Department of Sociology, University of Kentucky , Lexington.
Department of Pharmacy Practice and Science, University of Kentucky , Lexington.
Behav Sleep Med. 2020 Sep-Oct;18(5):680-689. doi: 10.1080/15402002.2019.1661249. Epub 2019 Aug 30.
OBJECTIVE/BACKGROUND: Appalachian women are disproportionately affected by insufficient sleep but live in a healthcare shortage area with prevalent prescription drug abuse. A self-administered, non-pharmacologic intervention such as Internet-based cognitive behavioral therapy for insomnia (CBT-I) may be ideal in this population, but psycho-social characteristics (e.g., high depression rates) and cultural norms (e.g., suspicion of technology) necessitate a pilot study. We evaluated the effectiveness of Sleep Healthy Using the Internet (SHUTi) on insomnia severity, sleep quality, perceived stress, depression symptoms, and sleep aid use in Appalachian women ages 45 +.
Forty-six women enrolled; 38 completed the six-week intervention in 2018 (mean age 55 years).
We employed a single group, pre/post-test, mixed-methods design. Participants completed an online survey and a qualitative interview pre- and post-intervention. Quantitative data were analyzed using one-way repeated measures ANOVA or generalized estimating equations. Interviews were qualitatively analyzed using a multi-stage coding process.
Positive and statistically significant ( < .01) improvements were observed on mean scores for the Insomnia Severity Index (15.1 to 6.5), the Pittsburgh Sleep Quality Index (12.1 to 8.5), the Perceived Stress Scale (20 to 14.6), and the Center for Epidemiologic Studies Depression Scale Revised (9.8 to 5.2). The odds of reporting sleep medication use post-intervention were significantly lower than pre-intervention (OR 0.28 [95% CI 0.11-0.74]). Interviews highlighted most and least helpful intervention components and suggested that participants benefitted from SHUTi.
Internet-based CBT-I may be a useful, non-pharmacologic treatment that reduces insomnia severity, perceived stress, depression symptoms, and sleep aid use in middle-aged Appalachian women.
目的/背景：阿巴拉契亚女性普遍受到睡眠不足的影响，但她们生活在医疗保健短缺地区，普遍存在处方药物滥用的问题。自我管理的非药物干预，如基于互联网的失眠认知行为疗法（CBT-I），可能是该人群的理想选择，但心理社会特征（如高抑郁率）和文化规范（如对技术的怀疑）需要进行试点研究。我们评估了 Sleep Healthy Using the Internet（SHUTi）在阿巴拉契亚 45 岁及以上女性的失眠严重程度、睡眠质量、感知压力、抑郁症状和助眠药物使用方面的有效性。
46 名女性参与；38 名女性在 2018 年完成了为期六周的干预（平均年龄 55 岁）。
我们采用了单组、前后测试、混合方法设计。参与者在干预前后完成了在线调查和定性访谈。使用单向重复测量方差分析或广义估计方程分析定量数据。访谈采用多阶段编码过程进行定性分析。
失眠严重程度指数（从 15.1 分降至 6.5 分）、匹兹堡睡眠质量指数（从 12.1 分降至 8.5 分）、感知压力量表（从 20 分降至 14.6 分）和修订后的流行病学研究中心抑郁量表（从 9.8 分降至 5.2 分）的平均得分均有显著改善（<0.01）。干预后报告使用睡眠药物的可能性显著低于干预前（比值比 0.28[95%CI 0.11-0.74]）。访谈突出了最有用和最无用的干预内容，并表明参与者从 SHUTi 中受益。
基于互联网的 CBT-I 可能是一种有用的非药物治疗方法，可以减轻中年阿巴拉契亚女性的失眠严重程度、感知压力、抑郁症状和助眠药物使用。
