Stanford Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California.
Palo Alto University, Palo Alto, California.
JAMA Netw Open. 2019 Sep 4;2(9):e1911944. doi: 10.1001/jamanetworkopen.2019.11944.
Owing to biological, behavioral, and societal factors, sleep duration in teenagers is often severely truncated, leading to pervasive sleep deprivation.
To determine whether a novel intervention, using both light exposure during sleep and cognitive behavioral therapy (CBT), would increase total sleep time in teenagers by enabling them to go to sleep earlier than usual.
DESIGN, SETTING, AND PARTICIPANTS: This double-blind, placebo-controlled, randomized clinical trial, conducted between November 1, 2013, and May 31, 2016, among 102 adolescents enrolled full-time in grades 9 to 12, who expressed difficulty going to bed earlier and waking up early enough, was composed of 2 phases. In phase 1, participants were assigned to receive either 3 weeks of light or sham therapy and were asked to try to go to sleep earlier. In phase 2, participants received 4 brief CBT sessions in addition to a modified light or sham therapy. All analyses were performed on an intent-to-treat basis.
Light therapy consisted of receiving a 3-millisecond light flash every 20 seconds during the final 3 hours of sleep (phase 1) or final 2 hours of sleep (phase 2). Sham therapy used an identical device, but delivered 1 minute of light pulses (appearing in 20-second intervals, for a total of 3 pulses) per hour during the final 3 hours of sleep (phase 1) or 2 hours of sleep (phase 2). Light therapy occurred every night during the 4-week intervention. Cognitive behavioral therapy consisted of four 50-minute in-person sessions once per week.
Primary outcome measures included diary-based sleep times, momentary ratings of evening sleepiness, and subjective measures of sleepiness and sleep quality.
Among the 102 participants (54 female [52.9%]; mean [SD] age, 15.6 [1.1] years), 72 were enrolled in phase 1 and 30 were enrolled in phase 2. Mixed-effects models revealed that light therapy alone was inadequate in changing the timing of sleep. However, compared with sham therapy plus CBT alone, light therapy plus CBT significantly moved sleep onset a mean (SD) of 50.1 (27.5) minutes earlier and increased nightly total sleep time by a mean (SD) of 43.3 (35.0) minutes. Light therapy plus CBT also resulted in a 7-fold greater increase in bedtime compliance than that observed among participants receiving sham plus CBT (mean [SD], 2.21 [3.91] vs 0.29 [0.76]), as well as a mean 0.55-point increase in subjective evening sleepiness as compared with a mean 0.48-point decrease in participants receiving sham plus CBT as measured on a 7-point sleepiness scale.
This study found that light exposure during sleep, in combination with a brief, motivation-focused CBT intervention, was able to consistently move bedtimes earlier and increase total sleep time in teenagers. This type of passive light intervention in teenagers may lead to novel therapeutic applications.
ClinicalTrials.gov identifier: NCT01406691.
由于生物、行为和社会因素的影响，青少年的睡眠时间通常严重缩短，导致普遍存在睡眠不足的问题。
确定一种新的干预措施，即同时在睡眠期间暴露于光线下和进行认知行为疗法（CBT），是否可以通过使青少年能够比平时更早入睡来增加他们的总睡眠时间。
设计、设置和参与者：这是一项双盲、安慰剂对照、随机临床试验，于 2013 年 11 月 1 日至 2016 年 5 月 31 日期间在全日制 9 至 12 年级的 102 名青少年中进行，这些青少年表示入睡和早起有困难，试验分为两个阶段。在第一阶段，参与者被分配接受 3 周的光疗或假治疗，并被要求尝试更早入睡。在第二阶段，参与者除了接受改良的光疗或假治疗外，还接受了 4 次简短的 CBT 疗程。所有分析均基于意向治疗进行。
光疗包括在睡眠的最后 3 小时（第 1 阶段）或最后 2 小时（第 2 阶段）期间每 20 秒接受 3 毫秒的光闪烁。假治疗使用相同的设备，但在睡眠的最后 3 小时（第 1 阶段）或 2 小时（第 2 阶段）期间，每小时提供 1 分钟的光脉冲（共 3 个脉冲，每个脉冲持续 20 秒）。光疗在 4 周的干预期间每晚进行。认知行为疗法包括每周一次的 50 分钟面对面 4 次疗程。
主要结局测量包括基于日记的睡眠时间、夜间睡眠困意的即时评分，以及睡眠困意和睡眠质量的主观测量。
在 102 名参与者（54 名女性[52.9%]；平均[标准差]年龄为 15.6[1.1]岁）中，72 名参与者进入第一阶段，30 名参与者进入第二阶段。混合效应模型显示，单独使用光疗不足以改变睡眠的时间。然而，与假治疗加 CBT 相比，光疗加 CBT 显著将入睡时间提前了 50.1（27.5）分钟，每晚总睡眠时间增加了 43.3（35.0）分钟。与接受假治疗加 CBT 的参与者相比，光疗加 CBT 使就寝时间的依从性增加了 7 倍（平均[标准差]，2.21[3.91]比 0.29[0.76]），与接受假治疗加 CBT 的参与者相比，主观夜间困意平均增加了 0.55 分（7 分制），而接受假治疗加 CBT 的参与者平均减少了 0.48 分。
本研究发现，睡眠期间暴露于光线下，结合简短的、以动机为重点的 CBT 干预，能够持续使青少年更早入睡并增加总睡眠时间。这种在青少年中使用的被动光干预可能会带来新的治疗应用。
ClinicalTrials.gov 标识符：NCT01406691。
