Brief CBT effective for reducing insomnia in at-risk adolescents

Results of the world’s first randomized controlled study of a 4-week brief insomnia prevention programme for at-risk adolescents show a 71 percent reduction in the risk of developing insomnia, investigators from the Chinese University of Hong Kong (CUHK) have reported.

“Insomnia is often associated with detrimental consequences among adolescents, including cognitive impairment, poor academic performance, negative impact on physical and mental health, and an increased risk of suicidality,” said Professor Yun-Kwok Wing of the Department of Psychiatry, CUHK. “Nonetheless, the rate of health-seeking behaviour for insomnia was low [10 percent] among children and adolescents in Hong Kong.” [Sleep Med 2016;21:106-113]

“Increasing evidence supports the use of cognitive behavioural therapy for insomnia [CBT-I] as first-line treatment for adolescents with insomnia, targeting behavioural, cognitive and physiological factors which perpetuate insomnia,” said Professor Charles Morin of Laval University, Canada. [Sleep 2015;38:1913-1926].

“The CBT-I–based intervention evaluated in our study provides behavioural strategies targeting perpetuating factors of the participants, such as poor sleep hygiene practice and distorted cognition towards sleep,” said Dr Shirley Li of the Department of Psychology, CUHK.

“Results of our study showed that adolescents who received the intervention had a remarkable 71 percent reduction in the risk of acute and chronic insomnia vs those who did not [hazard ratio, 0.29; 95 percent confidence interval, 0.12 to 0.66; p=0.003] over the 12-month follow-up period,” said Dr Rachel Ngan-Yin Chan of the Department of Psychiatry, CUHK. [Pediatrics 2021, doi: 10.1542/peds.2020-006833]

“Significant reductions in severity of insomnia symptoms and vulnerability to stress-related insomnia  were also observed in the intervention group at postintervention [p=0.02 and p=0.04, respectively] and at 12-month [p=0.004 and p=0.01, respectively] follow-up,” noted Chan.

“The programme achieved a high completion rate, with 94 percent of adolescents attending ≥3 sessions, indicating feasibility and high acceptability,” Chan continued.

The study included 242 at-risk adolescents (mean age, 15 years; female, 57 percent) with family history of insomnia and subthreshold insomnia symptoms from the community and local secondary schools. The participants were randomized (1:1) to either the intervention group (ie, 4-weekly, 60-minute group-based sessions either in their school or hospital) or control group. All participants had sleep pattern assessed based on 1-week sleep diary at baseline, and were followed up postintervention, and at 6 months and 12 months.

At 12-month follow-up, the cumulative incidence of insomnia (both acute and chronic) was 5.8 percent in the intervention group and 20.7 percent in the control group, with a number needed to treat of 6.7.

The intervention also led to significant increase in total sleep time (p=0.01), decrease in daytime sleepiness (p<0.05), and improved overall sleep hygiene practice (p=0.003) postintervention.

Symptoms of depression and anxiety were significantly reduced in the intervention group at 12-month follow-up (p=0.02).

“Our study showed that the 4-week brief cognitive behavioural insomnia preventive intervention not only reduced the risk of developing insomnia, but also reduced vulnerability and improved functional outcomes in at-risk adolescents,” concluded Wing.

“We plan to further explore implementation of the insomnia prevention programme in the general population, and to assess the impact of the programme in reducing the healthcare burden of insomnia in Hong Kong,” he added.