STUDY OBJECTIVES In a randomized controlled non-inferiority trial, we compared face-to-face and telemedicine delivery (via the AASM SleepTM platform) of CBT for insomnia for improving insomnia/sleep and daytime functioning at post-treatment and 3-month follow-up. A secondary objective compared the modalities on treatment credibility, satisfaction, and therapeutic alliance. METHODS Sixty-five adults with chronic insomnia (46 women, 47.2 ± 16.3 years of age) were randomized to 6 sessions of CBT for insomnia delivered individually via AASM SleepTM (n=33, CBT-TM) or face-to-face (n=32, CBT-F2F). Participants completed sleep diaries, the Insomnia Severity Index (ISI), and daytime functioning measures at pre-treatment, post-treatment, and 3-month follow-up. Treatment credibility, satisfaction, and therapeutic alliance were compared between treatment modalities. The ISI was the primary non-inferiority outcome. RESULTS Based on a non-inferiority margin of 4 points on the ISI and, after adjusting for confounders, CBT-TM was non-inferior to CBT-F2F at post-treatment (β = 0.54, SE=1.10, 95% CI -1.64 to 2.72) and follow-up (β = 0.34, SE=1.10, 95% CI -1.83 to 2.53). Daytime functioning measures, except the physical composite scale of the SF-12, were significantly improved at post-treatment and follow-up, with no difference between treatment formats. CBT-TM sessions were, on average, nearly 10 minutes shorter, yet participant ratings of therapeutic alliance were similar to CBT-F2F. CONCLUSIONS Telemedicine delivery of CBT for insomnia is not inferior to face-to-face for insomnia severity and yields similar improvements on other sleep and daytime functioning outcomes. Further, telemedicine allows for more efficient treatment delivery while not compromising therapeutic alliance.

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远程医疗与面对面治疗失眠的认知行为疗法：一项随机对照非劣效性试验

研究目标在一项随机对照非劣效性试验中，我们比较了 CBT 的面对面和远程医疗交付（通过 AASM SleepTM 平台）治疗失眠症，以改善治疗后和 3 个月随访时的失眠/睡眠和日间功能——向上。次要目标比较了治疗可信度、满意度和治疗联盟的方式。方法 65 名患有慢性失眠的成年人（46 名女性，47.2 ± 16.3 岁）被随机分配到 6 次 CBT 治疗，通过 AASM SleepTM（n=33，CBT-TM）或面对面（n =32，CBT-F2F）。参与者在治疗前、治疗后和 3 个月的随访中完成了睡眠日记、失眠严重程度指数 (ISI) 和日间功能测量。待遇信誉、满意、和治疗联盟在治疗方式之间进行了比较。ISI 是主要的非劣效性结局。结果 基于 ISI 上 4 分的非劣效性界限，并且在调整混杂因素后，CBT-TM 在治疗后不劣于 CBT-F2F（β = 0.54，SE=1.10，95% CI -1.64至 2.72）和随访（β = 0.34，SE=1.10，95% CI -1.83 至 2.53）。除了 SF-12 的物理综合量表外，日间功能测量在治疗后和随访中得到显着改善，治疗形式之间没有差异。CBT-TM 会议平均缩短了近 10 分钟，但治疗联盟的参与者评分与 CBT-F2F 相似。结论 对于失眠的严重程度而言，远程医疗提供 CBT 治疗失眠并不逊色于面对面治疗，并且对其他睡眠和日间功能结果产生类似的改善。此外，远程医疗允许更有效的治疗提供，同时不影响治疗联盟。