Zhang Ying, Su Jun, Wang Jingquan, Tang Guangzhang, Hu Wei, Mao Jinghong, Ren Wanwen, Liu Yi, Yu Zhenghe
Department of Medical Psychosomatic, Hangzhou Seventh People's Hospital Department of Intensive Care Unit, Hangzhou First People's Hospital, Hangzhou Department of Intensive Care Unit , Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China.
Medicine (Baltimore). 2018 Sep;97(37):e12383. doi: 10.1097/MD.0000000000012383.
Patients transferred out of the intensive care unit (ICU) are always impaired by sleep disorders. Cognitive behavioral therapy for insomnia (CBT-I) and eszopiclone are 2 commonly prescribed strategies for insomnia. In the current study, the effect of the combined application of the 2 methods on sleep disorders in ICU transferred out patients was assessed.Twenty-nine insomnia patients receiving combined treatment of CBT-I and eszopiclone and a corresponding number of patients treated with eszopiclone were collected. The incidence of discomfort experiences in ICU was recorded. Polysomnogram (PSG), Pittsburgh Sleep Quality Index (PSQI), self-rating anxiety scale (SAS), self-rating depression scale (SDS), and treatment emergent symptom scale (TESS) were used to assess the treatment efficacy and side effects.Hospitalization for over 7 days, use of benzodiazepines, and experiencing anxiety, insomnia, and mechanical ventilation increased chances of sleep disorders. The sleep latency, awakening time, and total sleep time were further improved in patients treated with the combined therapy than patients treated with eszopiclone (t = -2.334, -2.412, 2.383, P < .05). Similar changing pattern was observed for PSQI score (t = -2.262, P < .05). The improvement effect of the combined therapy on the sleep efficacy, SWS phase III, and rapid eye movement sleep was also significantly stronger (t = 2.112, 2.268, 2.311, P < .05). Moreover, the SAS and SDS scores in patients treated with the combined therapy decreased more than those of patients treated with eszopiclone.The efficacy of CBT-I combined with eszopiclone in the treatment of sleep disorders in ICU transferred out patients was better than eszopiclone.
转出重症监护病房（ICU）的患者总是会受到睡眠障碍的影响。认知行为疗法治疗失眠（CBT-I）和艾司佐匹克隆是两种常用的失眠治疗策略。在本研究中，评估了这两种方法联合应用对转出ICU患者睡眠障碍的影响。收集了29例接受CBT-I与艾司佐匹克隆联合治疗的失眠患者以及相应数量接受艾司佐匹克隆治疗的患者。记录了ICU中不适经历的发生率。使用多导睡眠图（PSG）、匹兹堡睡眠质量指数（PSQI）、自评焦虑量表（SAS）、自评抑郁量表（SDS）和治疗中出现的症状量表（TESS）来评估治疗效果和副作用。住院超过7天、使用苯二氮䓬类药物以及经历焦虑、失眠和机械通气会增加睡眠障碍的几率。联合治疗的患者比接受艾司佐匹克隆治疗的患者的睡眠潜伏期、觉醒时间和总睡眠时间进一步改善（t = -2.334，-2.412，2.383，P <.05）。PSQI评分也观察到类似的变化模式（t = -2.262，P <.05）。联合治疗对睡眠效率、慢波睡眠III期和快速眼动睡眠的改善效果也明显更强（t = 2.112，2.268，2.311，P <.05）。此外，联合治疗患者的SAS和SDS评分下降幅度大于接受艾司佐匹克隆治疗的患者。CBT-I联合艾司佐匹克隆治疗转出ICU患者睡眠障碍的疗效优于艾司佐匹克隆。
