认知行为疗法联合亮光疗法治疗青少年睡眠时相延迟障碍的随机对照试验。
A randomized controlled trial of cognitive-behavior therapy plus bright light therapy for adolescent delayed sleep phase disorder.
机构信息
Child & Adolescent Sleep Clinic, School of Psychology, Flinders University, Adelaide, SA, Australia.
出版信息
Sleep. 2011 Dec 1;34(12):1671-80. doi: 10.5665/sleep.1432.
OBJECTIVE
To evaluate cognitive-behavior therapy plus bright light therapy (CBT plus BLT) for adolescents diagnosed with delayed sleep phase disorder (DSPD).
DESIGN
Randomized controlled trial of CBT plus BLT vs. waitlist (WL) control with comparisons at pre- and post-treatment. There was 6-month follow-up for the CBT plus BLT group only.
SETTING
Flinders University Child & Adolescent Sleep Clinic, Adelaide, South Australia.
PATIENTS
49 adolescents (mean age 14.6 ± 1.0 y, 53% males) diagnosed with DSPD; mean chronicity 4 y 8 months; 16% not attending school. Eighteen percent of adolescents dropped out of the study (CBT plus BLT: N = 23 vs. WL: N = 17).
INTERVENTIONS
CBT plus BLT consisted of 6 individual sessions, including morning bright light therapy to advance adolescents' circadian rhythms, and cognitive restructuring and sleep education to target associated insomnia and sleep hygiene.
MEASUREMENTS AND RESULTS
DSPD diagnosis was performed via a clinical interview and 7-day sleep diary. Measurements at each time-point included online sleep diaries and scales measuring sleepiness, fatigue, and depression symptoms. Compared to WL, moderate-to-large improvements (d = 0.65-1.24) were found at post-treatment for CBT plus BLT adolescents, including reduced sleep latency, earlier sleep onset and rise times, total sleep time (school nights), wake after sleep onset, sleepiness, and fatigue. At 6-month follow-up (N = 15), small-to-large improvements (d = 0.24-1.53) continued for CBT plus BLT adolescents, with effects found for all measures. Significantly fewer adolescents receiving CBT plus BLT met DPSD criteria at post-treatment (WL = 82% vs. CBT plus BLT = 13%, P < 0.0001), yet 13% still met DSPD criteria at the 6-month follow-up.
CONCLUSIONS
CBT plus BLT for adolescent DSPD is effective for improving multiple sleep and daytime impairments in the immediate and long-term. Studies evaluating the treatment effectiveness of each treatment component are needed.
CLINICAL TRIAL INFORMATION
Australia-New Zealand Trials Registry Number: ACTRN12610001041044.
目的
评估认知行为疗法联合亮光疗法（CBT 联合 BLT）对患有睡眠时相延迟障碍（DSPD）的青少年的疗效。
设计
CBT 联合 BLT 与等待名单（WL）对照的随机对照试验，在治疗前和治疗后进行比较。仅对 CBT 联合 BLT 组进行 6 个月的随访。
地点
南澳大利亚阿德莱德弗林德斯大学儿童和青少年睡眠诊所。
患者
49 名青少年（平均年龄 14.6 ± 1.0 岁，53%为男性）被诊断为 DSPD；平均病程为 4 年 8 个月；16%未上学。18%的青少年退出了研究（CBT 联合 BLT：N = 23 与 WL：N = 17）。
干预措施
CBT 联合 BLT 包括 6 次个体治疗，包括早晨强光疗法以提前青少年的生物钟节律，以及认知重构和睡眠教育以针对相关的失眠和睡眠卫生问题。
测量和结果
通过临床访谈和 7 天睡眠日记进行 DSPD 诊断。每个时间点的测量包括在线睡眠日记和测量嗜睡、疲劳和抑郁症状的量表。与 WL 相比，CBT 联合 BLT 青少年在治疗后有中度到高度的改善（d = 0.65-1.24），包括减少睡眠潜伏期、更早的睡眠开始和上升时间、总睡眠时间（上学日）、睡眠后觉醒、嗜睡和疲劳。在 6 个月的随访（N = 15）中，CBT 联合 BLT 青少年的改善仍保持在小到中度（d = 0.24-1.53），所有测量结果均有效果。治疗后，接受 CBT 联合 BLT 的青少年符合 DSPD 标准的比例显著降低（WL = 82%与 CBT 联合 BLT = 13%，P < 0.0001），但在 6 个月的随访中仍有 13%符合 DSPD 标准。
结论
CBT 联合 BLT 治疗青少年 DSPD 在即时和长期内均有效改善多种睡眠和日间障碍。需要研究评估每种治疗成分的治疗效果。
临床试验信息
澳大利亚-新西兰临床试验注册中心编号：ACTRN12610001041044。
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