Edinger J D, Wohlgemuth W K, Radtke R A, Marsh G R, Quillian R E
Psychology Service (116B), VA Medical Center, 508 Fulton St, Durham, NC 27705, USA.
JAMA. 2001 Apr 11;285(14):1856-64. doi: 10.1001/jama.285.14.1856.
Use of nonpharmacological behavioral therapy has been suggested for treatment of chronic primary insomnia, but well-blinded, placebo-controlled trials demonstrating effective behavioral therapy for sleep-maintenance insomnia are lacking.
To test the efficacy of a hybrid cognitive behavioral therapy (CBT) compared with both a first-generation behavioral treatment and a placebo therapy for treating primary sleep-maintenance insomnia.
Randomized, double-blind, placebo-controlled clinical trial conducted at a single academic medical center, with recruitment from January 1995 to July 1997.
Seventy-five adults (n = 35 women; mean age, 55.3 years) with chronic primary sleep-maintenance insomnia (mean duration of symptoms, 13.6 years).
Patients were randomly assigned to receive CBT (sleep education, stimulus control, and time-in-bed restrictions; n = 25), progressive muscle relaxation training (RT; n = 25), or a quasi-desensitization (placebo) treatment (n = 25). Outpatient treatment lasted 6 weeks, with follow-up conducted at 6 months.
Objective (polysomnography) and subjective (sleep log) measures of total sleep time, middle and terminal wake time after sleep onset (WASO), and sleep efficiency; questionnaire measures of global insomnia symptoms, sleep-related self-efficacy, and mood.
Cognitive behavioral therapy produced larger improvements across the majority of outcome measures than did RT or placebo treatment. For example, sleep logs showed that CBT-treated patients achieved an average 54% reduction in their WASO whereas RT-treated and placebo-treated patients, respectively, achieved only 16% and 12% reductions in this measure. Recipients of CBT also showed a greater normalization of sleep and subjective symptoms than did the other groups with an average sleep time of more than 6 hours, middle WASO of 26.6 minutes, and sleep efficiency of 85.1%. In contrast, RT-treated patients continued to report a middle WASO of 43.3 minutes and sleep efficiency of 78.8%.
Our results suggest that CBT represents a viable intervention for primary sleep-maintenance insomnia. This treatment leads to clinically significant sleep improvements within 6 weeks and these improvements appear to endure through 6 months of follow-up.
有人建议使用非药物行为疗法治疗慢性原发性失眠，但缺乏充分双盲、安慰剂对照试验来证明行为疗法对维持睡眠性失眠有效。
比较混合认知行为疗法（CBT）与第一代行为疗法及安慰剂疗法治疗原发性维持睡眠性失眠的疗效。
在单一学术医学中心进行的随机、双盲、安慰剂对照临床试验，于1995年1月至1997年7月招募患者。
75名患有慢性原发性维持睡眠性失眠（症状平均持续时间13.6年）的成年人（n = 35名女性；平均年龄55.3岁）。
患者被随机分配接受CBT（睡眠教育、刺激控制和卧床时间限制；n = 25）、渐进性肌肉松弛训练（RT；n = 25）或准脱敏（安慰剂）治疗（n = 25）。门诊治疗持续6周，6个月时进行随访。
客观（多导睡眠图）和主观（睡眠日志）测量的总睡眠时间、入睡后中间和末期觉醒时间（WASO）以及睡眠效率；全球失眠症状、与睡眠相关的自我效能感和情绪的问卷调查指标。
在大多数观察指标上，认知行为疗法比RT或安慰剂治疗带来更大改善。例如，睡眠日志显示，接受CBT治疗的患者WASO平均降低54%，而接受RT治疗和安慰剂治疗的患者在该指标上分别仅降低16%和12%。接受CBT治疗的患者在睡眠和主观症状方面也比其他组有更大程度的正常化，平均睡眠时间超过6小时，中间WASO为26.6分钟，睡眠效率为85.1%。相比之下，接受RT治疗的患者中间WASO仍为43.3分钟，睡眠效率为78.8%。
我们的结果表明，CBT是原发性维持睡眠性失眠的一种可行干预措施。这种治疗在6周内可使睡眠得到临床上显著改善，且这些改善在6个月的随访中似乎持续存在。
