Nguyen Sylvia, McKay Adam, Wong Dana, Rajaratnam Shantha M, Spitz Gershon, Williams Gavin, Mansfield Darren, Ponsford Jennie L
Monash Institute of Cognitive & Clinical Neurosciences and School of Psychological Sciences, Monash University, Melbourne, VIC, Australia; Monash-Epworth Rehabilitation Research Centre, Melbourne, VIC, Australia.
Monash Institute of Cognitive & Clinical Neurosciences and School of Psychological Sciences, Monash University, Melbourne, VIC, Australia; Monash-Epworth Rehabilitation Research Centre, Melbourne, VIC, Australia.
Arch Phys Med Rehabil. 2017 Aug;98(8):1508-1517.e2. doi: 10.1016/j.apmr.2017.02.031. Epub 2017 Apr 8.
To evaluate the efficacy of adapted cognitive behavioral therapy (CBT) for sleep disturbance and fatigue in individuals with traumatic brain injury (TBI).
Parallel 2-group randomized controlled trial.
Outpatient therapy.
Adults (N=24) with history of TBI and clinically significant sleep and/or fatigue complaints were randomly allocated to an 8-session adapted CBT intervention or a treatment as usual (TAU) condition.
Cognitive behavior therapy.
The primary outcome was the Pittsburgh Sleep Quality Index (PSQI) posttreatment and at 2-month follow-up. Secondary measures included the Insomnia Severity Index, Fatigue Severity Scale, Brief Fatigue Inventory (BFI), Epworth Sleepiness Scale, and Hospital Anxiety and Depression Scale.
At follow-up, CBT recipients reported better sleep quality than those receiving TAU (PSQI mean difference, 4.85; 95% confidence interval [CI], 2.56-7.14). Daily fatigue levels were significantly reduced in the CBT group (BFI difference, 1.54; 95% CI, 0.66-2.42). Secondary improvements were significant for depression. Large within-group effect sizes were evident across measures (Hedges g=1.14-1.93), with maintenance of gains 2 months after therapy cessation.
Adapted CBT produced greater and sustained improvements in sleep, daily fatigue levels, and depression compared with TAU. These pilot findings suggest that CBT is a promising treatment for sleep disturbance and fatigue after TBI.
评估适应性认知行为疗法（CBT）对创伤性脑损伤（TBI）患者睡眠障碍和疲劳的疗效。
平行两组随机对照试验。
门诊治疗。
有TBI病史且有临床上显著睡眠和/或疲劳主诉的成年人（N = 24）被随机分配到接受8节适应性CBT干预或常规治疗（TAU）组。
认知行为疗法。
主要结局是治疗后及2个月随访时的匹兹堡睡眠质量指数（PSQI）。次要指标包括失眠严重程度指数、疲劳严重程度量表、简明疲劳量表（BFI）、爱泼沃斯嗜睡量表和医院焦虑抑郁量表。
随访时，接受CBT的患者报告的睡眠质量优于接受TAU的患者（PSQI平均差异，4.85；95%置信区间[CI]，2.56 - 7.14）。CBT组的每日疲劳水平显著降低（BFI差异，1.54；95% CI，0.66 - 2.42）。抑郁方面的次要改善也很显著。各指标在组内均有明显的大效应量（Hedges g = 1.14 - 1.93），且在治疗停止2个月后仍保持改善效果。
与TAU相比，适应性CBT在睡眠、每日疲劳水平和抑郁方面产生了更大且持续的改善。这些初步研究结果表明，CBT是治疗TBI后睡眠障碍和疲劳的一种有前景的疗法。
