CAJ | 학술논문

目的研究自助的认知行为疗法(cognitive behavioral therapy for insomnia-self help,CBTI-SH)治疗长期服用催眠药的慢性失眠患者的疗效及依从性.方法对象为门诊慢性失眠患者,连续使用催眠药超过6个月者为研究组,未服药者为对照组,各30例.两组均予以CBTI-SH,疗程4周.在基线及2,4周末评定睡眠相关量表.每天记录睡眠日志,评价指标包括入睡潜伏期、夜间醒来时间、总睡眠时间、睡眠效率.监测患者对行为疗法6种主要成分的依从程度.结果睡眠效率、卧床时间、夜间醒来时间在治疗前后不同时间之间的差异有统计学意义,时间因素和分组因素存在交叉效应(P＜0.05).对照组睡眠效率、卧床时间、夜间醒来时间[分别为(0.19±0.08)分,(92.48 ± 32.64)分,(103.08 ±64.82)分]的改善优于研究组[分别为(0.09 ±0.09)分,(78.06±60.05)分,(64.92±56.36)分],差异具有统计学意义,t值分别为4.437,3.328,4.004(均P＜0.05),效应量分别为1.14,0.85,0.62.研究组对“固定起床时间”、“限制卧床时间”的依从性低于对照组,差异有统计学意义(均P＜0.05).回归分析显示,共病慢性躯体疾病者、年龄越大者,对CBTI-SH依从性越差(P＜0.05).结论 CBTI-SH对长期服用催眠药的失眠患者的疗效和依从性均低于未服催眠药的患者,患者共病慢性躯体疾病、年龄大和依从性差有关.
목적 연구자조적인지행위요법(cognitive behavioral therapy for insomnia-self help,CBTI-SH)치료장기복용최면약적만성실면환자적료효급의종성.방법 대상위문진만성실면환자,련속사용최면약초과6개월자위연구조,미복약자위대조조,각30례.량조균여이CBTI-SH,료정4주.재기선급2,4주말평정수면상관량표.매천기록수면일지,평개지표포괄입수잠복기、야간성래시간、총수면시간、수면효솔.감측환자대행위요법6충주요성분적의종정도.결과 수면효솔、와상시간、야간성래시간재치료전후불동시간지간적차이유통계학의의,시간인소화분조인소존재교차효응(P＜0.05).대조조수면효솔、와상시간、야간성래시간[분별위(0.19±0.08)분,(92.48 ± 32.64)분,(103.08 ±64.82)분]적개선우우연구조[분별위(0.09 ±0.09)분,(78.06±60.05)분,(64.92±56.36)분],차이구유통계학의의,t치분별위4.437,3.328,4.004(균P＜0.05),효응량분별위1.14,0.85,0.62.연구조대“고정기상시간”、“한제와상시간”적의종성저우대조조,차이유통계학의의(균P＜0.05).회귀분석현시,공병만성구체질병자、년령월대자,대CBTI-SH의종성월차(P＜0.05).결론 CBTI-SH대장기복용최면약적실면환자적료효화의종성균저우미복최면약적환자,환자공병만성구체질병、년령대화의종성차유관.
Objective To test the efficacy of cognitive behavioral self help therapy for chronic insomnia (CBTI-SH) patients with hypnotic long-term use.Methods A total of 60 adults with chronic insomnia and common comorbidities were recruited.Participants were randomly assigned to either intervention group (IG,n =30) if they had used hypnotics more than 6 months,or control group(CG,n =30) if they had never used hypnotics in the past 6 months.All the patients were given CBTI-SH for 4 weeks.The primary outcome was self-report symptom,based on sleep diaries (including Sleep Latency(SL),Wake after Sleep Onset(WASO),Total Sleep Time(TST),Time In Bed(TIB),Sleep Efficiency(SE) which were evaluated on baseline and at the end of the 2nd,4th week treatment.Continuous variables were evaluated by repeated-measures multivariate analyses of variance (MANOVA).At the conclusion of treatment,each participant was asked how many days per week they enacted each of 6 core elements of the CBT regimen.Linear regression models were examined to determine net predictors of CBTI-SH adherence.Results The MANOVA showed a significant treatment group × time interaction,as well as time main effects for SE,TIB and WASO(P＜0.05).The patients in CG made better improvements than those in IG on SE,TIB and WASO((0.19 ±0.08) vs(0.09 ±0.09),(92.48 ± 32.64) vs (78.06 ±60.05),(103.08 ±64.82) vs (64.92 ±56.36),respectively) (P ＜ 0.05).Effect size were 1.14,0.85 and 0.62 respectively.Self-ratings of treatment adherence showed patients in the IG reported less adherence to standard rise time and TIB prescription than those in CG.(P ＜ 0.05).According to the linear regression models,both age and the comorbidity of chronic somatic diseases explained net associations with CBTI-SH adherence (P ＜ 0.05).Conclusion Chronic insomnia patients with hypnotic long-term use show less sleep improvement and less adherence to CBTI-SH compared with those who don' t use these medicines.Both age and the comorbidity of chronic somatic diseases explain net associations with CBTI-SH adherence.