Impact Of Phenotypic Heterogeneity Of Insomnia On The Patients’ Response To Cognitive-Behavioral Therapy For Insomnia: Current Perspectives

Figures & data

Table 1 Studies Evaluating OSD In CBT-I

Study	Population	Methods To Assess OSD	Type Of CBT-I Treatment	Results
Troxel et al. (2013)^Citation38	N = 39 (age: 72.54 ± 6.61)	Actigraphy record; PSG baseline recording	Three weeks of Brief Behavioral Treatment for Insomnia (BBTI)	Longer SL at the baseline: more likely to respond to BBTI SSD group: less remission of insomnia at the follow-up No evidence for an effect of overall delta activity or slope of delta activity across the night
Lovato et al. (2016)^Citation51	N = 91 (age: 63.34 ± 6.41) 39 SSD 52 NSD	PSG baseline recording	Four weeks of group CBT-I sessions	No differences in treatment outcomes between the two sleep duration groups
Bathgate et al. (2017)^Citation36	N = 60 (age: 56.2 ±10.1) 35 SSD 25 NSD	Actigraphy record	Eight weeks of individual CBT-I sessions	SSD group: Less remission of insomnia symptoms Lower improvements in SE and TWT More difficulty to fall asleep after awake during the night No significant changes in post-treatment TST
Miller et al. (2018)^Citation37	N = 96 (age: 41.4 ± 11.8) 43 SSD 53 NSD	PSG baseline recording	Different treatment modalities: Digital CBT only Face-to-face CBT only Digital CBT + face-to-face CBT Sleep Restriction Therapy only Sleep Restriction Therapy + face-to-face CBT Sleep Restriction Therapy + digital CBT	SSD group showed less response to CBT-I
Crönlein et al. (2018)^Citation52	N = 92 39 SSD (age: 53.0±11.7) 53 NSD (age 49.2±11.4)	PSG baseline recording	Two weeks of group CBT-I sessions	No group difference in the primary outcomes
Rochefort et al. (2019)^Citation53	N = 159 (age: 50.31 ± 10.14) 51 SSD 108 NSD	PSG baseline recording	Two treatment modalities: Eight week of CBT-I sessions Eight week of CBT-I sessions + Zolpidem	OSD did not moderate treatment response to either CBT-I or CBT-I+Zolpidem

Abbreviations: OSD, objective sleep duration; BBTI, brief behavioural treatment of insomnia; SSD, short sleep duration; NSD, normal sleep duration; SE, sleep efficiency; TWT, total wake time; TST, total sleep time; PSG, polysomnography.

Table 2 Subjective Sleep And Non-Sleep Predictors Of CBT-I Outcomes

Studies	Predictors Of Response To CBT-I
	Sample	Predictors
Galbiati et al. 2018^Citation54	292 ID patients (mean age 41.14 ± 12.45)	Short Sleeper (TST<6hrs) showed a boosted response (ISI and SE)
Chiu et al. 2018^Citation55	74 schizophrenia and related psychoses and self-reported insomnia (mean age=41.4 years)	Insomnia in comorbidity with schizophrenia: short TST, poor SE, and prolonged SL showed greatest benefits (TST and SE)
Bei et al. 2018^Citation74	148 adults with insomnia and MDD (age=46.6±12.6)	Insomnia in comorbidity with depression: significant baseline predictors of response trajectories in terms of depression outcomes were not found
Sánchez-Ortuño et al. 2010^Citation75	92 ID patients	Worry and symptom-focused insomnia are positively associated with large symptom reduction after CBT-I
Blanken et al. 2019^Citation34	Subtype 2: N=43 (26 treated, 17 waitlist controls) (age 50.8±12.9 years) Subtype 4: N=25 (16 treated, 9 waitlist controls) (age 53.2±9.8 years)	Subtype 2: Moderate grade of distress and intact responses to pleasurable emotions could predict strong decrease in ISI score and in SL after CBT-I Subtype 4: Slightly distressed and high reactivity to environment and life events showed SL no improvement, but a decreased in ISI score was found

Abbreviations: ID, insomnia disorders; TST, total sleep time; ISI, insomnia severity index; SE, sleep efficiency; SL, sleep latency; MDD, major depressive disorder.

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