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A Sleep Program to Improve Sleep Quality in People With HIV

Primary Purpose

HIV - Human Immunodeficiency Virus, Insomnia Disorder

Status
Terminated
Phase
Not Applicable
Locations
Canada
Study Type
Interventional
Intervention
Digital cognitive behavioural therapy for insomnia (dCBT-I)
Sponsored by
McGill University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional diagnostic trial for HIV - Human Immunodeficiency Virus focused on measuring HIV - Human Immunodeficiency Virus, digital cognitive behavioural therapy for insomnia (dCBT-I), insomnia, cognitive Impairment, concentration, productivity

Eligibility Criteria

35 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Evidence of insomnia disorder (Sleep Condition Indicator [SCI] ≤ 16)
  • Able to have convenient weekly access to the Internet
  • Stable medical condition
  • Have been on a stable HAART regimen for > 6 months
  • Have not had a change in medications that could potentially interfere with sleep or cognition in the past 4 months.

Exclusion Criteria:

  • Berlin questionnaire score indicating high risk of obstructive sleep apnea
  • Known history of sleep disorders (e.g., narcolepsy, hypersomnia, restless legs syndrome, REM-sleep behavior disorder) which currently require or previously required treatment
  • Ongoing involvement in night shift work
  • Not able to complete the 12 weeks of the sleep intervention due to a scheduling conflict

Sites / Locations

  • Montreal Neurological Institute and Hospital (McGill University)

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Immediate dCBT-I group

Waitlist control group

Arm Description

Digital cognitive behavioural therapy for insomnia (dCBT-I) is a 6 session training program (spanning 6 to 12 weeks) designed to improve sleep. Participants in the immediate dCBT-I group will receive the Sleepio intervention shortly after enrollment.

Participants in the waitlist control group will receive sleep hygiene recommendations from validated online resources for HIV patients (http://www.catie.ca/en/positiveside/winter-2013/sleep-tight) around the time of enrollment. They will start the digital cognitive behavioural therapy for insomnia (dCBT-I) intervention 12-14 weeks after the initial enrollment.

Outcomes

Primary Outcome Measures

Ratio of total sleep time over time in bed
Obtained from the online self-reported sleep diaries aggregated over 7 days, completed at study entry and again at 12 weeks

Secondary Outcome Measures

Insomnia Severity as assessed by the Insomnia Severity Index
Obtained from the online self-reported questionnaire completed at study entry and again at 12 weeks
Cognitive performance as assessed by the Brief Cognitive Ability Measure (B-CAM)
Ruler-like measure of cognitive ability combining self-report and performance items
Anxiety and Depression symptoms as assessed by the Hospital Anxiety Depression Scale
Questionnaire
Quality of life as assessed by the WHO-QOL-HIV
Questionnaire
Quality of life as assessed by the EQ-5D
Questionnaire

Full Information

First Posted
August 25, 2015
Last Updated
August 11, 2020
Sponsor
McGill University
Collaborators
Sleepio
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1. Study Identification

Unique Protocol Identification Number
NCT02571595
Brief Title
A Sleep Program to Improve Sleep Quality in People With HIV
Official Title
Efficacy Potential of an Internet-based Sleep Program to Improve Sleep Quality in People With HIV
Study Type
Interventional

2. Study Status

Record Verification Date
August 2020
Overall Recruitment Status
Terminated
Study Start Date
May 2015 (undefined)
Primary Completion Date
August 2020 (Actual)
Study Completion Date
August 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
McGill University
Collaborators
Sleepio

