Trial Outcomes & Findings for Improving Sleep Using Mentored Behavioral and Environmental Restructuring (NCT NCT03327324)

NCT ID: NCT03327324

Last Updated: 2023-02-08

Results Overview

Sleep efficiency (SE), commonly defined as the ratio of total sleep time (TST) to time in bed (TIB), will be reported as a percentage of time in bed. This data will be obtained from actigraphy analysis.

Recruitment status

COMPLETED

Study phase

NA

Target enrollment

110 participants

Primary outcome timeframe

Baseline

Results posted on

2023-02-08

Participant Flow

This is a stepped wedge intervention trial (SWT). In this SWT, all units receive the intervention but at different time points. Every unit provides baseline and follow-up data.

Participant milestones

Participant milestones
Measure
F1U1
Sequence 1 (Facility 1/Unit 1): Baseline, then 3 Month SLUMBER Intervention, then 39 Month Sustainability.
F1U2
Sequence 2 (Facility 1/Unit 2): Baseline, then 3 Month SLUMBER Intervention, then 33 Month Sustainability
F2U2
Sequence 3 (Facility 2/Unit 2): Baseline, then 3 Month SLUMBER Intervention, then 27 Month Sustainability
F2U3
Sequence 4 (Facility 2/Unit 3): Baseline, then 3 Month SLUMBER Intervention, then 21 Month Sustainability
F2U4
Sequence 5 (Facility 2/Unit 4): Baseline, then 3 Month SLUMBER Intervention, then 15 Month Sustainability
F3U1
Sequence 6 (Facility 3/Unit 1): Baseline, then 3 Month SLUMBER Intervention, then 9 Month Sustainability
Baseline (Month 0-Month 3)
STARTED
18
20
9
10
15
20
Baseline (Month 0-Month 3)
COMPLETED
18
17
9
9
13
14
Baseline (Month 0-Month 3)
NOT COMPLETED
0
3
0
1
2
6
Intervention (Month 3-Month 6)
STARTED
18
17
9
9
13
14
Intervention (Month 3-Month 6)
COMPLETED
13
16
6
8
11
0
Intervention (Month 3-Month 6)
NOT COMPLETED
5
1
3
1
2
14
Sustainability Follow-Up 1 (Month 6-9)
STARTED
13
16
6
8
11
0
Sustainability Follow-Up 1 (Month 6-9)
COMPLETED
9
14
5
5
6
0
Sustainability Follow-Up 1 (Month 6-9)
NOT COMPLETED
4
2
1
3
5
0
Sustainability Follow-Up 2 (Month 9-12)
STARTED
9
14
2
0
0
0
Sustainability Follow-Up 2 (Month 9-12)
COMPLETED
7
14
2
0
0
0
Sustainability Follow-Up 2 (Month 9-12)
NOT COMPLETED
2
0
0
0
0
0

