0397 Randomized Controlled Trial of Telehealth in Older Adults: Technology-assisted CBTi+, CBTi, and Sleep Hygiene
Bibliographic record
Abstract
Abstract Introduction Of 34M US adults affected by insomnia, 75% are older adults. Cognitive Behavioral Therapy for Insomnia (CBTi) is recommended because polypharmacy and fall risks accompany pharmacotherapies. We evaluated telehealth CBTi with an interactive patient-therapist application, SleepSpace, which integrates data from wearables and Internet of Things (IoT) devices. Methods This RCT (NCT05015803) followed community-dwelling participants 60-90 years old with an Insomnia Severity Index (ISI) score ≥11. Absence of mild cognitive impairment was affirmed with the Montreal Cognitive Assessment (MoCA) Blind v.8 (score ≥ 18). Participants wore actigraphy and an Apple Watch throughout and independently completed a weekly electronic ISI. They attended 7 weekly, ~1hr video-conference sessions (1 intake, 6 procedural) with a clinical therapist. Participants were randomly assigned to one of 3 study conditions (age-, gender-stratified): 1) education about sleep hygiene only (20%; “Hygiene”), 2) telehealth CBTi (40%; “CBTi”), and 3) telehealth CBTi with phone/IoT platform application enhancement (40%; “CBTi+”) including meditations, sound machines, smart light bulbs, an electronic diary, with visualizations, metrics, and wearable data shared with participants in the CBTi+ condition. Linear mixed models compared ISI change across time by group. Results Of 60 individuals enrolled, 54 were randomized and retained (39F, mean±SD age=71±4y). ISI slopes for both CBTi (-.09/day) and CBTi+ (-.09/day) declined at a significantly steeper rate than Hygiene (-.05/day; each p<.05), but did not differ from one another. Significantly more CBTi+ participants exhibited full remission (ISI < 8; 18/21, 85.7%) than in the Hygiene group (5/11, 45.4%; p=.03 Fisher’s Exact); CBTi alone (16/22, 72.7%) did not significantly differ from Hygiene, although with limited statistical power. Diary-reported sleep measures to calculate self-reported sleep efficiency (sSE) in the final week at end of treatment revealed differences in mean±SD for Hygiene (81±05%) vs. CBTI (88±07%), and vs. CBTI+ (90±04%, p< 0.05, t-test). Conclusion This research supports the efficacy of a remote, technology-assisted telehealth CBTi platform to improve insomnia symptoms comparable to standard telehealth-CBTi in older adults with insomnia. The platform provides enhanced data access for therapists and opportunities for data-driven engagement with patients. Support (if any) R44 AG056250, UL1TR002014
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.003 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.029 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".