Promoting Sleep and Physical Activity Among Adolescent Psychiatric Patients

NCT ID: NCT06407258

Last Updated: 2024-05-09

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

140 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-06-01

Study Completion Date

2026-06-30

Brief Summary

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Mental health disorders pose a significant burden on adolescent populations globally, often accompanied by sleep disturbances. Emerging evidence suggests that addressing sleep issues can improve mental health outcomes, while physical activity is increasingly recognized as beneficial for both sleep and mental well-being. This study aims to assess the effectiveness of a novel intervention (SLEEPAC), combining cognitive-behavioral therapy for insomnia (CBT-I), circadian treatment, and PA counseling, compared to treatment as usual (TAU), in improving psychopathology among adolescent psychiatric outpatients with sleep disturbances. Secondary outcomes include improvements in sleep health, physical activity levels, cognitive performance and self-esteem. Additionally, the study seeks to explore the predictive value of sleep neurophysiological biomarkers using high-density sleep electroencephalography (EEG), contributing to advancements in precision psychiatry for this population.

Detailed Description

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Background and rationale. Mental health disorders are the leading cause of disability in adolescents worldwide. 70 to 80% of individuals with mental disorders experience sleep disturbances. Preliminary evidence from adult studies suggest that treating sleep disturbances in these patients can improve mental health outcomes. Moreover, regular physical activity (PA) is increasingly promoted as a remedy for sleep and other mental health problems. Thus, combining sleep therapy and PA counseling may synergistically improve mental health outcomes in adolescent psychiatric patients. Guidance on how to address sleep disturbances and PA counselling among this population in routine clinical care has the potential to improve clinical and psychosocial outcomes.

Overall objectives. To improve psychopathology in adolescent psychiatric outpatients with comorbid sleep disturbances by testing a novel behavioral intervention (TRANSPAC) that improves both sleep and PA levels. This multi-component intervention combines CBT-I, circadian treatment, and PA counseling and will be compared against treatment as usual (TAU).

Specific aims. With the prospect of further developing and fine-tuning transdiagnostic treatment protocols for young psychiatric patients with comorbid sleep disturbances, the objectives of the proposed study are twofold: (1) To test the efficacy of a novel transdiagnostic blended care e-health sleep (CBT-I + circadian treatment) and PA therapy and to test its efficacy against TAU. The primary endpoint is severity reduction of psychopathology. Improvements of sleep health and regular PA levels will be investigated as secondary outcomes. (2) To evaluate the prognostic value of sleep neurophysiological biomarkers (high-density sleep-EEG) on intervention efficiency, thereby advancing current approaches in precision psychiatry.

Methods. The proposed study will recruit 140 psychiatric outpatients with comorbid sleep problems from our partner clinics in Basel and Bern (KJP-UPD Bern, UKBB Basel). Inclusion criteria: aged 13-18 years, presence of sleep problems in addition to a psychiatric diagnosis. Adolescents will be serially randomized over 1,5 years into one of 2 intervention arms: (a) TRANSPAC; or (b) TAU. The intervention will be delivered in 6 sessions over 12 weeks. Data will be collected at 3 time points: Baseline, post-intervention, and 6-months follow-up. Psychopathological load will be assessed via Symptom Checklist-90-Revised. The composite sleep health score is based on self-reported sleep quality, -quantity, and timing, complemented by 7-day sleep tracker (Oura Ring Gen3). PA will be assessed objectively via the same device (Oura Ring was selected due to prior compliance issues among this population with Actigraph). Primary biomarkers are the micro-architectural features of sleep assessed by a high-density sleep-EEG, such as sleep spindles, slow wave activity, and REM-latency. Secondary biomarkers include heart rate variability, and fitness.

Expected results. The proposed study aims to further develop and fine-tune transdiagnostic treatment protocols (i.e. for multiple psychiatric disorders) in adolescent psychiatric outpatients with sleep disturbances. Testing the potential of sleep treatments for improving psychopathology in young psychiatric patients is a promising and highly novel approach. Thus, it is expected that both TRANSPAC and TAU will improve psychopathology in youth, with TRANSPAC resulting in superior effects than TAU alone.