Reasons for withdrawal

Reasons for withdrawal
Measure
F1U1
Sequence 1 (Facility 1/Unit 1): Baseline, then 3 Month SLUMBER Intervention, then 39 Month Sustainability.
F1U2
Sequence 2 (Facility 1/Unit 2): Baseline, then 3 Month SLUMBER Intervention, then 33 Month Sustainability
F2U2
Sequence 3 (Facility 2/Unit 2): Baseline, then 3 Month SLUMBER Intervention, then 27 Month Sustainability
F2U3
Sequence 4 (Facility 2/Unit 3): Baseline, then 3 Month SLUMBER Intervention, then 21 Month Sustainability
F2U4
Sequence 5 (Facility 2/Unit 4): Baseline, then 3 Month SLUMBER Intervention, then 15 Month Sustainability
F3U1
Sequence 6 (Facility 3/Unit 1): Baseline, then 3 Month SLUMBER Intervention, then 9 Month Sustainability
Baseline (Month 0-Month 3)
Incomplete (participant did not complete all data items collected during study visit)
0
1
0
1
0
5
Baseline (Month 0-Month 3)
Refused
0
0
0
0
1
0
Baseline (Month 0-Month 3)
Withdrawal by Subject
0
2
0
0
0
0
Baseline (Month 0-Month 3)
Death
0
0
0
0
1
0
Baseline (Month 0-Month 3)
COVID-Incomplete (couldn't collect all subject data due to Nursing Home COVID shutdown)
0
0
0
0
0
1
Intervention (Month 3-Month 6)
Incomplete (participant did not complete all data items collected during study visit)
0
0
1
0
0
0
Intervention (Month 3-Month 6)
Withdrawal by Subject
2
1
1
0
1
0
Intervention (Month 3-Month 6)
Left Nursing Home Facility
2
0
0
0
0
0
Intervention (Month 3-Month 6)
Death
1
0
1
1
1
0
Intervention (Month 3-Month 6)
COVID-Incomplete (couldn't collect all subject data due to Nursing Home COVID shutdown)
0
0
0
0
0
14
Sustainability Follow-Up 1 (Month 6-9)
Incomplete (participant did not complete all data items collected during study visit)
1
0
0
0
0
0
Sustainability Follow-Up 1 (Month 6-9)
Left Nursing Home Facility
2
1
0
0
0
0
Sustainability Follow-Up 1 (Month 6-9)
Death
1
1
1
0
0
0
Sustainability Follow-Up 1 (Month 6-9)
COVID-Incomplete (couldn't collect all subject data due to Nursing Home COVID shutdown)
0
0
0
3
5
0
Sustainability Follow-Up 2 (Month 9-12)
Left Nursing Home
1
0
0
0
0
0
Sustainability Follow-Up 2 (Month 9-12)
Death
1
0
0
0
0
0

Baseline Characteristics

Improving Sleep Using Mentored Behavioral and Environmental Restructuring

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
F1U1
n=18 Participants
Sequence 1 (Facility 1/Unit 1): Baseline, then 3 Month SLUMBER Intervention, then 39 Month Sustainability
F1U2
n=17 Participants
Sequence 2: (Facility 1/Unit 2): Baseline, then 3 Month SLUMBER Intervention, then 33 Month Sustainability
F2U2
n=9 Participants
Sequence 3 (Facility 2/Unit 2): Baseline, then 3 Month SLUMBER Intervention, then 27 Month Sustainability
F2U3
n=9 Participants
Sequence 4 (Facility 2/Unit 3): Baseline, then 3 Month SLUMBER Intervention, then 21 Month Sustainability
F2U4
n=13 Participants
Sequence 5 (Facility 2/Unit 4): Baseline, then 3 Month SLUMBER Intervention, then 15 Month Sustainability
F3U1
n=14 Participants
Sequence 6 (Facility 3/Unit 1): Baseline, then 3 Month SLUMBER Intervention, then 9 Month Sustainability
Total
n=80 Participants
Total of all reporting groups
Age, Continuous
66 years
STANDARD_DEVIATION 8 • n=5 Participants
66 years
STANDARD_DEVIATION 8 • n=7 Participants
89 years
STANDARD_DEVIATION 7 • n=5 Participants
92 years
STANDARD_DEVIATION 8 • n=4 Participants
91 years
STANDARD_DEVIATION 5 • n=21 Participants
75 years
STANDARD_DEVIATION 11 • n=10 Participants
81 years
STANDARD_DEVIATION 14 • n=115 Participants
Sex: Female, Male
Female
9 Participants
n=5 Participants
11 Participants
n=7 Participants
4 Participants
n=5 Participants
8 Participants
n=4 Participants
9 Participants
n=21 Participants
11 Participants
n=10 Participants
52 Participants
n=115 Participants
Sex: Female, Male
Male
9 Participants
n=5 Participants
6 Participants
n=7 Participants
5 Participants
n=5 Participants
1 Participants
n=4 Participants
4 Participants
n=21 Participants
3 Participants
n=10 Participants
28 Participants
n=115 Participants
Ethnicity (NIH/OMB)
Hispanic or Latino
5 Participants
n=5 Participants
6 Participants
n=7 Participants
2 Participants
n=5 Participants
0 Participants
n=4 Participants
2 Participants
n=21 Participants
2 Participants
n=10 Participants
17 Participants
n=115 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
13 Participants
n=5 Participants
11 Participants
n=7 Participants
7 Participants
n=5 Participants
9 Participants
n=4 Participants
11 Participants
n=21 Participants
12 Participants
n=10 Participants
63 Participants
n=115 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
0 Participants
n=4 Participants
0 Participants
n=21 Participants
0 Participants
n=10 Participants
0 Participants
n=115 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
0 Participants
n=4 Participants
0 Participants
n=21 Participants
0 Participants
n=10 Participants
0 Participants
n=115 Participants
Race (NIH/OMB)
Asian
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
2 Participants
n=4 Participants
0 Participants
n=21 Participants
0 Participants
n=10 Participants
2 Participants
n=115 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
0 Participants
n=4 Participants
0 Participants
n=21 Participants
0 Participants
n=10 Participants
0 Participants
n=115 Participants
Race (NIH/OMB)
Black or African American
13 Participants
n=5 Participants
9 Participants
n=7 Participants
0 Participants
n=5 Participants
0 Participants
n=4 Participants
1 Participants
n=21 Participants
3 Participants
n=10 Participants
26 Participants
n=115 Participants
Race (NIH/OMB)
White
0 Participants
n=5 Participants
2 Participants
n=7 Participants
7 Participants
n=5 Participants
7 Participants
n=4 Participants
10 Participants
n=21 Participants
9 Participants
n=10 Participants
35 Participants
n=115 Participants
Race (NIH/OMB)
More than one race
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
0 Participants
n=4 Participants
0 Participants
n=21 Participants
0 Participants
n=10 Participants
0 Participants
n=115 Participants
Race (NIH/OMB)
Unknown or Not Reported
5 Participants
n=5 Participants
6 Participants
n=7 Participants
2 Participants
n=5 Participants
0 Participants
n=4 Participants
2 Participants
n=21 Participants
2 Participants
n=10 Participants
17 Participants
n=115 Participants
Region of Enrollment
United States
18 participants
n=5 Participants
17 participants
n=7 Participants
9 participants
n=5 Participants
9 participants
n=4 Participants
13 participants
n=21 Participants
14 participants
n=10 Participants
80 participants
n=115 Participants

