A pilot randomised control study to investigate the effect of the South African Adolescence Group Sleep Intervention (SAASI) on adolescent sleep and PTSD*

Figures & data

Table 1. Required measures/samples/intervention sessions at each visit for participants in the control and intervention group in the South African Adolescence Group Sleep Intervention (SAASI) pilot trial.

		Control group		Intervention group
Visit	Week	Requirements	Duration	Requirements	Duration
Pre-intervention	1	MINIkid; demographic questionnaire, written consent and/or assent	90 min	MINIkid; demographic questionnaire, written consent and/or assent	90 min
Visit 0	2	LEC, CPSS, MASC, KADS, ASWS, FoSI, ISI, PSQI, DUDIT, AUDIT; training in the use of sleep diaries	60 min	LEC, CPSS, MASC, KADS, ASWS, FoSI, ISI, PSQI, DUDIT, AUDIT; training in the use of sleep diaries, individual session with interventionist	90 min
Visit 1	3	Sleep diary	30 min	Sleep diary; group session 1 of intervention	110 min
Visit 2	4	Sleep diary	20 min	Sleep diary; group session 2 of intervention	100 min
Visit 3 (mid-point)	5	LEC, CPSS, MASC, KADS, ASWS, FoSI, ISI, PSQI, DUDIT, AUDIT; sleep diary	60 min	LEC, CPSS, MASC, KADS, ASWS, FoSI, ISI, PSQI, DUDIT, AUDIT; sleep diary; goup session 3 of intervention	140 min
Visit 4	6	sleep diary	30 min	Sleep diary; group session 4 of intervention	110 min
Post-intervention	7	LEC, CPSS, MASC, KADS, ASWS, FoSI, ISI, PSQI, DUDIT, AUDIT; sleep diary; MINIkid	110 min	LEC, CPSS, MASC, KADS, ASWS, FoSI, ISI, PSQI, DUDIT, AUDIT; sleep diary; MINIkid	110 min

Abbreviations: Mini International Neuropsychiatric Interview Kid Screen (MINIkid); Life Events Checklist (LEC); Child PTSD Symptom Scale self-report version for DSM-5 (CPSS); Multidimensional Anxiety Scale for Children (MASC); Kutcher Adolescent Depression Scale (KADS); Adolescent Sleep Wake Scale (ASWS); Fear of Sleep Inventory (FoSI); Insomnia Severity Index (ISI); Pittsburgh Sleep Quality Index (PSQI); Drug Use Disorders Identifications Test (DUDIT); Alcohol Use Disorders Identification Test (AUDIT).

Table 2. Modules and treatment sessions of South African Adolescence Group Sleep Intervention (SAASI).

Module	Session Number	Purpose
Functional Analysis (CC)	1& interwoven thereafter	Develop treatment goals. Introduce rationale for treatment
Sleep and Circadian education (CC)	1& interwoven thereafter	Provides treatment rationale
Motivational Interviewing (CC)	1& interwoven thereafter	Method to increase motivation to modify behaviour
Goal setting (CC)	1 & 2 then as needed	Setting goals for the night and day routine
Irregular sleep-wake times (CM)	2–5	Set regular bed and wake times across the week
Difficulty winding down (CM)	3–5	Supports keeping to regular schedule
Difficulty waking up (CM)	3–5	Supports setting a regular wake-up time and getting out of bed upon waking
Daytime impairment (CM)	3–5	Skills to cope the day after a bad night’s sleep
Unhelpful beliefs about sleep (CM)	4	Help change unhelpful beliefs to improve sleep and reduce anxiety about sleep
Poor sleep efficiency (OM)	2–5	Associate the bed with sleep and reduce time awake in bed by applying sleep restriction
Too much time in bed (OM)	2–5	To assist participants that spend too much time in bed to engage more fully in daytime activities
Dealing with delayed phase and advanced phase (OM)	2–5	To assist participants to get to bed early or late enough to ensure sufficient sleep
Sleep-related worry/vigilance (OM)	4	Reduce anxiety and pre-sleep arousal
Progressive Relaxation (CM)	5	Reduce anxiety and pre-sleep arousal
Maintenance of behaviour change (CM)	5	Relapse prevention and managing challenges

Note. C-C is Cross-cutting Module; CM is Core Module; OM is Optional Module; optional modules would be implemented if 1 or more group members required it.

