用于失眠自我管理的移动应用程序：退伍军人睡眠结果的初步研究结果
Mobile App Use for Insomnia Self-Management: Pilot Findings on Sleep Outcomes in Veterans.
作者信息
Reilly Erin D, Robinson Stephanie A, Petrakis Beth Ann, Kuhn Eric, Pigeon Wilfred R, Wiener Renda Soylemez, McInnes D Keith, Quigley Karen S
机构信息
Center for Social and Community Reintegration Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA, United States.
Center for Healthcare Outcomes and Implementation Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA, United States.
出版信息
Interact J Med Res. 2019 Jul 24;8(3):e12408. doi: 10.2196/12408.
BACKGROUND
Sleep disturbance is a major health concern among US veterans who have served since 2001 in a combat theater in Iraq or Afghanistan. We report subjective and objective sleep results from a pilot trial assessing self-management-guided use of a mobile app (CBT-i Coach, which is based on cognitive behavioral therapy for insomnia) as an intervention for insomnia in military veterans.
OBJECTIVE
The primary aim of this study was to evaluate changes in subjective and objective sleep outcomes from pre to postintervention.
METHODS
Subjective outcomes included the Insomnia Severity Index, the Pittsburgh Sleep Quality Inventory, and sleep-related functional status. A wearable sleep monitor (WatchPAT) measured objective sleep outcomes, including sleep efficiency, percent rapid eye movement (REM) during sleep, sleep time, and sleep apnea. A total of 38 participants were enrolled in the study, with 18 participants being withdrawn per the protocol because of moderate or severe sleep apnea and 9 others who dropped out or withdrew. Thus, 11 participants completed the full 6-week CBT-i Coach self-management intervention (ie, completers).
RESULTS
Completer results indicated significant changes in subjective sleep measures, including reduced reports of insomnia (Z=-2.68, P=.007) from pre (mean 16.63, SD 5.55) to postintervention (mean 12.82, SD 3.74), improved sleep quality (Z=-2.37, P=.02) from pre (mean 12.82, SD 4.60) to postintervention (mean 10.73, SD 3.32), and sleep-related functioning (Z=2.675, P=.007) from pre (mean 13.86, SD 3.69) to postintervention (mean 15.379, SD 2.94). Among the objective measures, unexpectedly, objective sleep time significantly decreased from pre to postintervention (χ=7.8, P=.02). There were no significant changes in percent REM sleep or sleep efficiency.
CONCLUSIONS
These findings suggest that the CBT-i Coach app can improve subjective sleep and that incorporating objective sleep measures into future, larger clinical trials or clinical practice may yield important information, particularly by detecting previously undetected sleep apnea.
TRIAL REGISTRATION
ClinicalTrials.gov NCT02392000; http://clinicaltrials.gov/ct2/show/NCT02392000.
背景
睡眠障碍是自2001年以来在伊拉克或阿富汗战区服役的美国退伍军人主要关注的健康问题。我们报告了一项初步试验的主观和客观睡眠结果，该试验评估了一款移动应用程序（基于失眠认知行为疗法的CBT-i Coach）在自我管理指导下作为退伍军人失眠干预措施的效果。
目的
本研究的主要目的是评估干预前后主观和客观睡眠结果的变化。
方法
主观结果包括失眠严重程度指数、匹兹堡睡眠质量指数以及与睡眠相关的功能状态。一款可穿戴睡眠监测仪（WatchPAT）测量客观睡眠结果，包括睡眠效率、睡眠期间快速眼动（REM）百分比、睡眠时间和睡眠呼吸暂停。共有38名参与者纳入研究，根据方案，18名参与者因中度或重度睡眠呼吸暂停退出，另有9人退出或撤回。因此，11名参与者完成了为期6周的CBT-i Coach自我管理干预（即完成者）。
结果
完成者的结果表明主观睡眠指标有显著变化，包括失眠报告从干预前（平均16.63，标准差5.55）减少到干预后（平均12.82，标准差3.74）（Z=-2.68，P=0.007），睡眠质量从干预前（平均12.82，标准差4.60）改善到干预后（平均10.73，标准差3.32）（Z=-2.37，P=0.02），以及与睡眠相关的功能从干预前（平均13.86，标准差3.69）改善到干预后（平均15.379，标准差2.94）（Z=2.675，P=0.007）。在客观指标中，出乎意料的是，干预前后客观睡眠时间显著减少（χ=7.8，P=0.02）。REM睡眠百分比或睡眠效率没有显著变化。
结论
这些发现表明CBT-i Coach应用程序可以改善主观睡眠，并且在未来更大规模的临床试验或临床实践中纳入客观睡眠指标可能会产生重要信息，特别是通过检测以前未发现的睡眠呼吸暂停。
试验注册
ClinicalTrials.gov NCT02392000；http://clinicaltrials.gov/ct2/show/NCT02392000 。
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