PRIMARY outcome

Timeframe: Baseline

Population: Sleep/wake time was measured using wrist actigraphs and some participants took off the watch, meaning some participants were not included in the analysis of this outcome measure.

Sleep efficiency (SE), commonly defined as the ratio of total sleep time (TST) to time in bed (TIB), will be reported as a percentage of time in bed. This data will be obtained from actigraphy analysis.

Outcome measures

Outcome measures
Measure
Resident of the Skilled Nursing Facility
n=52 Participants
Sleep Using Mentored Behavioral and Environmental Restructuring: SLUMBER is a non-pharmacological intervention program, delivered by providing mentoring to facility staff who work directly with residents. SLUMBER focuses on detecting sleep-disruptive factors including: nighttime noise and patient behaviors associated with poor sleep quality; disruptions caused by nighttime caregiving; daytime inactivity; and limited light exposure. In this model, staff-delivered interventions to improve these factors improve sleep quality thereby creating opportunities to test the impact of improving sleep quality (measured by actigraphy) on mood (depression and anxiety), pain, cognitive function, functional ability, and observed activity levels.
Sleep Efficiency (SE)
76.1 percentage of time in bed
Interval 71.83 to 80.38

PRIMARY outcome

Timeframe: Post-Treatment (Month 6 Post-Baseline)

Population: Sleep/wake time was measured using wrist actigraphs and some participants took off the watch, meaning some participants were not included in the analysis of this outcome measure.

Sleep efficiency (SE), commonly defined as the ratio of total sleep time (TST) to time in bed (TIB), will be reported as a percentage of time in bed. This data will be obtained from actigraphy analysis.

