title: Mid-Treatment Sleep Duration Predicts Clinically Significant Knee Osteoarthritis Pain reduction at 6 months: Effects From a Behavioral Sleep Medicine Clinical Trial.
abstract: To determine the relative influence of sleep continuity (sleep efficiency, sleep onset latency, total sleep time [TST], and wake after sleep onset) on clinical pain outcomes within a trial of cognitive behavioral therapy for insomnia (CBT-I) for patients with comorbid knee osteoarthritis and insomnia.
  
  
  
  Secondary analyses were performed on data from 74 patients with comorbid insomnia and knee osteoarthritis who completed a randomized clinical trial of 8-session multicomponent CBT-I versus an active behavioral desensitization control condition (BD), including a 6-month follow-up assessment. Data used herein include daily diaries of sleep parameters, actigraphy data, and self-report questionnaires administered at specific time points.
  
  
  
  Patients who reported at least 30% improvement in self-reported pain from baseline to 6-month follow-up were considered responders (N = 31). Pain responders and nonresponders did not differ significantly at baseline across any sleep continuity measures. At mid-treatment, only TST predicted pain response via t tests and logistic regression, whereas other measures of sleep continuity were nonsignificant. Recursive partitioning analyses identified a minimum cut-point of 382 min of TST achieved at mid-treatment in order to best predict pain improvements 6-month posttreatment. Actigraphy results followed the same pattern as daily diary-based results.
  
  
  
  Clinically significant pain reductions in response to both CBT-I and BD were optimally predicted by achieving approximately 6.5 hr sleep duration by mid-treatment. Thus, tailoring interventions to increase TST early in treatment may be an effective strategy to promote long-term pain reductions. More comprehensive research on components of behavioral sleep medicine treatments that contribute to pain response is warranted.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine,Baltimore, MD.
authors.forename: Jessica K
authors.initials: JK
authors.lastname: Salwen
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine,Baltimore, MD.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Smith
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine,Baltimore, MD.
authors.forename: Patrick H
authors.initials: PH
authors.lastname: Finan
mesh_terms: D056044:Actigraphy; D015928:Cognitive Behavioral Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D010146:Pain / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology; D057566:Self Report; D012890:Sleep / Q000502:physiology*; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications* / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
keywords: CBT-I; insomnia.; osteoarthritis; pain; total sleep time