Smith Michael T, Perlis Michael L
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Behavioral Medicine Research Laboratory and Clinic, Baltimore, MD 21287-7101, USA.
Health Psychol. 2006 Jan;25(1):15-9. doi: 10.1037/0278-6133.25.1.15.
Chronic insomnia impacts 1 in 10 adults and is linked to accidents, decreased quality of life, diminished work productivity, and increased long-term risk for medical and psychiatric diseases such as diabetes and depression. Recent National Institutes of Health consensus statements and the American Academy of Sleep Medicine's Practice Parameters recommend that cognitive-behavioral therapy for insomnia (CBT-I) be considered the 1st line treatment for chronic primary insomnia. Growing research also supports the extension of CBT-I for patients with persistent insomnia occurring within the context of medical and psychiatric comorbidity. In the emerging field of behavioral sleep medicine, there has yet to be a consensus point of view about who is an appropriate candidate for CBT-I and how this determination is made. This report briefly summarizes these issues, including a discussion of potential contraindications, and provides a schematic decision-to-treat algorithm.
慢性失眠影响着十分之一的成年人，与事故、生活质量下降、工作效率降低以及糖尿病和抑郁症等医学和精神疾病的长期风险增加有关。美国国立卫生研究院最近的共识声明以及美国睡眠医学学会的实践参数建议，失眠认知行为疗法（CBT-I）应被视为慢性原发性失眠的一线治疗方法。越来越多的研究也支持将CBT-I扩展应用于患有医学和精神共病且伴有持续性失眠的患者。在行为睡眠医学这一新兴领域，对于谁是CBT-I的合适候选人以及如何做出这一决定，尚未达成共识。本报告简要总结了这些问题，包括对潜在禁忌症的讨论，并提供了一个治疗决策示意图算法。