Outcome measures

Outcome measures
Measure
Resident of the Skilled Nursing Facility
n=52 Participants
Sleep Using Mentored Behavioral and Environmental Restructuring: SLUMBER is a non-pharmacological intervention program, delivered by providing mentoring to facility staff who work directly with residents. SLUMBER focuses on detecting sleep-disruptive factors including: nighttime noise and patient behaviors associated with poor sleep quality; disruptions caused by nighttime caregiving; daytime inactivity; and limited light exposure. In this model, staff-delivered interventions to improve these factors improve sleep quality thereby creating opportunities to test the impact of improving sleep quality (measured by actigraphy) on mood (depression and anxiety), pain, cognitive function, functional ability, and observed activity levels.
Sleep Efficiency (SE)
75.69 percentage of time in bed
Interval 70.89 to 80.49

PRIMARY outcome

Timeframe: Month 9 Post-Baseline

Population: Sleep/wake time was measured using wrist actigraphs and some participants took off the watch, meaning some participants were not included in the analysis of this outcome measure.

Sleep efficiency (SE), commonly defined as the ratio of total sleep time (TST) to time in bed (TIB), will be reported as a percentage of time in bed. This data will be obtained from actigraphy analysis.

Outcome measures

Outcome measures
Measure
Resident of the Skilled Nursing Facility
n=52 Participants
Sleep Using Mentored Behavioral and Environmental Restructuring: SLUMBER is a non-pharmacological intervention program, delivered by providing mentoring to facility staff who work directly with residents. SLUMBER focuses on detecting sleep-disruptive factors including: nighttime noise and patient behaviors associated with poor sleep quality; disruptions caused by nighttime caregiving; daytime inactivity; and limited light exposure. In this model, staff-delivered interventions to improve these factors improve sleep quality thereby creating opportunities to test the impact of improving sleep quality (measured by actigraphy) on mood (depression and anxiety), pain, cognitive function, functional ability, and observed activity levels.
Sleep Efficiency (SE)
75.61 percentage of time in bed
Interval 70.05 to 81.18

PRIMARY outcome

Timeframe: Baseline

Population: Sleep/wake time was measured using wrist actigraphs and some participants took off the watch, meaning some participants were not included in the analysis of this outcome measure.

Data will be obtained from antigraphy analysis.

Outcome measures

Outcome measures
Measure
Resident of the Skilled Nursing Facility
n=52 Participants
Sleep Using Mentored Behavioral and Environmental Restructuring: SLUMBER is a non-pharmacological intervention program, delivered by providing mentoring to facility staff who work directly with residents. SLUMBER focuses on detecting sleep-disruptive factors including: nighttime noise and patient behaviors associated with poor sleep quality; disruptions caused by nighttime caregiving; daytime inactivity; and limited light exposure. In this model, staff-delivered interventions to improve these factors improve sleep quality thereby creating opportunities to test the impact of improving sleep quality (measured by actigraphy) on mood (depression and anxiety), pain, cognitive function, functional ability, and observed activity levels.
Nighttime Total Awake Time
11.54 Minutes
Interval 9.92 to 13.15

PRIMARY outcome

Timeframe: Post-Treatment (Month 6 Post-Baseline)

Data will be obtained from antigraphy analysis.

Outcome measures

Outcome measures
Measure
Resident of the Skilled Nursing Facility
n=52 Participants
Sleep Using Mentored Behavioral and Environmental Restructuring: SLUMBER is a non-pharmacological intervention program, delivered by providing mentoring to facility staff who work directly with residents. SLUMBER focuses on detecting sleep-disruptive factors including: nighttime noise and patient behaviors associated with poor sleep quality; disruptions caused by nighttime caregiving; daytime inactivity; and limited light exposure. In this model, staff-delivered interventions to improve these factors improve sleep quality thereby creating opportunities to test the impact of improving sleep quality (measured by actigraphy) on mood (depression and anxiety), pain, cognitive function, functional ability, and observed activity levels.
Nighttime Total Awake Time
11.03 Minutes
Interval 9.22 to 12.84

PRIMARY outcome

Timeframe: Month 9 Post-Baseline

Population: Sleep/wake time was measured using wrist actigraphs and some participants took off the watch, meaning some participants were not included in the analysis of this outcome measure.