Impact. The onset of mental health disorders is often during adolescence, requiring countermeasures at an early developmental stage. Since sleep disturbances are a diagnostic feature for many psychiatric disorders, treating sleep problems transdiagnostically may positively impact other health outcomes. PA counseling may complement the benefits of the sleep intervention, working in concert to improve mental health outcomes.

Conditions

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Mental Disorder in Adolescence Insomnia Delayed Sleep-Wake Phase Disorder

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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SLEEPAC

In addition to treatment-as-usual (TAU), participants of the SLEEPAC arm will receive a multi-component sleep intervention combining elements of CBT-i, circadian adaptation, and physical activity counselling.

Group Type EXPERIMENTAL

SLEEPAC

Intervention Type BEHAVIORAL

6x individual blended-care counselling sessions:

* 1 x face-to-face kick-off sessions at study site (45 min)
* 1 x try-out exercise sessions at study site (45 min)
* 4 x online face-to-face sessions via zoom (30 min)
* Both the intervention and the waitlist control condition will continue with TAU.

Component 1: CBT-I: Sleep restriction, and cognitive therapy strategies with education about sleep-wake regulation, sleep hygiene, and pre-bedtime counter arousal methods.

Component 2: Circadian treatment: Morning bright light therapy with a gradual advanced sleep schedule and timed morning exercise.

Component 3: Physical activity counselling involves providing personalized guidance and support to individuals to help them adopt and maintain a physically active lifestyle tailored to their preferences and needs.

Control

Participants of the control group continue with their treatment as usual

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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SLEEPAC

6x individual blended-care counselling sessions:

* 1 x face-to-face kick-off sessions at study site (45 min)
* 1 x try-out exercise sessions at study site (45 min)
* 4 x online face-to-face sessions via zoom (30 min)
* Both the intervention and the waitlist control condition will continue with TAU.

Component 1: CBT-I: Sleep restriction, and cognitive therapy strategies with education about sleep-wake regulation, sleep hygiene, and pre-bedtime counter arousal methods.

Component 2: Circadian treatment: Morning bright light therapy with a gradual advanced sleep schedule and timed morning exercise.

Component 3: Physical activity counselling involves providing personalized guidance and support to individuals to help them adopt and maintain a physically active lifestyle tailored to their preferences and needs.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Aged between 13 to 18 years
* Presence of insomnia and/or delayed sleep-wake phase disorder
* At least one further diagnosis of DSM-5
* Written informed consent of parents / primary caregiver

Exclusion Criteria

* Organic sleep- and brain disorders (i.e., obstructive sleep apnea, narcolepsy, epilepsy)
* Suffering from medical conditions, which prevent participation in physical activity
* Changes to medication regime during the study protocol
* Color-blindness (due to stroop test)
Minimum Eligible Age

13 Years

Maximum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Department of Sport, Exercise, and Health, University of Basel

UNKNOWN

Sponsor Role collaborator

University Hospital of Child and Adolescent Psychiatry and Psychotherapy

UNKNOWN

Sponsor Role collaborator

University Children's Hospital of Basel

UNKNOWN

Sponsor Role collaborator

Psychiatry Baselland

UNKNOWN

Sponsor Role collaborator

Christin Lang

OTHER

Sponsor Role lead

Responsible Party

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Christin Lang

PhD

Responsibility Role SPONSOR_INVESTIGATOR

Locations

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Department of Sport, Exercise, and Health, University of Basel

Basel, Canton of Basel-City, Switzerland

Site Status

University Hospital of Child and Adolescent Psychiatry and Psychotherapy

Bern, Canton of Bern, Switzerland

Site Status

Countries

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Switzerland

Central Contacts

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Christin Lang, PhD

Role: CONTACT

+41 61 207 61 45

Leila Tarokh, Prof

Role: CONTACT

+41 31 932 86 19

Facility Contacts

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Christin Lang, PhD

Role: primary

0041 61 207 61 45

Markus Gerber, Prof

Role: backup

Christin Lang, PhD

Role: primary

0041 79 109 22 74

Leila Tarokh, Prof

Role: backup

Other Identifiers

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SLEEPAC

Identifier Type: -

Identifier Source: org_study_id

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