Insomnia Clinical Trial
— e-COSMOSOfficial title:
Improving Sleep to Protect Brain Health in Older Adults: Assessing a Novel Cognitive-behavioral Program for Insomnia Using a Multidomain Web Platform
The goal of this randomized controlled clinical trial is to assess a novel cognitive-behavioral program for sleep and mental health using a multidomain web platform (eCBTi+) in participants with insomnia and subjective cognitive complaint. The main questions it aims to answer are: - Whether the eCBTi+ intervention improves sleep (subjective: Insomnia severity index [ISI], objective: EEG-based sleep efficiency) sleep and mental health (Geriatric Anxiety Index [GAI] and Geriatric Depression Scale [GDS]) compared to the control intervention - Whether the eCBTi+ intervention improves cognitive abilities (subjective: Cognitive Failure Questionnaire [CFQ], objective: CANTAB executive functions composite score) compared to the control intervention
Status | Recruiting |
Enrollment | 275 |
Est. completion date | December 2025 |
Est. primary completion date | November 2025 |
Accepts healthy volunteers | Accepts Healthy Volunteers |
Gender | All |
Age group | 60 Years to 99 Years |
Eligibility | Inclusion - age 60 years or older at the time of enrolment - Sleep Condition Indicator, SCI = 16 and meeting DSM-V criteria based on the symptoms assessed by the SCI - subjective cognitive complaints (self-report version of Everyday Cognition scale (ECog), score = 3 on any item) - ability to read and understand French or English - ability to use a smartphone or tablet, and access to home internet connection - If on hypnotic or psychotropic medication (including cannabis), being on stable dosage for at least 2 months prior to study entry Exclusion - located outside of Québec or Ontario - current hospitalization or planned major surgery - uncorrected severe hearing or vision impairment - reported diagnosis of major neurocognitive disorder or mild cognitive impairment (MCI) - performance suggestive of major neurocognitive disorder or MCI on T-MoCA < 17 - reported diagnosis of schizophrenia or bipolar disorder - reported diagnosis or positive screen on the MINI for psychotic or bipolar disorders - high suicidal risk, as assessed by the modified Columbia-Suicide Severity Rating Scale - reported diagnosis or positive screening for another untreated sleep disorder (e.g., sleep disordered breathing (OSA), REM sleep behavior disorder (RBD), restless legs syndrome (RLS); individuals with treated and controlled OSA or RLS will not be excluded) - apnea-hypopnea index >10 on a level 3 home sleep apnea test or residual AHI >10 for individuals on CPAP - current shift work - currently receiving CBT - frequent alcohol consumption (>10 glasses/week), or illicit drugs (more than once a month) - smoking more than 10 cigarettes/day Additional exclusion criteria for neuroimaging - psychotropic (including hypnotic) medication in the past 2 weeks - contraindications for MRI (e.g., pacemaker, metallic implant, claustrophobia) - unable or unwilling to come to one of the participating MRI centers (Montreal, Ottawa) - medical conditions likely to affect sleep; in particular: - current neurological disorder (e.g., epilepsy with any seizure in the past year, concussion in the past 3 months, multiple sclerosis, Parkinson's disease) - past history of brain lesion (e.g., brain hemorrhage, brain tumor, any condition having required brain surgery) - major surgery (i.e., requiring general anesthesia) in the past 3 months - untreated thyroid disorder - chronic pain syndrome self-reported as interfering with sleep (e.g., migraine, fibromyalgia, rheumatoid arthritis) - recent and severe infection in the past 3 months (e.g., pneumonia, kidney infection) - active cancer or treated cancer with post-cancer treatment for less than 2 years Inclusion/exclusion criteria for good sleepers Twenty-five good sleepers without cognitive complaint will be recruited as controls for the MRI session following the same criteria described above, except that SCI = 17, not meeting the diagnostic criteria for chronic insomnia as assessed by the insomnia module of the SCID and no subjective cognitive complaint. |
