Zavesicka Lucie, Brunovsky Martin, Horacek Jiri, Matousek Milos, Sos Peter, Krajca Vladimir, Höschl Cyril
Prague Psychiatric Center, 3rd Faculty of Medicine, Charles University, Ustavni 91, 181 03 Praha 8 - Bohnice, Czech Republic.
Neuro Endocrinol Lett. 2008 Dec;29(6):895-901.
Cognitive behaviour therapy (CBT) of primary insomnia is frequently combined with various pharmacological treatments, including sedative antidepressants. The present study was undertaken to evaluate the clinical efficacy of CBT, singly and combined with trazodone pharmacotherapy, for primary insomnia.
Randomised, comparative clinical trial, at a single academic medical centre.
Twenty outpatients (15 women, 5 men) with chronic primary insomnia were randomly assigned to CBT or CBT +100mg trazodone and treated for 8 weeks. The treatment outcome was estimated by mean changes from baseline in self-reported clinical scales, sleep continuity data and sleep architecture parameters.
All patients perceived significant subjective sleep improvements. Sleep latency significantly shortened (p=0.03), sleep efficiency increased (p=0.004) and the total sleep time was significantly prolonged (p=0.006) after the CBT treatment in both groups. Sleep architecture showed that the combined approach (CBT + trazodone) resulted in a significant increase in slow wave sleep duration compared to treatment by CBT only (p=0.04).
CBT, singly and combined with the sedative antidepressant trazodone, is effective for the short-term management of chronic primary insomnia. Trazodone combined with CBT significantly increases slow wave sleep duration and this influence seems to be unrelated to its antidepressant effect.
原发性失眠的认知行为疗法（CBT）常与包括镇静性抗抑郁药在内的各种药物治疗联合使用。本研究旨在评估CBT单独使用以及与曲唑酮药物治疗联合使用对原发性失眠的临床疗效。
在单一学术医学中心进行的随机对照临床试验。
20名患有慢性原发性失眠的门诊患者（15名女性，5名男性）被随机分配至CBT组或CBT + 100mg曲唑酮组，并接受为期8周的治疗。通过自我报告临床量表、睡眠连续性数据和睡眠结构参数相对于基线的平均变化来评估治疗结果。
所有患者均感觉主观睡眠有显著改善。两组患者经CBT治疗后，睡眠潜伏期显著缩短（p = 0.03），睡眠效率提高（p = 0.004），总睡眠时间显著延长（p = 0.006）。睡眠结构显示，与仅采用CBT治疗相比，联合治疗方法（CBT + 曲唑酮）导致慢波睡眠时间显著增加（p = 0.04）。
CBT单独使用以及与镇静性抗抑郁药曲唑酮联合使用对慢性原发性失眠的短期治疗有效。曲唑酮与CBT联合使用可显著增加慢波睡眠时间，且这种影响似乎与其抗抑郁作用无关。
