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Cited by 53Sleep and related disordersDigital Mental Health InterventionsObstructive Sleep Apnea Research

A Computerized Cognitive behavioral therapy Randomized, Controlled, pilot trial for insomnia in Parkinson Disease (ACCORD-PD)

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Patel, Shnehal, Ojo, Oluwadamilola, Genc, Gencer, Oravivattanakul, Srivadee, Huo, Yang, Rasameesoraj, Tanaporn, Wang, Lu, Bena, James +4 more·2017·Journal of Clinical Movement Disorders
DOI 10.1186/s40734-017-0062-2PMC PMC5568719
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Abstract

Parkinson disease (PD) is associated with a high prevalence of insomnia, affecting up to 88% of patients. Pharmacotherapy studies in the literature addressing insomnia in PD reveal disappointing and inconsistent results. Cognitive behavioral therapy (CBT) is a novel treatment option with durable effects shown in primary insomnia. However, the lack of accessibility and expense can be limiting. For these reasons, computerized CBT for insomnia (CCBT-I) has been developed. The CCBT-I program is a 6-week web-based course consisting of daily “lessons” providing learnable skills and appropriate recommendations to help patients improve their sleep habits and patterns. We conducted a single-center, pilot, randomized controlled trial comparing CCBT-I versus standardized sleep hygiene instructions to treat insomnia in PD. Twenty-eight subjects with PD experiencing insomnia, with a score > 11 on the Insomnia Severity Index (ISI) were recruited. Based on a 6-point improvement in ISI in treatment group when compared to controls and an alpha = 0.05 and beta of 0.1 (power = 90%) a sample size of 11 patients (on active treatment) were required to detect this treatment effect using a dependent sample t-test. In total, 8/14 (57%) subjects randomized to CCBT-I versus 13/14 (93%) subjects randomized to standard education completed the study. Among completers, the improvement in ISI scores was greater with CCBT-I as compared to standard education (−7.9 vs −3.5; p = 0.03). However, in an intention-to-treat analysis, where all enrolled subjects were included, the change in ISI between groups was not significant (−.4.5 vs −3.3; p = 0.48), likely due to the high dropout rate in the CCBT-I group (43%). This pilot study suggests that CCBT-I can be an effective treatment option for PD patients with insomnia when the course is thoroughly completed. High drop-out rate in our study shows that although effective, it may not be a generalizable option; however, larger studies are needed for further evaluation.

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  • Four RCTs showed significant improvements in insomnia and sleep quality when comparing face-to-face or computerised CBT with education on basic sleep hygiene, sham light therapy, or TAU.

    “In particular, four RCTs showed significant improvements in participants' levels of insomnia and sleep quality when comparing face-to-face or computerised CBT with education on basic sleep hygiene (Leroi, Baker, Kehoe, Daniel, & Byrne, 2010; Patel et al., 2017), sham light therapy (Rios Romenets et al., 2013), or TAU (Kraepelien et al., 2020).”

    From Psychological interventions for people with Parkinson's disease in the early 2020s: Where do we stand? (2021) · cites this paper as Patel et al., 2017

    The Results and Discussion report that computerized CBT improved insomnia severity more than sleep-hygiene education among participants who completed the trial, and that sleep efficiency increased. The claim omits a decisive qualification: the between-group difference in insomnia severity was not significant in the intention-to-treat analysis (p = 0.48). (LLM, conf=0.89)

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Research works printed but not linked: 24

