Falloon Karen, Elley C Raina, Fernando Antonio, Lee Arier C, Arroll Bruce
Department of General Practice and Primary Health Care;
Department of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand.
Br J Gen Pract. 2015 Aug;65(637):e508-15. doi: 10.3399/bjgp15X686137.
Insomnia is common in primary care. Cognitive behavioural therapy for insomnia (CBT-I) is effective but requires more time than is available in the general practice consultation. Sleep restriction is one behavioural component of CBT-I.
To assess whether simplified sleep restriction (SSR) can be effective in improving sleep in primary insomnia.
Randomised controlled trial of patients in urban general practice settings in Auckland, New Zealand.
Adults with persistent primary insomnia and no mental health or significant comorbidity were eligible. Intervention patients received SSR instructions and sleep hygiene advice. Control patients received sleep hygiene advice alone. Primary outcomes included change in sleep quality at 6 months measured by the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and sleep efficiency (SE%). The proportion of participants reaching a predefined 'insomnia remission' treatment response was calculated.
Ninety-seven patients were randomised and 94 (97%) completed the study. At 6-month follow-up, SSR participants had improved PSQI scores (6.2 versus 8.4, P<0.001), ISI scores (8.6 versus 11.1, P = 0.001), actigraphy-assessed SE% (difference 2.2%, P = 0.006), and reduced fatigue (difference -2.3 units, P = 0.04), compared with controls. SSR produced higher rates of treatment response (67% [28 out of 42] versus 41% [20 out of 49]); number needed to treat = 4 (95% CI = 2.0 to 19.0). Controlling for age, sex, and severity of insomnia, the adjusted odds ratio for insomnia remission was 2.7 (95% CI = 1.1 to 6.5). There were no significant differences in other outcomes or adverse effects.
SSR is an effective brief intervention in adults with primary insomnia and no comorbidities, suitable for use in general practice.
失眠在基层医疗中很常见。失眠认知行为疗法（CBT-I）有效，但在全科诊疗中所需时间比可用时间更多。睡眠限制是CBT-I的一个行为组成部分。
评估简化睡眠限制（SSR）是否能有效改善原发性失眠患者的睡眠。
在新西兰奥克兰城市全科诊疗机构中对患者进行的随机对照试验。
符合条件的为患有持续性原发性失眠且无精神健康问题或重大合并症的成年人。干预组患者接受SSR指导和睡眠卫生建议。对照组患者仅接受睡眠卫生建议。主要结局包括通过匹兹堡睡眠质量指数（PSQI）、失眠严重程度指数（ISI）和睡眠效率（SE%）在6个月时测量的睡眠质量变化。计算达到预定义“失眠缓解”治疗反应的参与者比例。
97名患者被随机分组，94名（97%）完成了研究。在6个月随访时，与对照组相比，SSR组参与者的PSQI评分有所改善（6.2对8.4，P<0.001），ISI评分（8.6对11.1，P = 0.001），活动记录仪评估的SE%（差异2.2%，P = 0.006），且疲劳减轻（差异-2.3单位，P = 0.04）。SSR产生了更高的治疗反应率（67%[42例中的28例]对41%[49例中的20例]）；需治疗人数 = 4（95%CI = 2.0至19.0）。在控制年龄、性别和失眠严重程度后，失眠缓解的调整优势比为2.7（95%CI = 1.1至6.5）。在其他结局或不良反应方面无显著差异。
SSR是对无合并症的原发性失眠成年人的一种有效的简短干预措施，适用于全科诊疗。
