Vollert Bianka, Müller Luise, Jacobi Corinna, Trockel Mickey, Beintner Ina
Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany.
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States.
JMIR Ment Health. 2023 Mar 21;10:e39052. doi: 10.2196/39052.
A growing body of evidence for digital interventions to improve sleep shows promising effects. The interventions investigated so far have been primarily web-based; however, app-based interventions may reach a wider audience and be more suitable for daily use.
This study aims to evaluate the intervention effects, adherence, and acceptance of an unguided app-based intervention for individuals who wish to improve their sleep.
In a randomized controlled trial, we evaluated the effects of an app-based short intervention (Refresh) to improve sleep compared with a waitlist condition. Refresh is an 8-week unguided intervention covering the principles of cognitive behavioral therapy for insomnia (CBT-I) and including a sleep diary. The primary outcome was sleep quality (insomnia symptoms) as self-assessed by the Regensburg Insomnia Scale (RIS). The secondary outcomes were depression (9-item Patient Health Questionnaire [PHQ-9] score) and perceived insomnia-related impairment.
We included 371 participants, of which 245 reported poor sleep at baseline. About 1 in 3 participants who were allocated to the intervention group never accessed the intervention. Active participants completed on average 4 out of 8 chapters. Retention rates were 67.4% (n=250) at postassessment and 57.7% (n=214) at the 6-month follow-up. At postintervention, insomnia symptoms in the intervention group had improved more than those in the waitlist group, with a small effect (d=0.26) in the whole sample and a medium effect (d=0.45) in the subgroup with poor sleep. Effects in the intervention group were maintained at follow-up. Perceived insomnia-related impairment also improved from pre- to postassessment. No significant intervention effect on depression was detected. Working alliance and acceptance were moderate to good.
An app-based, unguided intervention is a feasible and effective option to scale-up CBT-I-based treatment, but intervention uptake and adherence need to be carefully addressed.
ISRCTN Registry ISRCTN53553517; https://www.isrctn.com/ISRCTN53553517.
越来越多的证据表明，数字干预对改善睡眠具有显著效果。目前所研究的干预措施主要基于网络；然而，基于应用程序的干预可能会覆盖更广泛的受众，并且更适合日常使用。
本研究旨在评估一种针对希望改善睡眠的个体的无指导的基于应用程序的干预措施的干预效果、依从性和接受度。
在一项随机对照试验中，我们评估了一种基于应用程序的短期干预措施（Refresh）与等待列表条件相比对改善睡眠的效果。Refresh是一项为期8周的无指导干预措施，涵盖失眠认知行为疗法（CBT-I）的原则，并包括一份睡眠日记。主要结局是由雷根斯堡失眠量表（RIS）自我评估的睡眠质量（失眠症状）。次要结局是抑郁（9项患者健康问卷[PHQ-9]评分）和感知到的与失眠相关的损害。
我们纳入了371名参与者，其中245名在基线时报告睡眠不佳。分配到干预组的参与者中约有三分之一从未使用过该干预措施。积极参与的参与者平均完成了8个章节中的4个。在评估后，保留率为67.4%（n = 250），在6个月随访时为57.7%（n = 214）。干预后，干预组的失眠症状改善程度超过等待列表组，在整个样本中效果较小（d = 0.26），在睡眠不佳的亚组中效果中等（d = 0.45）。干预组的效果在随访时得以维持。从评估前到评估后，感知到的与失眠相关的损害也有所改善。未检测到对抑郁有显著的干预效果。工作联盟和接受度为中等至良好。
基于应用程序的无指导干预是扩大基于CBT-I的治疗规模的一种可行且有效的选择，但干预的采用和依从性需要得到认真解决。
ISRCTN注册库ISRCTN53553517；https://www.isrctn.com/ISRCTN53553517。
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