Data will be obtained from antigraphy analysis.

Outcome measures

Outcome measures
Measure
Resident of the Skilled Nursing Facility
n=52 Participants
Sleep Using Mentored Behavioral and Environmental Restructuring: SLUMBER is a non-pharmacological intervention program, delivered by providing mentoring to facility staff who work directly with residents. SLUMBER focuses on detecting sleep-disruptive factors including: nighttime noise and patient behaviors associated with poor sleep quality; disruptions caused by nighttime caregiving; daytime inactivity; and limited light exposure. In this model, staff-delivered interventions to improve these factors improve sleep quality thereby creating opportunities to test the impact of improving sleep quality (measured by actigraphy) on mood (depression and anxiety), pain, cognitive function, functional ability, and observed activity levels.
Nighttime Total Awake Time
11.8 Minutes
Interval 9.29 to 14.31

PRIMARY outcome

Timeframe: Baseline

Population: Sleep/wake time was measured using wrist actigraphs and some participants took off the watch, meaning some participants were not included in the analysis of this outcome measure.

Wrist device / actigraphy will be used to measure sleep/wake time.

Outcome measures

Outcome measures
Measure
Resident of the Skilled Nursing Facility
n=52 Participants
Sleep Using Mentored Behavioral and Environmental Restructuring: SLUMBER is a non-pharmacological intervention program, delivered by providing mentoring to facility staff who work directly with residents. SLUMBER focuses on detecting sleep-disruptive factors including: nighttime noise and patient behaviors associated with poor sleep quality; disruptions caused by nighttime caregiving; daytime inactivity; and limited light exposure. In this model, staff-delivered interventions to improve these factors improve sleep quality thereby creating opportunities to test the impact of improving sleep quality (measured by actigraphy) on mood (depression and anxiety), pain, cognitive function, functional ability, and observed activity levels.
Daytime Sleeping (Napping) Time
305.91 Minutes
Interval 261.63 to 350.18

PRIMARY outcome

Timeframe: Post-Treatment (Month 6 Post-Baseline)

Population: Sleep/wake time was measured using wrist actigraphs and some participants took off the watch, meaning some participants were not included in the analysis of this outcome measure.

Wrist device / actigraphy will be used to measure sleep/wake time.

Outcome measures

Outcome measures
Measure
Resident of the Skilled Nursing Facility
n=52 Participants
Sleep Using Mentored Behavioral and Environmental Restructuring: SLUMBER is a non-pharmacological intervention program, delivered by providing mentoring to facility staff who work directly with residents. SLUMBER focuses on detecting sleep-disruptive factors including: nighttime noise and patient behaviors associated with poor sleep quality; disruptions caused by nighttime caregiving; daytime inactivity; and limited light exposure. In this model, staff-delivered interventions to improve these factors improve sleep quality thereby creating opportunities to test the impact of improving sleep quality (measured by actigraphy) on mood (depression and anxiety), pain, cognitive function, functional ability, and observed activity levels.
Daytime Sleeping (Napping) Time
369.7 Minutes
Interval 314.92 to 424.47

PRIMARY outcome

Timeframe: Month 9 Post-Baseline

Population: Sleep/wake time was measured using wrist actigraphs and some participants took off the watch, meaning some participants were not included in the analysis of this outcome measure.

Wrist device / actigraphy will be used to measure sleep/wake time.

Outcome measures

Outcome measures
Measure
Resident of the Skilled Nursing Facility
n=52 Participants
Sleep Using Mentored Behavioral and Environmental Restructuring: SLUMBER is a non-pharmacological intervention program, delivered by providing mentoring to facility staff who work directly with residents. SLUMBER focuses on detecting sleep-disruptive factors including: nighttime noise and patient behaviors associated with poor sleep quality; disruptions caused by nighttime caregiving; daytime inactivity; and limited light exposure. In this model, staff-delivered interventions to improve these factors improve sleep quality thereby creating opportunities to test the impact of improving sleep quality (measured by actigraphy) on mood (depression and anxiety), pain, cognitive function, functional ability, and observed activity levels.
Daytime Sleeping (Napping) Time
338.26 Minutes
Interval 287.79 to 388.73

PRIMARY outcome

Timeframe: Month 9 Post-Baseline

PSQI contains 19 self-rated questions. The 19 questions are combined to form seven "component" scores, each of which has a range of 0-3 points. In all cases, a score of "0" indicates no difficulty, while a score of "3" indicates severe difficulty. The total score range is 0-21; the higher the score, the greater the difficulties in all areas.

