Rev. 2012 Feb;16(1):83-94
pubmed: 21636297
Internet Interv. 2018 Apr 06;12:181-188
pubmed: 30135782
Behav Res Ther. 2013 Dec;51(12):797-805
pubmed: 24121097
JAMA Netw Open. 2020 Nov 2;3(11):e2018782
pubmed: 33156345
Sleep Med Clin. 2019 Sep;14(3):301-315
pubmed: 31375200
Neuropsychopharmacology. 2020 Jan;45(1):21-30
pubmed: 31176308
Gen Hosp Psychiatry. 2007 Sep-Oct;29(5):388-95
pubmed: 17888804
J Clin Psychiatry. 2011 Dec;72(12):1651-8
pubmed: 21457679
J Med Internet Res. 2017 Apr 11;19(4):e70
pubmed: 28400355
Sleep. 2016 Jan 01;39(1):13-4
pubmed: 26564140
World Psychiatry. 2019 Oct;18(3):325-336
pubmed: 31496095
J Gen Intern Med. 2018 Jun;33(6):955-962
pubmed: 29619651
Psychol Med. 2019 Feb;49(3):501-509
pubmed: 29747706
Internet Interv. 2016 Apr 07;4:51-60
pubmed: 30135790
J Clin Sleep Med. 2011 Jun 15;7(3):276-81
pubmed: 21677898
JAMA Psychiatry. 2019 Jan 1;76(1):21-30
pubmed: 30264137
Ann Intern Med. 2016 Jul 19;165(2):125-33
pubmed: 27136449
Sleep. 2009 Jun;32(6):807-15
pubmed: 19544758
JAMA Intern Med. 2015 Sep;175(9):1461-72
pubmed: 26147487
Behav Ther. 2007 Mar;38(1):49-57
pubmed: 17292694
Int J Public Health. 2015 Sep;60(6):643-50
pubmed: 25975374
J Med Internet Res. 2005 Mar 31;7(1):e11
pubmed: 15829473
Am J Manag Care. 2020 Mar;26(4 Suppl):S76-S84
pubmed: 32282177
Sleep. 2019 Oct 9;42(10):
pubmed: 31535688
J Occup Environ Med. 2016 Jul;58(7):683-9
pubmed: 27257747
Sleep Med Clin. 2020 Mar;15(1):71-76
pubmed: 32005351
Behav Sleep Med. 2012;10(2):106-21
pubmed: 22468929
J Adv Nurs. 2005 Jun;50(5):553-64
pubmed: 15882372
Lancet Psychiatry. 2016 Apr;3(4):333-41
pubmed: 26827250
Sleep Med. 2015 Apr;16(4):510-20
pubmed: 25796966
J Clin Sleep Med. 2008 Feb 15;4(1):11-3
pubmed: 18350955
Am J Public Health. 1999 Sep;89(9):1322-7
pubmed: 10474547
J Sleep Res. 2017 Dec;26(6):675-700
pubmed: 28875581
Sleep Med Rev. 2017 Feb;31:58-69
pubmed: 27090821
Behav Sleep Med. 2019 Mar-Apr;17(2):137-155
pubmed: 28345961
Lancet Digit Health. 2020 Aug;2(8):e381-e382
pubmed: 33328041
Sleep. 2008 Apr;31(4):489-95
pubmed: 18457236
Curr Psychiatry Rep. 2019 Jun 4;21(7):50
pubmed: 31161406
Sleep. 2009 Jan;32(1):55-64
pubmed: 19189779
J Clin Sleep Med. 2018 Oct 15;14(10):1783-1790
pubmed: 30353814
Sleep Med Rev. 2016 Dec;30:11-24
pubmed: 26687279
J Affect Disord. 2011 Dec;135(1-3):10-9
pubmed: 21300408
Clin Psychol Psychother. 2010 May-Jun;17(3):231-9
pubmed: 20013760
JAMA Psychiatry. 2017 Jan 01;74(1):68-75
pubmed: 27902836
J Sleep Res. 2020 Apr;29(2):e12967
pubmed: 31856367
Health Qual Life Outcomes. 2013 Apr 22;11:65
pubmed: 23601161
Clin Trials. 2005;2(5):379-86
pubmed: 16315646
Health Psychol. 2006 Jan;25(1):3-14
pubmed: 16448292
Sleep Med. 2007 Apr;8(3):198-208
pubmed: 17368098
Ann Intern Med. 2015 Aug 4;163(3):191-204
pubmed: 26054060
Sleep Med Rev. 2019 Feb;43:96-105
pubmed: 30537570
J Med Internet Res. 2015 Sep 04;17(9):e214
pubmed: 26341671
Sleep Med Rev. 2018 Apr;38:3-16
pubmed: 28392168
PLoS One. 2016 Feb 11;11(2):e0149139
pubmed: 26867139