Patients with chronic insomnia reported no differences between telemedicine and face-to-face cognitive behavioral therapy (CBT) in terms of overall satisfaction with treatment or the therapist's warmth and skills, data from a randomized controlled noninferiority trial showed.
"We know that cognitive behavioral therapy for insomnia is a very effective treatment," said Deirdre Conroy, PhD, of the University of Michigan in Ann Arbor, at the virtual SLEEP 2020, a joint meeting of the American Academy of Sleep Medicine (AASM) and the Sleep Research Society (SRS).
"However, in pre-COVID days, we didn't use it quite often by telemedicine or phone; most of the research we have is based on face-to-face interactions," she continued.
A barrier to widespread use of CBT for insomnia may be lack of evidence for formats besides face-to-face, she noted.
"The outcomes from this study suggest that the rapport and confidence a patient has with their therapist over telemedicine did not differ from therapy delivered in person," Conroy told MedPage Today. "This is especially important to consider as so much of our healthcare is now being delivered remotely during the pandemic."
The findings stemmed from a larger study of 65 chronic insomnia patients who were randomized 1:1 to either telemedicine using video visits through the AASM's SleepTM platform or face-to-face CBT. Patients taking sleep medicines were included if they met study criteria for insomnia and dosing was stable.
Participants had six weekly CBT sessions of 45 to 60 minutes each, covering topics like sleep hygiene, scheduling, relaxation, dysfunctional beliefs, and relapse prevention. Participants completed sleep diaries, the Insomnia Severity Index (ISI), and daytime functioning measures at pre-treatment, post-treatment, and 3-month follow-up. Insomnia severity was the primary noninferiority outcome.
Based on a noninferiority margin of four points on the ISI and after adjusting for confounders, telemedicine was noninferior to face-to-face CBT at post-treatment (β 0.54, SE 1.10, 95% CI 1.64-2.72) and at 3-month follow-up (β 0.34, SE 1.10, 95% CI 1.83-2.53). Most daytime functioning measures were significantly improved at post-treatment and follow-up, with no difference between treatment formats. Telemedicine sessions were on average about 10 minutes shorter.
In the analysis presented at SLEEP 2020, Conroy and colleagues looked at 62 participants (41 were women and mean age was about 49) who filled out the Client Satisfaction Questionnaire (CSQ-8) and the Therapy Evaluation Questionnaire (TEQ) after completing treatment. Scores on the CSQ-8 range from 8 to 32, with higher scores indicating greater satisfaction. The researchers analyzed two items on the TEQ that assessed patients' perceptions of a therapist's warmth and skills; these scores each range from 1 to 7, with higher scores indicating greater warmth and skills.
The researchers found no significant differences between telemedicine and face-to-face treatment in terms of patient satisfaction (28.5 vs 29.9, respectively), therapist warmth (6.0 vs 6.4), or therapist skills (6.4 vs 6.7).
"Perceptions from the patients about these characteristics were no different between SleepTM and face-to-face," Conroy said. "We suggest additional research in this area, but it looks to be promising."
The study tested only one telemedicine system (the AASM's SleepTM) and the results may not apply to other telemedicine platforms, the researchers noted. While the trial was powered to evaluate noninferiority on the primary outcome of insomnia severity, it's possible it was underpowered to find differences in secondary outcomes.