title: Measuring Treatment Outcomes in Comorbid Insomnia and Fibromyalgia: Concordance of Subjective and Objective Assessments.
abstract: OBJECTIVE
  In insomnia, actigraphy tends to underestimate wake time compared to diaries and PSG. When chronic pain co-occurs with insomnia, sleep may be more fragmented, including more movement and arousals. However, individuals may not be consciously aware of these arousals. We examined the baseline concordance of diaries, actigraphy, and PSG as well as the ability of each assessment method to detect changes in sleep following cognitive behavioral therapy for insomnia (CBT-I).
  
  
  METHODS
  Adults with insomnia and fibromyalgia (n = 113) were randomized to CBT-I, CBT for pain, or waitlist control. At baseline and posttreatment, participants completed one night of PSG and two weeks of diaries/actigraphy.
  
  
  RESULTS
  At baseline, objective measures estimated lower SOL, higher TST, and higher SE than diaries (ps < 0.05). Compared to PSG, actigraphic estimates were higher for SOL and lower for WASO (ps < 0.05). Repeated measures ANOVAs were conducted for the CBT-I group (n = 15), and significant method by time interactions indicated that the assessment methods differed in their sensitivity to detect treatment-related changes. PSG values did not change significantly for any sleep parameters. However, diaries showed improvements in SOL, WASO, and SE, and actigraphy also detected the WASO and SE improvements (ps < 0.05).
  
  
  CONCLUSIONS
  Actigraphy was generally more concordant with PSG than with diaries, which are the recommended assessment for diagnosing insomnia. However, actigraphy showed greater sensitivity to treatment-related changes than PSG; PSG failed to detect any improvements, but actigraphy demonstrated changes in WASO and SE, which were also found with diaries. In comorbid insomnia/fibromyalgia, actigraphy may therefore have utility in measuring treatment outcomes.
authors.affiliation: Clinical and Health Psychology, University of Florida, Gainesville, FL.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Mundt
authors.affiliation: Clinical and Health Psychology, University of Florida, Gainesville, FL.
authors.forename: Earl C
authors.initials: EC
authors.lastname: Crew
authors.affiliation: Clinical and Health Psychology, University of Florida, Gainesville, FL.
authors.forename: Kendra
authors.initials: K
authors.lastname: Krietsch
authors.affiliation: Clinical and Health Psychology, University of Florida, Gainesville, FL.
authors.forename: Alicia J
authors.initials: AJ
authors.lastname: Roth
authors.affiliation: Clinical and Health Psychology, University of Florida, Gainesville, FL.
authors.forename: Karlyn
authors.initials: K
authors.lastname: Vatthauer
authors.affiliation: Clinical and Health Psychology, University of Florida, Gainesville, FL.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Robinson
authors.affiliation: Rheumatology and Clinical Immunology, University of Florida, Gainesville, FL.
authors.forename: Roland
authors.initials: R
authors.lastname: Staud
authors.affiliation: Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Berry
authors.affiliation: Health Psychology, University of Missouri, Columbia, MO.
authors.forename: Christina S
authors.initials: CS
authors.lastname: McCrae
mesh_terms: D056044:Actigraphy; D001521:Behavior Therapy / Q000379:methods; D015928:Cognitive Behavioral Therapy; D005260:Female; D005356:Fibromyalgia / Q000150:complications*; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D017286:Polysomnography; D057566:Self Report; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications* / Q000628:therapy; D016896:Treatment Outcome
keywords: actigraphy; assessment; chronic pain; clinical trial; cognitive behavioral therapy; fibromyalgia; insomnia; polysomnography