Telemedicine-delivered cognitive-behavioral therapy for insomnia in alcohol use disorder (AUD): study protocol for a randomized controlled trial

Alcohol use disorder (AUD) is a leading preventable cause of morbidity and mortality, but relapse rates are high even with available treatments. Insomnia is a robust predictor of relapse and pilot studies have shown that CBT for insomnia improves insomnia and daytime functioning in adults with AUD a...

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Bibliographic Details
Published in:	Current controlled trials in cardiovascular medicine Vol. 23; no. 1; pp. 59 - 14
Main Authors:	Arnedt, J Todd, Cardoni, M Elizabeth, Conroy, Deirdre A, Graham, Mandilyn, Amin, Sajni, Bohnert, Kipling M, Krystal, Andrew D, Ilgen, Mark A
Format:	Journal Article
Language:	English
Published:	England BioMed Central Ltd 20-01-2022 BioMed Central BMC
Subjects:	Abstinence Adult Alcohol use Alcohol use disorder, Insomnia, Non-medication treatment, Relapse Alcohol-related disorders Alcoholism - complications Alcoholism - diagnosis Alcoholism - therapy Behavior modification Care and treatment Clinical outcomes Clinical trials Cognitive Behavioral Therapy Cognitive therapy Complications and side effects Diagnosis Eye movements Fatigue Homeostasis Humans Hypotheses Insomnia Methods Randomized Controlled Trials as Topic Risk factors Sleep Sleep Initiation and Maintenance Disorders - diagnosis Sleep Initiation and Maintenance Disorders - therapy Study Protocol Telemedicine Testing United States United States > US Alcohol use disorder, Insomnia, Non-medication treatment, Relapse
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Summary:	Alcohol use disorder (AUD) is a leading preventable cause of morbidity and mortality, but relapse rates are high even with available treatments. Insomnia is a robust predictor of relapse and pilot studies have shown that CBT for insomnia improves insomnia and daytime functioning in adults with AUD and insomnia. The impact of CBT for insomnia on relapse, however, is unclear. This trial will compare telemedicine-delivered CBT for insomnia (CBT-TM) with sleep hygiene education (SHE-TM) on improving insomnia/sleep, daytime symptom, and drinking outcomes in treatment-seeking AUD adults with insomnia. The study will also determine the effects of treatment on sleep mechanisms and their association with clinical outcomes. This is a single-site randomized controlled trial with planned enrollment of 150 adults meeting criteria for both AUD and chronic insomnia. Eligible participants will be randomized 1:1 to 6 sessions of telemedicine-delivered Cognitive Behavioral Therapy for Insomnia (CBT-TM) or Sleep Hygiene Education (SHE-TM) with clinical assessments conducted at pre-treatment, post- treatment, and at 3, 6, and 12 months post-treatment. Overnight polysomnography will be conducted before and after treatment. Primary clinical outcomes will include post-treatment scores on the Insomnia Severity Index and the General Fatigue subscale of the Multidisciplinary Fatigue Inventory, and the percent of days abstinent (PDA) on the interview-administered Time Line Follow Back. EEG delta activity, derived from overnight polysomnography, will be the primary endpoint to assess the sleep homeostasis mechanism. This adequately powered randomized controlled trial will provide clinically relevant information about whether targeting insomnia is effective for improving treatment outcomes among treatment-seeking adults with AUD. Additionally, the study will offer new scientific insights on the impact of an evidence-based non-medication treatment for insomnia on a candidate mechanism of sleep dysfunction in this population - sleep homeostasis. CClinicalTrials.gov NCT # 04457674 . Registered on 07 July 2020.
ISSN:	1745-6215 1745-6215
DOI:	10.1186/s13063-021-05898-y