Department of Psychiatry, University of Missouri, Columbia, Missouri.
Durham VA Medical Center, Durham, Virginia.
J Clin Sleep Med. 2018 Sep 15;14(9):1595-1603. doi: 10.5664/jcsm.7344.
Insomnia frequently co-occurs with fibromyalgia, which is associated with gray matter atrophy. We examined the effect of cognitive behavioral therapy for insomnia (CBT-I) and pain (CBT-P) on cortical thickness.
Patients with fibromyalgia and insomnia underwent MRI before and after random assignment to CBT-I (n = 14), CBT-P (n = 16), or waitlist control (WLC; n = 7).
Repeated-measures analyses of variance revealed significant interactions for two regions (left lateral orbitofrontal cortex, left rostral middle frontal, s < .05) and trends for four regions (right medial orbitofrontal cortex, right posterior cingulate, left caudal middle frontal, left transverse temporal; s < .10). Cortical thickness increased in all regions for CBT-I and decreased in five regions for CBT-P and WLC. Hierarchical regressions revealed that for the CBT-I group, reductions in wake after sleep onset were associated with an increase in cortical thickness.
Our pilot study presents novel evidence suggesting that CBT-I may slow or reverse cortical gray matter atrophy in patients with fibromyalgia and insomnia.
Registry: ClinicalTrials.gov, Identifier: NCT02001077, Title: Sleep and Pain Interventions in Fibromyalgia (SPIN), URL: https://clinicaltrials.gov/ct2/show/NCT02001077.
失眠常与纤维肌痛同时发生，后者与灰质萎缩有关。我们研究了认知行为疗法治疗失眠（CBT-I）和疼痛（CBT-P）对皮质厚度的影响。
纤维肌痛伴失眠患者在随机分配至 CBT-I（n=14）、CBT-P（n=16）或候补名单对照（WLC；n=7）之前和之后进行 MRI。
重复测量方差分析显示两个区域（左侧外侧眶额皮质、左侧额中回前部）存在显著交互作用（s<.05），四个区域（右侧内侧眶额皮质、右侧后扣带回、左侧中回后部、左侧横颞叶）存在趋势（s<.10）。CBT-I 组所有区域的皮质厚度增加，CBT-P 和 WLC 组五个区域的皮质厚度降低。分层回归显示，对于 CBT-I 组，睡眠后觉醒减少与皮质厚度增加相关。
我们的初步研究提供了新的证据，表明 CBT-I 可能减缓或逆转纤维肌痛伴失眠患者的灰质萎缩。
注册号：ClinicalTrials.gov，标识符：NCT02001077，标题：纤维肌痛中的睡眠和疼痛干预（SPIN），网址：https://clinicaltrials.gov/ct2/show/NCT02001077。
