Cultural adaptations of psychological interventions for prevalent sleep disorders and sleep disturbances: A systematic review of randomized controlled trials in the United States

Alcántara, Carmela; Cosenzo, Luciana Giorgio; McCullough, Elliot; Vogt, Tiffany; Falzon, Andrea L.; Ibarra, Irene Perez

doi:10.1016/j.smrv.2021.101455

Cited by 29 publications

(10 citation statements)

References 83 publications

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“…The development of a culturally tailored intervention may be the key to better engaging racial and ethnic minority patients with proven insomnia treatment . Despite increasing awareness of the importance of the sociocultural context in understanding racial and ethnic sleep health disparities, to our knowledge, there has not previously been a cultural adaptation of CBT-I for any racial or ethnic minority group . This limitation is reflected in a recent American Academy of Sleep Medicine systematic review and meta-analysis, which concluded that racial and ethnic minority groups have been largely overlooked in CBT-I trials .…”

Section: Introductionmentioning

confidence: 99%

“…34,35 Despite increasing awareness of the importance of the sociocultural context in understanding racial and ethnic sleep health disparities, 36 to our knowledge, there has not previously been a cultural adaptation of CBT-I for any racial or ethnic minority group. 37 This limitation is reflected in a recent American Academy of Sleep Medicine systematic review and meta-analysis, which concluded that racial and ethnic minority groups have been largely overlooked in CBT-I trials. 38 Other meta-analyses do not discuss the effect of race and ethnicity on intervention efficacy, 39,40 with participant data on race and ethnicity often not even reported.…”

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confidence: 99%

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Effect of Culturally Tailored, Internet-Delivered Cognitive Behavioral Therapy for Insomnia in Black Women

et al. 2022

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IMPORTANCE Black women are at risk for insomnia disorder. Despite interest in addressing sleep health disparities, there is limited research investigating the efficacy of criterion-standard treatment (cognitive behavioral therapy for insomnia [CBT-I]) among this racial minority population. OBJECTIVE To compare the efficacy of a standard version of an internet-delivered CBT-I program, a culturally tailored version, and a sleep education control at improving insomnia symptoms. DESIGN, SETTING, AND PARTICIPANTS In this single-blind, 3-arm randomized clinical trial, participants in a national, longitudinal cohort (Black Women's Health Study [BWHS]) were recruited between October 2019 and June 2020. BWHS participants with elevated insomnia symptoms were enrolled and randomized in the current study. INTERVENTIONS Participants were randomized to receive (1) an automated internet-delivered treatment called Sleep Healthy Using the Internet (SHUTi); (2) a stakeholder-informed, tailored version of SHUTi for Black women (SHUTi-BWHS); or (3) patient education (PE) about sleep. MAIN OUTCOMES AND MEASURESThe primary outcome was insomnia severity (Insomnia Severity Index [ISI]). Index score ranged from 0 to 28 points, with those scoring less than 8 points considered to not have clinically significant insomnia symptoms and a score of 15 points or higher suggesting insomnia disorder. An ISI score reduction of more than 7 points was considered a clinically significant improvement in insomnia symptoms. The SHUTi-BWHS program was hypothesized to be more effective at significantly decreasing insomnia severity compared with the SHUTi program and PE.RESULTS A total of 333 Black women were included in this trial, and their mean (SD) age was 59.5 (8.0) years. Those randomized to receive either SHUTi or SHUTi-BWHS reported significantly greater reductions in ISI score at 6-month follow-up (SHUTi: −10.0 points; 95% CI, −11.2 to −8.7; SHUTi-BWHS: −9.3 points; 95% CI, −10.4 to −8.2) than those randomized to receive PE (−3.6 points; 95% CI, −4.5 to −2.1) (P < .001). Significantly more participants randomized to SHUTi-BWHS completed the intervention compared with those randomized to SHUTi (86 of 110 [78.2%] vs 70 of 108 [64.8%]; P = .008). Participants who completed either intervention showed greater reductions in insomnia severity compared with noncompleters (−10.4 points [95% CI, −11.4 to −9.4] vs −6.2 points [95% CI, −8.6 to −3.7]). CONCLUSIONS AND RELEVANCEIn this randomized clinical trial, both the SHUTi and SHUTi-BWHS programs decreased insomnia severity and improved sleep outcomes more than PE. The culturally tailored SHUTi-BWHS program was more effective at engaging participants with the program, as a greater proportion completed the full intervention. Program completion was associated with greater improvements in sleep.

