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NCT02782780: CBTi GWI

Cognitive Behavioral Therapy for Insomnia for Gulf War Illness

Completed NA Results posted Last updated 2 February 2021
What this trial tests

NA trial testing Cognitive Behavioral Therapy for Insomnia (CBTi) in Gulf War Illness in 165 participants. Completed in 1 June 2020.

Timeline
24 October 2016
Primary endpoint
31 January 2020
1 June 2020

Quick facts

Lead sponsorVA Office of Research and Development
PhaseNA
StatusCompleted
Study typeINTERVENTIONAL
Allocationrandomized
Designparallel
Maskingsingle
Primary purposetreatment
Enrollment165
Start date24 October 2016
Primary completion31 January 2020
Estimated completion1 June 2020
Sites1 location across United States

Drugs / interventions tested

Conditions studied

Sponsor

VA Office of Research and Development — full company profile →

Who can join

Eligibility, any sex, with Gulf War Illness or Insomnia. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Gulf War Illness Symptom Severity Index Primary · At baseline, after 8 weeks of study participation in all subjects, in subjects randomized to CBTi, 6 months after study participation

Due to its novelty, complexity, and variability, no single measure of severity addresses all possible presentations of Gulf War Illness (GWI). Therefore, we used the symptom portion of the Kansas Gulf War Military History and Health Questionnaire to query about fatigue/sleep problems, somatic pain, skin abnormalities, gastrointestinal, respiratory, and neurologic/cognitive/mood symptoms, based on the Kansas GWI and CDC CMI case definition. To assess current GWI symptoms, participants will be asked about the absence (0), presence, and severity (1=mild; 2=moderate; 3=severe) of the symptoms over

Baseline
GroupValue95% CI
Monitor Only6753 – 78
CBTi6758 – 82
Post-treatment
GroupValue95% CI
Monitor Only6150 – 78
CBTi4944 – 62
6-month follow-up
GroupValue95% CI
CBTi5449 – 66
Insomnia Severity Index (ISI) Primary · At baseline, after 8 weeks of study participation in all subjects, in subjects randomized to CBTi, 6 months after study participation

The ISI is a 7-item self-report questionnaire assessing the nature, severity, and impact of insomnia in the last month. The dimensions evaluated are: severity of sleep onset, sleep maintenance, and early morning awakening problems, sleep dissatisfaction, interference of sleep difficulties with daytime functioning, noticeability of sleep problems by others, and distress caused by the sleep difficulties. A 5-point Likert scale is used to rate each item (e.g., 0 = no problem; 4 = very severe problem), yielding a total score ranging from 0 to 28. Higher scores indicate more severe insomnia. This o

Baseline
GroupValue95% CI
Monitor Only19.016.0 – 24.0
CBTi21.018.0 – 24.0
post-treatment
GroupValue95% CI
Monitor Only19.013.5 – 22.0
CBTi10.06.0 – 15.0
6-month follow-up
GroupValue95% CI
CBTi13.07.0 – 18.0
Fatigue Severity Scale (FSS) Secondary · Baseline, after 8 weeks of study participation in all subjects, in subjects randomized to CBTi, 6 months after study participation

The FSS is a 9-item questionnaire reflecting the consequences of fatigue. It gives a single score (range 0-7, high scores represent high levels of fatigue). A score of 4 has been described as the cutoff for clinical fatigue. This outcome will be measured at baseline, after 8 weeks in both the CBTi and monitor-only groups and at 6 months in subjects randomized to CBTi.

Baseline
GroupValue95% CI
Monitor Only5.063.47 – 5.78
CBTi5.564.67 – 6.28
Post-treatment
GroupValue95% CI
Monitor Only5.113.22 – 5.83
CBTi3.442.89 – 5.03
6-month follow-up
GroupValue95% CI
CBTi3.672.78 – 5.44
Brief Pain Inventory (BPI) - Pain Interference Secondary · Baseline, after 8 weeks of study participation in all subjects, in subjects randomized to CBTi, 6 months after study participation

The BPI is a 17-item self-rating scale assessing demographic data, use of medications, as well as sensory, and reactive components of pain. The BPI measures two domains: pain intensity (severity) and the impact of pain on functioning (interference). The score range for BPI-Severity is 0-10, higher score = more severe/intense pain. The range for BPI-interference is 0-10, higher score = greater impact of pain on function. This outcome will be measured at baseline, after 8 weeks in both the CBTi and monitor-only groups and at 6 months in subjects randomized to CBTi.

