Background and objectives: One of the most common sleep disturbances in older people is insomnia. Cognitive-behavioral therapy is the first-line treatment for this condition in older adults, but in-person treatment is costly and often unavailable. In this study, in a group of older and young subjects, we aimed to compare: (a) their initial perceptions of a fully automated mobile health intervention to manage insomnia, (b) how these perceptions related to treatment completion, and (c) the effects of the intervention on insomnia severity and related outcomes.

Research design and methods: A case-series study was conducted with a self-selected sample of older (≥65 years) and young (18-35 years) adults (n = 5,660) who downloaded a free app, available in France, that delivers a brief behavioral intervention for insomnia aided by a virtual companion (VC). The 17-day intervention included sleep hygiene and stimulus control recommendations. Primary outcome was treatment completion (yes/no). At the beginning of the intervention, treatment acceptability and trust in the VC were assessed with 2 short questionnaires (completion rate: 1,597 users). Insomnia was evaluated with the Insomnia Severity Index.

Results: Logistic regression analyses showed that higher credibility and trust in the app's VC were associated with higher odds of treatment completion, but only in older adults (trust scores × age group: odds ratio [OR] = 1.12; 95% confidence interval [CI] = 1.01-1.25; p < .05, and credibility scores × age group: OR = 1.25 [95% CI = 1.06-1.47], p < .01). Within the subset of users who completed the intervention (n = 289), insomnia remission (χ² = 2.72, NS) and insomnia response rates (χ² = 2.34, NS) were comparable across both groups.

Discussion and implications: This brief behavioral intervention appears to be efficacious for the self-management of insomnia symptoms in older adults. The integration of persuasive interaction elements, such as avatars and virtual coaches, in fully automated interventions could be particularly useful to stimulate older adults' engagement.

Clinical trials registration number: NCT05074901.

Keywords: Mobile health intervention; Sleep; User engagement.

© The Author(s) 2024. Published by Oxford University Press on behalf of the Gerontological Society of America.

背景与目的： 老年人中最常见的睡眠障碍之一是失眠。认知行为疗法是治疗老年人这种状况的首选治疗方法，但面对面治疗成本高昂且常常不可用。在这项研究中，在一组老年和年轻受试者中，我们旨在比较：（a）他们对管理失眠的完全自动化的移动健康干预措施的初始看法；（b）这些看法与完成治疗的关系；以及（c）该干预措施在减轻失眠严重程度及相关结果方面的效果。

研究设计和方法： 一项案例系列研究针对的是一个自愿选择样本，包括年龄≥65岁的老年人和18-35岁年轻人（n=5,660），这些受试者下载了一款在法国提供的免费应用，该应用通过虚拟伴侣（VC）提供一种简短的行为干预措施以帮助管理失眠。这项为期17天的干预措施包括睡眠卫生和刺激控制建议。主要结果指标是治疗完成情况（是否完成）。在干预开始时，使用2份简短问卷评估了治疗接受度及对VC的信任程度（完成率：1,597名用户）。失眠通过失眠严重指数进行评价。

结果： 逻辑回归分析显示，在老年人中，对应用程序的虚拟伴侣更高的信任和可信度与更高的治疗完成几率相关联（信任评分 × 年龄组：比值比[OR] = 1.12；95%置信区间[CI] = 1.01-1.25；p

讨论与意义： 这种简短的行为干预措施似乎对于老年人自我管理失眠症状是有效的。在完全自动化的干预措施中整合说服性互动元素，如化身和虚拟教练，可能特别有助于激发老年人的参与度。

临床试验注册号： NCT05074901.

关键词： 移动健康干预；睡眠；用户参与。