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Section: Introductionmentioning

confidence: 99%

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confidence: 99%

Effect of Culturally Tailored, Internet-Delivered Cognitive Behavioral Therapy for Insomnia in Black Women

et al. 2022

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“…Based on a recent systematic review, most cultural adaptations of CBT-i resulted in significantly improved insomnia symptoms [54]. Adaptions included changes to the delivery modality (e.g., groupbased or online setting), the use of nonclinician interventionists, shortened length of treatment, and linguistic adaptations [54]. Given the substantial public health burden of insomnia [2,[4][5][6][7][8], there is a crucial need to increase awareness of effective insomnia treatments and to continue advancing implementation research [55].…”

Section: Discussionmentioning

confidence: 99%

Insomnia among community members in Florida: Associations with demographics, health conditions, and social support

Fidler

Chaudhari

Sims

et al. 2023

J. Clin. Trans. Sci.

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Objectives: To identify associations between demographics, social determinants of health, health conditions, and reported history of insomnia. A cross-sectional study including 11,960 adult community members recruited through HealthStreet, a community outreach program at University of Florida. Methods: Health assessments were conducted via interviews. Participants reported their demographic background, level of social support, history of health conditions, and insomnia. Logistic regression was used to understand associations between risk factors and history of insomnia. Results: The prevalence of self-reported insomnia was 27.3%. Adults aged ≥ 65 years (OR = 1.16) and women (OR = 1.18) reported higher rates of insomnia than their counterparts. Black/African American individuals reported lower rates of insomnia (OR = 0.72) than White individuals. Individuals with food insecurity (OR = 1.53), a military history (OR = 1.30), lower social support (OR = 1.24), living alone (OR = 1.14), anxiety (OR = 2.33), cardiometabolic disease (OR = 1.58), and attention-deficit hyperactivity disorder (ADHD) (OR = 1.44) were significantly more likely to endorse insomnia compared with their counterparts. Depression (OR = 2.57) had the strongest association with insomnia. Conclusions: This study provides evidence regarding who is at greater risk for insomnia among a large community-based sample. Our findings highlight the importance of screening for insomnia, particularly among patients who experience food insecurity, are military veterans, have anxiety, depression, ADHD, or cardiometabolic disease, as well as those who live alone or have lower levels of social support. Future public health campaigns should provide education on insomnia symptoms, treatments, and evidenced-based sleep-promotion strategies.

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“…Such results underscore the need for evidence-based sleep interventions in this community, such as cognitive behavioral therapy for insomnia or continuous positive airway pressure for OSA. Critically, only 7% of published studies on psychological interventions for sleep disorders have targeted underserved groups, including racial/ethnic minorities (Alcantara et al, 2021). However, none of these studies explicitly targeted linguistic minorities or immigrants, suggesting a potential treatment gap among Asian Indian communities.…”

Section: Discussionmentioning

confidence: 99%

Posttraumatic Stress Disorder Symptoms and Sleep Disturbances Among Asian Indians: A Systematic Review

Contractor

Almeida

Fentem

et al. 2023

Trauma, Violence, & Abuse

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Substantial comorbidity exists between posttraumatic stress disorder and sleep disturbances/disorders. Such comorbidities are understudied in minority groups, including Asian Indians residing in countries outside India. Thus, we synthesized the existing literature specific to this group of Asian Indians to determine (a) prevalence estimates of posttraumatic stress disorder (PTSD) and sleep disturbances/disorders; and (b) PTSD-sleep comorbidity estimates. For this systematic review, we searched four databases (PubMed, PsycInfo, PTSDpubs, Web of Science) using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Of 3,796 screened articles, 9 articles (10 studies) met inclusion criteria. Study sample sizes ranged from 11 to 2,112 Asian Indians; studies were conducted in Singapore or Malaysia. No reviewed study examined PTSD. All studies examined sleep disturbances/disorders among Asian Indians; prevalence estimates were: 8.3% to 70.4% for short sleep duration, 2.0% to 22.9% for long sleep duration, 25.9% to 56.3% for poor sleep quality, 3.4% to 67.5% for insomnia diagnosis or probable insomnia, 7.7% for excessive daytime sleepiness, 3.8% to 54.6% for obstructive sleep apnea (OSA) diagnosis or high OSA risk, and 5.1% to 11.1% for sleep-disordered breathing. Specific to Asian Indians residing in countries outside India, this review advances PTSD-sleep literature by (a) suggesting substantial prevalence of sleep disturbances/disorders; (b) highlighting the need for culturally relevant sleep interventions; and (c) highlighting research gaps (e.g., no PTSD-focused research).

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Cultural adaptations of psychological interventions for prevalent sleep disorders and sleep disturbances: A systematic review of randomized controlled trials in the United States

Cited by 29 publications

References 83 publications

Effect of Culturally Tailored, Internet-Delivered Cognitive Behavioral Therapy for Insomnia in Black Women

Effect of Culturally Tailored, Internet-Delivered Cognitive Behavioral Therapy for Insomnia in Black Women

Insomnia among community members in Florida: Associations with demographics, health conditions, and social support

Posttraumatic Stress Disorder Symptoms and Sleep Disturbances Among Asian Indians: A Systematic Review

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