Technology-based Sleep Self-Management Intervention for Adults with Subarachnoid Hemorrhage

PROJECT SUMMARY/ABSTRACT
Subarachnoid hemorrhage (SAH) accounts for 27% of all stroke-related years of potential life lost before 65
years of age. Sleep disturbance (insufficient sleep, poor quality) and daytime sleepiness (falling asleep during
activities) are highly prevalent following SAH. These symptoms negatively impact overall daily function and
quality of life and increase healthcare use, yet often go undetected or untreated during clinical care. This
proposed study builds upon our prior research, where we found that SAH survivors use patient activation and
self-management strategies in an attempt to improve sleep (e.g., seek knowledge and skills, exercise or relax),
but become frustrated when there is no support or structure to aid their strategies. Our findings suggest that
targeted sleep self-management interventions focusing on patient activation improve sleep in this population.
However, effective interventions focusing on sleep disturbance tailored to SAH have not been reported in the
literature. In this study, we will integrate input from SAH survivors and their caregivers, employ an iterative
human-centered design using a mixed methods approach, and develop a technology-based intervention to
improve self-management skills (patient activation and engagement) for SAH survivors with sleep disturbance.
We will tailor the face-to-face Sleep BETTER 4-week intervention, effective in improving sleep in other chronic
illness populations, to meet the unique needs of SAH survivors, and convert it to a technology-based format
using responsive-design web technology to support deployment over web, tablet, and mobile devices. This
program includes six components: 1) bedroom environment, 2) exercise, 3) tension, 4) time in bed, 5) eating
and drinking, and 6) rhythm for sleep-wake routines. In this study we aim to: 1) Tailor the Sleep BETTER
intervention to meet the unique needs of SAH survivors (e.g., enhanced social support and self-management
skills) to improve sleep disturbance (i.e., self-report sleep quality and daytime sleepiness; actigraphy total
sleep time and sleep efficiency) with 32 SAH survivors and their caregivers, 2) Develop a technology-based
intervention, using an iterative human-centered design and qualitative methods (i.e., iterative cycles of semi-
structured audio-recorded sessions) with 24 SAH survivors and their caregivers, 3) Refine and test the usability
of a technology-based intervention, employing think-aloud observation sessions, the System Usability Scale,
and semi-structured interviews with 32 SAH survivors and their caregivers, and 4) Assess the overall feasibility
and acceptability of collecting primary (i.e., self-report sleep quality and daytime sleepiness; actigraphy total
sleep time and sleep efficiency) and secondary measures (i.e., patient activation, motor or cognitive
impairments, and social support) to refine the intervention protocol. A technology-based intervention to improve
sleep has the potential to reduce health disparities by providing an intervention for SAH survivors who are
typically geographically dispersed with limited access to sleep specialists. Our results will provide critical data
for further development of a large scale randomized controlled trial to improve sleep in this population.

Grant Number: 1R56HL167681-01A1
NIH Institute/Center: NIH
Principal Investigator: Eeeseung Byun