摘要
目的探索数字化失眠认知行为治疗(digital cognitive behavioral therapy for insomnia,dCBT-I)对失眠障碍伴焦虑和抑郁症状的疗效和治疗依从性,为dCBT-I在临床中的推广提供参考依据。方法于2023年12月至2024年12月从内蒙古自治区脑科医院门诊患者中招募失眠障碍伴焦虑和抑郁症状患者102例,采用简单随机方法分为dCBT-I组(n=56)和数字化睡眠卫生教育(digital sleep hygiene education,dSHE)组(n=46)。dCBT-I组接受4周包括5个核心模块的治疗,dSHE组接受4周数字化睡眠卫生教育,2组均由治疗师每周定期给予指导。分别于治疗开始前、治疗开始后第4、8、12周末采用失眠严重程度指数(Insomnia Severity Index,ISI)评估主观睡眠质量,汉密尔顿焦虑量表(Hamilton Anxiety Scale,HAMA)评估焦虑程度,17项汉密尔顿抑郁量表(Hamilton Depression Scale-17,HAMD 17)评估抑郁程度;并于治疗开始前、治疗开始后第4周末采用多导睡眠监测(polysomnography,PSG)评估客观睡眠质量,重复性成套神经心理测验(Repeatable Battery for the Assessment of Neuro-psychological Status,RBANS)评估认知功能。采用线性混合效应模型分析组别和测量时点对量表评分(ISI、HAMA、HAMD 17、RBANS)及PSG参数的影响。以用药史、年龄、性别、受教育程度、民族和婚姻状况作为协变量,组别和测量时点作为固定因子,并纳入组别×测量时点交互项。结果dCBT-I组42例、dSHE组34例完成4周治疗,治疗依从性为74.5%(76/102)。第4、8、12周末,dCBT-I组相较dSHE组,ISI、HAMA、HAMD 17评分均降低(β=-1.70~-0.66,t=-15.38~-6.21),减药率高于dSHE组(χ^(2)=16.40、9.22、6.66),差异均有统计学意义(均P<0.05);4周治疗后,dCBT-I相较dSHE组PSG各参数差异无统计学意义,RBANS中的即刻回忆、语言功能、延时记忆得分显著提高(β=0.45、0.86、1.43,t=3.09、2.67、4.36),差异均有统计学意义(均P<0.05)。结论dCBT-I干预失眠障碍伴焦虑和抑郁症状具有良好的疗效和治疗依从性,值得临床推广。
Objective To investigate the efficacy and treatment adherence of digital cognitive behavioral therapy for insomnia(dCBT-I)in patients with insomnia disorder accompanied by anxiety and depressive symptoms,and to provide empirical evidence for its clinical application.MethodsFrom December 2023 to December 2024,102 patients with insomnia disorder accompanied by anxiety and depressive symptoms were recruited from the outpatient department of Inner Mongolia Brain Hospital and randomly assigned to either the dCBT-I group(n=56)or the digital sleep hygiene education(dSHE)group(n=46).The dCBT-I group received a 4-week intervention comprising 5 core modules,while the dSHE group received 4 weeks of digital sleep hygiene education.Both groups received weekly guidance from clinical psychologists.Subjective sleep quality(Insomnia Severity Index,ISI),anxiety(Hamilton Anxiety Scale,HAMA),and depressive symptoms(17-item Hamilton Depression Scale,HAMD 17)were assessed at baseline,week 4,week 8,and week 12.Objective sleep parameters(polysomnography,PSG)and cognitive function(Repeatable Battery for the Assessment of Neuropsychological Status,RBANS)were evaluated at baseline and week 4.Linear mixed-effects model was used to analyze the effects of group,timepoint,and their interaction on outcome measures,after controlling medication history,age,sex,education level,ethnicity,and marital status as covariates.ResultsA total of 76 patients(dCBT-I:n=42;dSHE:n=34)completed the 4-week intervention,yielding a treatment adherence rate of 74.5%(76/102).At weeks 4,8,and 12,the dCBT-I group demonstrated significantly lower scores on the ISI,HAMA,and HAMD 17 scales compared to the dSHE group(β=-1.70--0.66,t=-15.38--6.21,all P<0.05),along with higher rates of medication reduction(χ^(2)=16.40,9.22,6.66,all P<0.05).No significant differences were observed in PSG parameters between the two groups.However,the dCBT-I group demonstrated significant improvements in RBANS subdomains,including immediate memory,language function,and delayed memory(β=0.45,0.86,1.43,t=3.09,2.67,4.36,all P<0.05).ConclusiondCBT-I is an effective and well-adhered intervention for patients with insomnia disorder accompanied by anxiety and depressive symptoms,warranting broader clinical implementation.
作者
刘敏
伊如汗
韩子亮
林武宏
陈敏
姚萍
杨培锋
吕东升
Liu Min;Yi Ruhan;Han Ziliang;Lin Wuhong;Chen Min;Yao Ping;Yang Peifeng;Lyu Dongsheng(The Mental Health Center of Inner Mongolia Autonomous Region,the Third Hospital of Inner Mongolia Autonomous Region,Brain Hospital of Inner Mongolia Autonomous Region,Hohhot 010010,China;The Mental Health Center of Xing′an League,Xing′an League 137400,China)
出处
《中华精神科杂志》
北大核心
2025年第8期630-638,共9页
Chinese Journal of Psychiatry
基金
中央引导地方科技发展资金项目(2022ZY0028)
首府地区公立医院高水平临床专科建设科技项目(2023SGGZ0009,2023SGGZ048)。
关键词
入睡和睡眠障碍
焦虑和抑郁症状
数字化失眠认知行为治疗
疗效
Sleep initiation and maintenance disorders
Anxiety and depressive symptoms
Digital cognitive behavioral therapy for insomnia
Efficacy
