电话解决问题疗法可改善患有与战斗相关的轻度创伤性脑损伤的军人的睡眠质量：一项随机临床试验的结果
Telephone Problem-Solving Treatment Improves Sleep Quality in Service Members With Combat-Related Mild Traumatic Brain Injury: Results From a Randomized Clinical Trial.
作者信息
Vuletic S, Bell K R, Jain S, Bush N, Temkin N, Fann J R, Stanfill K E, Dikmen S, Brockway J A, He F, Ernstrom K, Raman R, Grant G, Stein M B, Gahm G A
机构信息
National Center for Telehealth and Technology (T2), Tacoma, Washington (Drs Vuletic, Bush, Stanfill, and Gahm); Departments of Rehabilitation Medicine (Drs Bell, Temkin, Dikmen, and Brockway), Neurological Surgery (Drs Temkin and Dikmen), Biostatistics (Drs Temkin and Fann), and Psychiatry and Behavioral Sciences (Dr Fann), University of Washington, Seattle; Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas (Dr Bell); Departments of Family Medicine and Public Health (Drs Jain, Raman, and Stein and Messrs He and Ernstrom) and Psychiatry (Dr Stein), University of California San Diego, La Jolla; Department of Neurosurgery, Stanford University School of Medicine, Stanford, California (Dr Grant); and Defense Centers of Excellence (DCoE), Olympia, Washington (Dr Gahm).
出版信息
J Head Trauma Rehabil. 2016 Mar-Apr;31(2):147-57. doi: 10.1097/HTR.0000000000000221.
OBJECTIVE
Evaluate sleep quality, its correlates, and the effect of telephone-based problem-solving treatment (PST) in active duty postdeployment service members with mild traumatic brain injury (mTBI) SETTING:: Randomized clinical trial.
PARTICIPANTS
Active duty service members with combat-related mTBI.
STUDY DESIGN
Education-only (EO) and PST groups (N = 178 each) received printed study materials and 12 educational brochures. The PST group additionally received up to 12 PST telephone calls addressing participant-selected issues. Outcomes were evaluated postintervention (6 months) and at 12 months.
MAIN MEASURE
Pittsburgh Sleep Quality Index.
RESULTS
Sleep quality was manifestly poor in both groups at baseline (Pittsburgh Sleep Quality Index = 12.5 ± 4). Overall sleep quality was significantly different between the PST and EO groups at 6 months (P = .003) but not at 12 months. Longitudinally, PST significantly improved sleep quality at 6 months (P = .001) but not over the follow-up. Low sleep quality was associated with concussion symptoms, pain, depression, and posttraumatic stress disorder at all time points (P < .0001).
CONCLUSIONS
Sleep disorders, common in postdeployment service members with mTBI, are strongly associated with the presence of pain, posttraumatic stress disorder, and depression. Telephone-based PST may be an effective therapeutic approach for reducing sleep disorders in this population. Research should focus on maintenance of treatment gains.
目的
评估现役部署后患有轻度创伤性脑损伤（mTBI）的军人的睡眠质量、相关因素以及基于电话的问题解决疗法（PST）的效果。
背景
随机临床试验。
参与者
与战斗相关的mTBI现役军人。
研究设计
仅接受教育（EO）组和PST组（每组N = 178）收到了印刷的研究材料和12份教育手册。PST组还额外接到了多达12个针对参与者所选问题的PST电话。在干预后（6个月）和12个月时对结果进行评估。
主要测量指标
匹兹堡睡眠质量指数。
结果
两组在基线时睡眠质量明显较差（匹兹堡睡眠质量指数 = 12.5 ± 4）。PST组和EO组在6个月时的总体睡眠质量有显著差异（P = .003），但在12个月时没有。纵向来看，PST在6个月时显著改善了睡眠质量（P = .001），但在随访期间没有。在所有时间点，低睡眠质量都与脑震荡症状、疼痛、抑郁和创伤后应激障碍相关（P < .0001）。
结论
睡眠障碍在部署后患有mTBI的军人中很常见，与疼痛、创伤后应激障碍和抑郁的存在密切相关。基于电话的PST可能是减少该人群睡眠障碍的一种有效治疗方法。研究应侧重于维持治疗效果。
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