Abstract
BackgroundSleep difficulties are highly prevalent among adolescents, and are associated with significant impairments. The effectiveness and acceptability of Cognitive Behavioural Therapy-based (CBT-based) treatment for insomnia in adolescents is established for High Income Countries, but unknown for African settings. Thus, the aim of this study was to assess the effect of CBT-based intervention among in-school adolescents with sleep difficulties in Southern Nigeria.MethodsThis was a pilot controlled trial involving 50 adolescents with highest ranked scores on the Insomnia Severity Index (ISI) recruited from four schools (two government and two privately owned). Balloting was used to assign two schools (public and private) with 25 participants to the intervention group, and the other two schools (public and private) with 25 participants as waiting-list controls. The two groups were dyad-matched for baseline ISI scores, gender, and type of school to reduce baseline differences. The treatment group received weekly group-based manualised CBT-based intervention over 5 weeks. Primary outcome was ISI score at 6th week. Secondary outcomes were sleep onset latency (SOL), Total sleep duration (TSD), depressive symptoms, sleep hygiene, and knowledge about sleep.ResultsParticipants were aged 13–17 years (M = 14.9, SD = 1.16) and consisted of 18 males and 32 females. Controlling for baseline scores, the intervention group showed significantly lower post-intervention insomnia scores compared with the control group {F (1, 34) = 1.10, p = 0.0001, (ηp2 = 0.59}, shorter SOL {F (1, 33) = 1.41, p = 0.0001, ηp2 = 0.39}, longer TSD {F (1, 33) = 1.03, p = 0.0001, ηp2 = 0.47}, lower depressive symptoms {F (1, 31) = 1.32, p = 0.002 (ηp2 = 0.34}, higher knowledge of sleep {F (1, 34) = 1.02, p = 0.001, ηp2 = 0.36}, but no significant change in sleep hygiene {F (1, 32) = 1.08, p = 0.08, ηp2 = 0.15}. All participants in the intervention group rated the programme as good or excellent.ConclusionThis pilot CBT-based intervention for adolescents with insomnia was feasible, well received and showed promising efficacy in this setting. Larger controlled trials are recommended to establish the generalisability of these findings in this region.Trial registration Pan African Clinical Trial Registry (Registration Number PACTR202001710494962)
Highlights
Sleep difficulties are highly prevalent among adolescents in all regions of the world [1]
Socio‐demographic characteristics of study participants and baseline scores on outcome measures The participants ranged in age from 13 to 17 years (M = 14.9 years; SD = 1.16)
Majority of the students in both groups were from monogamous homes, and most had parents who were currently married
Summary
Sleep difficulties are highly prevalent among adolescents in all regions of the world [1] Poor sleep in this age group is associated with significant impairments including, poor concentration, poor emotional regulation, depression, anxiety, and poor academic performance [2]. Despite the good evidence-base for interventions like CBT-I, most affected adolescents go untreated due to limited access to the intervention in most countries [7]. This treatment gap is likely to be worse in resource-limited regions in Low and Middle Income Countries (LMICs) like Nigeria. The effectiveness and acceptability of Cognitive Behavioural Therapy-based (CBT-based) treatment for insomnia in adolescents is established for High Income Countries, but unknown for African settings.
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