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InsomniaPhase 3Sleep-HDNCT03534284

Short and Long-Term Effectiveness of Existing Insomnia Therapies for Patients Undergoing Hemodialysis

A Phase 3 study testing Cognitive Behavioral Therapy for Insomnia and Trazodone in people with Insomnia and End Stage Renal Disease, run by University of Washington at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Insomnia is a common and distressing symptom for patients on hemodialysis (HD), and there is evidence for a much larger impact on the health of patients. Chronic insomnia is disrupted sleep that occurs at least three nights per week and lasts at least three months. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Insomnia, End Stage Renal Disease
What is being tested?
Cognitive Behavioral Therapy for Insomnia and Trazodone
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
126 participants
Where
1 siteUnited States
Study dates
19 Sep 2018to 17 Nov 2022
Phase
Phase 3
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Undergoing thrice-weekly maintenance hemodialysis for ≥ 3 months
  • Able to speak English
  • ISI score ≥ 10 at pre-screening with sleep disturbances for ≥ 3 nights per week for ≥ 3 months

Who cannot join

  • Severe cognitive impairment on Mini-COG cognitive test (score < 3)
  • Severe depression assessed by Patient Health Questionnaire (PHQ)-2 and if appropriate, PHQ-9
  • Suicidal Ideation
  • Alcohol abuse on CAGE alcohol assessment questionnaire (score ≥ 2) or substance abuse on Drug Abuse Screening Test (DAST)-10 questionnaire (score > 5)
  • Severe restless leg syndrome
  • Treatment with trazodone in the past one month
Show all 14Show fewer
  • Known allergy to trazodone (self-report or by chart review)
  • Current treatment with monoamine oxidase inhibitors or in the preceding 14 days
  • Current treatment with linezolid (self-report or by chart review)
  • Current treatment with other drugs that are inhibitors of CYP3A4 (e.g., itraconazole, clarithromycin, voriconazole), or known to prolong QT interval including Class 1A antiarrhythmics (e.g., quinidine, procainamide) or Class 3 antiarrhythmics (e.g., amiodarone, sotalol), antipsychotic medications (ziprasidone, chlorpromazine, thioridazine), and quinolone antibiotics
  • Pregnancy, or lactation, or women of childbearing potential not willing to use adequate birth control
  • Life Expectancy < 3 months
  • Expected to receive a kidney transplant or transition to home dialysis (peritoneal dialysis or home hemodialysis) within 6 months
  • Any other condition that, in the opinion of the investigator, should preclude patient participation in the clinical trial

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Northwest Kidney Centers

    Seattle, Washington, 98122

Other trials in United States

About this study

Official title: Short and Long-Term Effectiveness of Existing Insomnia Therapies for Patients Undergoing Hemodialysis (Sleep-HD)

Insomnia is a common and distressing symptom for patients on hemodialysis (HD), and there is evidence for a much larger impact on the health of patients. Chronic insomnia is disrupted sleep that occurs at least three nights per week and lasts at least three months.

The SLEEP-HD study is a randomized open-label clinical trial to compare two types of treatment for insomnia in participants who have end-stage renal disease on HD, and who have been diagnosed with chronic insomnia. The two types of treatment involved in the study are Cognitive Behavioral Therapy for Insomnia (CBT-I) or treatment with a drug (trazodone vs placebo).

126 participants will be enrolled who are undergoing HD in two study locations (Seattle, Washington and Albuquerque, New Mexico).

Read the detailed description

Most HD patients have significant impairments in quality of life, largely from the high frequency of disabling symptoms. Insomnia is one of the most frequently reported symptoms and studies of HD patients and/or other populations suggest that it is a significant contributor to other common symptoms and poor health outcomes. There are unique contributors to chronic insomnia in HD patients and these include the biologic effects of residual uremia after partial correction as is achieved with current dialysis technology, maladaptation to treatment schedules, and patients' napping during treatments.

There is a compelling need to identify effective treatments for insomnia in HD patients and the interventions being studied in this clinical trial, telehealth cognitive behavioral therapy for insomnia (CBT-I) and trazodone, have a strong scientific premise. If telehealth (web-based) CBT-I is effective for insomnia in HD patients, it will make a treatment that is presently inaccessible available to patients. Trazodone is widely used but the data on efficacy for insomnia are limited; no such data exist for HD patients.

SLEEP-HD is a parallel group randomized controlled trial wherein 125 HD patients with chronic insomnia, treated in community-based dialysis facilities in Seattle and Albuquerque, will be randomized 1:1:1 over 31 months to 6-week treatment with telehealth CBT-I, trazodone, or medication placebo.

Being tested
Cognitive Behavioral Therapy for Insomnia, Trazodone, Placebo
Keywords
Hemodialysis, Kidney disease, Trazodone, Cognitive behavioral therapy
Medical subject headings
Sleep Initiation and Maintenance Disorders, Kidney Failure, Chronic, Kidney Diseases

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Cognitive Behavioral Therapy for InsomniaBehavioural

    Also called CBT-I

    Once weekly treatment sessions for 6 weeks. The content of each of these sessions will be adapted to include changes in behavior during HD treatments (such as napping) and to help patients better adjust to treatment schedules. The CBT-I sessions will be delivered by a therapist face-to-face with the patient via a fully interactive video telehealth platform.

