Mundt Jennifer M, Crew Earl C, Krietsch Kendra, Roth Alicia J, Vatthauer Karlyn, Robinson Michael E, Staud Roland, Berry Richard B, McCrae Christina S
Clinical and Health Psychology, University of Florida, Gainesville, FL.
Rheumatology and Clinical Immunology, University of Florida, Gainesville, FL.
J Clin Sleep Med. 2016 Feb;12(2):215-23. doi: 10.5664/jcsm.5488.
In insomnia, actigraphy tends to underestimate wake time compared to diaries and PSG. When chronic pain co-occurs with insomnia, sleep may be more fragmented, including more movement and arousals. However, individuals may not be consciously aware of these arousals. We examined the baseline concordance of diaries, actigraphy, and PSG as well as the ability of each assessment method to detect changes in sleep following cognitive behavioral therapy for insomnia (CBT-I).
Adults with insomnia and fibromyalgia (n = 113) were randomized to CBT-I, CBT for pain, or waitlist control. At baseline and posttreatment, participants completed one night of PSG and two weeks of diaries/actigraphy.
At baseline, objective measures estimated lower SOL, higher TST, and higher SE than diaries (ps < 0.05). Compared to PSG, actigraphic estimates were higher for SOL and lower for WASO (ps < 0.05). Repeated measures ANOVAs were conducted for the CBT-I group (n = 15), and significant method by time interactions indicated that the assessment methods differed in their sensitivity to detect treatment-related changes. PSG values did not change significantly for any sleep parameters. However, diaries showed improvements in SOL, WASO, and SE, and actigraphy also detected the WASO and SE improvements (ps < 0.05).
Actigraphy was generally more concordant with PSG than with diaries, which are the recommended assessment for diagnosing insomnia. However, actigraphy showed greater sensitivity to treatment-related changes than PSG; PSG failed to detect any improvements, but actigraphy demonstrated changes in WASO and SE, which were also found with diaries. In comorbid insomnia/fibromyalgia, actigraphy may therefore have utility in measuring treatment outcomes.
在失眠症中，与日记和多导睡眠图（PSG）相比，活动记录仪往往会低估清醒时间。当慢性疼痛与失眠症同时出现时，睡眠可能会更加碎片化，包括更多的身体活动和觉醒。然而，个体可能并未有意识地察觉到这些觉醒。我们研究了日记、活动记录仪和PSG在基线时的一致性，以及每种评估方法在失眠认知行为疗法（CBT-I）后检测睡眠变化的能力。
患有失眠症和纤维肌痛的成年人（n = 113）被随机分为接受CBT-I、疼痛认知行为疗法或等待名单对照。在基线和治疗后，参与者完成一晚的PSG检查以及两周的日记/活动记录仪记录。
在基线时，客观测量方法估计的睡眠起始潜伏期（SOL）更低、总睡眠时间（TST）更高、睡眠效率（SE）更高，与日记记录相比（p值<0.05）。与PSG相比，活动记录仪对SOL的估计值更高，对清醒时间（WASO）的估计值更低（p值<0.05）。对CBT-I组（n = 15）进行重复测量方差分析，时间与方法的显著交互作用表明，评估方法在检测与治疗相关变化的敏感性方面存在差异。PSG检查的任何睡眠参数均未发生显著变化。然而，日记显示SOL、WASO和SE有所改善，活动记录仪也检测到了WASO和SE的改善（p值<0.05）。
一般来说，活动记录仪与PSG的一致性高于与日记的一致性，而日记是诊断失眠症的推荐评估方法。然而，活动记录仪对与治疗相关变化的敏感性高于PSG；PSG未能检测到任何改善，但活动记录仪显示WASO和SE有变化，日记记录也发现了这些变化。因此，在失眠症/纤维肌痛共病的情况下，活动记录仪可能有助于测量治疗效果。