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
Sleep problems, such as insomnia, are more frequent and intense in individuals living with HIV. These sleep difficulties can increase the difficulties in thinking and concentrating. Digital cognitive behavioral therapy for insomnia (dCBT-I) is a computer-based treatment intervention that provides strategies to improve sleep. This intervention has been shown to improve sleep and daytime function (concentration, productivity) in people with insomnia. However, the effects of this intervention in people living with HIV are unknown.
Detailed Description
Sleep disturbances have been consistently reported in HIV+ individuals, and occur early in the course of infection. Among disorders of sleep commonly found in HIV, insomnia is by far the most frequent condition, affecting almost 75% of HIV-infected individuals. Compared to non-infected individuals, HIV+ patients are 17% more likely to develop insomnia. Furthermore, not only is insomnia more frequent in HIV; it is also more severe in HIV+ compared to HIV- individuals. The precise mechanisms underlying the vulnerability of this population to insomnia still remain hypothetical, and might involve neurodegenerative processes related to the infection, associated mood disorders (e.g., depression, anxiety), side effects of antiretroviral medications, and psychosocial factors. Importantly, sleep disorders in HIV have been demonstrated to affect the severity of the infection. For instance, sleep disturbances were shown to mediate the association between psychological distress and immune status (T-cytotoxic/suppressor cell counts). In addition, sleep disruption also affects responses to treatment, as illustrated by a report demonstrating that sleep disturbances mediate the association between medication adherence and self-reported HIV symptom severity. Finally, insomnia in HIV seems to be closely associated with the presence of cognitive disturbances. Indeed, virtually all HIV infected individuals with cognitive impairment present insomnia complaints, and greater sleep disturbances were associated with worse cognitive performance (e.g., executive functions, psychomotor speed) in this population. Therefore, insomnia has been shown to affect symptom severity, treatment adherence and cognition in HIV+ individuals. Despite this demonstrated importance of sleep for the well-being of HIV patients, there are very few studies of sleep treatment interventions in HIV. Two studies have implemented an educational intervention promoting healthy sleep habits (e.g., healthy diet, reduced caffeine consumption, no exercise before bedtime, regular sleep-wake schedules), consisting of either one single session or 10 weekly sessions, with little or no consistent sleep improvement in this population. This is not surprising given that previous studies showed the very limited efficacy of interventions focusing solely on sleep hygiene in a general chronic insomnia population. The most effective treatment for chronic insomnia currently consists of a multimodal psychological intervention, called cognitive-behavioral therapy for insomnia (CBT-I). CBT-I improves sleep to the same degree as hypnotic medications in the short term, but, in contrast to hypnotics, shows no side effects and remains effective in the long term, with sustained improvement in sleep and daytime functioning up to 2 years after completion of the therapy. CBT-I has proven effective in patients with primary insomnia (i.e. without associated medical condition), as well as in insomnia comorbid with depression or cancer. However, the efficacy of CBT-I has not been studied in HIV+ individuals with insomnia. Digital Cognitive-Behavioural Therapy for Insomnia (CBT-I): the Sleepio program CBT-I is an intervention aimed at breaking the patterns of maladaptive thinking and behavior that serve to maintain insomnia. It includes a range of techniques including a behavioral component (stimulus control, sleep restriction, relaxation) combined with a cognitive (managing sleep related worries, the racing mind and intrusive thoughts) and an educational (sleep hygiene) component. CBT-I is usually dispensed in group sessions, including 5 to 8 patients and a trained therapist. The different components of CBT-I are then covered in 6 to 8 weekly sessions of 60-90 minutes each. While CBT-I has been demonstrated as an efficacious treatment option, the personnel-intensive nature of CBT-I constitutes an important barrier to widespread clinical use. Web-based (digital) CBT-I has been developed to overcome this barrier. Two randomized controlled trials (RCT) have evaluated separate digital CBT-I (dCBT-I) applications. In a first study, a six-week wait-list controlled trial of self-help dCBT-I was tested via a simple web-based platform delivering CBT-I content. Insomnia improvement was significantly better in the dCBT-I group when compared to wait-list control, at 4 weeks follow-up. In addition, 48 weeks following the intervention, within-subjects improvements in insomnia severity were also observed. The second RCT of CBT-I included a six-week placebo-controlled dCBT-I intervention, using a media rich, interactive application with an online discussion forum for users. This platform, named Sleepio (www.sleepio.com), allowed users to receive weekly, interactive sessions with an online virtual therapist. That RCT showed large effects on sleep efficiency (d=1.00) and insomnia severity (using the Sleep Condition Indicator (SCI) scale, d= .77), relative to the placebo control, at 8 week follow-up. Overall more than 75% of patients responded to the intervention, as defined by the recovery of healthy sleep efficiency levels. In addition, dCBT-I also significantly improved daytime function, including self-reported assessment of concentration and productivity, thereby suggesting a potential benefit of CBT-I for cognitive functions. The current intervention sub-study will test the Sleepio dCBT-I intervention in people with HIV. Free access will be provided to the Sleepio program. The program will be delivered entirely online, in 6 weekly sessions spread over 6-12 weeks. The CBT-I sessions will be delivered by an animated virtual therapist, "The Prof". At the start of therapy, participants will complete a short questionnaire, which will be used to suggest examples of goals. Participants will be encouraged to complete a daily sleep diary online throughout the entire course, which will be used to provide personalized help. Indeed, all interactions with the virtual therapist will be dynamically driven by information from daily sleep diaries completed by the user, to provide baseline, adherence, performance and progress data; sleep diary information will also be used to tailor sleep restriction schedules as a function of to the patients' usual bedtimes. Within each therapy session, sleep diary data will be reviewed, goals will be reviewed and new targets will be set. The treatment content will be based on CBT for insomnia manuals and includes the following techniques: psycho-education, goal setting, sleep hygiene, sleep restriction, stimulus control, cognitive restructuring, paradoxical intention, mindfulness, positive imagery, relaxation (progressive muscle relaxation & autogenic training), putting the day to rest, thought stopping. Participants will be encouraged to select an appointment time for the Sleepio session and will be prompted via email if they do not attend. In addition, participants will receive an email reminder each morning to prompt them to fill in their sleep diary and will have access to a moderated online community and an online library of information about sleep throughout the course of the intervention. They will be able to view their online 'case file' which includes four sections: a progress review, a reminder of strategies to try out in between sessions, an agreed sleep schedule and a list of further reading. In addition to the Sleepio program, participants will be asked to complete a short set of questionnaires assessing mood, quality of life, cognitive symptoms and sleep quality via an online link prior at the start and end of the program, and at their next routine (main study) follow-up visit.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
HIV - Human Immunodeficiency Virus, Insomnia Disorder
Keywords
HIV - Human Immunodeficiency Virus, digital cognitive behavioural therapy for insomnia (dCBT-I), insomnia, cognitive Impairment, concentration, productivity

