A controlled trial of Cognitive Behavioural Therapy-based strategies for insomnia among in-school adolescents in southern Nigeria

Abstract

Background Sleep difficulties are highly prevalent among adolescents, and are associated with significant impairments. The effectiveness and acceptability of Cognitive Behavioural Therapy-based (CBT-based) treatment for insomnia in adolescents is established for High Income Countries, but unknown for African settings. Thus, the aim of this study was to assess the effect of CBT-based intervention among in-school adolescents with sleep difficulties in Southern Nigeria. Methods This was a pilot controlled trial involving 50 adolescents with highest ranked scores on the Insomnia Severity Index (ISI) recruited from four schools (two government and two privately owned). Balloting was used to assign two schools (public and private) with 25 participants to the intervention group, and the other two schools (public and private) with 25 participants as waiting-list controls. The two groups were dyad-matched for baseline ISI scores, gender, and type of school to reduce baseline differences. The treatment group received weekly group-based manualised CBT-based intervention over 5\xa0weeks. Primary outcome was ISI score at 6th week. Secondary outcomes were sleep onset latency (SOL), Total sleep duration (TSD), depressive symptoms, sleep hygiene, and knowledge about sleep. Results Participants were aged 13–17\xa0years (M\u2009=\u200914.9, SD\u2009=\u20091.16) and consisted of 18 males and 32 females. Controlling for baseline scores, the intervention group showed significantly lower post-intervention insomnia scores compared with the control group {F (1, 34)\u2009=\u20091.10, p\u2009=\u20090.0001, (ηp 2 \u2009=\u20090.59}, shorter SOL {F (1, 33)\u2009=\u20091.41, p\u2009=\u20090.0001, ηp 2 \u2009=\u20090.39}, longer TSD {F (1, 33)\u2009=\u20091.03, p\u2009=\u20090.0001, ηp 2 \u2009=\u20090.47}, lower depressive symptoms {F (1, 31)\u2009=\u20091.32, p\u2009=\u20090.002 (ηp 2 \u2009=\u20090.34}, higher knowledge of sleep {F (1, 34)\u2009=\u20091.02, p\u2009=\u20090.001, ηp 2 \u2009=\u20090.36}, but no significant change in sleep hygiene {F (1, 32)\u2009=\u20091.08, p\u2009=\u20090.08, ηp 2 \u2009=\u20090.15}. All participants in the intervention group rated the programme as good or excellent. Conclusion This pilot CBT-based intervention for adolescents with insomnia was feasible, well received and showed promising efficacy in this setting. Larger controlled trials are recommended to establish the generalisability of these findings in this region. Trial registration Pan African Clinical Trial Registry (Registration Number PACTR202001710494962)