Department of Psychosocial Science, University of Bergen , Bergen , Norway.
Department of Health Promotion, Norwegian Institute of Public Health , Bergen , Norway.
Chronobiol Int. 2019 Oct;36(10):1384-1398. doi: 10.1080/07420528.2019.1647435. Epub 2019 Aug 1.
A post-hoc analysis comparing morning and evening persons with insomnia on sleep and mental health characteristics was conducted in order to investigate whether an Internet-based cognitive behavioral therapy for insomnia (ICBTi) was effective both for morning and evening persons. Adult patients (N = 178, mean age = 44.8, 67% females) with insomnia were randomized to either ICBTi (N = 92; morning persons = 41; evening persons = 51) or a web-based patient education condition (N = 86; morning persons = 44; evening persons = 42). All patients were assessed with sleep diaries, the Insomnia Severity Index (ISI), the Bergen Insomnia Scale (BIS), the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS-16), the Hospital Anxiety and Depression Scale (HADS) and the Chalder Fatigue Scale (CFQ). Patients were characterized as morning or evening persons based on a median split on the Horne-Östberg Morningness Eveningness Questionnaire. Short and long-term effects of treatment were examined with mixed-model repeated-measures analyses. Morning and evening persons did not differ in terms of age, gender or educational status. At baseline, morning persons had more wake time after sleep onset (= 0.54, < .001) and more early morning awakening (= 0.38, < .05) compared to evening persons, while evening persons reported longer sleep onset latency (= 0.60, < .001), more time in bed (= 0.56, < .001), longer total sleep time (= 0.45, < .01), more fatigue (= 0.31, < .05) and more dysfunctional beliefs and attitudes about sleep (= 0.47, < .01). Despite these differences at baseline, both morning and evening persons receiving ICBTi benefitted more across most measures compared to morning and evening persons who received patient education. For morning persons in the ICBTi group, ISI scores were reduced from 17.3 at baseline to 8.8 (d = 2.48, < .001) at post-assessment, and to 10.0 at 18-month follow up (d = 2.13, < .001). Comparable results were found for evening persons in the ICBTi group, with a reduction in ISI scores from 17.4 at baseline to 8.6 (d = 2.24, < .001) at post-assessment, and to 8.7 at 18-month follow up (d = 2.19, < .001). Similar results were found on the BIS, DBAS, HADS, CFQ and sleep diary data. Despite different insomnia symptomatology between the two groups, the current study suggests that ICBTi is effective across scores on the morningness-eveningness dimension. The study was pre-registered at: ClinicalTrials.gov Identifier: NCT02261272.
一项针对失眠患者的晨间和晚间个体的回顾性分析比较了睡眠和心理健康特征，以调查基于互联网的认知行为疗法（ICBTi）是否对晨间和晚间个体都有效。178 名成年失眠患者（平均年龄为 44.8 岁，67%为女性）被随机分为 ICBTi 组（n = 92；晨间个体 = 41；晚间个体 = 51）或基于网络的患者教育条件组（n = 86；晨间个体 = 44；晚间个体 = 42）。所有患者均采用睡眠日记、失眠严重程度指数（ISI）、卑尔根失眠量表（BIS）、睡眠信念和态度量表（DBAS-16）、医院焦虑和抑郁量表（HADS）和 Chalder 疲劳量表（CFQ）进行评估。基于 Horne-Östberg 晨间-晚间问卷的中位数分割，将患者定义为晨间或晚间个体。采用混合模型重复测量分析来检查治疗的短期和长期效果。晨间和晚间个体在年龄、性别或教育程度方面没有差异。在基线时，与晚间个体相比，晨间个体的睡眠后觉醒时间更长（= 0.54，< 0.001），早醒时间更早（= 0.38，< 0.05），而晚间个体的入睡潜伏期更长（= 0.60，< 0.001），在床上的时间更长（= 0.56，< 0.001），总睡眠时间更长（= 0.45，< 0.01），疲劳感更重（= 0.31，< 0.05），睡眠信念和态度更失调（= 0.47，< 0.01）。尽管基线时有这些差异，但与接受患者教育的晨间和晚间个体相比，接受 ICBTi 的晨间和晚间个体在大多数评估指标上都有更大的改善。对于接受 ICBTi 的晨间个体，ISI 评分从基线时的 17.3 分降至 8.8 分（d = 2.48，< 0.001），在 18 个月随访时降至 10.0 分（d = 2.13，< 0.001）。接受 ICBTi 的晚间个体也出现了类似的结果，ISI 评分从基线时的 17.4 分降至 8.6 分（d = 2.24，< 0.001），在 18 个月随访时降至 8.7 分（d = 2.19，< 0.001）。BIS、DBAS、HADS、CFQ 和睡眠日记数据也得到了类似的结果。尽管两组患者的失眠症状不同，但本研究表明，ICBTi 在晨间-晚间维度上的评分都有效。该研究在 ClinicalTrials.gov 上进行了预先注册：注册号：NCT02261272。
