Obsessive-compulsive personality disorder features and response to behavioral therapy for insomnia among patients with hypnotic-dependent insomnia

Abstract

Objective: To compare therapeutic response to behavioral therapy for insomnia (BT-I) among hypnotic-dependent insomnia (HDI) patients with and without Cluster C personality disorders. Participants: Twenty-three adults with HDI (17 females), aged between 33 and 68 (M = 53; SD = 9.9) were included in the study. Methods: Participants completed a personality disorder assessment (baseline), as well as sleep diaries, polysomnography (PSG), and an insomnia severity assessment (baseline, posttreatment, and one-year follow-up). Treatment consisted of eight weeks of individual BT-I and gradual hypnotic medication withdrawal. Multilevel mixed-effects linear regression models examined the interaction between study visit and Cluster C personality disorders status on treatment response to BT-I. Results: Obsessive-compulsive personality disorder (OCPD) was the most prevalent of the Cluster C personality disorders with 38% (n = 8) of participants meeting criteria. There were no significant treatment differences by OCPD status across time as measured by sleep diaries and insomnia severity status. However, there were significant treatment differences by OCPD status by one-year follow-up on PSG outcomes, indicating that patients with OCPD status had shorter and more disrupted sleep than patients without OCPD status. Conclusions: Based on self-reported sleep measures, patients with insomnia and features of OCPD responded equivalently to BT-I at one-year follow-up compared to patients without features of OCPD. However, polysomnography outcomes indicated objective sleep deteriorated in these patients, which may suggest greater vulnerability to relapse.

Figure 1.. OCPD status by time for self-reported sleep onset latency, wake after sleep onset, total sleep time, sleep efficiency, Insomnia Severity Index score, sleep quality rating, and hypnotic medication dosage.

No significant OCPD status by time interactions were found. Note. Error bars show 95% CI with the exception of wake after sleep onset and hypnotic medication dosage, which show standard errors due to 95%CI that included zero. LRD = lowest recommended dosage units

Figure 2.. OCPD status by time for polysomnography-derived sleep onset latency, wake after sleep onset, number of awakenings, total sleep time, and sleep efficiency.

Significant OCPD status by time interaction effects were found for sleep onset latency, sleep efficiency, and total sleep time. Note. Error bars show 95% CI with the exception of sleep onset latency which shows standard error due to 95%CI that included zero.

Figure 3.. OCPD status by time for total sleep time, sleep efficiency, sleep quality ratings, and State Trait Anxiety Inventory scores during polysomnography recording nights.

Significant OCPD status by time interaction effects were found for total sleep time, sleep efficiency, sleep quality ratings, and State Trait Anxiety Inventory scores. Note. Error bars show 95% CI.

Figure 4.. OCPD status by time for polysomnography-derived N1, N2, N3, and REM percentages.

Significant OCPD status by time interaction effects were found for N2 percentage only. Note. Error bars show 95% CI with the exception of sleep onset latency which shows standard errors due to 95%CI that included zero.