Department of Psychiatry, Sleep and Chronobiology Faculty, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
J Sleep Res. 2015 Feb;24(1):32-9. doi: 10.1111/jsr.12220. Epub 2014 Sep 14.
Discrepancy between subjective and objective measures of sleep is associated with insomnia and increasing age. Cognitive behavioural therapy for insomnia improves sleep quality and decreases subjective-objective sleep discrepancy. This study describes differences between older adults with insomnia and controls in sleep discrepancy, and tests the hypothesis that reduced sleep discrepancy following cognitive behavioural therapy for insomnia correlates with the magnitude of symptom improvement reported by older adults with insomnia. Participants were 63 adults >60 years of age with insomnia, and 51 controls. At baseline, participants completed sleep diaries for 7 days while wearing wrist actigraphs. After receiving cognitive behavioural therapy for insomnia, insomnia patients repeated this sleep assessment. Sleep discrepancy variables were calculated by subtracting actigraphic sleep onset latency and wake after sleep onset from respective self-reported estimates, pre- and post-treatment. Mean level and night-to-night variability in sleep discrepancy were investigated. Baseline sleep discrepancies were compared between groups. Pre-post-treatment changes in Insomnia Severity Index score and sleep discrepancy variables were investigated within older adults with insomnia. Sleep discrepancy was significantly greater and more variable across nights in older adults with insomnia than controls, P ≤ 0.001 for all. Treatment with cognitive behavioural therapy for insomnia was associated with significant reduction in the Insomnia Severity Index score that correlated with changes in mean level and night-to-night variability in wake after sleep onset discrepancy, P < 0.001 for all. Study of sleep discrepancy patterns may guide more targeted treatments for late-life insomnia.
主观和客观睡眠测量之间的差异与失眠和年龄增长有关。失眠的认知行为疗法可改善睡眠质量并减少主观与客观睡眠差异。本研究描述了失眠老年患者与对照组之间的睡眠差异，并检验了以下假设，即失眠的认知行为疗法后睡眠差异的减少与失眠老年患者报告的症状改善程度相关。参与者为 63 名年龄在 60 岁以上的失眠成年人和 51 名对照组。基线时，参与者在佩戴腕动图仪的情况下连续 7 天完成睡眠日记。接受失眠的认知行为疗法后，失眠患者重复此睡眠评估。通过从各自的自我报告估计中减去腕动图睡眠潜伏期和睡眠后醒来时间来计算睡眠差异变量，在治疗前后。研究了睡眠差异的平均水平和夜间变异性。比较了两组之间的基线睡眠差异。研究了失眠老年患者中失眠严重程度指数评分和睡眠差异变量的治疗前后变化。与对照组相比，失眠老年患者的睡眠差异在夜间之间明显更大且更具变异性，所有差异均 P≤0.001。失眠的认知行为疗法治疗与失眠严重程度指数评分的显著降低相关，这种降低与睡眠后醒来差异的平均水平和夜间变异性的变化相关，所有差异均 P<0.001。研究睡眠差异模式可能会为老年失眠症提供更有针对性的治疗方法。
