Cognitive Behavioral Therapy vs. Tai Chi for Late Life Insomnia and Inflammatory Risk: A Randomized Controlled Comparative Efficacy Trial.


Author: Irwin MR1, Olmstead R1, Carrillo C1, Sadeghi N1, Breen EC1, Witarama T1, Yokomizo M1, Lavretsky H1, Carroll JE1, Motivala SJ1, Bootzin R2, Nicassio P1.

Affiliation: 1University of California, Los Angeles - Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Los Angeles, CA. 2University of Arizona, Department of Psychology, Tucson, AZ.
Conference/Journal: Sleep
Date published: 2014 Sep 1
Other:
 Volume ID: 37   ,  Issue ID: 9   ,  Pages: 1543-52   ,  Word Count: 312  
    

STUDY OBJECTIVES:

To investigate the comparative efficacy of cognitive behavioral therapy (CBT), Tai Chi Chih (TCC), and sleep seminar education control (SS) on the primary outcome of insomnia diagnosis, and secondary outcomes of sleep quality, fatigue, depressive symptoms, and inflammation in older adults with insomnia.

DESIGN:

Randomized controlled, comparative efficacy trial.

SETTING:

Los Angeles community.

PATIENTS:

123 older adults with chronic and primary insomnia.

INTERVENTIONS:

Random assignment to CBT, TCC, or SS for 2-hour group sessions weekly over 4 months with follow-up at 7 and 16 months.

MEASUREMENTS:

Insomnia diagnosis, patient-reported outcomes, polysomnography (PSG), and high-sensitivity C-reactive protein (CRP) levels.

RESULTS:

CBT performed better than TCC and SS in remission of clinical insomnia as ascertained by a clinician (P < 0.01), and also showed greater and more sustained improvement in sleep quality, sleep parameters, fatigue, and depressive symptoms than TCC and SS (all P values < 0.01). As compared to SS, CBT was associated with a reduced risk of high CRP levels (> 3.0 mg/L) at 16 months (odds ratio [OR], 0.26 [95% CI, 0.07-0.97] P < 0.05). Remission of insomnia was associated with lower levels of CRP (P < 0.05) at 16 months. TCC was associated with improvements in sleep quality, fatigue, and depressive symptoms as compared to SS (all P's < 0.05), but not insomnia remission. PSG measures did not change.

CONCLUSIONS:

Treatment of late-life insomnia is better achieved and sustained by cognitive behavioral therapies. Insomnia treatment and remission reduces a marker of inflammatory risk, which has implications for cardiovascular morbidity and diabetes observed with sleep disturbance in epidemiologic surveys.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT00280020.

CITATION:

Irwin MR, Olmstead R, Carrillo C, Sadeghi N, Breen EC, Witarama T, Yokomizo M, Lavretsky H, Carroll JE, Motivala SJ, Bootzin R, Nicassio P. Cognitive behavioral therapy vs. Tai Chi for late life insomnia and inflammatory risk: a randomized controlled comparative efficacy trial. SLEEP 2014;37(9):1543-1552.

KEYWORDS:

behavioral treatment; inflammation; insomnia; late life; randomized controlled trial



PMID: 25214694