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Abstract Introduction Insomnia is prevalent in more than 50% of cancer survivors, occurring during and after their treatment trajectory, potentially leading to subsequent insomnia disorder. Brief Behavioral Treatment for Insomnia (BBTI) aims to assist cancer survivors to self-manage their behaviors to improve their sleep to reduce insomnia symptom burden. This study determined efficacy of BBTI versus a healthy eating program attention control on insomnia severity index (ISI) and sleep quality measures overtime, in a heterogeneous sample of cancer survivors. Methods A sample of 132 eligible cancer survivors were recruited and randomized into BBTI (experimental) and control groups. All participants completed baseline demographics and sleep-related surveys (e.g., ISI, Pittsburgh Sleep Quality Index PSQI) at: baseline, 1-month, 3-month, and 12-month post intervention. Statistical analysis of ISI and sleep quality at each time point proceeded using fitted ANCOVA models with independent variables including randomized treatment assignment, participant cancer type, the interaction between treatment assignment and cancer type, and baseline outcome level. Tests for treatment effect were performed using an exact permutation testing approach with a two-sided 0.05 nominal significance level. Results Statistically significant group differences (p-values 0.05) were observed at all time points for both ISI and sleep quality. Mean differences (95% CI) in ISI (BBTI minus control) were estimated to be -2.2(-4.1, 0.4), -2.1(-4.2, 0.1), and -2.3(-4.4, 0.1) at 1-, 3-, and 12-months, respectively. For sleep quality, the estimated mean differences were -1.4(-2.6, 0.2), -1.8(-3.0, 0.5), and -1.8(-3.3, 0.3), respectively. When adjusting for covariates known to be predictive of outcome, ISI results were robust, with treatment group difference remaining statistically significant except for when adjusting for treatment related surgery where results became borderline non-significant. Conclusion BBTI was significantly effective in reducing insomnia severity and improving sleep quality overtime compared to control among cancer survivors with insomnia symptoms. Use of BBTI in cancer survivors can help bridge the gap in addressing insomnia symptoms in survivorship settings. Support (if any) NIH/NINR R01NR018215 (Dean/Dickerson), ClinicalTrials-NCT03810365
Dickerson et al. (Sat,) studied this question.