Country | Name | City | State |
---|---|---|---|
Canada | Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de l'Île-de-Montréal. CCSMTL - IUGM | Montréal | Quebec |
Canada | The Royal's Institute of Mental Health Research (IMHR) | Ottawa | Ontario |
Lead Sponsor | Collaborator |
---|---|
Centre de Recherche de l'Institut Universitaire de Geriatrie de Montreal |
Canada,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Insomnia severity index | Change in Insomnia Severity Index. ISI range from 0 to 28, higher score means more severe insomnia symptoms. | At baseline, at 10-12 weeks and at 24 weeks after the start of the intervention | |
Primary | Subjective cognitive impairment based on cognitive failure questionnaire | Change in Cognitive Failure Questionnaire (CFQ) total score as well as number of items with a score = 3. The CFQ comprises 25 items and total score corresponds to the sum of all completed items, total score range from 0 to 100. | At baseline, at 10-12 weeks and at 24 weeks after the start of the intervention | |
Primary | Objective cognitive performance based on a composite score for executive functions from the CANTAB | Change in the Cambridge Neuropsychological Test Automated Battery (CANTAB) executive functions composite score (Intra-Extra Dimensional Set Shift [IED] and Stocking of Cambridge [SOC], ranging from 0 to 100 with higher scores reflecting poorer executive functions. | At baseline and at 24 weeks after the start of the intervention | |
Primary | Geriatric anxiety index | Change in Geriatric anxiety index. GAI scores range from 0 to 20 and higher scores mean more severe anxiety symptoms. | At baseline, at 10-12 weeks and at 24 weeks after the start of the intervention | |
Primary | Geriatric depression scale | Change in Geriatric depression scale. GDS scores range from 0 to 15, higher scores mean more severe depression symptoms. | At baseline, at 10-12 weeks and at 24 weeks after the start of the intervention | |
Secondary | Sleep quality based on the Pittsburgh sleep quality index | Change in Pittsburgh sleep quality index. PSQI scores range from 0 to 21, higher scores mean worse sleep quality. | At baseline, at 10-12 weeks and at 24 weeks after the start of the intervention | |
Secondary | Objective sleep measures based on actigraphy: Sleep Efficiency | Change in Sleep Efficiency (SE) from actigraphs. Sleep efficiency ranges from 0 to 100, values closer to 100 mean greater sleep efficiency. | At baseline, at 10-12 weeks and at 24 weeks after the start of the intervention | |
Secondary | Objective sleep measures based on actigraphy: Sleep Latency | Change in Sleep Latency (SL) from actigraphs. Sleep latency in minutes, greater values mean longer time to fall asleep. | At baseline, at 10-12 weeks and at 24 weeks after the start of the intervention | |
Secondary | Objective sleep measures based on actigraphy: Total Sleep Time | Change in Total Sleep Time (TST) from actigraphs. Total Sleep Time in minutes, greater values mean longer time spent asleep. | At baseline, at 10-12 weeks and at 24 weeks after the start of the intervention | |
Secondary | Objective sleep measures based on actigraphy: Wake After Sleep Onset | Change in Wake After Sleep Onset (WASO) from actigraphs. Wake After Sleep Onset in minutes, greater values mean longer time spent awake. | At baseline, at 10-12 weeks and at 24 weeks after the start of the intervention | |
Secondary | Objective sleep measures based on EEG: Sleep Efficiency | Change in Sleep Efficiency (SE) from EEG. Sleep efficiency ranges from 0 to 100, values closer to 100 mean greater sleep efficiency. | At baseline, at 10-12 weeks and at 24 weeks after the start of the intervention | |
Secondary | Objective sleep measures based on EEG: Sleep Latency | Change in Sleep Latency (SL) from EEG. Sleep latency in minutes, greater values mean longer time to fall asleep | At baseline, at 10-12 weeks and at 24 weeks after the start of the intervention | |
