慢性失眠老年患者夜间睡眠变异性：简短行为疗法（BBT-I）随机对照试验中的中介因素和调节因素。
Night-to-Night Sleep Variability in Older Adults With Chronic Insomnia: Mediators and Moderators in a Randomized Controlled Trial of Brief Behavioral Therapy (BBT-I).
机构信息
Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.
TIRR Memorial Hermann, Houston, Texas.
出版信息
J Clin Sleep Med. 2017 Nov 15;13(11):1243-1254. doi: 10.5664/jcsm.6790.
STUDY OBJECTIVES
Sleep variability is a clinically significant variable in understanding and treating insomnia in older adults. The current study examined changes in sleep variability in the course of brief behavioral therapy for insomnia (BBT-I) in older adults who had chronic insomnia. Additionally, the current study examined the mediating mechanisms underlying reductions of sleep variability and the moderating effects of baseline sleep variability on treatment responsiveness.
METHODS
Sixty-two elderly participants were randomly assigned to either BBT-I or self-monitoring and attention control (SMAC). Sleep was assessed by sleep diaries and actigraphy from baseline to posttreatment and at 3-month follow-up. Mixed models were used to examine changes in sleep variability (within-person standard deviations of weekly sleep parameters) and the hypothesized mediation and moderation effects.
RESULTS
Variabilities in sleep diary-assessed sleep onset latency (SOL) and actigraphy-assessed total sleep time (TST) significantly decreased in BBT-I compared to SMAC (Pseudo = .12, .27; = .018, .008). These effects were mediated by reductions in bedtime and wake time variability and time in bed. Significant time × group × baseline sleep variability interactions on sleep outcomes indicated that participants who had higher baseline sleep variability were more responsive to BBT-I; their actigraphy-assessed TST, SOL, and sleep efficiency improved to a greater degree (Pseudo = .15 to .66; < .001 to .044).
CONCLUSIONS
BBT-I is effective in reducing sleep variability in older adults who have chronic insomnia. Increased consistency in bedtime and wake time and decreased time in bed mediate reductions of sleep variability. Baseline sleep variability may serve as a marker of high treatment responsiveness to BBT-I.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov, Identifier: NCT02967185.
研究目的
睡眠可变性是理解和治疗老年人失眠的一个重要临床变量。本研究检测了在对慢性失眠的老年人进行简短行为疗法（BBT-I）的过程中，睡眠可变性的变化。此外，本研究还检测了睡眠可变性降低的潜在机制以及基线睡眠可变性对治疗反应性的调节作用。
方法
62 名老年参与者被随机分配到 BBT-I 组或自我监测和注意控制（SMAC）组。基线到治疗后和 3 个月随访时，通过睡眠日记和活动记录仪评估睡眠。使用混合模型来检测睡眠可变性（每周睡眠参数的个体内标准差）和假设的中介和调节作用的变化。
结果
与 SMAC 组相比，BBT-I 组睡眠日记评估的入睡潜伏期（SOL）和活动记录仪评估的总睡眠时间（TST）的可变性显著降低（Pseudo =.12，.27； =.018，.008）。这些影响是通过减少睡前和醒来时间的可变性和在床上的时间来介导的。睡眠结果上的显著时间×组×基线睡眠可变性交互作用表明，基线睡眠可变性较高的参与者对 BBT-I 的反应更好；他们的活动记录仪评估的 TST、SOL 和睡眠效率改善程度更大（Pseudo =.15 至.66； <.001 至.044）。
结论
BBT-I 可有效降低慢性失眠老年患者的睡眠可变性。睡前和醒来时间的一致性增加以及在床上的时间减少介导了睡眠可变性的降低。基线睡眠可变性可能是对 BBT-I 高度治疗反应的标志物。
临床试验注册
ClinicalTrials.gov，标识符：NCT02967185。
Zotero 插件