The effects of improving sleep on mental health (OASIS): a randomised controlled trial with mediation analysis - PubMed (original) (raw)

Randomized Controlled Trial

. 2017 Oct;4(10):749-758.

doi: 10.1016/S2215-0366(17)30328-0. Epub 2017 Sep 6.

Bryony Sheaves 2, Guy M Goodwin 2, Ly-Mee Yu 3, Alecia Nickless 3, Paul J Harrison 2, Richard Emsley 4, Annemarie I Luik 5, Russell G Foster 6, Vanashree Wadekar 7, Christopher Hinds 7, Andrew Gumley 8, Ray Jones 9, Stafford Lightman 10, Steve Jones 11, Richard Bentall 12, Peter Kinderman 13, Georgina Rowse 12, Traolach Brugha 14, Mark Blagrove 15, Alice M Gregory 16, Leanne Fleming 17, Elaine Walklet 18, Cris Glazebrook 19, E Bethan Davies 20, Chris Hollis 19, Gillian Haddock 21, Bev John 22, Mark Coulson 23, David Fowler 24, Katherine Pugh 25, John Cape 26, Peter Moseley 27, Gary Brown 28, Claire Hughes 29, Marc Obonsawin 30, Sian Coker 31, Edward Watkins 32, Matthias Schwannauer 33, Kenneth MacMahon 33, A Niroshan Siriwardena 34, Colin A Espie 5

Affiliations

Randomized Controlled Trial

The effects of improving sleep on mental health (OASIS): a randomised controlled trial with mediation analysis

Daniel Freeman et al. Lancet Psychiatry. 2017 Oct.

Abstract

Background: Sleep difficulties might be a contributory causal factor in the occurrence of mental health problems. If this is true, improving sleep should benefit psychological health. We aimed to determine whether treating insomnia leads to a reduction in paranoia and hallucinations.

Methods: We did this single-blind, randomised controlled trial (OASIS) at 26 UK universities. University students with insomnia were randomly assigned (1:1) with simple randomisation to receive digital cognitive behavioural therapy (CBT) for insomnia or usual care, and the research team were masked to the treatment. Online assessments took place at weeks 0, 3, 10 (end of therapy), and 22. The primary outcome measures were for insomnia, paranoia, and hallucinatory experiences. We did intention-to-treat analyses. The trial is registered with the ISRCTN registry, number ISRCTN61272251.

Findings: Between March 5, 2015, and Feb 17, 2016, we randomly assigned 3755 participants to receive digital CBT for insomnia (n=1891) or usual practice (n=1864). Compared with usual practice, the sleep intervention at 10 weeks reduced insomnia (adjusted difference 4·78, 95% CI 4·29 to 5·26, Cohen's d=1·11; p<0·0001), paranoia (-2·22, -2·98 to -1·45, Cohen's d=0·19; p<0·0001), and hallucinations (-1·58, -1·98 to -1·18, Cohen's d=0·24; p<0·0001). Insomnia was a mediator of change in paranoia and hallucinations. No adverse events were reported.

Interpretation: To our knowledge, this is the largest randomised controlled trial of a psychological intervention for a mental health problem. It provides strong evidence that insomnia is a causal factor in the occurrence of psychotic experiences and other mental health problems. Whether the results generalise beyond a student population requires testing. The treatment of disrupted sleep might require a higher priority in mental health provision.

Funding: Wellcome Trust.

Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

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Figure

Trial profile SCI=Sleep Condition Indicator. *Some participants excluded for two or more reasons. †Not all participants accessed all treatment sessions. ‡Had at least one measurement at week 3, 10, or 22.

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