CClinicalTrials.gg
CompletedNCT03327324SLUMBERUpdated Feb 8, 2023Results posted

Improving Sleep Using Mentored Behavioral and Environmental Restructuring

An interventional study of Sleep Using Mentored Behavioral and Environmental Restructuring in Insomnia, sponsored by NYU Langone Health. Completed at 1 site in United States. Open to participants aged 18 Years and older, including healthy volunteers. Per ClinicalTrials.gov, last updated 2023-02-08.

Sponsored by NYU Langone Health · Not applicable, Interventional, and Supportive care

Phase
Not applicable
Study type
Interventional
Enrollment
110
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

The goal of this study is to test potential functional/psychosocial benefits of improved sleep using a program designed to teach nursing facility staff to improve sleep promoting strategies and environment for nursing home residents. Sleep disturbances are quite common in skilled nursing facilities and affect as many as 69% of residents while staff do not fully understand how to improve sleep without using medications. Medications for sleep are commonly used as first-line therapy for older adults but this is problematic because these medications can lead to greater problems with thinking, more frequent falls, and even worse sleep over time. In addition, poor sleep can lead to depressed mood, greater trouble with thinking and memory, worse pain, and greater need for help with daily activities.

Read the detailed description

This is a study to test the effects of improved sleep quality on downstream functional/psychosocial outcomes.

02

Conditions studied

  • Insomnia
03

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
Yes

Inclusion criteria

  • living in the unit of intervention,
  • ability to communicate and follow simple commands,
  • English- or Spanish-speaking,
  • capacity to consent assessed with standard questions used to assess capacity or having a surrogate who can provide consent.

Exclusion criteria

Exclusion Criteria:

  • Does not have capacity and does not show enthusiasm for the research
  • Does not have capacity and does not have a proxy.
  • obtunded or comatose state,
  • inability to communicate verbally,
  • inability to consent and without surrogate
  • non-English and non-Spanish speaking. In keeping with QI strategies, all residents will be exposed to the environmental aspects of the intervention, as these strategies represent clinically proven non-experimental behavioral strategies with no perceptible harm.
04

Study design

Phase
Not applicable
Primary purpose
Supportive care
Allocation
Randomized
Intervention model
Sequential assignment
Masking
None (open label)
Enrollment
110 participants (actual)

Study arms

  • Experimental
    F1U1

    Sequence 1 (Facility 1/Unit 1): Baseline, then 3 Month SLUMBER Intervention, then 39 Month Sustainability.

    Behavioral: Sleep Using Mentored Behavioral and Environmental Restructuring

  • Experimental
    F1U2

    Sequence 2 (Facility 1/Unit 2): Baseline, then 3 Month SLUMBER Intervention, then 33 Month Sustainability

    Behavioral: Sleep Using Mentored Behavioral and Environmental Restructuring

  • Experimental
    F2U2

    Sequence 3 (Facility 2/Unit 2): Baseline, then 3 Month SLUMBER Intervention, then 27 Month Sustainability

    Behavioral: Sleep Using Mentored Behavioral and Environmental Restructuring

  • Experimental
    F2U3

    Sequence 4 (Facility 2/Unit 3): Baseline, then 3 Month SLUMBER Intervention, then 21 Month Sustainability

    Behavioral: Sleep Using Mentored Behavioral and Environmental Restructuring

  • Experimental
    F2U4

    Sequence 5 (Facility 2/Unit 4): Baseline, then 3 Month SLUMBER Intervention, then 15 Month Sustainability

    Behavioral: Sleep Using Mentored Behavioral and Environmental Restructuring

  • Experimental
    F3U1

    Sequence 6 (Facility 3/Unit 1): Baseline, then 3 Month SLUMBER Intervention, then 9 Month Sustainability

    Behavioral: Sleep Using Mentored Behavioral and Environmental Restructuring

Interventions

  • BehavioralSleep 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.

    Also known as: SLUMBER

05

What researchers measure

Primary outcomes

  1. Sleep Efficiency (SE)

    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.

    Time frame: Baseline

  2. Sleep Efficiency (SE)

    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.

    Time frame: Post-Treatment (Month 6 Post-Baseline)

  3. Sleep Efficiency (SE)

    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.

    Time frame: Month 9 Post-Baseline

  4. Nighttime Total Awake Time

    Data will be obtained from antigraphy analysis.

    Time frame: Baseline

  5. Nighttime Total Awake Time

    Data will be obtained from antigraphy analysis.

