Sleep-HD: Short and Long-Term Effectiveness of Existing Insomnia Therapies for Patients Undergoing Hemodialysis
Study Details
Study Description
Brief Summary
Insomnia is a common and distressing symptom for patients on hemodialysis (HD), and there is evidence for a much larger impact on the health of patients. Chronic insomnia is disrupted sleep that occurs at least three nights per week and lasts at least three months.
The SLEEP-HD study is a randomized open-label clinical trial to compare two types of treatment for insomnia in participants who have end-stage renal disease on HD, and who have been diagnosed with chronic insomnia. The two types of treatment involved in the study are Cognitive Behavioral Therapy for Insomnia (CBT-I) or treatment with a drug (trazodone vs placebo).
126 participants will be enrolled who are undergoing HD in two study locations (Seattle, Washington and Albuquerque, New Mexico).
Condition or Disease | Intervention/Treatment | Phase |
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Phase 3 |
Detailed Description
Most HD patients have significant impairments in quality of life, largely from the high frequency of disabling symptoms. Insomnia is one of the most frequently reported symptoms and studies of HD patients and/or other populations suggest that it is a significant contributor to other common symptoms and poor health outcomes. There are unique contributors to chronic insomnia in HD patients and these include the biologic effects of residual uremia after partial correction as is achieved with current dialysis technology, maladaptation to treatment schedules, and patients' napping during treatments.
There is a compelling need to identify effective treatments for insomnia in HD patients and the interventions being studied in this clinical trial, telehealth cognitive behavioral therapy for insomnia (CBT-I) and trazodone, have a strong scientific premise. If telehealth (web-based) CBT-I is effective for insomnia in HD patients, it will make a treatment that is presently inaccessible available to patients. Trazodone is widely used but the data on efficacy for insomnia are limited; no such data exist for HD patients.
SLEEP-HD is a parallel group randomized controlled trial wherein 125 HD patients with chronic insomnia, treated in community-based dialysis facilities in Seattle and Albuquerque, will be randomized 1:1:1 over 31 months to 6-week treatment with telehealth CBT-I, trazodone, or medication placebo.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Active Comparator: CBT-I Cognitive Behavioral Therapy for Insomnia sessions: a 30-minute treatment session once weekly for six weeks. |
Behavioral: Cognitive Behavioral Therapy for Insomnia
Once weekly treatment sessions for 6 weeks. The content of each of these sessions will be adapted to include changes in behavior during HD treatments (such as napping) and to help patients better adjust to treatment schedules. The CBT-I sessions will be delivered by a therapist face-to-face with the patient via a fully interactive video telehealth platform.
Other Names:
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Active Comparator: Medication- Trazodone Trazodone (50-100 mg): |
Drug: Trazodone
trazodone tablet
Other Names:
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Placebo Comparator: Medication- Placebo Placebo (for trazodone) |
Drug: Placebo
Inactive pill manufactured to mimic trazodone tablets.
Other Names:
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Outcome Measures
Primary Outcome Measures
- Insomnia Severity Index (ISI) Short-term [Week 7]
summary score obtained from the ISI, measuring insomnia, range from 0 to 28. Higher score indicates greater insomnia, at Week 7 describing the short-term effect of the intervention
- Insomnia Severity Index (ISI) Long-term [Week 25]
summary score obtained from the ISI, measuring insomnia, range from 0 to 28. Higher score indicates greater insomnia, at Week 25 describing the long-term effect of the intervention
Secondary Outcome Measures
- Patient-reported Outcomes (PRO) - Pittsburgh Sleep Quality Index - Short-term [Week 7]
Score from Pittsburgh Sleep Quality Index, measuring sleep quality, range 0 to 21. Higher scores indicates worse sleep quality: at Week 7 describing the short-term effect of the intervention
- Patient-reported Outcomes (PRO) - Pittsburgh Sleep Quality Index - Long-term [Week 25]
Score from Pittsburgh Sleep Quality Index, measuring sleep quality, range 0 to 21. Higher scores indicates worse sleep quality: at Week 25 describing the long-term effect of the intervention
- Patient-reported Outcomes (PRO) - Epworth Sleepiness Scale - Short-term [Week 7]
Score from Epworth Sleepiness Scale, measuring sleepiness, range 0 to 24. Higher scores indicates greater sleepiness: at Week 7 describing the short-term effect of the intervention
- Patient-reported Outcomes (PRO) - Epworth Sleepiness Scale - Long-term [Week 25]
Score from Epworth Sleepiness Scale, measuring sleepiness, range 0 to 24. Higher scores indicates greater sleepiness: at Week 25 describing the long-term effect of the intervention
- Patient-reported Outcomes (PRO) - FACIT Fatigue Scale- Short-term [Week 7]
Score from FACIT Fatigue Scale, measuring fatigue, range 0 to 52. Higher scores indicates greater fatigue: at Week 7 describing the short-term effect of the intervention
- Patient-reported Outcomes (PRO) - FACIT Fatigue Scale- Long-term [Week 25]
Score from FACIT Fatigue Scale, measuring fatigue, range 0 to 52. Higher scores indicates greater fatigue: at Week 25 describing the long-term effect of the intervention
- Patient-reported Outcomes (PRO) - Two-Item Graded Chronic Pain scale - Short-term [Week 7]
Score from Two-Item Graded Chronic Pain scale, measuring pain, range 0 to 10. Higher scores indicates greater pain: at Week 7 describing the short-term effect of the intervention