Baseline
GroupValue95% CI
Monitor Only4.292.46 – 6.68
CBTi5.863.79 – 7.29
Post-treatment
GroupValue95% CI
Monitor Only4.572.07 – 6.86
CBTi4.291.57 – 5.57
6-month follow-up
GroupValue95% CI
CBTi4.291.64 – 6.64
Brief Pain Inventory (BPI) - Pain Severity Secondary · Baseline, after 8 weeks of study participation in all subjects, in subjects randomized to CBTi, 6 months after study participation

The BPI is a 17-item self-rating scale assessing demographic data, use of medications, as well as sensory, and reactive components of pain. The BPI measures two domains: pain intensity (severity) and the impact of pain on functioning (interference). The score range for BPI-Severity is 0-10, higher score = more severe/intense pain. The range for BPI-interference is 0-10, higher score = greater impact of pain on function. This outcome will be measured at baseline, after 8 weeks in both the CBTi and monitor-only groups and at 6 months in subjects randomized to CBTi.

Baseline
GroupValue95% CI
Monitor Only4.122.88 – 6.75
CBTi5.003.38 – 6.50
Post-treatment
GroupValue95% CI
Monitor Only4.252.88 – 5.75
CBTi5.253.00 – 5.75
6-month follow-up
GroupValue95% CI
CBTi5.003.00 – 6.00
Multiple Abilities Self-Report Questionnaire (MASQ) Secondary · Baseline, after 8 weeks of study participation in all subjects, in subjects randomized to CBTi, 6 months after study participation

The MASQ is a 38-item self-report measure of cognitive function compared to same age peers across 5 domains (i.e., verbal memory, attention, language, visual memory, visuo-perceptual ability). Score range: 38-190. Higher scores = greater cognitive dysfunction. This outcome will be measured at baseline, after 8 weeks in both the CBTi and monitor-only groups and at 6 months in subjects randomized to CBTi.

Baseline
GroupValue95% CI
Monitor Only6439 – 77
CBTi6144 – 76
Post-treatment
GroupValue95% CI
Monitor Only6842 – 89
CBTi5537 – 69
6-month followup
GroupValue95% CI
CBTi5444 – 77
Hospital Anxiety and Depression Scale (HADS), Anxiety Secondary · Baseline, after 8 weeks of study participation in all subjects, in subjects randomized to CBTi, 6 months after study participation

The HADS will be used to assess anxiety and depressive symptoms. The HADS is widely used in community settings and in primary care and not just in "hospitals." The range for HADS-anxiety measure is 0-21. Higher scores = more anxiety. This outcome will be measured at baseline, after 8 weeks in both the CBTi and monitor-only groups and at 6 months in subjects randomized to CBTi.

Baseline
GroupValue95% CI
Monitor Only10.56.2 – 13.8
CBTi12.59.2 – 14.0
Post-treatment
GroupValue95% CI
Monitor Only11.07.0 – 15.5
CBTi8.05.0 – 11.0
6-month follow-up
GroupValue95% CI
CBTi9.06.5 – 11.0
Hospital Anxiety and Depression Scale (HADS), Depression Secondary · Baseline, after 8 weeks of study participation in all subjects, in subjects randomized to CBTi, 6 months after study participation

The HADS will be used to assess anxiety and depressive symptoms. The HADS is widely used in community settings and in primary care and not just in "hospitals." The range for HADS-depression measure is 0-21. Higher scores = more anxiety. This outcome will be measured at baseline, after 8 weeks in both the CBTi and monitor-only groups and at 6 months in subjects randomized to CBTi.

Baseline
GroupValue95% CI
Monitor Only9.05.2 – 11.8
CBTi9.57.0 – 12.0
Post-treatment
GroupValue95% CI
Monitor Only9.05.5 – 11.0
CBTi4.02.0 – 8.0
6-month follow-up
GroupValue95% CI
CBTi6.03.0 – 9.0
Pittsburgh Sleep Quality Index (PSQI) Secondary · Baseline, after 8 weeks of study participation in all subjects, in subjects randomized to CBTi, 6 months after study participation

The PSQI is a self-report measure that provides a subjective assessment of sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbances, use of sedative-hypnotics, and daytime energy. This index is widely used and has been validated by polysomnography. The score range for the PSQI is 0 to 21, with the higher scores indicating worse sleep quality.This outcome will be measured at baseline, after 8 weeks in both the CBTi and monitor-only groups and at 6 months in subjects randomized to CBTi.

