The underestimation of sleep duration phenotype is associated with better treatment response to cognitive behavior therapy for insomnia in patients with chronic insomnia: a preliminary study.

Abstract

To examine treatment response to cognitive behavior therapy for insomnia (CBT-I) in patients with chronic insomnia with and without underestimation of sleep duration. We studied 41 patients with chronic insomnia who had received 5-week CBT-I. Self-reported and objective sleep were assessed with sleep diary and actigraphy, respectively. Sleep perception was calculated as self-reported total sleep time/objective total sleep time. The underestimation of sleep duration group was defined based on sleep perception less than the median of the overall sample (85%). Insomnia Severity Index was used to assess the severity of insomnia. The total scores of Insomnia Severity Index decreased significantly after CBT-I in both groups with and without underestimation of sleep duration. Compared to pretreatment, self-reported sleep efficiency increased and total wake time decreased after CBT-I, while the magnitude of changes in sleep efficiency (d = 1.40 vs d=0.81, interaction P = .016) and total wake time (d = -1.82 vs d = -0.85, interaction P < .001) were larger in the underestimation of sleep duration group . Furthermore, self-reported sleep onset latency (interaction P = .520) and wake after sleep onset (interaction P = .052) decreased in the underestimation of sleep duration group (all P < .05), but not in patients without underestimation of sleep duration. Linear regressions showed that lower sleep perception at baseline predicted greater increase in self-reported sleep efficiency (β = -0.99, P < .001) and total sleep time (β = -0.51, P = .006) and greater decrease in self-reported total wake time (β=1.22, P = .023) after CBT-I after adjusting for confounders. The current preliminary study suggests that sleep perception moderates the self-reported CBT-I effects on chronic insomnia: the phenotype of underestimation of sleep duration is associated with a better response to CBT-I, especially in self-reported sleep parameters. Sun Q, Dai Y, Chen B, etal. The underestimation of sleep duration phenotype is associated with better treatment response to cognitive behavior therapy for insomnia in patients with chronic insomnia: a preliminary study. J Clin Sleep Med. 2022;18(10):2443-2450.