Evidence map›Paper›PMID 39115347›Full record

Trial reportSleep2025

Effects of a Triage Checklist to optimize insomnia treatment outcomes and reduce hypnotic use: the RCT of the effectiveness of stepped-care sleep therapy in general practice study.

Rachel Manber, Nicole B Gumport, Isabelle A Tully, Jane P Kim, Bohye Kim, Norah Simpson, Lisa G Rosas, Donna M Zulman, Jeremy D Goldhaber-Fiebert, Elizabeth Rangel and 3 more

Erratum issued Registry-linked trialAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Sleep, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT03532282 (Randomized Controlled Study of the Effectiveness of Stepped-Care Sleep Therapy In General Practice), which is not on this map. Cited by 5 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03532282 nacompletednot on this map

Randomized Controlled Study of the Effectiveness of Stepped-Care Sleep Therapy In General Practice

TypeinterventionalSponsorStanford UniversityRan2019 to 2023Enrolled388ConditionsInsomniaArmsONLINE ONLY, STEPPED CARE
3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Trial
  3. Article
  4. Article
  5. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors.

Rachel ManberDepartment of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.ORCID 0000-0003-2829-8892
Nicole B GumportDepartment of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.ORCID 0000-0002-1502-1985
Isabelle A TullyDepartment of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
Jane P KimDepartment of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.ORCID 0000-0002-1475-9822
Bohye KimDepartment of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
Norah SimpsonDepartment of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
Lisa G RosasDepartment of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA.
Donna M ZulmanDepartment of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
Jeremy D Goldhaber-FiebertDepartment of Health Policy, Stanford University School of Medicine, Stanford, CA, USA.
Elizabeth RangelDepartment of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
Jessica R DietchDepartment of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.ORCID 0000-0001-9434-0791
Joshua TutekDepartment of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
Latha PalaniappanDepartment of Health Policy, Stanford University School of Medicine, Stanford, CA, USA.

Funding

Spectrum Stanford Center for clinical and Translational Research and EducationUL1TR001085 · NCATS · STANFORD UNIVERSITY · PI CULLEN, MARK RICHARD, GREENBERG, HARRY BERNARD · 2013 to 2017
$37.1M
RCT of the Effectiveness of Stepped-Care Sleep Therapy In General Practice (RESTING)R01AG057500 · NIA · STANFORD UNIVERSITY · PI MANBER, RACHEL · 2018 to 2022
$2.4M
NCATS NIH HHS UL1 TR001085NIA NIH HHS R01 AG057500
6 · The paper itself

Abstract

STUDY

objectivesEvaluate a triaged stepped-care strategy among adults 50 and older with insomnia disorder.

methodsParticipants (N = 245) were classified at baseline by a Triage Checklist. Those projected to do better if they start treatment with therapist versus digitally delivered CBT-I (tCBT-I vs dCBT-I) constituted the YES stratum (n = 137); the rest constituted the NO stratum (n = 108). Participants were randomized within stratum to a strategy that utilized only dCBT-I (ONLN) or to a strategy that prospectively allocated the first step of care to dCBT-I or tCBT-I based on the Triage Checklist and switched dCBT-I nonresponders at 2-months to tCBT-I (STEP). Co-primary outcomes were the insomnia severity index (ISI) and the average nightly amount of prescription hypnotic medications used (MEDS), assessed at 2, 4, 6, 9, and 12 months postrandomization.

resultsMixed effects models revealed that, compared to ONLN, participants in STEP had greater reductions in ISI (p = .001; η2 = 0.01) and MEDS (p = .019, η2 = 0.01). Within the YES stratum, compared to ONLN, those in STEP had greater reductions in ISI (p = .0001, η2 = 0.023) and MEDS (p = .018, η2 = 0.01). Within the ONLN arm, compared to the YES stratum, those in the NO stratum had greater reductions in ISI (p = .015, η2 = 0.01) but not in MEDS. Results did not change with treatment-dose covariate adjustment.

conclusionsTriaged-stepped care can help guide the allocation of limited CBT-I treatment resources to promote effective and safe treatment of chronic insomnia among middle-aged and older adults. Further refinement of the Triage Checklist and optimization of the timing and switching criteria may improve the balance between effectiveness and use of resources. CLINICAL TRIAL INFORMATION: Name: The RESTING Insomnia Study: Randomized Controlled Study on Effectiveness of Stepped-Care Sleep Therapy. TRIAL REGISTRATION ID: NCT03532282. URL: https://clinicaltrials.gov/study/NCT03532282.

Indexed as

ChecklistCognitive Behavioral TherapyHypnotics and SedativesSleep Initiation and Maintenance DisordersTriageAgedFemaleGeneral PracticeHumansMaleMiddle AgedTreatment OutcomeHypnotics and Sedativesdigitalhypnoticsinsomniastepped care

Identifiers

PMID39115347
PMCPMC13032131

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.