  • TrazodoneDrug

    Also called Desyrel

    trazodone tablet

  • PlaceboDrug

    Also called Placebo (for trazodone)

    Inactive pill manufactured to mimic trazodone tablets.

Study groups in NCT03534284
Study groupRoleWhat they receive
CBT-IActive comparatorCognitive Behavioral Therapy for Insomnia sessions: a 30-minute treatment session once weekly for six weeks.
Receives: Behavioral: Cognitive Behavioral Therapy for Insomnia
Medication- TrazodoneActive comparatorTrazodone (50-100 mg):
Receives: Drug: Trazodone
Medication- PlaceboPlacebo comparatorPlacebo (for trazodone)
Receives: Drug: Placebo

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Insomnia Severity Index (ISI) Short-term

    summary score obtained from the ISI, measuring insomnia, range from 0 to 28. Higher score indicates greater insomnia, at Week 7 describing the short-term effect of the intervention

    Measured: Week 7

  2. Insomnia Severity Index (ISI) Long-term

    summary score obtained from the ISI, measuring insomnia, range from 0 to 28. Higher score indicates greater insomnia, at Week 25 describing the long-term effect of the intervention

    Measured: Week 25

Secondary outcomes (22)
  1. Patient-reported Outcomes (PRO) - Pittsburgh Sleep Quality Index - Short-term

    Score from Pittsburgh Sleep Quality Index, measuring sleep quality, range 0 to 21. Higher scores indicates worse sleep quality: at Week 7 describing the short-term effect of the intervention

    Measured: Week 7

  2. Patient-reported Outcomes (PRO) - Pittsburgh Sleep Quality Index - Long-term

    Score from Pittsburgh Sleep Quality Index, measuring sleep quality, range 0 to 21. Higher scores indicates worse sleep quality: at Week 25 describing the long-term effect of the intervention

    Measured: Week 25

  3. Patient-reported Outcomes (PRO) - Epworth Sleepiness Scale - Short-term

    Score from Epworth Sleepiness Scale, measuring sleepiness, range 0 to 24. Higher scores indicates greater sleepiness: at Week 7 describing the short-term effect of the intervention

    Measured: Week 7

  4. Patient-reported Outcomes (PRO) - Epworth Sleepiness Scale - Long-term

    Score from Epworth Sleepiness Scale, measuring sleepiness, range 0 to 24. Higher scores indicates greater sleepiness: at Week 25 describing the long-term effect of the intervention

    Measured: Week 25

  5. Patient-reported Outcomes (PRO) - FACIT Fatigue Scale- Short-term

    Score from FACIT Fatigue Scale, measuring fatigue, range 0 to 52. Higher scores indicates greater fatigue: at Week 7 describing the short-term effect of the intervention

    Measured: Week 7

  6. Patient-reported Outcomes (PRO) - FACIT Fatigue Scale- Long-term

    Score from FACIT Fatigue Scale, measuring fatigue, range 0 to 52. Higher scores indicates greater fatigue: at Week 25 describing the long-term effect of the intervention

    Measured: Week 25

  7. Patient-reported Outcomes (PRO) - Graded Chronic Pain Scale - Short-term

    Score from first item Graded Chronic Pain scale, measuring pain, range 0 to 10. Higher scores indicates greater pain: at Week 7 describing the short-term effect of the intervention

    Measured: Week 7

  8. Patient-reported Outcomes (PRO) - Graded Chronic Pain Scale - Long-term

    Score from first item Graded Chronic Pain scale, measuring pain, range 0 to 10. Higher scores indicates greater pain: at Week 25 describing the long-term effect of the intervention

    Measured: Week 25

  9. Patient-reported Outcomes (PRO) - Graded Chronic Pain Scale - Interference - Short-term

    Score from Second Item Graded Chronic Pain scale, measuring pain interference, range 0 to 10. Higher scores indicates greater interference from pain: at Week 7 describing the short-term effect of the intervention

    Measured: Week 7

  10. Patient-reported Outcomes (PRO) - Graded Chronic Pain Scale - Interference - Long-term

    Score from Second Item Graded Chronic Pain scale, measuring pain interference, range 0 to 10. Higher scores indicates greater interference from pain: at Week 25 describing the long-term effect of the intervention

    Measured: Week 25

  11. Patient-reported Outcomes (PRO) - Patient Health Questionnaire 9 - Short-term

    Score from Patient Health Questionnaire 9, measuring depression, range 0 to 27. Higher scores indicates greater depression: at Week 7 describing the short-term effect of the intervention

    Measured: Week 7

  12. Patient-reported Outcomes (PRO) - Patient Health Questionnaire 9 - Long-term

    Score from Patient Health Questionnaire 9, measuring depression, range 0 to 27. Higher scores indicates greater depression: at Week 25 describing the long-term effect of the intervention