Secondary | Objective sleep measures based on EEG: Total Sleep Time | Change in Total Sleep Time (TST) from EEG. Total Sleep Time in minutes, greater values mean longer time spent asleep. | At baseline, at 10-12 weeks and at 24 weeks after the start of the intervention | |
Secondary | Objective sleep measures based on EEG: Wake After Sleep Onset | Change in Wake After Sleep Onset (WASO) from EEG. Wake After Sleep Onset in minutes, greater values mean longer time spent awake. | At baseline, at 10-12 weeks and at 24 weeks after the start of the intervention | |
Secondary | Objective sleep measures based on EEG: Slow Wave Activity | Change in Slow Wave Activity (SWA) power density from EEG. | At baseline, at 10-12 weeks and at 24 weeks after the start of the intervention | |
Secondary | Objective sleep measures based on EEG: Slow Wave Sleep | Change in Slow Wave Sleep (SWS) from EEG. Slow Wave Sleep in minutes, greater values mean longer time spent in Slow Wave Sleep. | At baseline, at 10-12 weeks and at 24 weeks after the start of the intervention | |
Secondary | Subjective sleep measures based on sleep diaries: Sleep Efficiency | Change in Sleep Efficiency (SE) from sleep diaries. Sleep efficiency ranges from 0 to 100, values closer to 100 mean greater sleep efficiency. | At baseline, at 10-12 weeks and at 24 weeks after the start of the intervention | |
Secondary | Subjective sleep measures based on sleep diaries: Sleep Latency | Change in Sleep Latency (SL) from sleep diaries. Sleep latency in minutes, greater values mean longer time to fall asleep. | At baseline, at 10-12 weeks and at 24 weeks after the start of the intervention | |
Secondary | Subjective sleep measures based on sleep diaries: Total Sleep Time | Change in Total Sleep Time (TST) from sleep diaries. Total Sleep Time in minutes, greater values mean longer time spent asleep. | At baseline, at 10-12 weeks and at 24 weeks after the start of the intervention | |
Secondary | Subjective sleep measures based on sleep diaries: Wake After Sleep Onset | Change in Wake After Sleep Onset (WASO) from sleep diaries. Wake After Sleep Onset in minutes, greater values mean longer time spent awake. | At baseline, at 10-12 weeks and at 24 weeks after the start of the intervention | |
Secondary | Cognitive performances from the CANTAB: Rapid Visual Information Processing (RVP) | Change in Rapid Visual Information Processing RVP - A' (sensitivity to the target sequence) and probability of false alarm (range: 0.00 - 1.00; bad to good)]. | At baseline, at 10-12 weeks and at 24 weeks after the start of the intervention | |
Secondary | Cognitive performances from the CANTAB: Spatial Span (SSP) | Change in Spatial Span [SSP - Forward/Reverse Span Lengths (range: 2-9; bad to good] | At baseline, at 10-12 weeks and at 24 weeks after the start of the intervention | |
Secondary | Cognitive performances from the CANTAB: Spatial Working Memory (SWM) | Change in Spatial Working Memory [SWM - Number of times the subject incorrectly revisits a box in which a token has previously been found (range: 0 - 8; good to bad)]. | At baseline, at 10-12 weeks and at 24 weeks after the start of the intervention | |
Secondary | Cognitive performances from the CANTAB: Paired Associates Learning (PAL) | Change in Paired Associates Learning [PAL - Total errors adjusted (range: 0 - 70; good to bad; First attempt memory score (range: 0-20; bad to good)] | At baseline, at 10-12 weeks and at 24 weeks after the start of the intervention | |
Secondary | Cognitive performances from the CANTAB: Pattern Recognition Memory (PRM) | Change in Pattern Recognition Memory [PRM - Percent correct immediate/delayed (range: 0-100; bad to good)]. | At baseline, at 10-12 weeks and at 24 weeks after the start of the intervention | |
