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Abstract: FR-PO434

Engagement in CBT-I in the SLEEP-HD Trial for People on Long-Term Hemodialysis with Insomnia

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis


  • Cukor, Daniel, Rogosin Institute, New York, New York, United States
  • Mccurry, Susan M., University of Washington, Seattle, Washington, United States
  • Rue, Tessa, University of Washington, Seattle, Washington, United States
  • Roumelioti, Maria-Eleni, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States
  • Heagerty, Patrick James, University of Washington, Seattle, Washington, United States
  • Unruh, Mark L., University of New Mexico School of Medicine, Albuquerque, New Mexico, United States
  • Mehrotra, Rajnish, University of Washington, Seattle, Washington, United States

Patients with end-stage kidney disease treated with hemodialysis (HD) experience distressing symptoms including sleep disturbances. Unique aspects of HD treatments and schedules possibly contribute to the high prevalence of insomnia. Cognitive-behavioral therapy for insomnia (CBT-I) is a first-line therapy but largely inaccessible to HD patients, partly due to significant dialysis treatment time. CBT-I delivered by telehealth could overcome barriers to access, but the level of engagement has not been tested for these patients.


SLEEP-HD was a parallel-group randomized controlled trial (RCT) wherein 126 HD patients treated in community-based dialysis facilities in Seattle and Albuquerque were randomized 1:1:1 to 6-week treatment with telehealth delivered CBT-I, trazodone, or medication placebo. Primary goals were to compare the efficacy of a 6-week treatment with telehealth CBT-I vs. trazodone vs. placebo for the treatment of chronic insomnia at treatment conclusion and follow-up. Herein we describe data available on CBT-I engagement of the study participants.


43 SLEEP-HD participants were randomized to the 6-week CBTI telehealth intervention with 51% women and 49% men (average age: 60.1 years (SD 15.2)). The protocol called for 6 sessions over 6 weeks and 74% of participants had all 6 sessions, while 5% had none. Participants were asked to keep sleep diaries during the intervention period and 40% kept for all weeks and 19% kept none. After each session, study therapists rated their perception of the participant’s level of engagement and effort in following previous week’s treatment recommendations (“homework”). Engagement scores across the six sessions indicated that 98% of participants were, on average, at least somewhat engaged during the sessions and 83% were well-engaged. The average homework scores indicated that 18% of the participants were rated as not putting in significant effort, and 43% were rated as putting in considerable effort.


CBT-I can be demanding and patient engagement is an important part of the treatment model. In this telehealth administered CBT-I protocol adapted for people on long-term HD, overall levels of engagement in the sessions seemed high, although the level of skills practice and follow through on sleep recommendations was more limited.


  • NIDDK Support