Measuring Treatment Outcomes in Comorbid Insomnia and Fibromyalgia: Concordance of Subjective and Objective Assessments

Abstract

Study Objectives: In insomnia, actigraphy tends to underestimate wake time compared to diaries and PSG. When chronic pain co-occurs with insomnia, sleep may be more fragmented, including more movement and arousals. However, individuals may not be consciously aware of these arousals. We examined the baseline concordance of diaries, actigraphy, and PSG as well as the ability of each assessment method to detect changes in sleep following cognitive behavioral therapy for insomnia (CBT-I). Methods: Adults with insomnia and fibromyalgia (n = 113) were randomized to CBT-I, CBT for pain, or waitlist control. At baseline and posttreatment, participants completed one night of PSG and two weeks of diaries/actigraphy. Results: At baseline, objective measures estimated lower SOL, higher TST, and higher SE than diaries (ps < 0.05). Compared to PSG, actigraphic estimates were higher for SOL and lower for WASO (ps < 0.05). Repeated measures ANOVAs were conducted for the CBT-I group (n = 15), and significant method by time interactions indicated that the assessment methods differed in their sensitivity to detect treatment-related changes. PSG values did not change significantly for any sleep parameters. However, diaries showed improvements in SOL, WASO, and SE, and actigraphy also detected the WASO and SE improvements (ps < 0.05). Conclusions: Actigraphy was generally more concordant with PSG than with diaries, which are the recommended assessment for diagnosing insomnia. However, actigraphy showed greater sensitivity to treatment-related changes than PSG; PSG failed to detect any improvements, but actigraphy demonstrated changes in WASO and SE, which were also found with diaries. In comorbid insomnia/fibromyalgia, actigraphy may therefore have utility in measuring treatment outcomes. Keywords: insomnia, fibromyalgia, chronic pain, assessment, actigraphy, polysomnography, cognitive behavioral therapy, clinical trial Citation: Mundt JM, Crew EC, Krietsch K, Roth AJ, Vatthauer K, Robinson ME, Staud R, Berry RB, McCrae CS. Measuring treatment outcomes in comorbid insomnia and fibromyalgia: concordance of subjective and objective assessments. J Clin Sleep Med 2016;12(2):215-223. I NTRO DUCTI O NChronic insomnia is a primarily subjective disorder that is defined by self-reported difficulty falling asleep, staying asleep, awakening too early, or experiencing sleep that is routinely non-restorative and accompanied by at least one of many possible daytime impairments (e.g., mood disturbance, daytime sleepiness, fatigue or malaise).1 The high prevalence of chronic insomnia among patients with chronic pain has been well-established, with reported rates of insomnia as high as 88% in this population.2,3 Independently, sleep and pain are known to be associated with a host of negative consequences including decreased quality of life, mood disturbance, impaired quality of social interactions, dependence on medication, and cognitive dysfunction. However, these consequences are often exacerbated in chronic pain patients with comorbid insomnia. [...

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