Randomized controlled trial of digital cognitive behavior therapy for prenatal insomnia symptoms: effects on postpartum insomnia and mental health

Sleep

article

Felder, Jennifer N¹  Epel, Elissa S²  Neuhaus, John⁴  Krystal, Andrew D²  Prather, Aric A² 

[1] Osher Center for Integrative Health, University of California;Department of Psychiatry and Behavioral Sciences, University of California;Center for Health and Community, University of California;Department of Epidemiology and Biostatistics, University of California

关键词: cognitive behavior therapy;    insomnia;    depression;    anxiety;    pregnancy;    postpartum;   

DOI  :  10.1093/sleep/zsab280

学科分类：生理学

来源: American Academy of Sleep Medicine

【 摘 要 】

Study Objectives To evaluate the effects of digital cognitive behavior therapy for insomnia (dCBT-I) delivered during pregnancy on subjective sleep outcomes, depressive symptoms, and anxiety symptoms through 6 months postpartum.Methods People up to 28 weeks gestation (N = 208) with insomnia were randomized to 6 weekly sessions of dCBT-I or standard care. We report follow-up data at 3 and 6 months postpartum. The primary outcome was insomnia symptom severity. Secondary sleep outcomes included global sleep quality and insomnia caseness. Mental health outcomes included depressive and anxiety symptom severity. We evaluated between-condition differences in change from baseline for each postpartum timepoint and categorical outcomes.Results dCBT-I participants did not experience significantly greater improvements in insomnia symptom severity relative to standard care participants, but they did experience higher rates of insomnia remission and lower rates of insomnia caseness at 6 months postpartum. dCBT-I participants experienced greater improvements in depressive symptom severity from baseline to both postpartum timepoints, and in anxiety symptom severity from baseline to 3 months postpartum. The proportion of participants with probable major depression at 3 months postpartum was significantly higher among standard care (18%) than dCBT-I (4%, p = 0.006) participants; this between-condition difference was pronounced among the subset (n = 143) with minimal depressive symptoms at baseline (18% vs 0%).Conclusion dCBT-I use during pregnancy leads to enduring benefits for postpartum insomnia remission. Findings provide strong preliminary evidence that dCBT-I use during pregnancy may prevent postpartum depression and anxiety, which is notable when considering the high frequency and importance of these problems. Clinical Trials: ClinicalTrials.gov, https://clinicaltrials.gov/ct2/show/NCT02805998, NCT02805998.

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