Concomitant Hypnotics, Comorbidities Not Factors in CBT-I Efficacy
SEATTLE, WA—The effect of cognitive behavioral therapy for insomnia (CBT-I) does not vary based on medication use or comorbidity, according to data presented by Genevieve Nesom, BA, at SLEEP 2015.
Building on previous research demonstrating that in-clinic outcomes were comparable to meta-analytic outcomes in CBT-I efficacy, Nesom, of the University of Pennsylvania in Philadelphia, and colleagues examined whether “real-world,” clinical outcomes vary with medication use or comorbidity.
The researchers evaluated 79 patients (47% female, mean age = 5±15.8 years) who were grouped according to medication use or comorbidities:
- “Nonmed” (n=39) consisted of patients who did not use hypnotics during treatment, while “Med” (n=40) consisted of patients who either used hypnotics throughout the treatment or who were tapered off during treatment
- Patients with ≥1 medical comorbidities (n=37), ≥1 psychiatric comorbidities (n=5), both medical and psychiatric comorbidities (n=29), and no comorbid illnesses (n=8).
Outcome data were coded to reflect either treatment response (sleep latency [SL] and/or wake time after sleep onset [WASO] reduced by 50%) or remission (SL and/or WASO <30 min). Changes were calculated based on data from the first and final sessions. Although all subjects had at least four sessions, the absolute number of sessions varied.
There were no significant group differences in rates of response and remission for patients using or not using hypnotics, or patients with or without comorbidities.
Nesom noted that the analysis based on concurrent use and non-use of medication was adequately powered, but “potential confounding effects of medication may have varied, based on number of sessions or whether subjects were weaned from medication or only reduced medication use.” The analysis of outcomes by comorbidity was inadequately powered for the psychiatric comorbidity and no comorbid illness groups. Alternative analyses are ongoing.