Secondary | Cognitive performances from the CANTAB: Intra-Extra Dimensional Set Shift (IED) | Intra-Extra Dimensional Set Shift, IED - number of times that the subject failed to select the stimulus compatible with the current rule on the stage where the extra-dimensional shift occurs (range: 0-50; good to bad); Total errors adjusted (range: 0-402; good to bad) | At baseline, at 10-12 weeks and at 24 weeks after the start of the intervention | |
Secondary | Cognitive performances from the CANTAB: Stocking of Cambridge (SOC) | Stocking of Cambridge, SOC - Number of problems successfully completed in the minimum possible number of moves (range: 0 - 12; bad to good); Mean number of moves required to complete problems (range: 5 - 12; good to bad); Initial thinking time median (range: 0 ms to 8; longer times may indicate better planning efforts | At baseline, at 10-12 weeks and at 24 weeks after the start of the intervention | |
Secondary | Negative emotional bias measured on the Cambridge Neuropsychological Test Automated Battery (CANTAB) | Change in Emotional Bias Task (EBT) subscales from the CANTAB [EBT - proportion of trials rated as 'Happy' (range: 0-15, bad to good)]. | At baseline, at 10-12 weeks and at 24 weeks after the start of the intervention | |
Secondary | Memory encoding fMRI activations | Change in fMRI activation level (arbitrary units) in the hippocampus, temporal lobe and prefrontal cortex during the memory encoding task. | At baseline, at 24 weeks after the start of the intervention | |
Secondary | Cognitive performance (classical neuropsychological tests) | all subscales from classical neuropsychological test battery (Trail Making Test A [TMT-A], Digit Symbol Substitution test (WAIS), Boston Naming Test, Digit Span - forward and backward (WAIS), Rey Auditory Verbal Learning test, Logical Memory I and II (Wechsler Memory Scale), Brief Visuospatial Memory Test Revised (BVMT-R), Trail Making Test B [TMT-B], Verbal Fluency Test (from D-KEFS), Color-Word Interference Test [Stroop test, from D-KEFS]). | At baseline, at 24 weeks after the start of the intervention | |
Secondary | Cortical thickness measures | Change in cortical thickness (mm) in the prefrontal cortex and precuneus. | At baseline, at 24 weeks after the start of the intervention | |
Secondary | Fractional anisotropy | Change in fractional anisotropy of the superior longitudinal fasciculus and internal capsule. | At baseline, at 24 weeks after the start of the intervention | |
Secondary | Resting-state measures | Change in the ratio between segregation and integration within and between the default-mode network and the limbic network during resting-state as measured with functional connectivity. | At baseline, at 24 weeks after the start of the intervention | |
Secondary | GABA/glutamate ratio from magnetic resonance spectroscopy | Change in the GABA/glutamate ratio in the anterior cingulate cortex. | At baseline, at 24 weeks after the start of the intervention | |
Secondary | Treatment-mediated association between changes in sleep and cognition | Mediation estimate of the extent to which exposure to eCBTi+ explains the association between improved sleep and improved cognition | At 10-12 weeks and at 24 weeks after the start of the intervention | |
Secondary | Satisfaction from System Usability Scale | Score on the System Usability Scale, reflecting the degree to which participants were satisfied with the eCBTi+ and the control intervention. Percentage ranging between 0 and 100%. | At 10-12 weeks after the start of the intervention | |
Secondary | Technology acceptance | Score on the extended version of the Technology Acceptance Model-2 reflecting th degree to which participants use and intend to use the eCBTi+ (and control intervention) as implemented on e-SPACE. Each process influencing technology acceptance is scored on a 7-point Likert scale. | At 10-12 weeks after the start of the intervention | |
Secondary | Adherence to treatment | Number of modules completed as a measure of treatment adherence | At 10-12 weeks after the start of the intervention |
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