Effects of nurse-led, web-based brief behavioral therapy on insomnia severity in patients in the chronic stage of stroke recovery: a preliminary randomized controlled trial

Abstract

Study objectives: Insomnia is prevalent among stroke survivors in the chronic stage of stroke. However, effective interventions remain limited. This study examined the effects of nurse-led, face-to-face, and web-based brief behavioral therapy for insomnia (BBTI) compared with sleep hygiene education (SHE) on sleep outcomes in stroke survivors.

Methods: A total of 45 stroke survivors were recruited from an outpatient clinic in Java, Indonesia, and randomly assigned (1:1:1) to either a face-to-face BBTI, web-based BBTI, or SHE group. Both BBTI interventions followed a standardized 4-week protocol delivered in person or through an online platform. The primary outcome was insomnia severity, measured using the Indonesian Insomnia Severity Index (ISI-INA). Secondary outcomes included sleep onset latency, wake after sleep onset, sleep efficiency, excessive daytime sleepiness, anxiety, depression, and fatigue. Data were analyzed using generalized estimating equations.

Results: The ISI-INA scores were significantly lower in the BBTI groups than in the SHE group. After 1 month, insomnia remission (ISI-INA score < 8) was achieved in 93.3% of the web-based BBTI group and 86.7% of the face-to-face BBTI group. These values were significantly higher than the 33.3% remission rate observed in the SHE group (P < .001). Improvements were observed in sleep onset latency, wake after sleep onset, and sleep efficiency. The BBTI groups reported reduced daytime sleepiness, although no significant changes in depression, anxiety, or fatigue were observed.

Conclusions: Nurse-led BBTI, whether in the face-to-face or web-based format, effectively reduces insomnia severity and improves sleep outcomes in stroke survivors, highlighting nurses' essential role in delivering sleep interventions.

Clinical trial registration: Registry: ClinicalTrials.gov; Identifier: NCT05310136.

Keywords: cognitive behavioral therapy; nurses; poststroke patient; randomized controlled trial; sleep hygiene; sleep initiation and maintenance disorders; stroke rehabilitation.