    Time frame: Post-Treatment (Month 6 Post-Baseline)

  6. Nighttime Total Awake Time

    Data will be obtained from antigraphy analysis.

    Time frame: Month 9 Post-Baseline

  7. Daytime Sleeping (Napping) Time

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

    Time frame: Baseline

  8. Daytime Sleeping (Napping) Time

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

    Time frame: Post-Treatment (Month 6 Post-Baseline)

  9. Daytime Sleeping (Napping) Time

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

    Time frame: Month 9 Post-Baseline

  10. Score on Pittsburgh Sleep Quality Index (PSQI)

    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.

    Time frame: Month 9 Post-Baseline

  11. Brief Anxiety and Depression Scale (BADS) Questionnaire Score

    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

    Time frame: Month 9 Post-Baseline

  12. Score on Brief Cognitive Assessment Tool (BCAT)

    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.

    Time frame: Month 9 Post-Baseline

06

Results

Posted Feb 8, 2023

Participant flow

Baseline (Month 0-Month 3)
Participant flow — Baseline (Month 0-Month 3)
MilestoneF1U1F1U2F2U2F2U3F2U4F3U1
Started18209101520
Completed1817991314
Not completed030126
Withdrew: Incomplete (participant did not complete all data items collected during study visit)010105
Withdrew: Refused000010
Withdrew: Withdrawal by subject020000
Withdrew: Death000010
Withdrew: Covid-incomplete (couldn't collect all subject data due to nursing home covid shutdown)000001
Intervention (Month 3-Month 6)
Participant flow — Intervention (Month 3-Month 6)
MilestoneF1U1F1U2F2U2F2U3F2U4F3U1
Started1817991314
Completed131668110
Not completed5131214
Withdrew: Incomplete (participant did not complete all data items collected during study visit)001000
Withdrew: Withdrawal by subject211010
Withdrew: Left nursing home facility200000
Withdrew: Death101110
Withdrew: Covid-incomplete (couldn't collect all subject data due to nursing home covid shutdown)0000014
Sustainability Follow-Up 1 (Month 6-9)
Participant flow — Sustainability Follow-Up 1 (Month 6-9)
MilestoneF1U1F1U2F2U2F2U3F2U4F3U1
Started131668110
Completed9145560
Not completed421350
Withdrew: Incomplete (participant did not complete all data items collected during study visit)100000
Withdrew: Left nursing home facility210000
Withdrew: Death111000
Withdrew: Covid-incomplete (couldn't collect all subject data due to nursing home covid shutdown)000350
Sustainability Follow-Up 2 (Month 9-12)
Participant flow — Sustainability Follow-Up 2 (Month 9-12)
MilestoneF1U1F1U2F2U2F2U3F2U4F3U1
Started9142000
Completed7142000
Not completed200000
Withdrew: Left nursing home100000
Withdrew: Death100000

Outcome measures

PrimarySleep Efficiency (SE)

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.

Time frame:
Baseline
Reported as:
Mean · percentage of time in bed
Sleep Efficiency (SE)
percentage of time in bedResident of the Skilled Nursing Facility
Sleep Efficiency (SE)76.1 (71.83 to 80.38)
PrimarySleep Efficiency (SE)

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.

Time frame:
Post-Treatment (Month 6 Post-Baseline)
Reported as:
Mean · percentage of time in bed
Sleep Efficiency (SE)
percentage of time in bedResident of the Skilled Nursing Facility
Sleep Efficiency (SE)75.69 (70.89 to 80.49)
PrimarySleep Efficiency (SE)

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.

Time frame:
Month 9 Post-Baseline
Reported as:
Mean · percentage of time in bed
Sleep Efficiency (SE)
percentage of time in bedResident of the Skilled Nursing Facility
Sleep Efficiency (SE)75.61 (70.05 to 81.18)
PrimaryNighttime Total Awake Time

Data will be obtained from antigraphy analysis.

Time frame:
Baseline
Reported as:
Mean · Minutes
Nighttime Total Awake Time
MinutesResident of the Skilled Nursing Facility
Nighttime Total Awake Time11.54 (9.92 to 13.15)
PrimaryNighttime Total Awake Time

Data will be obtained from antigraphy analysis.

Time frame:
Post-Treatment (Month 6 Post-Baseline)
Reported as:
Mean · Minutes
Nighttime Total Awake Time
MinutesResident of the Skilled Nursing Facility
Nighttime Total Awake Time11.03 (9.22 to 12.84)
PrimaryNighttime Total Awake Time

Data will be obtained from antigraphy analysis.