Outcome measures

Outcome measures
Measure
Resident of the Skilled Nursing Facility
n=56 Participants
Sleep Using Mentored Behavioral and Environmental Restructuring: SLUMBER is a non-pharmacological intervention program, delivered by providing mentoring to facility staff who work directly with residents. SLUMBER focuses on detecting sleep-disruptive factors including: nighttime noise and patient behaviors associated with poor sleep quality; disruptions caused by nighttime caregiving; daytime inactivity; and limited light exposure. In this model, staff-delivered interventions to improve these factors improve sleep quality thereby creating opportunities to test the impact of improving sleep quality (measured by actigraphy) on mood (depression and anxiety), pain, cognitive function, functional ability, and observed activity levels.
Score on Pittsburgh Sleep Quality Index (PSQI)
6.5 score on a scale
Interval 5.54 to 7.52

PRIMARY outcome

Timeframe: Month 9 Post-Baseline

BADS is a brief screening tool for mood impairment developed for older adults. It consists of 8 questions, answered 0 (no), 1(somewhat), or 2 (yes). The total score range is 0-16; the higher the score, the higher the level of mood impairment

Outcome measures

Outcome measures
Measure
Resident of the Skilled Nursing Facility
n=56 Participants
Sleep Using Mentored Behavioral and Environmental Restructuring: SLUMBER is a non-pharmacological intervention program, delivered by providing mentoring to facility staff who work directly with residents. SLUMBER focuses on detecting sleep-disruptive factors including: nighttime noise and patient behaviors associated with poor sleep quality; disruptions caused by nighttime caregiving; daytime inactivity; and limited light exposure. In this model, staff-delivered interventions to improve these factors improve sleep quality thereby creating opportunities to test the impact of improving sleep quality (measured by actigraphy) on mood (depression and anxiety), pain, cognitive function, functional ability, and observed activity levels.
Brief Anxiety and Depression Scale (BADS) Questionnaire Score
5.15 score on a scale
Interval 3.74 to 6.55

PRIMARY outcome

Timeframe: Month 9 Post-Baseline

BCAT is a multi-domain cognitive instrument that assesses orientation, verbal recall, visual recognition, visual recall, attention, abstraction, language, executive functions, and visuo-spatial processing in adult and older adult populations. It consists of 21 items. The total score range is 0-50; the higher the score, the more normal the level of cognitive functioning and independent living.

Outcome measures

Outcome measures
Measure
Resident of the Skilled Nursing Facility
n=56 Participants
Sleep Using Mentored Behavioral and Environmental Restructuring: SLUMBER is a non-pharmacological intervention program, delivered by providing mentoring to facility staff who work directly with residents. SLUMBER focuses on detecting sleep-disruptive factors including: nighttime noise and patient behaviors associated with poor sleep quality; disruptions caused by nighttime caregiving; daytime inactivity; and limited light exposure. In this model, staff-delivered interventions to improve these factors improve sleep quality thereby creating opportunities to test the impact of improving sleep quality (measured by actigraphy) on mood (depression and anxiety), pain, cognitive function, functional ability, and observed activity levels.
Score on Brief Cognitive Assessment Tool (BCAT)
28.33 score on a scale
Interval 25.42 to 31.23

Adverse Events

Resident of the Skilled Nursing Facility

Serious events: 0 serious events
Other events: 0 other events
Deaths: 9 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Adverse event data not reported

Additional Information

Joshua Chodosh, MD, MSHS

NYU Langone Health

Phone: (212) 263-6768

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place