健康与遗传心理学研究室知识库

目的本研究旨在探索失眠的认知行为疗法（CBT-i）治疗不同类型失眠障碍的疗效及疗效的对比。方法84例符合失眠障碍诊断的患者，按照其是否伴有躯体疾病分为单纯组（42例）和共患组（42例）。两组分别给予CBT-i干预。采用自陈式心理量表及睡眠日记来测量被试的失眠情况及与失眠有关的情绪和心理状态。上述测量分别于治疗前（基线）、治疗结束时、治疗结束后第4周及第16周对两组被试施测，用以评估两组在接受CBT-i治疗后的短期及长期疗效，并进行比较。结果治疗结束时，单纯组的平均睡眠潜伏期由51.72 min降至10.53 min（P 〈 0.01），平均总睡眠时间由317.74 min升至355.49 min（P 〈 0.01），平均睡眠效率由71%升至95%（P 〈 0.01）；共患组平均睡眠潜伏期由59.26 min降至15.67 min（P 〈 0.01），平均睡眠效率由68%升至90%（P 〈 0.01），平均总睡眠时间无显著改善。两组患者的改善具有持久性（P 〈 0.01）；单纯组在睡眠潜伏期、总睡眠时间和睡眠效率方面显著优于共患组（中位值比较：10.00 min比13.93 min，P 〈 0.05；355.71 min比327.85 min，P 〈 0.05；95%比91%，P 〈 0.01），其他心理及睡眠指标与共患组差异无统计学意义。随访结果显示，治疗后第4周及第16周单纯组在睡眠潜伏期和睡眠效率方面明显优于共患组（P 〈 0.05）。结论CBT-i对失眠障碍患者总体是有效的，但是与单纯失眠障碍的患者相比，伴躯体疾病的失眠障碍患者在睡眠潜伏期、总睡眠时间和睡眠效率方面的治疗效果不如前者。

ObjectivesTo evaluate the effectiveness of cognitive behavior therapy for insomnia （CBT-i） in chronic insomnia patients in terms of the improvements of psychological and sleep diary parameters.MethodsPatients who met the diagnostic criteria of chronic insomnia, were divided into primary group or comorbid group. Both groups received standard CBT-i interventions. Psychological scales and sleep diaries were used to evaluate participants＇ severity of insomnia and psychological conditions related to insomnia at four time points： before intervention （baseline）, immediate after intervention, 4 weeks and 16 weeks after intervention.ResultsBoth groups achieved significant improvements after intervention on psychological measurements and sleep diary parameters. Such improvements were maintained at 4-week and 16-week follow-ups. The sleep diary data indicated that by the end of the intervention, there were significant differences on sleep onset latency （51.72 min to 10.53 min in primary group, P〈0.01; 59.26 min to 15.67min in comorbid group, P〈0.01） and sleep efficiency （71% to 95% in primary group, P〈0.01; 68% to 90% in comorbid group, P〈0.01）. There were differences on sleep onset latency （10.00 min vs. 13.93 min, P〈0.05）, total sleep time （355.71 min vs. 327.85 min, P〈0.05） and sleep efficiency （95% vs. 91%, P〈0.01） in primary group and comorbid group respectively. No differences were found on wake after sleep onset in the two groups.ConclusionsChronic insomnia patients with or without comorbidities both have improvements after CBT-i. Sleep diary parameters rather than psychological measurements are different in two groups. Thus, CBT-i is an effective non-pharmaceutical therapy inpatients with chronic insomnia.

北京市科委重点临床特色课题(Z121107001012034)