  1. [1]Chahine LM, Amara AW, Videnovic A. A systematic review of the literature on disorders of sleep and wakefulness in Parkinson’s disease from 2005 to 2015. Sleep Med Rev. 2016. doi:10.1016/j.smrv.2016.08.001. [Epub ahead of print]. PMC5332351 27863901 · DOI
  2. [3]Oerlemans WG de Weerd AW The prevalence of sleep disorders in patients with Parkinson’s disease: a self-reported, community-based survey Sleep Med 2002 3 147 149 10.1016/S1389-9457(01)00127-7 14592234 · DOI
  3. [4]Factor SA McAlarney T Sanchez-Ramos JR Weiner WJ Sleep disorders and sleep effect in Parkinson's disease Mov Disord 1990 5 4 280 285 10.1002/mds.870050404 2259351 · DOI
  4. [5]Tandberg E Larsen JP Karlsen K A community-based study of sleep disorders in patients with Parkinson’s disease Mov Disord 1998 13 895 899 10.1002/mds.870130606 9827612 · DOI
  5. [6]Gjerstad MD, Wentzel-Larsen T, Aarsland D, Larsen JP. Insomnia in Parkinson's disease: frequency and progression over time. J Neurol Neurosurg Psychiatry. 07;78(5):476–479. Epub 2006 Nov 10. PMC2117851 17098844
  6. [7]National Institutes of Health NIH state-of-the-science conference statement on manifestations and management of chronic insomnia in adults NIH Consens State Sci Statements 2005 22 1 30 17308547
  7. [8]Morin CM Insomnia: psychological assessment and management 1993 New York The Guilford Press
  8. [9]Bearnstein A Allexandre D Bena J Doyle J Gendy G Wang L Fay S Mehra R Moul D Foldvary-Schaefer N Roizen M Drerup M “go! To sleep”: a web-based therapy for insomnia Telemedicine and e-Health 2017 23 1 10 10.1089/tmj.2017.29001.crd 28112590 · DOI
  9. [13]Ström L Pettersson R Andersson G Internet-based treatment for insomnia: a controlled evaluation J Consult Clin Psychol 2004 72 113 120 10.1037/0022-006X.72.1.113 14756620 · DOI
  10. [14]Suzuki E Tsuchiya M Hirokawa K Taniguchi T Mitsuhashi T Kawakami N Evaluation of an internet-based self-help program for better quality of sleep among Japanese workers: a randomized controlled trial J Occup Health 2008 50 387 399 10.1539/joh.L7154 18716392 · DOI
  11. [16]Riley WT Mihm P Behar A Morin CM A computer device to deliver behavioral interventions for insomnia Behav Sleep Med 2010 8 2 15 10.1080/15402000903425314 20043245 · DOI
  12. [18]Diederich NJ, McIntyre DJ. Sleep disorders in Parkinson's disease: many causes, few therapeutic options. Neurol Sci. 2012;314(1–2):12–19. doi:10.1016/j.jns.2011.10.025. Epub 2011 Nov 25. Review. 22118862 · DOI
  13. [19]Menza M Dobkin RD Marin H Treatment of insomnia in Parkinson's disease: a controlled trial of eszopiclone and placebo Mov Disord 2010 25 1708 1714 10.1002/mds.23168 20589875 PMC2928867 · DOI
  14. [20]Juri C Chaná P Tapia J Kunstmann C Parrao T Quetiapine for insomnia in Parkinson disease: results from an open-label trial Clin Neuropharmacol 2005 28 185 187 10.1097/01.wnf.0000174932.82134.e2 16062098 · DOI
  15. [21]Medeiros CA Carvalhedo de Bruin PF Lopes LA Magalhães MC de Lourdes Seabra M de Bruin VM Effect of exogenous melatonin on sleep and motor dysfunction in Parkinson's disease. A randomized, double blind, placebo-controlled study J Neurol 2007 254 459 464 10.1007/s00415-006-0390-x 17404779 · DOI
  16. [22]Rios Romenets S, Creti L, Fichten C, Bailes S, Libman E, Pelletier A, Postuma RB. Doxepin and cognitive behavioural therapy for insomnia in patients with Parkinson's disease - A randomized study. Parkinsonism Relat Disord. 2013. doi:10.1016/j.parkreldis.2013.03.003. 23561946 · DOI · Paper page
  17. [23]Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991:50–5. 1798888
  18. [26]Krupp LB LaRocca NG Muir-Nash J Steinberg AD The fatigue severity scale: application to patients with multiple sclerosis and systemic lupus erythematosis Arch Neurol 1989 46 1121 1123 10.1001/archneur.1989.00520460115022 2803071 · DOI · Paper page
  19. [28]Jenkinson C Fitzpatrick R Peto V Greenhall R Hyman N The PDQ-8: development and validation of a short-form Parkinson’s disease questionnaire Psychol Health 1997 12 6 805 814 10.1080/08870449708406741 · DOI
  20. [29]Yang M, et al. Interpreting score differences in the insomnia severity index: using health-related outcomes to define the minimally important difference. Journal Curr Med Res Opin. 2009;25(10):2487–94. 19689221
  21. [30]Bastien CH, Vallières A, Morin CM. Validation of the insomnia severity index as an outcome measure for insomnia research. Sleep Med. 2001;2(4):297–307. 11438246
  22. [31]Adler CH, Thorpy MJ. Sleep issues in Parkinson's disease. Neurology. 2005;64(12 Suppl 3):S12–20. 15994219
  23. [32]Kaynak D, Kiziltan G, Kaynak H, Benbir G, Uysal O. Sleep and sleepiness in patients with Parkinson's disease before and after dopaminergic treatment. Eur J Neurol. 2005;12(3):199–207. 15693809
  24. [33]Yan-Yee Ho F Chung K-F Yeung W-F Self-help cognitive-behavioral therapy for insomnia: A meta-analysis of randomized controlled trials Sleep Med Rev 2015 19 17 28 10.1016/j.smrv.2014.06.010 25104471 · DOI

Cited by

Sorted by citations

Authors
Patel, S., Ojo, O., Genc, G., Oravivattanakul, S., Huo, Y., Rasameesoraj, T., Wang, L., Bena, J., Drerup, M., Foldvary-Schaefer, N., Ahmed, A., & Fernandez, H. H.
Corresponding author
Patel, Shnehal
ORCID
Venue
Journal of Clinical Movement Disorders
Publisher
Springer Science and Business Media LLC
Published
2017-08-21
Volume
4
Issue
1
Pages
16-16
ISSN
2054-7072 (ISSN-L)
DOI
10.1186/s40734-017-0062-2
PMC
PMC5568719
OpenAlex
W2748808641
Cited by
53
References
8
Citations by year
2026: 6 · 2025: 6 · 2024: 9 · 2023: 6 · 2022: 2 · 2021: 5 · 2020: 9 · 2019: 7 · 2018: 3
FWCI
6.77
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Journal of Clinical Movement Disorders (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders
Cleveland Clinic
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
Keywords
Parkinson's disease, insomnia, sleep hygiene education, Insomnia Severity Index, treatment discontinuation

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