Incorporating EMA and EMI Into CBT-I Using mHealth and Wearable Technologies

Chinese University of Hong Kong90 enrolled

Overview

This study will be a randomised controlled trial to investigate an integrated platform that incorporates ecological momentary assessments/interventions (EMA/I) into cognitive behavioural therapy for insomnia (CBT-I) using mHealth and wearable technology. The intervention is a promising prospect to address current challenges in the context of sleep medicine to provide real-time and real-world intervention with accuracy, low cost, and easy accessibility.

It will be a randomised, assessor-blind controlled trial embedding both outcome and process evaluation, of the EMA/I CBT-I in conjunction with wearable sensors. The outcome evaluation will examine the treatment effect of EMA/I CBT-I compared with care-as-usual (CAU), whilst process evaluation will enhance the understanding of the causal assumptions that underpin EMA/I CBT-I to inform policy and clinical practice. 60 eligible participants will be randomly assigned to the EMA/I CBT-I group and CAU in a 1:1 allocation ratio. The participants in the EMA/I CBT-I group will receive 6 weeks of smartphone-based EMA/I CBT-I supported by a therapist. The trained therapist will prescribe EMI, provide personalised sleep advice, and adjust the treatment by dynamically adapting real-time rest-activity assessments collected using EMA and wearable devices. Assessments will be managed by an independent assessor (a research assistant) who is blind to group allocation at baseline, week 7 (1 week after treatment), and week 18 (12 weeks after treatment). The proposed study will follow the recommendations of the Consolidated Standards of Reporting Trials (CONSORT) and will be registered on ClinicalTrials.gov to ensure compliance with study design and results reporting requirements. The treatment will be provided free of charge.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

Conditions

Insomnia

Interventions

Ecological momentary assessments/interventions with cognitive behavioural therapy for insomnia (EMA/I CBT-I)BEHAVIORAL

an integrated system based on an existing multicomponent cognitive behavioural therapy for insomnia (CBT-I) and EMA app

Self-help cognitive behavioural therapy for insomniaBEHAVIORAL

An mobile app that delivers CBT-I content.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 65 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Hong Kong residents at least 18 years of age; 2. able to read Chinese and type in Chinese or English; 3. meet the DSM-5 diagnostic criteria of insomnia disorder (difficulty initiating and/or maintaining sleep or early morning awakening, alongside clinically significant daytime impairment) based on the Brief Insomnia Questionnaire (BIQ), a diagnostic tool validated by the team; 4. have an Insomnia Severity Index (ISI) score of at least 10 indicating clinical-level insomnia; 5. have adequate opportunity and circumstances for sleep to occur; 6. have an Internet-enabled mobile device (iOS or Android operating system), and 7. are willing to provide informed consent. Exclusion Criteria: To mimic real-world settings, a less stringent set of exclusion criteria will be adopted. 1. A Beck Depression Inventory (BDI-II) Item 9 score of at least 2 indicating a current moderate suicidal risk that requires active crisis management (referral information to professional services will be provided to those with serious suicidal risk); 2. involvement in CBT-I in the past 6 months; 3. a history of severe mental illness (e.g., bipolar disorder, psychotic disorder); 4. major medical or neurocognitive disorders or side effects of medication that contribute significantly to insomnia or make participation infeasible based on the team's clinical experience; 5. other untreated sleep disorders, including narcolepsy, obstructive sleep apnoea (OSA), and restless leg syndrome (RLS)/periodic leg movement disorder (PLMD) based on the cut-off scores (≥7 on narcolepsy; ≥15 on OSA; ≥7 on RLS/PLMD) in SLEEP-50; 6. taking over-the-counter medication or psychotropic drugs that target insomnia within 2 weeks prior to the baseline assessment; and 7. shift work, pregnancy, family or other commitments that interfere with regular sleep-wake patterns.

Outcomes

Primary Outcomes

Changes in Insomnia Severity Index (ISI)

ISI is a 7-item scale designed to evaluate perceived insomnia severity. Ratings on the 5- point Likert scale are obtained on the perceived severity of sleep-onset, sleep-maintenance, early morning awakening problems, satisfaction with current sleep pattern, interference with daily functioning, noticeable impairment attributed to the sleep problem, and level of distress caused by the sleep problem.

Time frame: Baseline, Immediate post-treatment, 12-week follow up

Secondary Outcomes

Changes in the Pittsburgh Sleep Quality Index (PSQI-19)

The PSQI-19 is a 19-item questionnaire used for measuring and identifying the quality of sleep. It provides a measure of global sleep quality, including sleep latency, sleep duration, habitual sleep efficiency and sleep disturbances.

Time frame: Baseline, Immediate post-treatment, 12-week follow up

Changes in 7-Day Consensus Sleep Diary

The standardized sleep diary records sleep-onset latency (SOL; min), wake after sleep onset (WASO; min), total wake time (TWT; min), total sleep time (TST; min), time in bed (TIB; min), etc.

Time frame: Baseline, Immediate post-treatment, 12-week follow up

Changes in Hospital Anxiety and Depression Scale (HADS)

A 14-item self-rating scale that measures anxiety and depression in both hospital and community settings. It is divided into an Anxiety subscale (HADS-A) and a Depression subscale (HADS-D) both containing seven intermingled items. It is for screening purposes and is not meant to be a diagnostic tool. HADS scores of 8-10, 11-14, and 15-21 represent mild, moderate, and severe anxiety and depression separately.

Time frame: Baseline, Immediate post-treatment, 12-week follow up

Changes in Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS)

The DBAS is a 16-item questionnaire used to assess sleep-related cognitions.

Central Contacts

Vincent Lam

CONTACT

39436575 pmhlab@cuhk.edu.hk

Data from ClinicalTrials.gov

This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.