CAJ | 학술논문

目的比较电话指导下的认知行为自助疗法(CBTI-SH)和酒石酸唑吡坦对慢性失眠的疗效. 方法选择自2011年7月至2012年10月中山大学附属三院精神心理科门诊慢性失眠患者60例,按奇偶数法分为研究组和对照组各30例.对照组给予睡眠卫生教育+剂量递减的酒石酸唑吡坦治疗:药物起始剂量为10 mg/d,每周递减1/4剂量,疗程4周；研究组给予睡眠卫生教育+CBTI-SH治疗:疗程4周,内容包括认知重建、睡眠限制、刺激控制、放松训练,将CBTI-SH的内容制成文字材料,由患者自助实施,第1、3周末分别给予15 min的电话指导.在基线时及第2、4、6周末应用匹茨堡睡眠质量指数量表(PSQI)、Epworth嗜睡量表(ESS)对睡眠情况进行评价；要求患者每天记录睡眠日志,评价指标包括入睡潜伏期、入睡后觉醒时间、睡眠时间、卧床时间、睡眠效率；要求患者进行依从性评价,即过去1周内有多少天按照要求执行了CBTI-SH或睡眠卫生教育的6种主要成分. 结果重复测量的方差分析显示,研究组和对照组PSQI量表、ESS量表评分及入睡潜伏期、睡眠效率、睡眠时间、卧床时间、入睡后觉醒时间在治疗前后不同时间之间的差异均有统计学意义(P＜0.05),且研究组的改善明显优于对照组,效应量分别为1.93、0.04、1.00、0.98、0.11、0.57、0.43.研究组对“不在床上做其他事”和“不在床上担忧”的依从性高于对照组,而对“限制卧床时间”、“不能睡则离开床”的依从性低于对照组,差异均有统计学意义(P＜0.05). 结论和应用剂量递减的酒石酸唑吡坦治疗策略相比,CBTI-SH治疗慢性失眠及伴随的日间思睡的疗效更优,但部分依从性有待提高.
목적 비교전화지도하적인지행위자조요법(CBTI-SH)화주석산서필탄대만성실면적료효. 방법 선택자2011년7월지2012년10월중산대학부속삼원정신심이과문진만성실면환자60례,안기우수법분위연구조화대조조각30례.대조조급여수면위생교육+제량체감적주석산서필탄치료:약물기시제량위10 mg/d,매주체감1/4제량,료정4주；연구조급여수면위생교육+CBTI-SH치료:료정4주,내용포괄인지중건、수면한제、자격공제、방송훈련,장CBTI-SH적내용제성문자재료,유환자자조실시,제1、3주말분별급여15 min적전화지도.재기선시급제2、4、6주말응용필자보수면질량지수량표(PSQI)、Epworth기수량표(ESS)대수면정황진행평개；요구환자매천기록수면일지,평개지표포괄입수잠복기、입수후각성시간、수면시간、와상시간、수면효솔；요구환자진행의종성평개,즉과거1주내유다소천안조요구집행료CBTI-SH혹수면위생교육적6충주요성분. 결과 중복측량적방차분석현시,연구조화대조조PSQI량표、ESS량표평분급입수잠복기、수면효솔、수면시간、와상시간、입수후각성시간재치료전후불동시간지간적차이균유통계학의의(P＜0.05),차연구조적개선명현우우대조조,효응량분별위1.93、0.04、1.00、0.98、0.11、0.57、0.43.연구조대“불재상상주기타사”화“불재상상담우”적의종성고우대조조,이대“한제와상시간”、“불능수칙리개상”적의종성저우대조조,차이균유통계학의의(P＜0.05). 결론 화응용제량체감적주석산서필탄치료책략상비,CBTI-SH치료만성실면급반수적일간사수적료효경우,단부분의종성유대제고.
Objective To test the efficacy of cognitive behavioral self-help therapy (CBTI-SH) on patients with chronic insomnia vs.a zolpidem control condition.Methods A total of 60 adults with chronic insomnia and common comorbidities were recruited from our hospital from July 2011 to October 2012.Participants were randomly assigned to either intervention group (n=30),consisting of sleep hygiene plus four-week CBTI-SH with printed material and 2 telephone instruction-calls,or control group (n=30),consisting of sleep hygiene plus a four-week supervised zolpidem tapering therapy.The CBTI-SH included cognitive restruction,stimulus control therapy,sleep restriction therapy and relaxation therapy.The primary outcome was self-report symptom,based on sleep diaries (including Sleep Latency-SL,Total Sleep Time-TST,Time In Bed-TIB,Sleep Efficiency-SE,Wake after Sleep Onset-WASO),Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleeping Scale (ESS) which were evaluated at baseline and at the end of the 2th,4th,6th week treatment.Continuous variables were evaluated by repeated-measures multivariate analyses of variance (MANOVA).At the end of every two weeks,each participant was asked to assess treatment adherence to the six core recommendations of CBTI-SH or sleep hygiene.Results The multivariate analysis of variance showed a significant treatment group plus time interaction,and time main effects for PSQI,ESS,SL,SE,TST,TIB and WASO in the two groups (P＜0.05).The patients in the intervention group had significantly better outcomes than those in control group.Effect sizes (Cohen d)were 1.93,0.04,1.00,0.98,0.11,0.57 and 0.43,respectively.The intervention group reported higher average adherence scores in "use of the bed only for sleeping,not worrying in bed",and lower average scores in "adherence to TIB prescription,getting out of bed when unable to sleep",compared with those in the control group.Conclusion CBTI-SH is effective for treating chronic insomnia and daytime sleepiness as compared with supervised zolpidem tapering therapy,but the treatment adherence needs to be improved.