- Patient-reported Outcomes (PRO) - Two-Item Graded Chronic Pain scale - Long-term [Week 25]
Score from Two-Item Graded Chronic Pain scale, measuring pain, range 0 to 10. Higher scores indicates greater pain: at Week 25 describing the long-term effect of the intervention
- Patient-reported Outcomes (PRO) - Patient Health Questionnaire 9 - Short-term [Week 7]
Score from Patient Health Questionnaire 9, measuring depression, range 0 to 27. Higher scores indicates greater depression: at Week 7 describing the short-term effect of the intervention
- Patient-reported Outcomes (PRO) - Patient Health Questionnaire 9 - Long-term [Week 25]
Score from Patient Health Questionnaire 9, measuring depression, range 0 to 27. Higher scores indicates greater depression: at Week 25 describing the long-term effect of the intervention
- Patient-reported Outcomes (PRO) - Generalized Anxiety Disorder 7 Scale - Short-term [Week 7]
Score from Generalized Anxiety Disorder 7 Scale, measuring anxiety, range 0 to 21. Higher scores indicates greater anxiety: at Week 7 describing the short-term effect of the intervention
- Patient-reported Outcomes (PRO) - Generalized Anxiety Disorder 7 Scale - Long-term [Week 25]
Score from Generalized Anxiety Disorder 7 Scale, measuring anxiety, range 0 to 21. Higher scores indicates greater anxiety: at Week 25 describing the long-term effect of the intervention
- Patient-reported Outcomes (PRO) - Quality of Life Short Form 12 scale - Short-term [Week 7]
Score from Quality of Life Short Form 12 scale, measuring quality of life, range 0 to 100. Higher scores indicates better quality of life: at Week 7 describing the short-term effect of the intervention
- Patient-reported Outcomes (PRO) - Quality of Life Short Form 12 scale - Long-term [Week 25]
Score from Quality of Life Short Form 12 scale, measuring quality of life, range 0 to 100. Higher scores indicates better quality of life: at Week 25 describing the long-term effect of the intervention
- Cumulative Weekly use of Sedatives/Hypnotics - Short-term [Week 7]
This will be defined, as the number of days that the patient took a drug to help sleep, range from 0 to 7: at Week 7 describing the short-term effect of the intervention
- Cumulative Weekly use of Sedatives/Hypnotics - Long-term [Week 25]
This will be defined, as the number of days that the patient took a drug to help sleep, range from 0 to 7: at Week 25 describing the long-term effect of the intervention
- Objective Measure of Sleep - Short-term [Week 6]
Actigraphy measurement of average nighttime sleep efficiency (percent time asleep of time in bed): at Week 6 describing the short-term effect of the intervention
- Objective Measure of Sleep - Long-term [Week 25]
Actigraphy measurement of average nighttime sleep efficiency (percent time asleep of time in bed): at Week 25 describing the long-term effect of the intervention
Eligibility Criteria
Criteria
Inclusion Criteria:
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Undergoing thrice-weekly maintenance hemodialysis for ≥ 3 months
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Able to speak English
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ISI score ≥ 10 at pre-screening with sleep disturbances for ≥ 3 nights per week for ≥ 3 months
Exclusion Criteria:
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Severe cognitive impairment on Mini-COG cognitive test (score < 3)
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Severe depression assessed by Patient Health Questionnaire (PHQ)-2 and if appropriate, PHQ-9
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Suicidal Ideation
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Alcohol abuse on CAGE alcohol assessment questionnaire (score ≥ 2) or substance abuse on Drug Abuse Screening Test (DAST)-10 questionnaire (score > 5)
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Severe restless leg syndrome
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Treatment with trazodone in the past one month
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Known allergy to trazodone (self-report or by chart review)
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Current treatment with monoamine oxidase inhibitors or in the preceding 14 days
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Current treatment with linezolid (self-report or by chart review)
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Current treatment with other drugs that are inhibitors of CYP3A4 (e.g., itraconazole, clarithromycin, voriconazole), or known to prolong QT interval including Class 1A antiarrhythmics (e.g., quinidine, procainamide) or Class 3 antiarrhythmics (e.g., amiodarone, sotalol), antipsychotic medications (ziprasidone, chlorpromazine, thioridazine), and quinolone antibiotics
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Pregnancy, or lactation, or women of childbearing potential not willing to use adequate birth control
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Life Expectancy < 3 months
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Expected to receive a kidney transplant or transition to home dialysis (peritoneal dialysis or home hemodialysis) within 6 months
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Any other condition that, in the opinion of the investigator, should preclude patient participation in the clinical trial
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
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1 | Northwest Kidney Centers | Seattle | Washington | United States | 98122 |
Sponsors and Collaborators
- University of Washington
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Investigators
- Principal Investigator: Raj Mehrotra, MD, University of Washington
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- STUDY00004678
- R01DK115468