Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI.
Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI.
Sleep. 2019 Feb 1;42(2). doi: 10.1093/sleep/zsy217.
Insomnia is a leading cause of disability in postmenopausal women. Multicomponent cognitive-behavioral therapy for insomnia (CBTI) is a first-line treatment for chronic insomnia, but support for its efficacy in treating menopause-related insomnia is scarce. The present study evaluated whether CBTI is an efficacious treatment for menopause-related chronic insomnia, and whether sleep restriction therapy (SRT)-a single component of CBTI-is equally efficacious compared with CBTI.
In a single-site, randomized controlled trial, 150 postmenopausal women (56.44 ± 5.64 years) with chronic DSM-5 insomnia disorder related to menopause were randomized to three treatment conditions: sleep hygiene education (SHE), SRT, or CBTI. Blinded assessments were performed at baseline, posttreatment, and 6 months after treatment. The Insomnia Severity Index (ISI) and sleep diaries served as primary outcomes.
From baseline to posttreatment, ISI decreased 7.70 points in the CBTI group (p < .001), 6.56 points in the SRT group (p < .001), and 1.12 in the SHE group (p = .01). Although average sleep duration increased in all groups by 6 month follow-up, CBTI patients obtained 40-43 more minutes of nightly sleep than those who received SHE or SRT. Remission rates in the CBTI (54%-84%) and SRT (38%-57%) groups were higher than SHE patients (4%-33%) at posttreatment and 6 month follow-up. CBTI patients were generally more likely to remit than SRT patients.
CBTI and SRT effectively treat menopause-related insomnia disorder and are superior to SHE. Response to CBTI and SRT is similar, but CBTI outperforms SRT in improving sleep maintenance, which may increase likelihood of remission. Clinical Trial Name: Behavioral Treatment of Menopausal Insomnia: Sleep and Daytime Outcomes. URL: clinicaltrials.gov. Registration: NCT01933295.
失眠是绝经后女性残疾的主要原因。多组分认知行为疗法治疗失眠（CBTI）是慢性失眠的一线治疗方法，但对其治疗与绝经相关的失眠的疗效的支持很少。本研究评估了 CBTI 是否是治疗与绝经相关的慢性失眠的有效方法，以及睡眠限制疗法（SRT）-CBTI 的单一组成部分-是否与 CBTI 同样有效。
在一项单站点、随机对照试验中，将 150 名患有与绝经相关的慢性 DSM-5 失眠障碍的绝经后妇女（56.44 ± 5.64 岁）随机分为三种治疗条件：睡眠卫生教育（SHE）、SRT 或 CBTI。在基线、治疗后和治疗后 6 个月进行盲法评估。失眠严重程度指数（ISI）和睡眠日记作为主要结果。
从基线到治疗后，CBTI 组的 ISI 下降了 7.70 分（p <.001），SRT 组下降了 6.56 分（p <.001），SHE 组下降了 1.12 分（p =.01）。尽管所有组在 6 个月随访时的平均睡眠时间都有所增加，但 CBTI 患者每晚获得的睡眠时间比接受 SHE 或 SRT 的患者多 40-43 分钟。在治疗后和 6 个月随访时，CBTI（54%-84%）和 SRT（38%-57%）组的缓解率高于 SHE 组（4%-33%）。CBTI 患者比 SRT 患者更有可能缓解。
CBTI 和 SRT 有效治疗与绝经相关的失眠障碍，优于 SHE。对 CBTI 和 SRT 的反应相似，但 CBTI 在改善睡眠维持方面优于 SRT，这可能增加缓解的可能性。
绝经相关失眠的行为治疗：睡眠和日间结果。网址：clinicaltrials.gov。注册：NCT01933295。
