Citation

Tomfohr-Madsen L, Madsen JW, Bonneville D, Virani S, Plourde V, Barlow KM, Yeates KO, Brooks BL. J. Head Trauma Rehabil. 2019; ePub(ePub): ePub.

Affiliation

Departments of Psychology (Drs Tomfohr-Madsen, Madsen, Yeates, & Brooks) Psychiatry (Ms Bonneville), and Faculty of Kinesiology (Mr Virani), University of Calgary, Calgary, Alberta, Canada; Faculté St Jean, University of Alberta, Edmonton, Alberta, Canada (Dr Plourde); Neuropsychology Service, Alberta Children's Hospital, Calgary, Alberta, Canada (Mr Virani and Dr Brooks); Faculty of Medicine, University of Queensland, Brisbane, New South Wales, Australia (Dr Barlow); Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada (Drs Tomfohr-Madsen, Yeates, Brooks, and Barlow); Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada (Drs Tomfohr-Madsen, Yeates, and Brooks and Mr Virani); Hotchkiss Brain Institute, Calgary, Alberta, Canada (Drs Yeates and Brooks); and Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada (Drs Yeates and Brooks).

Copyright

(Copyright © 2019, Lippincott Williams and Wilkins)

DOI

10.1097/HTR.0000000000000504

PMID

31246882

Abstract

OBJECTIVE: Cognitive-behavioral therapy for insomnia (CBT-I) is an effective insomnia treatment but has yet to be applied to adolescents with sleep disruption following concussion. This pilot study evaluated CBT-I to improve insomnia in adolescents with protracted concussion recovery. SETTING: Tertiary pediatric hospital. PARTICIPANTS: Participants (N = 24) were 12 to 18 years old (M = 15.0, SD = 1.4), 15.1 weeks (SD = 9.2) postinjury, and presenting with sleep disruption and persistent postconcussion symptoms.

DESIGN: A single-blind, parallel-group randomized controlled trial (RCT) design comparing 6 weeks of CBT-I and a treatment-as-usual control group. Outcomes were measured before treatment, at treatment completion, and 4 weeks after completion. MAIN MEASURES: Primary outcome was Insomnia Severity Index. Secondary outcomes included Pittsburgh Sleep Quality Index, Dysfunctional Beliefs and Attitudes about Sleep Scale, 7-night sleep diary, PROMIS Depression, PROMIS Anxiety, and Health and Behavior Inventory.

RESULTS: Adolescents who received CBT-I demonstrated large and clinically significant improvements in insomnia ratings at posttreatment that were maintained at follow-up. They also reported improved sleep quality, fewer dysfunctional beliefs about sleep, better sleep efficiency, shorter sleep-onset latency, and longer sleep time compared with those with treatment as usual. There was also a modest reduction in postconcussion symptoms.

CONCLUSION: In this pilot RCT, 6 weeks of CBT-I produced significant improvement in sleep in adolescents with persistent postconcussion symptoms. A larger trial is warranted.

Language: en