Horwitz Tanya B, Sarfan Laurel D, Milner Anne E, Varghese Joshua, Callaway Catherine A, Harvey Allison G
University of California, Berkeley.
Kaiser Permanente.
Res Sq. 2025 Aug 6:rs.3.rs-7189279. doi: 10.21203/rs.3.rs-7189279/v1.
This study investigated the extent to which self-reported psychiatric disorders and comorbidities in patients receiving the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TSC) predicted symptom/impairment severity and treatment outcome.
This secondary analysis drew from a subset of 489 patients in California-based Community Mental Health Centers with serious mental illness (SMI) and sleep/circadian problems who had participated in a randomized controlled trial of TSC. Of these patients, 253 received Immediate TSC and 236 received usual care followed by delayed treatment (UC-DT). Some patients received Standard TSC (N=149) while others received Adapted TSC (N=340). We analyzed patients' baseline/pre-treatment and post-treatment scores for psychiatric symptoms, sleep disturbance, sleep-related impairment, overall sleep health, and functional impairment. We also used patient-reported data on history of psychiatric diagnoses.
At baseline, patients with more disorders had worse psychiatric symptom scores (b=2.27, SE=0.39, p<.001), greater sleep disturbance prior to eliminating outliers (b=0.71, SE=0.31, p=.023), greater sleep-related impairment (b=1.25, SE=0.34, p<.001), worse overall sleep health (b=-0.20, SE=0.06, p=.001), and greater functional impairment (b=0.32, SE=0.11, p=.005). Number of psychiatric disorders was not associated with treatment outcome or differences in benefits between Standard and Adapted TSC. When analyzed independently, the most common psychiatric disorder groups all demonstrated significantly more improvement in the Immediate TSC group than in the UC-DT group on sleep disturbance and sleep-related impairment.
These results build on strong evidence that transdiagnostic sleep treatment is an important approach to treating populations with comorbid SMI and sleep/circadian problems. This secondary analysis was not pre-registered but uses data from primary analyses that were pre-registered on clinicaltrials.gov (phase 1/generation 1: https://clinicaltrials.gov/study/NCT04154631; phase 2/generation 2: https://clinicaltrials.gov/study/NCT05805657).
本研究调查了接受睡眠与昼夜节律功能障碍跨诊断干预（TSC）的患者自我报告的精神疾病和共病在多大程度上预测了症状/损害严重程度及治疗结果。
本二次分析的数据来自加利福尼亚社区心理健康中心的489名患有严重精神疾病（SMI）和睡眠/昼夜节律问题的患者子集，他们参与了TSC的一项随机对照试验。在这些患者中，253人接受了即时TSC，236人接受了常规护理并随后接受延迟治疗（UC-DT）。一些患者接受标准TSC（N = 149），而另一些患者接受适应性TSC（N = 340）。我们分析了患者在精神症状、睡眠障碍、睡眠相关损害、总体睡眠健康和功能损害方面的基线/治疗前和治疗后评分。我们还使用了患者报告的精神疾病诊断史数据。
在基线时，患有更多疾病的患者精神症状评分更差（b = 2.27，SE = 0.39，p <.001），在剔除异常值之前睡眠障碍更严重（b = 0.71，SE = 0.31，p =.023），睡眠相关损害更大（b = 1.25，SE = 0.34，p <.001），总体睡眠健康更差（b = -0.20，SE = 0.06，p =.001），功能损害更大（b = 0.32，SE = 0.11，p =.005）。精神疾病的数量与治疗结果或标准TSC和适应性TSC之间的获益差异无关。当独立分析时，在即时TSC组中，最常见的精神疾病组在睡眠障碍和睡眠相关损害方面的改善均显著大于UC-DT组。
这些结果基于有力证据，即跨诊断睡眠治疗是治疗患有SMI和睡眠/昼夜节律共病问题人群的重要方法。本二次分析未预先注册，但使用了来自在clinicaltrials.gov上预先注册的主要分析的数据（第1阶段/第1代：https://clinicaltrials.gov/study/NCT04154631；第2阶段/第2代：https://clinicaltrials.gov/study/NCT05805657）。
