Department of Psychiatry, Medical University of Gdańsk, Gdańsk, Poland.
Psychiatr Danub. 2012 Sep;24 Suppl 1:S51-5.
Primary insomnia (PI) is a common sleep disorder affecting diurnal functioning. It may contribute to the development of several comorbidities such as major depression or arterial hypertension. It affects about 7% of the adult population. Pharmacotherapy remains the most common treatment for insomnia. However, many studies suggest CBT may be a supreme therapeutic approach resulting in a better long-term outcome. The aim of the study was to determine the efficacy of a CBT-protocol in the treatment of PI by means of sleep onset latency and the number of awakenings during night parameters along with sleep quality and the level of psychophysiological hyperarousal. The secondary outcomes were focused on CBT efficacy as determined by the predisposition to insomnia as related to higher vulnerability to stress (measured with FIRST) MATERIAL AND METHODS: Twenty-six individuals from a tertiary reference sleep disorders outpatients' clinic (22 women; mean age 41.4; 4 men; mean age 42.5) with primary insomnia (DSM-IV-TR) were included in the study. The exclusion covered other primary sleep disorders, secondary insomnia (psychiatric illness, unstable somatic illness, shift work), substance abuse/dependence, high results in HADS-M scale (score above 11). The participants were scored with HADS-M, Ford Insomnia Response to Stress Test (FIRST) at the beginning of the study. The Athens Insomnia Scale (AIS), Hyperarousal Scale, Leeds Sleep Questionnaire (LSEQ) were applied at the beginning, at the end and three months after the end of the study. The participants were also examined by 7 days actigraphic records before and after treatment. During the course of the treatment patients completed a Sleep Diary (SD). The CBT program employed was based on the Perlis protocol. Standard individual sessions of 50 minutes were provided on a weekly basis for 8-10 weeks by a board certified CBT therapist. After 3 months a follow-up session was scheduled.
The significant improvement as related to the CBT treatment was present in the measures of sleep onset latency (67.2 vs. 23.4 min.; p<0.000), numbers of awakenings during night (2 vs. 0.4; p<0.000) and sleep efficiency (77.3 vs. 91%; p<0.000) - data from SD, quality of falling asleep (3.2 vs. 6; p<0.000), quality of sleep (3.3 vs. 5.8; p<0.000) and quality of morning awakening (3.2 vs. 6; p<0.000) - data from LSEQ. The improvement reached the significance level in the measure of psychophysiological arousal (52.3 vs. 42.4; p<0.000) and AIS (15.7vs. 6.8; p<0.000). No significant differences were identified between actigraphic records (light/dark ratio) before and after CBT. FIRST scores allocating patients to high and low stress vulnerability groups were non-contributory to the observed treatment efficacy.
CBT is an effective treatment in primary insomnia. No relationship between CBT efficacy and predisposition to insomnia as determined by higher vulnerability to stress was identified.
原发性失眠（PI）是一种常见的睡眠障碍，会影响日间功能。它可能导致多种合并症的发生，如重度抑郁症或动脉高血压。它影响约 7%的成年人口。药物治疗仍然是治疗失眠最常用的方法。然而，许多研究表明，认知行为疗法（CBT）可能是一种最佳的治疗方法，可带来更好的长期效果。本研究的目的是通过睡眠潜伏期和夜间觉醒次数等参数来确定 CBT 方案治疗 PI 的疗效，以及睡眠质量和心理生理唤醒水平。次要结果集中在 CBT 疗效上，表现为与更高的压力易感性相关的失眠易感性（用 FIRST 测量）。
26 名来自三级参考睡眠障碍门诊（22 名女性；平均年龄 41.4；4 名男性；平均年龄 42.5）的原发性失眠（DSM-IV-TR）患者被纳入研究。排除标准包括其他原发性睡眠障碍、继发性失眠（精神疾病、不稳定的躯体疾病、轮班工作）、物质滥用/依赖、HADS-M 量表评分较高（评分高于 11）。在研究开始时，参与者接受了 HADS-M 和福特失眠应激反应测试（FIRST）评分。在研究开始时、结束时和结束后三个月分别应用了雅典失眠量表（AIS）、唤醒量表和利兹睡眠问卷（LSEQ）。在治疗前后，参与者还接受了 7 天的活动记录仪记录。在治疗过程中，患者完成了睡眠日记（SD）。采用的 CBT 方案基于 Perlis 方案。由经过认证的 CBT 治疗师每周提供 50 分钟的标准个体治疗，持续 8-10 周。3 个月后安排了一次随访。
CBT 治疗的显著改善体现在睡眠潜伏期（67.2 分钟对 23.4 分钟；p<0.000）、夜间觉醒次数（2 次对 0.4 次；p<0.000）和睡眠效率（77.3%对 91%；p<0.000）方面——SD 数据，入睡质量（3.2 对 6；p<0.000）、睡眠质量（3.3 对 5.8；p<0.000）和早晨觉醒质量（3.2 对 6；p<0.000）——LSEQ 数据。心理生理唤醒（52.3 对 42.4；p<0.000）和 AIS（15.7 对 6.8；p<0.000）的测量也达到了显著水平。CBT 前后的活动记录仪（亮/暗比值）记录没有明显差异。将患者分配到高压力易感性和低压力易感性组的 FIRST 评分对观察到的治疗效果没有贡献。
CBT 是原发性失眠的有效治疗方法。CBT 疗效与通过更高的压力易感性确定的失眠易感性之间没有关系。
