Unhealthy sleep and cardiometabolic risk are two major public health concerns in emerging Black/African American (BAA) adults. Evidence-based sleep interventions such as cognitive-behavioral therapy for insomnia (CBT-I) are available but not aligned with the needs of this at-risk group. Innovative work on the development of an artificial intelligence sleep chatbot using CBT-I guidelines will provide scalable and efficient sleep interventions for emerging BAA adults.
Abnormal metabolic syndrome (MetS) components affect up to 40% of emerging adults (18-25 years), particularly Black/African Americans (BAA). MetS risk in early life tracks into adulthood and predicts cardiovascular diseases and type 2 diabetes mellitus later in life. Unhealthy sleep is a known modifiable factor for MetS components. However, the prevalence of unhealthy sleep (up to 60%) in emerging adults is alarming, potentially exacerbating downstream future cardiometabolic health. Cognitive-behavioral therapy for insomnia (CBT-I) is an evidence-based intervention for unhealthy sleep that improves both sleep quantity and quality. Compared with traditional in-person intervention paradigms, digital CBT-I has comparable efficacy with enhanced accessibility and affordability. However, current digital CBT-I based programs are unable to deliver tailored content and interactive services in a humanlike way, thus are unable to meet the needs of emerging BAA adults at risk for MetS. Building on prior work by the team, the investigators will leverage artificial intelligence (AI) technologies and refine an AI sleep chatbot using CBT-I guidelines and examine its feasibility and efficacy in a 4-week clinical trial in short-or-poor sleeping, emerging BAA adults with at least one MetS factor.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
26
Personalized intervention algorithms will be developed based on CBT-I guidelines, focus group data, individual sleep baseline information and self-reported prioritized sleep goals. The CBT-I intervention will focus on principles of sleep restriction and stimulus control, with other CBT-I components used as on-demand content. The sleep chatbot system will facilitate sleep goal-setting with the participant and communicate weekly behavioral prescriptions and educational modules. After baseline data collection, the research coordinator will provide intervention orientation and set up the first-week sleep modification goal during the in-person/Zoom meeting. Sleep modification goals in the remaining weeks will be developed through the participant-chatbot interaction. The Chatbot system will send sleep-related information and behavioral reminders/feedback based on the interactive conversation with participants. Participants will also complete a sleep diary prompted by a chatbot.
University of Delaware
Newark, Delaware, United States
Acceptability
Results were report as # of participants reporting Acceptable and Completely acceptable. Acceptability question: "Overall, how acceptable was the sleep chat bot intervention to you? (Completely unacceptable; Unacceptable; No opinion; Acceptable; Completely acceptable)."
Time frame: End of intervention (at week 4)
Retention Rate
Percentage of enrolled participants completed the intervention, completed end-of-intervention assessment, and completed one-month follow-up assessment; among those who received intervention modules (that is, excluding those who withdrew before intervention began), the rate of core module completion.
Time frame: End of intervention (week 4) and one-month follow-up (week 8)
Insomnia Severity
The Insomnia Severity Index is composed of 7 items measuring insomnia-related sleep disturbance and daytime dysfunction. The seven answers are added up to get a total score (0-28), with higher scores indicating severer insomnia.
Time frame: End of intervention (at week 4)
PSQI
The Pittsburgh Sleep Quality Index (PSQI) is a widely-used, self-rated questionnaire that assesses sleep quality and disturbances over a 1-month period.The scores from all seven components are summed to yield a single Global PSQI Score, ranging from 0 to 21. Greater scores mean worse sleep.
Time frame: End of intervention (at week 4)
Total Sleep Time
The total amount of sleep time (hours) was estimated each night for seven consecutive days using a wrist-worn ActiGraph GT9X Link. The average sleep time over a week were used in data analysis.
Time frame: End of intervention (at week 4)
Sleep Efficiency
Sleep efficiency (percentage of time spent asleep while in bed) were estimated each night for seven consecutive days using a wrist-worn ActiGraph GT9X Link. The average sleep efficiency over a week were used in data analysis. This variable indicates sleep quality.
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Time frame: End of intervention (at week 4)
Intra-individual Variability in Midsleep Times
Sleep time and awakening time were estimated for seven consecutive days using a wrist-worn ActiGraph GT9X Link. Mid-sleep time each night refers to the mid-point between sleep time and awakening time. Intra-individual variability in midsleep times were calculated as the standard deviation of the mid-sleep time over a week for each participant. This variable reflects the regularity of sleep, with higher values showing greater irregularity.
Time frame: End of intervention (at week 4)
Sleep Self Efficacy
The Sleep Self-Efficacy Scale, a 9-item scale assessing participants' beliefs in their ability to engage in productive sleep behaviors, measured sleep-related self efficacy. Each item was scored on a standard Likert scale from 1 (Not confident at all) to 5 (Very confident).The total scores ranged from 9 to 45, with higher scores indicating greater sleep self-efficacy.
Time frame: End of intervention (at week 4)
Composite Metabolic Health
Composite metabolic health was calculated by the total number of metabolic syndrome components, including high BMI, high blood pressure, high fasting triglycerides and glucose, and low HDL, were calculated to indicate metabolic health (higher value, worse metabolic health). A point-of-care test provided the fasting glucose and cholesterol panel.
Time frame: End of intervention (at week 4)