PUMAS Intervention Results in Greater Insomnia Remission Rates, Reduced Depression in Prenatal Insomnia Than CBT-I

Christopher Drake, PhD

In a comparative study, findings showed that a mindfulness-based intervention—Perinatal Understanding of Mindful Awareness for Sleep (PUMAS)—was more effective than cognitive behavioral therapy-insomnia (CBT-I) for insomnia remission in a cohort of pregnant women, and significantly outperformed control on outcomes of depression, insomnia, and cognitive arousal.

These data were presented at 2023 SLEEP Annual Meeting, June 3-7, in Indianapolis, Indiana, by senior Christopher Drake, PhD, section head, Sleep Research, Henry Ford Hospital. The intent-to-treat analysis, which comprised of 64 pregnant women, showed significant reductions in Insomnia Severity Index (ISI) in those randomly assigned to PUMAS (­–11.05 [±3.84]) and CBT-I (–11.20 [±6.87]) relative to control (–4.27 [±1.96]). Treatment outcomes were analyzed through general linear models, while the PRODCLIN method tested mediation models in evaluation of treatment mechanisms.

The mindfulness intervention, PUMAS, placed behavioral sleep strategies within a mindfulness framework and tailored all components to pregnancy. Both the PUMAS and CBT-I groups received 6 telemedicine sessions, whereas controls electronically received 6 weekly information sheets on perinatal sleep health. At the conclusion of the trial, the PUMAS group showed the highest rate of insomnia remission (81.8%), followed by CBT-I (65.0%) and controls (13.6%).

READ MORE: Solriamfetol Improves Cognition in Patients With Obstructive Sleep Apnea

In comparison with controls, those assigned to PUMAS showed significantly alleviated depression, as expressed by scores on Edinburgh postnatal depression scale (EPDS; –3.77 [±3.88] vs –0.59 [±2.84]; P = .017), whereas CBT-I did not differ (–2.55 [±4.25]; P = .017). Pre-sleep arousal scale’s cognitive factor (PSASC), which assessed cognitive arousal, was significantly alleviated in the PUMAS group relative to controls (–8.82 [±4.99] vs –3.45 [±4.53]; P = 009), whereas CBT-I did not differ from either group (–7.30 [±7.49]; P ≥.104). Mediation analyses estimated that reductions in cognitive arousal mediated 26.0% and 40.6% of PUMAS effects on insomnia and depression.

Drake and colleagues presented another study at SLEEP 2023, assessing a small cohort of pregnant women with insomnia who received 6 weekly telemedicine sessions of PUMAS. Eleven of the 12 patients completed all 6 sessions (91.7%). Intent-to-treat analyses revealed large reductions in ISI (14.50 [±2.50] to 3.67 [±3.11]; P <.001; Cohen’s d = 3.05), resulting in an 83.3% insomnia remission rate (n = 10). Patients reported high rates of treatment satisfaction for improvement in insomnia (100%), energy (90.9%), pregnancy stress (90.9%), mood (90.9%), and coping with stress (83.3%).

Among the 5 participants with comorbid depression (EPDS: 14.00 [±3.32] to 5.00 [±2.55] P = .004; Cohen’s d = 2.76), and all 5 participants remitted from depression at posttreatment. Additionally, PUMAS yielded large reductions in cognitive arousal (PSASC: 20.75 [±4.58] to 12.50 [±4.23]; P <.001; Cohen’s d = 2.08) and sleep effort, as demonstrated by Glasgow Sleep Effort Scale (5.92 [±2.64] to 2.08 [±1.62]; P <.001; Cohen’s d = 2.06).

Click here for more coverage of SLEEP 2023.

REFERENCES
1. Kalmbach D, Cheng P, Ong J, et al. A three arm randomized controlled trial examining mindfulness-based and cognitive-behavioral therapies for prenatal insomnia. Presented at: 2023 SLEEP Annual Meeting; June 3-7; Indianapolis, Indiana. Abstract 0370
2. Seymour G, Kalmbach D, Cheng P, et al. A single-arm proof-of-concept clinical trial of mindfulness-based intervention for prenatal insomnia. Presented at: 2023 SLEEP Annual Meeting; June 3-7; Indianapolis, Indiana. Abstract 0317