Espie Colin A, MacMahon Kenneth M A, Kelly Heidi-Louise, Broomfield Niall M, Douglas Neil J, Engleman Heather M, McKinstry Brian, Morin Charles M, Walker Andrew, Wilson Philip
University of Glasgow Sleep Research Laboratory, Southern General Hospital, Scotland, UK.
Sleep. 2007 May;30(5):574-84. doi: 10.1093/sleep/30.5.574.
Persistent insomnia, although very common in general practice, often proves problematic to manage. This study investigates the clinical effectiveness and the feasibility of applying cognitive behavior therapy (CBT) methods for insomnia in primary care.
Pragmatic randomized controlled trial of CBT versus treatment as usual.
General medical practice.
Two hundred one adults (mean age, 54 years) randomly assigned to receive CBT (n = 107; 72 women) or treatment as usual (n = 94; 65 women).
CBT comprised 5 sessions delivered in small groups by primary care nurses. Treatment as usual comprised usual care from general practitioners.
Assessments were completed at baseline, after treatment, and at 6-month follow-up visits. Sleep outcomes were appraised by sleep diary, actigraphy, and clinical endpoint. CBT was associated with improvements in self-reported sleep latency, wakefulness after sleep onset, and sleep efficiency. Improvements were partly sustained at follow-up. Effect sizes were moderate for the index variable of sleep efficiency. Participants receiving treatment as usual did not improve. Actigraphically estimated sleep improved modestly after CBT, relative to no change in treatment as usual. CBT was also associated with significant positive changes in mental health and energy/vitality. Comorbid physical and mental health difficulties did not impair sleep improvement following CBT.
This study suggests that trained and supervised nurses can effectively deliver CBT for insomnia in routine general medical practice. Treatment response to small-group service delivery was encouraging, although effect sizes were smaller than those obtained in efficacy studies. Further research is required to consider the possibility that CBT could become the treatment of first choice for persistent insomnia in primary healthcare.
持续性失眠在普通医疗实践中非常常见，但往往难以处理。本研究调查了在初级保健中应用认知行为疗法（CBT）治疗失眠的临床有效性和可行性。
CBT与常规治疗的实用随机对照试验。
普通医疗实践。
201名成年人（平均年龄54岁），随机分配接受CBT（n = 107；72名女性）或常规治疗（n = 94；65名女性）。
CBT由初级保健护士以小组形式进行5次授课。常规治疗包括全科医生的常规护理。
在基线、治疗后和6个月随访时完成评估。通过睡眠日记、活动记录仪和临床终点评估睡眠结果。CBT与自我报告的睡眠潜伏期、入睡后觉醒和睡眠效率的改善相关。随访时部分改善得以维持。睡眠效率指数变量的效应大小为中等。接受常规治疗的参与者没有改善。与常规治疗无变化相比，CBT后活动记录仪估计的睡眠有适度改善。CBT还与心理健康和精力/活力的显著积极变化相关。合并的身心健康问题并未妨碍CBT后睡眠的改善。
本研究表明，经过培训和监督的护士可以在常规普通医疗实践中有效地提供CBT治疗失眠。尽管效应大小小于疗效研究中的结果，但对小组服务提供的治疗反应令人鼓舞。需要进一步研究，以考虑CBT成为初级医疗保健中持续性失眠首选治疗方法的可能性。
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