7. Study Design

Primary Purpose
Diagnostic
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
Participant
Allocation
Randomized
Enrollment
27 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Immediate dCBT-I group
Arm Type
Experimental
Arm Description
Digital cognitive behavioural therapy for insomnia (dCBT-I) is a 6 session training program (spanning 6 to 12 weeks) designed to improve sleep. Participants in the immediate dCBT-I group will receive the Sleepio intervention shortly after enrollment.
Arm Title
Waitlist control group
Arm Type
Experimental
Arm Description
Participants in the waitlist control group will receive sleep hygiene recommendations from validated online resources for HIV patients (http://www.catie.ca/en/positiveside/winter-2013/sleep-tight) around the time of enrollment. They will start the digital cognitive behavioural therapy for insomnia (dCBT-I) intervention 12-14 weeks after the initial enrollment.
Intervention Type
Behavioral
Intervention Name(s)
Digital cognitive behavioural therapy for insomnia (dCBT-I)
Other Intervention Name(s)
Sleepio
Intervention Description
dCBT-I is a computer-based treatment intervention that provides strategies to improve sleep and daytime function (concentration, productivity) in individuals with insomnia
Primary Outcome Measure Information:
Title
Ratio of total sleep time over time in bed
Description
Obtained from the online self-reported sleep diaries aggregated over 7 days, completed at study entry and again at 12 weeks
Time Frame
12 weeks
Secondary Outcome Measure Information:
Title
Insomnia Severity as assessed by the Insomnia Severity Index
Description
Obtained from the online self-reported questionnaire completed at study entry and again at 12 weeks
Time Frame
12 weeks
Title
Cognitive performance as assessed by the Brief Cognitive Ability Measure (B-CAM)
Description
Ruler-like measure of cognitive ability combining self-report and performance items
Time Frame
9 months
Title
Anxiety and Depression symptoms as assessed by the Hospital Anxiety Depression Scale
Description
Questionnaire
Time Frame
9 months
Title
Quality of life as assessed by the WHO-QOL-HIV
Description
Questionnaire
Time Frame
9 months
Title
Quality of life as assessed by the EQ-5D
Description
Questionnaire
Time Frame
9 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
35 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Evidence of insomnia disorder (Sleep Condition Indicator [SCI] ≤ 16) Able to have convenient weekly access to the Internet Stable medical condition Have been on a stable HAART regimen for > 6 months Have not had a change in medications that could potentially interfere with sleep or cognition in the past 4 months. Exclusion Criteria: Berlin questionnaire score indicating high risk of obstructive sleep apnea Known history of sleep disorders (e.g., narcolepsy, hypersomnia, restless legs syndrome, REM-sleep behavior disorder) which currently require or previously required treatment Ongoing involvement in night shift work Not able to complete the 12 weeks of the sleep intervention due to a scheduling conflict
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Lesley K Fellows, MD, DPhil
Organizational Affiliation
McGill University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Montreal Neurological Institute and Hospital (McGill University)
City
Montreal
State/Province
Quebec
ZIP/Postal Code
H3A 2B4
Country
Canada

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Fully anonymized individual data may be requested from the investigators.
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A Sleep Program to Improve Sleep Quality in People With HIV

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