Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jun 13, 2023
Date Accepted: May 8, 2024
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Just-in-time Adaptive Intervention for Stabilizing Sleep Hours of Japanese Workers: A Micro-randomized Trial
ABSTRACT
Background:
Sleep disturbance is a major contributor to future health and occupational issues. Mobile health (mHealth) can provide interventions that address adverse health behaviors for individuals in vulnerable health state in real-world settings [just-in-time adaptive intervention (JITAI)].
Objective:
The aim of this paper was to identify a subpopulation with vulnerable sleep state in daily life (study 1) and, immediately afterwards, to test whether providing mHealth intervention improved habitual sleep behaviors and psychological wellness in real-world settings by conducting micro-randomized trial (study 2).
Methods:
Japanese workers (N = 182) were instructed to collect data on their habitual sleep behaviors and momentary symptoms (including depressive mood, anxiety, and subjective sleep quality) using digital devices in a real-world setting. In study 1, we calculated intra-individual mean and variability of sleep hours, midpoint of sleep and sleep efficiency to characterize their habitual sleep behaviors. In study 2, we designed and conducted a sleep JITAI, which delivered objective push-type sleep feedback messages to improve their sleep hours, for a subset of participants in study 1 (N = 81). The feedback messages were generated based on their sleep data measured in previous nights and randomly sent to participants with 50% chance for each day (micro-randomization).
Results:
In study 1, we applied hierarchical clustering to dichotomize the population into two clusters (group A and group B) and found that group B was characterized by unstable habitual sleep behaviors (large intra-individual variabilities). In addition, linear mixed-effect models showed that the inter-individual variability of sleep hours was significantly associated with depressive mood (β = 3.83, P = .004), anxiety (β = 5.70, P = .03), and subjective sleep quality (β = -3.37, P = .03). In study 2, we found that providing sleep feedback prolonged subsequent sleep hours (increasing up to 40 minutes, P = .01), and this effect lasted for up to 7 days. Overall, stability of sleep hours in study 2 was significantly improved among participants in group B compared to study 1 (P = .001).
Conclusions:
This is the first study to demonstrate that providing sleep feedback can benefit modification of habitual sleep behaviors in a micro-randomized trial. The findings of this study encourage the use of digitalized health intervention trials that employs real-time health monitoring and personalized feedback.
Citation
