使用非临床睡眠教练对老年退伍军人失眠进行认知行为疗法：随机对照试验。
Cognitive Behavioral Therapy for Insomnia in Older Veterans Using Nonclinician Sleep Coaches: Randomized Controlled Trial.
作者信息
Alessi Cathy, Martin Jennifer L, Fiorentino Lavinia, Fung Constance H, Dzierzewski Joseph M, Rodriguez Tapia Juan C, Song Yeonsu, Josephson Karen, Jouldjian Stella, Mitchell Michael N
机构信息
Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.
Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
出版信息
J Am Geriatr Soc. 2016 Sep;64(9):1830-8. doi: 10.1111/jgs.14304. Epub 2016 Aug 22.
OBJECTIVES
To test a new cognitive behavioral therapy for insomnia (CBT-I) program designed for use by nonclinicians.
DESIGN
Randomized controlled trial.
SETTING
Department of Veterans Affairs healthcare system.
PARTICIPANTS
Community-dwelling veterans aged 60 and older who met diagnostic criteria for insomnia of 3 months duration or longer (N = 159).
INTERVENTION
Nonclinician "sleep coaches" delivered a five-session manual-based CBT-I program including stimulus control, sleep restriction, sleep hygiene, and cognitive therapy (individually or in small groups), with weekly telephone behavioral sleep medicine supervision. Controls received five sessions of general sleep education.
MEASUREMENTS
Primary outcomes, including self-reported (7-day sleep diary) sleep onset latency (SOL-D), wake after sleep onset (WASO-D), total wake time (TWT-D), and sleep efficiency (SE-D); Pittsburgh Sleep Quality Index (PSQI); and objective sleep efficiency (7-day wrist actigraphy, SE-A) were measured at baseline, at the posttreatment assessment, and at 6- and 12-month follow-up. Additional measures included the Insomnia Severity Index (ISI), depressive symptoms (Patient Health Questionnaire-9 (PHQ-9)), and quality of life (Medical Outcomes Study 12-item Short-form Survey version 2 (SF-12v2)).
RESULTS
Intervention subjects had greater improvement than controls between the baseline and posttreatment assessments, the baseline and 6-month assessments, and the baseline and 12-month assessments in SOL-D (-23.4, -15.8, and -17.3 minutes, respectively), TWT-D (-68.4, -37.0, and -30.9 minutes, respectively), SE-D (10.5%, 6.7%, and 5.4%, respectively), PSQI (-3.4, -2.4, and -2.1 in total score, respectively), and ISI (-4.5, -3.9, and -2.8 in total score, respectively) (all P < .05). There were no significant differences in SE-A, PHQ-9, or SF-12v2.
CONCLUSION
Manual-based CBT-I delivered by nonclinician sleep coaches improves sleep in older adults with chronic insomnia.
目的
测试一种专为非临床医生设计的新型失眠认知行为疗法（CBT-I）项目。
设计
随机对照试验。
设置
退伍军人事务部医疗保健系统。
参与者
60岁及以上符合持续3个月或更长时间失眠诊断标准的社区居住退伍军人（N = 159）。
干预措施
非临床医生“睡眠教练”提供了一个基于手册的五节CBT-I项目，包括刺激控制、睡眠限制、睡眠卫生和认知疗法（单独或小组进行），并每周进行电话行为睡眠医学监督。对照组接受五节一般睡眠教育课程。
测量指标
主要结局包括自我报告的（7天睡眠日记）入睡潜伏期（SOL-D）、睡眠中觉醒时间（WASO-D）、总觉醒时间（TWT-D）和睡眠效率（SE-D）；匹兹堡睡眠质量指数（PSQI）；以及客观睡眠效率（7天腕部活动记录仪，SE-A），在基线、治疗后评估以及6个月和12个月随访时进行测量。其他测量指标包括失眠严重程度指数（ISI）、抑郁症状（患者健康问卷-9（PHQ-9））和生活质量（医学结局研究12项简短调查版本2（SF-12v2））。
结果
在基线与治疗后评估之间、基线与6个月评估之间以及基线与12个月评估之间，干预组受试者在SOL-D（分别为-23.4、-15.8和-17.3分钟）、TWT-D（分别为-68.4、-37.0和-30.9分钟）、SE-D（分别为10.5%、6.7%和5.4%）、PSQI（总分分别为-3.4、-2.4和-2.1）和ISI（总分分别为-4.5、-3.9和-2.8）方面的改善均大于对照组（所有P <.05）。在SE-A、PHQ-9或SF-12v2方面无显著差异。
结论
由非临床医生睡眠教练提供的基于手册的CBT-I可改善患有慢性失眠的老年人的睡眠。
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