一项针对青少年和年轻成人睡眠时相后移障碍的亮光疗法和晨间活动的随机对照试验。

A randomised controlled trial of bright light therapy and morning activity for adolescents and young adults with Delayed Sleep-Wake Phase Disorder.

机构信息

Flinders University, College of Education, Psychology and Social Work, Adelaide, Australia.

出版信息

Sleep Med. 2018 May;45:114-123. doi: 10.1016/j.sleep.2018.02.001. Epub 2018 Feb 9.

DOI:10.1016/j.sleep.2018.02.001

PMID:29680419

Abstract

UNLABELLED

A randomised controlled trial evaluated bright light therapy and morning activity for the treatment of Delayed Sleep-Wake Phase Disorder (DSWPD) in young people. 60 adolescents and young adults (range = 13-24 years, mean = 15.9 ± 2.2 y, 63% f) diagnosed with DSWPD were randomised to receive three weeks of post-awakening Green Bright Light Therapy (∼507 nm) and Sedentary Activity (sitting, watching TV), Green Bright Light Therapy and Morning Activity (standing, playing motion-sensing videogame), Red Light Therapy (∼643 nm) and Sedentary Activity or Red Light Therapy and Morning Activity. Sleep (ie sleep onset time, wake up time, sleep onset latency, total sleep time) and daytime functioning (ie morning alertness, daytime sleepiness, fatigue, functional impairment) were measured pre-treatment, post-treatment and at one and three month follow-up. Contrary to predictions, there were no significant differences in outcomes between treatment groups; and interaction effects between treatment group and time for all outcome variables were not statistically significant. However, adolescents and young adults in morning activity conditions did not meaningfully increase their objective activity (ie movement frequency). Overall, adolescents reported significantly improved sleep timing (d = 0.30-0.46), sleep onset latency (d = 0.32) and daytime functioning (d = 0.45-0.87) post-treatment. Improvements in sleep timing (d = 0.53-0.61), sleep onset latency (d = 0.57), total sleep time (d = 0.51), and daytime functioning (d = 0.52-1.02) were maintained, or improved upon, at the three month follow-up. However, relapse of symptomology was common and 38% of adolescents and young adults requested further treatment in addition to the three weeks of light therapy. Although there is convincing evidence for the short-term efficacy of chronobiological treatments for DSWPD, long-term treatment outcomes can be improved. To address this gap in our current knowledge, avenues for future research are discussed.

CLINICAL TRIAL

Australian & New Zealand Clinical Trials Registry, https://www.anzctr.org.au, ACTRN12614000308695.

摘要

目的

评价光疗法和晨间活动对青少年睡眠时相延迟障碍（DSWPD）的治疗作用。

方法

60 例青少年和年轻成人（年龄 13-24 岁，平均 15.9±2.2 岁，63%为女性）DSWPD 患者被随机分为三组：接受唤醒后三周的绿光疗法（~~507nm）和静坐活动（坐着、看电视）、绿光疗法和晨间活动（站立、玩运动感应视频游戏）、红光疗法（~~643nm）和静坐活动或红光疗法和晨间活动。在治疗前、治疗后和 1、3 个月随访时测量睡眠（即入睡时间、醒来时间、入睡潜伏期、总睡眠时间）和日间功能（即晨间警觉性、日间嗜睡、疲劳、功能障碍）。

结果

与预测相反，治疗组之间的结局无显著差异；且治疗组与时间之间的所有结局变量的交互作用均无统计学意义。然而，在晨间活动条件下的青少年和年轻成人的客观活动（即运动频率）并未显著增加。总体而言，青少年在治疗后睡眠时间（d=0.30-0.46）、入睡潜伏期（d=0.32）和日间功能（d=0.45-0.87）显著改善。睡眠时间（d=0.53-0.61）、入睡潜伏期（d=0.57）、总睡眠时间（d=0.51）和日间功能（d=0.52-1.02）在 3 个月随访时得以维持或改善。然而，症状复发很常见，38%的青少年和年轻成人在接受三周的光疗外还要求进一步治疗。