Time frame:
Month 9 Post-Baseline
Reported as:
Mean · Minutes
Nighttime Total Awake Time
MinutesResident of the Skilled Nursing Facility
Nighttime Total Awake Time11.8 (9.29 to 14.31)
PrimaryDaytime Sleeping (Napping) Time

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

Time frame:
Baseline
Reported as:
Mean · Minutes
Daytime Sleeping (Napping) Time
MinutesResident of the Skilled Nursing Facility
Daytime Sleeping (Napping) Time305.91 (261.63 to 350.18)
PrimaryDaytime Sleeping (Napping) Time

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

Time frame:
Post-Treatment (Month 6 Post-Baseline)
Reported as:
Mean · Minutes
Daytime Sleeping (Napping) Time
MinutesResident of the Skilled Nursing Facility
Daytime Sleeping (Napping) Time369.7 (314.92 to 424.47)
PrimaryDaytime Sleeping (Napping) Time

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

Time frame:
Month 9 Post-Baseline
Reported as:
Mean · Minutes
Daytime Sleeping (Napping) Time
MinutesResident of the Skilled Nursing Facility
Daytime Sleeping (Napping) Time338.26 (287.79 to 388.73)
PrimaryScore on Pittsburgh Sleep Quality Index (PSQI)

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.

Time frame:
Month 9 Post-Baseline
Reported as:
Mean · score on a scale
Score on Pittsburgh Sleep Quality Index (PSQI)
score on a scaleResident of the Skilled Nursing Facility
Score on Pittsburgh Sleep Quality Index (PSQI)6.5 (5.54 to 7.52)
PrimaryBrief Anxiety and Depression Scale (BADS) Questionnaire Score

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

Time frame:
Month 9 Post-Baseline
Reported as:
Mean · score on a scale
Brief Anxiety and Depression Scale (BADS) Questionnaire Score
score on a scaleResident of the Skilled Nursing Facility
Brief Anxiety and Depression Scale (BADS) Questionnaire Score5.15 (3.74 to 6.55)
PrimaryScore on Brief Cognitive Assessment Tool (BCAT)

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.

Time frame:
Month 9 Post-Baseline
Reported as:
Mean · score on a scale
Score on Brief Cognitive Assessment Tool (BCAT)
score on a scaleResident of the Skilled Nursing Facility
Score on Brief Cognitive Assessment Tool (BCAT)28.33 (25.42 to 31.23)

Adverse events

Collected over 12 months. Non-serious events are listed at a 0% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Resident of the Skilled Nursing Facility9/110 (8.2%)0/110 (0%)0/110 (0%)

Baseline characteristics

Age, Continuous
Age, Continuous(years)F1U1F1U2F2U2F2U3F2U4F3U1Total
Mean66 ± 866 ± 889 ± 792 ± 891 ± 575 ± 1181 ± 14
Sex: Female, Male
Sex: Female, Male(Participants)F1U1F1U2F2U2F2U3F2U4F3U1Total
Female9114891152
Male96514328
Ethnicity (NIH/OMB)
Ethnicity (NIH/OMB)(Participants)F1U1F1U2F2U2F2U3F2U4F3U1Total
Hispanic or Latino56202217
Not Hispanic or Latino131179111263
Unknown or Not Reported0000000
Race (NIH/OMB)
Race (NIH/OMB)(Participants)F1U1F1U2F2U2F2U3F2U4F3U1Total
American Indian or Alaska Native0000000
Asian0002002
Native Hawaiian or Other Pacific Islander0000000
Black or African American139001326
White027710935
More than one race0000000
Unknown or Not Reported56202217
Region of Enrollment
Region of Enrollment(participants)F1U1F1U2F2U2F2U3F2U4F3U1Total
United States181799131480
07

Study locations

1 site
  • New York University School of Medicine
    New York, New York 10016, United States
08

References and documents

Study documents

  • Protocol and statistical analysis plan · Aug 27, 2018

Documents are hosted by the registry — open the source record to download them.

09

Registry details

Key details

Study ID
NCT03327324
Lead sponsor
NYU Langone Health
Collaborators
National Institutes of Health (NIH), National Institute of Nursing Research (NINR)
Responsible party
Sponsor
First posted
Oct 31, 2017
Start date
Mar 27, 2018
Primary completion
Feb 23, 2021
Completion
Feb 23, 2021
Results posted
Feb 8, 2023
Last update
Feb 8, 2023

Study contacts

Joshua Chodosh, MD
principal investigator · NYU Langone Health

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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