OP0295-HPR THE EFFECT OF GROUP-BASED COGNITIVE BEHAVIOURAL THERAPY FOR INSOMNIA IN PATIENTS WITH RHEUMATOID ARTHRITIS: A RANDOMISED CONTROLLED TRIAL

Autor: K. M. Latocha, K. Løppenthin, M. Østergaard, P. Jennum, M. L. Hetland, H. Røgind, T. Lundbak, J. Midtgaard, R. Christensen, B. A. Esbensen
Rok vydání: 2022
Předmět:
Zdroj: Annals of the Rheumatic Diseases. 81:196-197
ISSN: 1468-2060
0003-4967
2562-0673
Popis: BackgroundInsomnia is highly prevalent in patients with rheumatoid arthritis (RA) and may exacerbate symptoms and burdens, such as fatigue, depressive symptoms, and pain1. Cognitive behavioural therapy for insomnia (CBT-I) has been shown to produce positive effects on sleep in other clinical populations2,3. However, CBT-I has not previously been investigated in patients with RA.ObjectivesThe primary objective was to compare the effect of nurse-led group-based CBT-I to usual care on sleep efficiency, measured by polysomnography (PSG) immediately after the intervention (i.e. seven weeks after baseline) in patients with RA. Secondary objectives included comparing the longer-term effect of CBT-I on sleep and RA-related outcomes at 26 weeks’ follow-up.MethodsIn a randomised controlled trial, using a parallel group design, the experimental intervention was six weeks’ CBT-I; the control comparator was usual care. CBT-I was delivered face-to-face by a CBT-I trained nurse. The primary analyses were based on the intention-to-treat (ITT) population; missing data were statistically handled using repeated-measures linear mixed effects models adjusted for the level at baseline.ResultsThe ITT population consisted of 62 patients (89% women), with an average age of 58 years (SD 10), DAS28-CRP of 3.4 (SD 1.0), Insomnia Severity Index (ISI) score of 18.9 (SD 4.4) and median Patient Global Assessment score of 55 (IQR 28;71).When primary outcome was measured by PSG at week seven, sleep efficiency was 88.7% in the CBT-I group, compared to 83.7% in the control group (difference: 5.0 [95% CI -0.4 to 10.4]; p=0.068) (See Table 1). Secondary outcomes measured by PSG had not improved at week 26 either. However, for all secondary sleep and RA-related patient-reported outcomes, there were statistically highly significant differences between CBT-I and usual care e.g. insomnia (ISI: -9.8 [95% CI -11.8 to -7.9]), RA impact of disease (RAID: -1.4 [95% CI-1.9 to -0.80]) and Patient Global Assessment (-13.0 [95% CI -20.9 to -5.1]) at 26 weeks’ follow-up.Table 1.Primary and key secondary outcomes at week 7 and week 26, and differences between treatment groups (based on the ITT population)CBT-I n=31Usual care n=31Difference between groups (95% CI)P-valueAt week 7Sleep efficiency (PSG, %)188.7 (1.8)83.7 (2.0)5.0 (-0.4 to 10.4)0.068At week 26Sleep efficiency (PSG, %)84.8 (1.9)86.3 (2.0)-1.5 (-7.0 to 3.9)0.577Total sleep time (PSG, minutes)376.5 (11.8)394.6 (12.8)-18.1 (-52.5 to 16.4)0.302Sleep onset latency (PSG, minutes)14.2 (2.2)10.0 (2.4)4.2 (-2.2 to 10.7)0.197Wake after sleep onset (PSG, minutes)52.1 (10.7)41.5 (11.6)10.6 (-20.7 to 41.9)0.505Insomnia severity (ISI 0-28)27.6 (0.7)17.4 (0.7)-9.8 (-11.8 to -7.9)Sleep quality global (PSQI 0-21)35.9 (0.5)11.1 (0.5)-5.2 (-6.6 to -3.8)Fatigue (BRAF-MDQ 0-70)424.0 (1.4)36.4 (1.5)-12.4 (-16.5 to -8.4)RA impact of disease (RAID 0-10)54.2 (0.20)5.5 (0.20)-1.4 (-1.9 to -0.80)Depressive symptoms (HADS-D 0-21)63.8 (0.5)6.5 (0.5)-2.7 (-4.1 to -1.3)Values are reported as least squares means (standard errors) by group, while the differences between groups are reported with 95% confidence intervals.1Polysomnography, 2Insomnia Severity Index, 3Pittsburgh Sleep Quality Index, 4Bristol Rheumatoid Arthritis Fatigue - Multidimensional Questionnaire, 5Rheumatoid Arthritis Impact of Disease, 6Hospital Anxiety and Depression Scale - Depression.ConclusionNurse-led, group-based CBT-I for two hours per week for six weeks, did not improve objectively measured sleep efficiency or any other outcomes measured by PSG. However, CBT-I showed long-term improvement on patient-reported outcomes such as fatigue, impact of disease, depression, pain, and Patient Global Assessment – a finding that could have important clinical implications.References[1]PMID: 25620673[2]PMID: 16804151[3]PMID: 26434673AcknowledgementsWe thank the participants for their time and commitment and the patient research partners for valuable insight into the process and content of the trial.Disclosure of InterestsNone declared
Databáze: OpenAIRE
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