Developing a cognitive behavioral therapy for hypersomnia using telehealth: a feasibility study

Abstract

Study objectives: The purpose of this study was to evaluate the feasibility and acceptability of a novel cognitive behavioral therapy for hypersomnia (CBT-H) in people with central disorders of hypersomnolence and co-occurring depressive symptoms using a telehealth model for delivery and assessment.

Methods: Thirty-five adults with narcolepsy or idiopathic hypersomnia received a 6-session CBT-H delivered individually or in small groups using videoconferencing. The clinical impact of CBT-H was evaluated using the Patient Health Questionnaire, Patient-Reported Outcomes Measurement Information System measures, Epworth Sleepiness Scale, and other patient-reported outcomes collected online at baseline and posttreatment. Feasibility and acceptability of the intervention and telehealth model was also evaluated using qualitative data collected from exit interviews conducted through videoconferencing.

Results: Forty percent of the sample achieved a clinically significant baseline to posttreatment change in depressive symptoms (decrease in Patient Health Questionnaire ≥ 5), which is below the prespecified efficacy benchmark (50% of the sample). The prespecified benchmark for a minimal clinically important difference (Cohen's d > 0.5) on other psychosocial measures was met only on the Patient-Reported Outcomes Measurement Information System global self-efficacy (d = 0.62) in the total sample. Qualitative data revealed enthusiasm for the accessibility of telehealth delivery and the usefulness of several cognitive and behavioral modules but also revealed opportunities to refine the CBT-H program.

Conclusions: These findings indicate that this new CBT-H program can potentially reduce depressive symptoms and improve self-efficacy in people with central disorders of hypersomnolence. Furthermore, telehealth is a promising model for remote delivery and data collection to enhance participant accessibility and engagement.

Clinical trial registration: Registry: ClinicalTrials.gov; Name: Psychosocial Adjunctive Treatment for Hypersomnia (PATH); URL: https://clinicaltrials.gov/ct2/show/NCT03904238; Identifier: NCT03904238.

Keywords: cognitive-behavior therapy; depression; health-related quality of life; idiopathic hypersomnia; narcolepsy; psychosocial.

Figure 1. CONSORT flow diagram.

Figure 2. Within-subject effect sizes by clinical measures for total sample.

(A) The within-subject effect size (Cohen’s d) from baseline to posttreatment for each of the following clinical measures: Patient Health Questionnaire (PHQ), Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ), Sleep Inertia Questionnaire (SIQ), and Restorative Sleep Questionnaire (RSQ). (B) The within-subject effect size (Cohen’s d) from baseline to posttreatment for each of the following Patient-Reported Outcomes Measurement Information Systems measures: Depression (Dep), Anxiety (Anx), Sleep Disturbance (Sleep Dist), Sleep-Related Impairment (Sleep Imp), Fatigue, General Self-Efficacy (GSE), Self-Efficacy for Managing Emotions (SEMEM), Self-Efficacy for Managing Social Interactions (SEMSS), Self-Efficacy for Managing Symptoms (SEMSX), Ability to Participate in Social Roles and Activities (Participate), Social Isolation (Soc Isolation), Cognitive Functioning (Cog Funct), Physical Functioning (Phys Funct), Global Mental Health (Global MH), and Global Physical Health (Global PH). An effect size of d > 0.5 was the prespecified benchmark for a minimal clinically important difference.

Figure 3. Within-subject effect sizes by diagnosis.

(A) The within-subject effect size (Cohen’s d) from baseline to posttreatment for narcolepsy type 1 (NT1), narcolepsy type 2 (NT2), and idiopathic hypersomnia (IH) across the following clinical measures: Patient Health Questionnaire (PHQ), Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ), Sleep Inertia Questionnaire (SIQ), and Restorative Sleep Questionnaire (RSQ). (B) The within-subject effect size (Cohen’s d) from baseline to posttreatment for each diagnostic group across the following Patient-Reported Outcomes Measurement Information Systems measures: Depression (Dep), Anxiety (Anx), Sleep Disturbance (Sleep Dist), Sleep-Related Impairment (Sleep Imp), Fatigue, General Self-Efficacy (GSE), Self-Efficacy for Managing Emotions (SEMEM), Self-Efficacy for Managing Social Interactions (SEMSS), Self-Efficacy for Managing Symptoms (SEMSX), Ability to Participate in Social Roles and Activities (Participate), Social Isolation (Soc Isolation), Cognitive Functioning (Cog Funct), Physical Functioning (Phys Funct), Global Mental Health (Global MH), and Global Physical Health (Global PH). An effect size of d > 0.5 was the prespecified benchmark for a minimal clinically important difference.