Department of Psychiatry, University of Missouri School of Medicine, 1 Hospital Drive DC 067.00, Columbia, MO 65212, USA; Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-5, Providence, RI 02912, USA; Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-4, Providence, RI 02912, USA.
Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Ave, Providence RI 02906, USA.
Drug Alcohol Depend. 2017 Dec 1;181:200-207. doi: 10.1016/j.drugalcdep.2017.09.029. Epub 2017 Oct 20.
To determine the efficacy of behavioral and pharmacological interventions for insomnia among individuals with alcohol use disorder (AUD).
Comprehensive literature searches of psychological, medical, and educational databases were conducted through October 2016. Eligible studies evaluated the efficacy of an insomnia intervention, included a comparison condition, sampled individuals with AUD and either insomnia disorder or complaints of insomnia, assessed sleep-related outcomes, and provided relevant statistics to calculate between-group effect sizes. Effect sizes were estimated for sleep quality, days of alcohol abstinence, and symptoms of depression. Type of intervention (behavioral versus pharmacological) was tested as a moderator of intervention efficacy.
Nine studies met eligibility criteria and were included in the final review and meta-analysis. Random-effects models indicated that intervention participants reported greater improvements in sleep quality (d+=0.62, 95% CI=0.28, 0.97) and symptoms of depression (d+=0.52, 95% CI=0.06, 0.98) than control participants. Participants reported significantly greater improvements in sleep quality in response to behavioral (d+=1.20, 95% CI=0.70, 1.70) as opposed to pharmacological (d+=0.43, 95% CI=0.19, 0.67) interventions. Behavioral (d+=0.74, 95% CI=0.31, 1.18) and pharmacological (d+=0.08, 95% CI=-0.64, 0.78) interventions did not have significantly different effects on depressive symptoms. Neither behavioral nor pharmacological interventions improved rates of alcohol abstinence.
Insomnia interventions improve sleep quality and reduce symptoms of depression among individuals with comorbid AUD. Given the methodological weaknesses of studies reviewed, additional research is needed to determine the efficacy of insomnia treatment in improving rates of alcohol relapse within this population.
确定行为和药物干预对患有酒精使用障碍（AUD）的个体失眠的疗效。
通过 2016 年 10 月对心理、医学和教育数据库进行了全面的文献检索。合格的研究评估了失眠干预的疗效，包括比较条件，抽样患有 AUD 且有失眠障碍或失眠抱怨的个体，评估与睡眠相关的结果，并提供相关统计数据以计算组间效应大小。睡眠质量、戒酒天数和抑郁症状的效应大小进行了估计。干预类型（行为与药物）被测试为干预效果的调节剂。
符合纳入标准的九项研究被纳入最终审查和荟萃分析。随机效应模型表明，干预组参与者报告睡眠质量（d+=0.62，95%置信区间=0.28，0.97）和抑郁症状（d+=0.52，95%置信区间=0.06，0.98）的改善明显大于对照组。与药物（d+=0.43，95%置信区间=0.19，0.67）干预相比，参与者对行为（d+=1.20，95%置信区间=0.70，1.70）干预的睡眠质量改善明显更大。行为（d+=0.74，95%置信区间=0.31，1.18）和药物（d+=0.08，95%置信区间=-0.64，0.78）干预对抑郁症状没有显著不同的影响。无论是行为还是药物干预都没有改善戒酒率。
失眠干预可改善共病 AUD 个体的睡眠质量并减轻抑郁症状。鉴于所审查研究的方法学弱点，需要进一步研究以确定失眠治疗在改善该人群中酒精复发率方面的疗效。
