title: Cognitive behavioral therapy vs. Tai Chi for late life insomnia and inflammatory risk: a randomized controlled comparative efficacy trial.
abstract: OBJECTIVE
  To investigate the comparative efficacy of cognitive behavioral therapy (CBT), Tai Chi Chih (TCC), and sleep seminar education control (SS) on the primary outcome of insomnia diagnosis, and secondary outcomes of sleep quality, fatigue, depressive symptoms, and inflammation in older adults with insomnia.
  
  
  METHODS
  Randomized controlled, comparative efficacy trial.
  
  
  METHODS
  Los Angeles community.
  
  
  METHODS
  123 older adults with chronic and primary insomnia.
  
  
  METHODS
  Random assignment to CBT, TCC, or SS for 2-hour group sessions weekly over 4 months with follow-up at 7 and 16 months.
  
  
  METHODS
  Insomnia diagnosis, patient-reported outcomes, polysomnography (PSG), and high-sensitivity C-reactive protein (CRP) levels.
  
  
  RESULTS
  CBT performed better than TCC and SS in remission of clinical insomnia as ascertained by a clinician (P < 0.01), and also showed greater and more sustained improvement in sleep quality, sleep parameters, fatigue, and depressive symptoms than TCC and SS (all P values < 0.01). As compared to SS, CBT was associated with a reduced risk of high CRP levels (> 3.0 mg/L) at 16 months (odds ratio [OR], 0.26 [95% CI, 0.07-0.97] P < 0.05). Remission of insomnia was associated with lower levels of CRP (P < 0.05) at 16 months. TCC was associated with improvements in sleep quality, fatigue, and depressive symptoms as compared to SS (all P's < 0.05), but not insomnia remission. PSG measures did not change.
  
  
  CONCLUSIONS
  Treatment of late-life insomnia is better achieved and sustained by cognitive behavioral therapies. Insomnia treatment and remission reduces a marker of inflammatory risk, which has implications for cardiovascular morbidity and diabetes observed with sleep disturbance in epidemiologic surveys.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Irwin
authors.forename: Richard
authors.initials: R
authors.lastname: Olmstead
authors.forename: Carmen
authors.initials: C
authors.lastname: Carrillo
authors.forename: Nina
authors.initials: N
authors.lastname: Sadeghi
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Breen
authors.forename: Tuff
authors.initials: T
authors.lastname: Witarama
authors.forename: Megumi
authors.initials: M
authors.lastname: Yokomizo
authors.forename: Helen
authors.initials: H
authors.lastname: Lavretsky
authors.forename: Judith E
authors.initials: JE
authors.lastname: Carroll
authors.forename: Sarosh J
authors.initials: SJ
authors.lastname: Motivala
authors.forename: Richard
authors.initials: R
authors.lastname: Bootzin
authors.forename: Perry
authors.initials: P
authors.lastname: Nicassio
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000032:analysis; D015928:Cognitive Behavioral Therapy; D003863:Depression / Q000523:psychology; D005221:Fatigue / Q000503:physiopathology; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D017286:Polysomnography; D012306:Risk; D012890:Sleep / Q000502:physiology; D007319:Sleep Initiation and Maintenance Disorders / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy*; D026302:Tai Ji; D016896:Treatment Outcome
chemical_list: D002097:C-Reactive Protein
keywords: behavioral treatment; inflammation; insomnia; late life; randomized controlled trial