Riemann Dieter, Perlis Michael L
Center for Sleep Research and Sleep Medicine, Department of Psychiatry and Psychotherapy, Freiburg University Medical Center, Hauptstrasse 5, 79104 Freiburg, Germany.
Sleep Med Rev. 2009 Jun;13(3):205-14. doi: 10.1016/j.smrv.2008.06.001. Epub 2009 Feb 7.
The present review provides an assessment of the efficacy and safety of benzodiazepine receptor agonists (BZRAs) and psychological and behavioral interventions for insomnia. These methods include relaxation techniques, sleep hygiene rules, stimulus control, sleep restriction and cognitive techniques, often also referred to as cognitive-behavioral therapy (CBT) when encompassing cognitive strategies and at least one kind of behavioral intervention. In order to provide a comprehensive assessment of the literature regarding the efficacy and safety of these standard treatments for insomnia, an integrative synthesis of the existing meta-analytic studies for each of the various treatment modalities was conducted. Where meta-analytic studies were not available, data from double-blind placebo-controlled randomized controlled trials (RCTs) were included. The summary findings from this review are (1) BZRAs and psychological and behavioral methods are effective to treat insomnia in the short-term and the latter have significantly more durable effects when active treatment is discontinued; and (2) there is only very limited evidence that BZRAs retain their efficacy during long-term treatment. The present review underscores the need for further research regarding the comparative efficacy and safety of these treatments for insomnia, how this varies with age and comorbidity, and how the various treatment modalities impact (1) daytime functioning, (2) quality of life, (3) health care utilization; and (4) pharmacoeconomics. Finally, it is particularly important that studies be conducted to determine if successful insomnia treatment influences the clinical course of the diseases that often occur co-morbidly with sleep continuity disturbance.
本综述评估了苯二氮䓬受体激动剂（BZRAs）以及针对失眠的心理和行为干预措施的疗效和安全性。这些方法包括放松技巧、睡眠卫生规则、刺激控制、睡眠限制和认知技巧，当包含认知策略和至少一种行为干预时，通常也被称为认知行为疗法（CBT）。为了全面评估有关这些失眠标准治疗方法的疗效和安全性的文献，对各种治疗方式的现有荟萃分析研究进行了综合分析。在没有荟萃分析研究的情况下，纳入了双盲安慰剂对照随机对照试验（RCT）的数据。本综述的总结结果是：（1）BZRAs以及心理和行为方法在短期内对治疗失眠有效，并且在停止积极治疗后，后者具有更显著的持久效果；（2）只有非常有限的证据表明BZRAs在长期治疗期间仍保持其疗效。本综述强调需要进一步研究这些失眠治疗方法的比较疗效和安全性，它们如何随年龄和合并症而变化，以及各种治疗方式如何影响（1）日间功能、（2）生活质量、（3）医疗保健利用；以及（4）药物经济学。最后，开展研究以确定成功的失眠治疗是否会影响常与睡眠连续性障碍共病的疾病的临床病程尤为重要。
