Stanford University School of Medicine, Department of Psychiatry and Behavioral Science, Stanford, CA 94301, USA.
Sleep Med. 2012 May;13(5):469-75. doi: 10.1016/j.sleep.2011.10.034. Epub 2012 Feb 20.
To evaluate the clinical relevance of night-to-night variability of sleep schedules and insomnia symptoms.
The sample consisted of 455 patients (193 men, mean age=48) seeking treatment for insomnia in a sleep medicine clinic. All participants received group cognitive behavioral therapy for insomnia (CBTI). Variability in sleep parameters was assessed using sleep diary data. Two composite scores were computed, a behavioral schedule composite score (BCS) and insomnia symptom composite score (ICS). The Insomnia Severity Index, the Beck Depression Inventory, and the Morningness-Eveningness Composite Scale were administered at baseline and post-treatment.
Results revealed that greater BCS scores were significantly associated with younger age, eveningness chronotype, and greater depression severity (p<0.001). Both depression severity and eveningness chronotype independently predicted variability in sleep schedules (p<0.001). Finally, CBTI resulted in reduced sleep variability for all sleep diary variables except bedtime. Post-treatment symptom reductions in depression severity were greater among those with high versus low baseline BCS scores (p<0.001).
Results suggest that variability in sleep schedules predict reduction in insomnia and depressive severity following group CBTI. Schedule variability may be particularly important to assess and address among patients with high depression symptoms and those with the evening chronotype.
评估睡眠时间表和失眠症状的夜间变化的临床相关性。
该样本由 455 名（男性 193 名，平均年龄=48）在睡眠医学诊所寻求失眠治疗的患者组成。所有参与者均接受团体认知行为疗法治疗失眠（CBTI）。使用睡眠日记数据评估睡眠参数的可变性。计算了两个综合得分，即行为时间表综合得分（BCS）和失眠症状综合得分（ICS）。在基线和治疗后进行了失眠严重程度指数、贝克抑郁量表和晨晚型综合量表的评估。
结果表明，BCS 得分越高与年龄较小、夜间型和抑郁严重程度较大显著相关（p<0.001）。抑郁严重程度和夜间型独立预测睡眠时间表的可变性（p<0.001）。最后，CBTI 导致除就寝时间外，所有睡眠日记变量的睡眠可变性降低。与基线 BCS 得分低的患者相比，基线 BCS 得分高的患者在治疗后抑郁严重程度的症状减轻更大（p<0.001）。
结果表明，睡眠时间表的可变性可预测团体 CBTI 后失眠和抑郁严重程度的降低。在具有高抑郁症状和夜间型的患者中，可变性可能特别重要，需要进行评估和处理。
