Clinical Sleep Research Unit, School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, UK.
J Am Geriatr Soc. 2012 Oct;60(10):1803-10. doi: 10.1111/j.1532-5415.2012.04175.x. Epub 2012 Oct 4.
To evaluate the effectiveness of a self-help cognitive behavioral intervention in improving sleep quality in older adults reporting insomnia symptoms associated with chronic disease.
A pragmatic two-arm randomized controlled trial comparing supported self-help with treatment as usual (TAU).
Primary care.
One hundred ninety-three self-referred individuals aged 55 to 87 with long-term conditions and chronic insomnia symptoms (as defined according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition).
Self-help participants received six consecutive booklets, at weekly intervals, providing structured advice on important components of cognitive behavioral therapy for insomnia (CBT-I, including self-monitoring, sleep restriction, stimulus control procedures, and cognitive strategies), plus access to a telephone helpline. Control group participants received a single sheet of advice detailing standard sleep hygiene measures.
The primary outcome was sleep quality, measured by the Pittsburgh Sleep Quality Index (PSQI). Secondary outcomes were the Insomnia Severity Index (ISI), the subjective sleep efficiency index, and the Fatigue Severity Scale.
In the self-help group, sleep outcomes showed significant improvements after treatment (PSQI, P < .001; ISI, P < .001; sleep efficiency, P < .001) and at 3-month (PSQI, P = .002; ISI, P = .006; sleep efficiency, P = .001) and 6-month (PSQI, P = .003; ISI, P = .003; sleep efficiency, P = .001) follow-up. Effect sizes were moderate (range of adjusted Cohen d = 0.51-0.75). Treatment had no effect on levels of daytime fatigue. Most treated participants (73%) said they would recommend the self-help program to others.
Self-help CBT-I offers a practical first-line response to individual reporting insomnia symptoms associated with chronic disease in primary care settings. In these individuals, symptoms of daytime fatigue may be more closely associated with disease processes than with sleep quality.
评估自我帮助认知行为干预在改善报告与慢性疾病相关的失眠症状的老年成年人睡眠质量方面的有效性。
一项实用的双臂随机对照试验，比较支持性自我帮助与常规治疗（TAU）。
初级保健。
193 名自我推荐的年龄在 55 至 87 岁之间的患有长期疾病和慢性失眠症状的个体（根据《精神障碍诊断与统计手册》第四版定义）。
自我帮助组参与者每周接受六本连续的小册子，提供认知行为疗法（CBT-I）中关于失眠重要组成部分的结构化建议（包括自我监测、睡眠限制、刺激控制程序和认知策略），并可拨打电话热线。对照组参与者收到一张详细说明标准睡眠卫生措施的单页建议。
主要结果是睡眠质量，用匹兹堡睡眠质量指数（PSQI）测量。次要结果是失眠严重程度指数（ISI）、主观睡眠效率指数和疲劳严重程度量表。
在自我帮助组中，治疗后睡眠结果显示出显著改善（PSQI，P<0.001；ISI，P<0.001；睡眠效率，P<0.001），并且在 3 个月（PSQI，P=0.002；ISI，P=0.006；睡眠效率，P=0.001）和 6 个月（PSQI，P=0.003；ISI，P=0.003；睡眠效率，P=0.001）随访时也有改善。效应大小为中等（调整后的 Cohen d 范围为 0.51-0.75）。治疗对白天疲劳水平没有影响。大多数接受治疗的参与者（73%）表示他们会向他人推荐自我帮助计划。
自我帮助认知行为疗法为初级保健环境中报告与慢性疾病相关的失眠症状的个体提供了一种实用的一线应对措施。在这些个体中，白天疲劳的症状可能与疾病过程更密切相关，而不是与睡眠质量更相关。
