Departments of Psychology (Drs Tomfohr-Madsen, Madsen, Yeates, & Brooks) Psychiatry (Ms Bonneville), and Faculty of Kinesiology (Mr Virani), University of Calgary, Calgary, Alberta, Canada; Faculté St Jean, University of Alberta, Edmonton, Alberta, Canada (Dr Plourde); Neuropsychology Service, Alberta Children's Hospital, Calgary, Alberta, Canada (Mr Virani and Dr Brooks); Faculty of Medicine, University of Queensland, Brisbane, New South Wales, Australia (Dr Barlow); Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada (Drs Tomfohr-Madsen, Yeates, Brooks, and Barlow); Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada (Drs Tomfohr-Madsen, Yeates, and Brooks and Mr Virani); Hotchkiss Brain Institute, Calgary, Alberta, Canada (Drs Yeates and Brooks); and Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada (Drs Yeates and Brooks).
J Head Trauma Rehabil. 2020 Mar/Apr;35(2):E103-E112. doi: 10.1097/HTR.0000000000000504.
Cognitive-behavioral therapy for insomnia (CBT-I) is an effective insomnia treatment but has yet to be applied to adolescents with sleep disruption following concussion. This pilot study evaluated CBT-I to improve insomnia in adolescents with protracted concussion recovery.
Tertiary pediatric hospital.
Participants (N = 24) were 12 to 18 years old (M = 15.0, SD = 1.4), 15.1 weeks (SD = 9.2) postinjury, and presenting with sleep disruption and persistent postconcussion symptoms.
A single-blind, parallel-group randomized controlled trial (RCT) design comparing 6 weeks of CBT-I and a treatment-as-usual control group. Outcomes were measured before treatment, at treatment completion, and 4 weeks after completion.
Primary outcome was Insomnia Severity Index. Secondary outcomes included Pittsburgh Sleep Quality Index, Dysfunctional Beliefs and Attitudes about Sleep Scale, 7-night sleep diary, PROMIS Depression, PROMIS Anxiety, and Health and Behavior Inventory.
Adolescents who received CBT-I demonstrated large and clinically significant improvements in insomnia ratings at posttreatment that were maintained at follow-up. They also reported improved sleep quality, fewer dysfunctional beliefs about sleep, better sleep efficiency, shorter sleep-onset latency, and longer sleep time compared with those with treatment as usual. There was also a modest reduction in postconcussion symptoms.
In this pilot RCT, 6 weeks of CBT-I produced significant improvement in sleep in adolescents with persistent postconcussion symptoms. A larger trial is warranted.
认知行为疗法治疗失眠（CBT-I）是一种有效的失眠治疗方法，但尚未应用于脑震荡后睡眠障碍的青少年。本初步研究评估了 CBT-I 对改善脑震荡后恢复时间较长的青少年失眠的效果。
三级儿童医院。
共有 24 名参与者（年龄 12-18 岁，M=15.0，SD=1.4；受伤后 15.1 周，SD=9.2；存在睡眠障碍和持续性脑震荡症状）。
采用单盲、平行组随机对照试验（RCT）设计，比较 6 周 CBT-I 和常规治疗对照组。在治疗前、治疗结束时和治疗结束后 4 周进行评估。
主要结局指标为失眠严重程度指数。次要结局指标包括匹兹堡睡眠质量指数、睡眠障碍信念和态度量表、7 天睡眠日记、PROMIS 抑郁量表、PROMIS 焦虑量表和健康和行为量表。
接受 CBT-I 的青少年在治疗后失眠严重程度评分有显著且具有临床意义的改善，并且在随访中得以维持。与常规治疗组相比，他们还报告睡眠质量改善、睡眠障碍信念减少、睡眠效率提高、入睡潜伏期缩短和睡眠时间延长。脑震荡后症状也有适度减轻。
在本初步 RCT 中，6 周的 CBT-I 可显著改善持续性脑震荡后症状青少年的睡眠。需要进行更大规模的试验。