    Measured: Week 25

  13. Patient-reported Outcomes (PRO) - Generalized Anxiety Disorder 7 Scale - Short-term

    Score from Generalized Anxiety Disorder 7 Scale, measuring anxiety, range 0 to 21. Higher scores indicates greater anxiety: at Week 7 describing the short-term effect of the intervention

    Measured: Week 7

  14. Patient-reported Outcomes (PRO) - Generalized Anxiety Disorder 7 Scale - Long-term

    Score from Generalized Anxiety Disorder 7 Scale, measuring anxiety, range 0 to 21. Higher scores indicates greater anxiety: at Week 25 describing the long-term effect of the intervention

    Measured: Week 25

  15. Patient-reported Outcomes (PRO) - Quality of Life Short Form 12 Scale - Physical Component Score - Short-term

    Score from Quality of Life Short Form 12 scale - Physical Component Score, measuring quality of life, range 0 to 100. Higher scores indicates better quality of life: at Week 7 describing the short-term effect of the intervention

    Measured: Week 7

  16. Patient-reported Outcomes (PRO) - Quality of Life Short Form 12 Scale - Physical Component Score - Long-term

    Score from Quality of Life Short Form 12 scale - Physical Component Score, measuring quality of life, range 0 to 100. Higher scores indicates better quality of life: at Week 25 describing the long-term effect of the intervention

    Measured: Week 25

  17. Patient-reported Outcomes (PRO) - Quality of Life Short Form 12 Scale - Mental Component Score - Short-term

    Score from Quality of Life Short Form 12 scale - Mental Component Score, measuring quality of life, range 0 to 100. Higher scores indicates better quality of life: at Week 7 describing the short-term effect of the intervention

    Measured: Week 7

  18. Patient-reported Outcomes (PRO) - Quality of Life Short Form 12 Scale - Mental Component Score - Long-term

    Score from Quality of Life Short Form 12 scale - Mental Component Score, measuring quality of life, range 0 to 100. Higher scores indicates better quality of life: at Week 25 describing the long-term effect of the intervention

    Measured: Week 25

  19. Cumulative Weekly Use of Sedatives/Hypnotics - Short-term

    This will be defined, as the number of days that the patient took a drug to help sleep, range from 0 to 7: at Week 7 describing the short-term effect of the intervention

    Measured: Week 7

  20. Cumulative Weekly Use of Sedatives/Hypnotics - Long-term

    This will be defined, as the number of days that the patient took a drug to help sleep, range from 0 to 7: at Week 25 describing the long-term effect of the intervention

    Measured: Week 25

  21. Objective Measure of Sleep - Short-term

    Actigraphy measurement of average nighttime sleep efficiency (percent time asleep of time in bed): at Week 7 describing the short-term effect of the intervention

    Measured: Week 7

  22. Objective Measure of Sleep - Long-term

    Actigraphy measurement of average nighttime sleep efficiency (percent time asleep of time in bed): at Week 25 describing the long-term effect of the intervention

    Measured: Week 25

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted23 May 2018
  2. Study start19 Sep 2018
  3. Primary completion17 Oct 2022
  4. Study completion17 Nov 2022

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
SLEEP-HD is a parallel group randomized controlled trial wherein 125 HD patients with chronic insomnia, treated in community-based dialysis facilities in Seattle and Albuquerque, will be randomized 1:1:1 over 31 months to 6-week treatment with telehealth CBT-I, trazodone, or medication placebo.
Masking
Triple blind
Who is masked
Participant, Care provider, Investigator
Enrolment
126 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03534284
Sponsor's protocol ID
STUDY00004678
Other IDs
R01DK115468
Acronym
Sleep-HD
Status last verified
Feb 2024
First submitted
1 May 2018
Last updated
5 Feb 2024
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No

Publications

  • Mehrotra R, Cukor D, McCurry SM, Rue T, Roumelioti ME, Heagerty PJ, Unruh M. Effectiveness of Existing Insomnia Therapies for Patients Undergoing Hemodialysis : A Randomized Clinical Trial. Ann Intern Med. 2024 Feb;177(2):177-188. doi: 10.7326/M23-1794. Epub 2024 Jan 16.

    PubMed 38224591
  • Unruh M, Cukor D, Rue T, Abad K, Roumelioti ME, McCurry SM, Heagerty P, Mehrotra R. Sleep-HD trial: short and long-term effectiveness of existing insomnia therapies for patients undergoing hemodialysis. BMC Nephrol. 2020 Oct 20;21(1):443. doi: 10.1186/s12882-020-02107-x.

    PubMed 33081705

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Cognitive Behavioral Therapy for Insomnia and Trazodone in people with Insomnia and End Stage Renal Disease, run by University of Washington at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 14 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 5 Feb 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 5 Feb 2024). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Insomnia Severity Index (ISI) Short-term (time frame: Week 7). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03534284, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 5 Feb 2024.

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Sleep-HD Clinical Trial NCT03534284 | AzTrials