Wellness Check: Sleep
Digital cognitive behavioral therapy improves insomnia symptoms in stroke survivors
1. In this randomized controlled trial, patients who received digital cognitive behavioral therapy (dCBT) demonstrated improvements in insomnia symptoms compared to the control group.
2. Although there were also improvements in sleep-onset latency and mood in those who received dCBT, there was no significant improvement in quality of life.
Evidence Rating Level: 1 (Excellent)
Stroke survivors tend to suffer from long-term sleep disruption, negatively impacting their quality of life. Cognitive behavioral therapy (CBT) is often prescribed to treat insomnia, but its role in improving sleep disruption in stroke patients has not been well established. As a result, the objective of the present study was to evaluate the effectiveness of a digital CBT (dCBT) program in improving the sleep of stroke patients.
This randomized controlled trial enlisted 84 participants in the UK between February 2020 and June 2021. Participants were included if they were older than 18 years of age, >3 months post-stroke, and had a desire to improve their sleep. Participants were excluded if they had a severe condition that would affect their participation, had an upcoming surgery scheduled within five months, received psychological treatment for insomnia, were pregnant, had seizures, had untreated obstructive sleep apnea, or engaged in shiftwork. Participants were randomized to either the dCBT intervention or a control group that received information on sleep hygiene. The intervention group completed six weekly dCBT sessions. Insomnia symptoms were determined using the Sleep Condition Indicator-8 (SCI-8). Insomnia symptoms and information on sleep-onset latency, mood, and quality of life were assessed at baseline, at the end of the intervention, and again 8 weeks later. The primary outcome was self-reported insomnia symptoms.
The results demonstrated that patients in the dCBT group experienced significant improvements in insomnia symptoms compared to the control group, as evidenced by improved SCI-8 scores. Furthermore, the dCBT group demonstrated improvements in sleep-onset latency and mood compared to the control group, but there were no differences in other factors, such as quality of life. Despite this, the results were limited by the self-reported nature of stroke symptoms, which limited the ability to investigate differences in stroke characteristics between the treatment and control groups. Nonetheless, the study identified dCBT as a possible therapy for improving insomnia symptoms in stroke survivors.
1. In this retrospective study, it was found that inflammatory bowel disease (IBD) activity was associated with poorer sleep scores in pediatric patients.
2. Furthermore, pediatric patients with IBD demonstrated poorer overall sleep compared to controls, as evidenced by a later sleep time and shorter sleep duration in IBD patients.
Evidence Rating Level: 2 (Good)
Sleep disturbances are common among patients with inflammatory bowel disease (IBD), and there is a well-identified link between sleep disorders and conditions of the gastrointestinal tract. However, the impact of IBD disease activity and sleep disturbances has not been well established, particularly in younger populations. Therefore, the present study aimed to assess the association between disease activity and sleep in pediatric patients with IBD.
The study enlisted 99 (n=44 Crohn’s disease, 55 ulcerative colitis) pediatric patients who were assessed for their IBD between 2015 and 2020 and 80 healthy controls. Patients were included if they were between 6 and 18 years old. Patient medical records were retrospectively reviewed, and the pediatric ulcerative colitis index (PUCAI) and Crohn’s disease activity index (PCDAI) were administered to determine IBD disease activity. The Pittsburgh sleep quality index (PSQI) was administered to all participants to assess sleep quality. The primary outcome was the association between disease activity and sleep quality.
The results demonstrated a strong correlation between IBD disease activity index and PSQI scores for patients with both Crohn’s disease and Ulcerative colitis, suggesting an association between disease activity and poor sleep quality. Furthermore, those in the IBD group demonstrated poorer overall sleep than controls, as evidenced by a later sleep time and shorter sleep duration. The study was limited by its retrospective design, which prevented further analysis of the long-term effects of IBD on sleep disturbance. Nonetheless, the study identified that pediatric patients with IBD may experience poorer sleep quality, which can be worsened by disease activity.
Some sleep problems are associated with multimorbidity
1. In this systematic review and meta-analysis, short sleep duration, long sleep duration, and insomnia were associated with higher odds of multimorbidity.
2. There were also associations between multimorbidity and snoring, obstructive sleep apnea, and restless leg syndrome.
Evidence Rating Level: 1 (Excellent)
It is well known that those who experience sleep problems, including insomnia and obstructive sleep apnea, are more susceptible to chronic health conditions. Multimorbidity is the existence of two or more chronic health conditions in a given individual. Although there is evidence of a link between sleep disturbances and chronic health conditions, the impact of sleep problems on multimorbidity has not been elucidated. Therefore, the present study aimed to investigate the potential association between sleep problems and multimorbidity.
Of 20,902 identified records, 17 studies (n=133,575 participants) published between 2005 and 2021 were included in the review. Observational studies that investigated an association between any sleep problem and multimorbidity were included. Studies were excluded if they investigated sleep problems in children or adolescents. The review was performed using PRISMA guidelines. The study quality was assessed using the Agency for Healthcare Research and Quality and the Newcastle-Ottawa scale. The primary outcome was the association between sleep problems and multimorbidity.
The results demonstrated that there were higher odds of multimorbidity in those with short sleep duration, long sleep duration, and insomnia. There were also associations between multimorbidity and snoring, obstructive sleep apnea, and restless leg syndrome. Despite these findings, the study was limited by the inclusion of primarily cross-sectional studies, which prevented the investigation of the long-term effects of sleep problems on multimorbidity. Nonetheless, the study provided evidence suggesting that sleep problems may negatively impact multimorbidity.
Image: PD
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