Baseline
GroupValue95% CI
Monitor Only12.09.2 – 14.8
CBTi11.09.0 – 15.0
Post-treatment
GroupValue95% CI
Monitor Only11.08.5 – 13.0
CBTi8.03.0 – 9.0
6-month follow-up
GroupValue95% CI
CBTi7.05.0 – 10.5
Sleep Efficiency (SE) Secondary · Baseline, after 8 weeks of study participation in all subjects, in subjects randomized to CBTi, 6 months after study participation

Sleep Efficiency, as determined by self-reported sleep diary, is the total sleep time (TST) divided by the time in bed, multiplied by 100. Good sleepers have high sleep efficiency because they are asleep the majority of time they spend in bed. Insomniacs tend to have low sleep efficiency because they spend a lot of time awake while they are in bed (tossing and turning). This outcome will be measured at baseline, after 8 weeks in both the CBTi and monitor-only groups and at 6 months in subjects randomized to CBTi.

Baseline
GroupValue95% CI
Monitor Only8274 – 89
CBTi8374 – 88
Post-treatment
GroupValue95% CI
Monitor Only7873 – 89
CBTi9490 – 95
6-month follow-up
GroupValue95% CI
CBTi9189 – 94
Minutes of Wake After Sleep Onset (WASO) Secondary · Baseline and after 8 weeks of study participation in all subjects; in subjects randomized to CBTi, 6 months after study participation

Wake After Sleep Onset is the amount of time that a person is awake time during the night, as recorded in a self-report sleep diary. Insomniacs tend to have greater WASO than good sleepers because they wake up a lot in the middle of the might. This outcome will be measured at baseline, post-treatment in both the CBTi and monitor-only groups and at 6 months in subjects randomized to CBTi.

Baseline
GroupValue95% CI
Monitor Only2511 – 43
CBTi3119 – 53
Post-treatment
GroupValue95% CI
Monitor Only3318 – 57
CBTi74 – 22
6-month follow-up
GroupValue95% CI
CBTi2011 – 27
Sleep Latency (SL) Secondary · Baseline, after 8 weeks of study participation in all subjects, in subjects randomized to CBTi, 6 months after study participation

Sleep latency (SL) is the amount of time that it takes someone to fall asleep. Participants will be asked to estimate this time in their sleep diaries. Good sleepers tend to have low sleep latencies because they can fall asleep quickly. Insomniacs tend to have longer sleep latencies because it takes them a long time to fall asleep. This outcome will be measured at baseline, after 8 weeks in both the CBTi and monitor-only groups and at 6 months in subjects randomized to CBTi.

Baseline
GroupValue95% CI
Monitor Only2215 – 44
CBTi2213 – 34
Post-treatment
GroupValue95% CI
Monitor Only2414 – 46
CBTi107 – 12
6-month follow-up
GroupValue95% CI
CBTi127 – 16

Sponsor's own description

Sleep disturbance is a common complaint of Veterans with Gulf War Illness (GWI). Because there is clinical evidence that sleep quality influences pain, fatigue, mood, cognition, and daily functioning, this study will investigate whether a type of behavioral sleep treatment called Cognitive Behavioral Therapy for Insomnia (CBTi) can help Gulf War Veterans with GWI. CBTi is a multicomponent treatment where patients learn about sleep and factors affecting sleep as well as how to alter habits that may impair or even prevent sleep. The investigators hypothesize that helping Gulf War Veterans learn how to achieve better sleep with CBTi may also help to alleviate their other non-sleep symptoms of GWI.

Publications & conference data

2 peer-reviewed publications reference this trial (live from Europe PMC):

  1. Gulf War Illness: Mechanisms Underlying Brain Dysfunction and Promising Therapeutic Strategies.
    Dickey B, Madhu LN, Shetty AK. · · 2021 · cited 54× · PMID 33164782 · DOI 10.1016/j.pharmthera.2020.107716
  2. Cognitive behavioral therapy for insomnia in veterans with gulf war illness: Results from a randomized controlled trial.
    Chao LL, Kanady JC, Crocker N, Straus LD, et al · · 2021 · cited 11× · PMID 33549595 · DOI 10.1016/j.lfs.2021.119147

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Other trials of Cognitive Behavioral Therapy for Insomnia (CBTi)

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