1063 Predictors of Insufficient Treatment Response to Digital CBT-I: Results from the RESTING Study

Abstract Introduction Triaged stepped-care approaches start patients in either lower or higher intensity of treatment based on participant characteristics, switching patients who demonstrate insufficient progress in lower intensity treatment to higher intensity treatment. The purpose of the present study was to investigate characteristics of participants who were predicted to benefit from lower intensity treatment (digital CBT-I [dCBT-I]) and made insufficient progress following two-months of dCBTI, compared to similar participants who made sufficient progress. Methods Participants were 101 adults aged 50 or older who were triaged to begin treatment with dCBT-I as part of the RCT of the Effectiveness of Stepped-Care Sleep Therapy in General Practice (RESTING) study. Specifically, these participants had to have taken sleep medications < 4x/week, score below clinical cutoffs for moderate-severe mental health comorbidity and daytime sleepiness, and sleep >4.5hrs/night on average. T-tests were used to compare baseline characteristics of participants who made insufficient progress after two months of dCBT-I to those who made sufficient progress. Sufficient progress was defined as ISI ≤ 10 or reduction of at least 50% in sleep medication use. Results Those with insufficient progress in dCBT-I (N= 74) had higher insomnia severity index (ISI) scores at baseline than those with sufficient progress in dCBT-I (p=.002, d=.70). There were no significant differences in terms of baseline Dysfunctional Beliefs and Attitudes about Sleep (DBAS) scores (p=.39), chronotype (Morningness-Eveningness Questionnaire: MEQ; p=.32) or sleep medication use (p=.39); effect sizes for the differences were small (d=.19-.23). Further, there was no significant difference in the number of digital modules completed (p=.13, d= .35) between those who did and those who did not make sufficient progress. Conclusion Only greater insomnia severity at baseline was a significant predictor of insufficient treatment response among participants who were triaged to begin treatment with dCBT-I. Further research is needed to determine if insomnia severity alone or when combined with the RESTING study triage algorithm will improve the identification of those likely to benefit optimally from dCBT-I. Support (if any) R01AG057500