STUDY OBJECTIVES Sleep schedule consistency is fundamental to cognitive behavioral therapy for insomnia (CBT-I), although there is limited evidence suggesting whether it predicts treatment response. This analysis tested whether: (1) an Internet-based CBT-I program affects intra-individual variability (IIV) in sleep schedule, and (2) sleep schedule IIV predicts insomnia symptom remission. METHODS This secondary analysis compares participants (N=303) randomized to an Internet-based CBT-I program (SHUTi - Sleep Healthy Using the Internet) or Internet-based patient education (PE). Participants reported daily bedtimes and rising times on ten online sleep diaries collected over two weeks at baseline and nine-week post-intervention assessment. Participants completed the Insomnia Severity Index (ISI) at post-assessment and six-month follow-up; symptom remission was defined by ISI<8. Mixed effects location scale modeling was used to examine the effect of SHUTi on bedtime and rising time IIV; a novel two-staged analysis examined the effect of bedtime and rising time IIV on insomnia symptom remission. RESULTS At post-assessment, SHUTi participants reported about 30% less bedtime and 32% less rising time variability compared to PE (ps<.03). Bedtime and rising time IIV was not independently associated with likelihood of insomnia symptom remission at the subsequent time point (ps>.18), nor did sleep schedule IIV moderate treatment response (ps>.12). CONCLUSIONS Findings demonstrate that an Internet-delivered CBT-I program can effectively increase users' sleep schedule consistency relative to an educational control. This consistency, however, was not related to treatment outcome when defined by insomnia symptom remission, suggesting that enforcing rigid sleep schedules for patients may not be necessary for treatment success.

中文翻译：

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睡眠时间表的个体差异：基于互联网的认知行为疗法对失眠计划的影响及其与症状缓解的关系

研究目标 睡眠时间表的一致性是失眠认知行为疗法 (CBT-I) 的基础，尽管有限的证据表明它是否能预测治疗反应。该分析测试了：（1）基于互联网的 CBT-I 程序是否会影响睡眠时间表中的个体差异（IIV），以及（2）睡眠时间表 IIV 是否能预测失眠症状的缓解。方法 该次要分析比较了参与者（N=303）随机分配到基于互联网的 CBT-I 计划（SHUTi - 使用互联网的健康睡眠）或基于互联网的患者教育 (PE)。参与者报告了在基线和干预后九周评估时收集的十个在线睡眠日记的每日就寝时间和起床时间。参与者在评估后和六个月的随访中完成了失眠严重程度指数（ISI）；症状缓解定义为 ISI<8。使用混合效应位置量表模型检验舒提对就寝时间和起床时间 IIV 的影响；一项新的两阶段分析检查了就寝时间和起床时间 IIV 对失眠症状缓解的影响。结果 在评估后，与 PE 相比，SHUTi 参与者报告的就寝时间减少了约 30%，起床时间变异性减少了 32% (ps<.03)。就寝时间和起床时间 IIV 与随后时间点失眠症状缓解的可能性没有独立相关性 (ps>.18)，睡眠时间表 IIV 也不影响治疗反应 (ps>.12)。结论 研究结果表明，与教育控制相比，互联网提供的 CBT-I 程序可以有效地提高用户睡眠时间表的一致性。然而，这种一致性，