Figure 1. CONSORT Flow Diagram of SAASI.

Table 3. Demographic and trauma exposure information for the intervention and control group in the South African Adolescence Group Sleep Intervention (SAASI) pilot trial.

	SAASI N = 31	Control N = 30
Demographic Information
Age	15.94 (SD = 1)	16.17 (SD = 0.99)
Gender: Female	24 (77.42%)	22 (73.33)
Ethnicity: White Coloured (Mixed race) African	1 (3.50%) 18 (64.29%) 9 (32.14%)	0 (0%) 18 (60.0%) 12 (40%)
Home Language: English Afrikaans isiXhosa Other	12 (38.71%) 11 (35.48%) 7 (22.58%) 1 (3.50%)	4 (13.33%) 14 (46.7%) 10 (33.7%) 2 (6.7%)
Religion: Christian Muslim Other/ No Religion	24 (77.42%) 4 (12.9%) 3 (9.68)	19 (70.37%) 3 (11.11%) 8 (13.79%)
Current Grade: 6–9 10–12	3 (9.68%) 26 (83.67%)	13 (43.33%) 16 (53.33%)
Index trauma: Sexual assault Other unwanted sexual experience Physical assault Assault with a weapon Sudden accidental death Transport accident Sudden violent death Fire or explosion Serious injury/ harm caused to other Other trauma	7 1 6 5 2 3 1 0 1 3	9 1 5 1 4 1 2 1 0 1

Note: Numbers may not add up to 100% due to missing data.

Table 4. Baseline Sleep Characteristics – ISI.

		Rarely/Never	Sometimes	Usually/Always
Satisfaction	Are you satisfied with your sleep?	17 (27.9%)	34 (55.7%)	4 (6.6)
Alertness	Do you stay awake all day without dozing	10 (16.4%)	31 (50.8%)	12 (19.7%)
Timing	Are you asleep (or trying to sleep) between 2:00 am and 4:00 am?	4 (6.6%)	24 (39.3%)	25 (41.0%)
Efficiency	Do you spend less than 30 min awake at night? (This includes the time it takes to fall asleep and awakenings from sleep.)	9 (14.8%)	29 (47.5%)	17 (27.9%)
Duration	Do you sleep between 6 and 8 h per day?	17 (27.9%)	28 (45.9%)	9 (14.8%)

Table 5. Between-group outcome data for primary measures in the South African Adolescence Group Sleep Intervention (SAASI) pilot trial.

	SAASI (n = 31)	Control (n = 30)	Mean diff	p	Cohens’s d	95% CI Lower Upper
Primary Outcome
Self-report (PSQI), n, mean, (SD)
Baseline	(n = 26) 9.96 (2.73)	(n = 26) 11.81 (2.65)	−1.82	.013	−0.68	−3.25	−0.38
Mid-treatment	(n = 17) 9.18 (3.28)	(n = 18) 11.28 (2.14)	−2.82	.002	−1.05	−4.60	−1.04
Post-treatment	(n = 14) 7.36 (2.68)	(n = 17) 9.94 (3.58)	−1.99	.050	−0.74	−3.98	0.00
1-month follow-up	(n = 17) 7.82 (3.70)	(n = 12) 9.58 (4.01)	−2.78	.028	−1.03	−5.25	−0.31
Self-reported PTSD (CPSS-SR-5), (n), mean (SD)
Baseline	(n = 26) 43.92 (14.71)	(n = 23) 46.52 (14.51)	−5.90	.159	−0.40	−14.13	2.32
Mid-treatment	(n = 19) 31.95 (18.49)	(n = 17) 38.41 (15.29)	−8.03	.055	−0.55	−16.24	0.17
Post-treatment	(n = 16) 27.00 (18.30)	(n = 17) 41.88 (18.96)	−9.10	.045	−0.62	−17.98	−0.21
1-month follow-up	(n = 15) 30.53 (17.16)	(n = 13) 31.54 (16.73)	−11.23	.049	−0.77	−22.43	−0.03

Note. n indicates number of participants with completed self-reports and have not dropped out.

Data availability statement

The data that support the findings of this study are available from the corresponding author, Jaco Rossouw, upon reasonable request.