School of Psychology, University of Sydney, Sydney, Australia.
Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA.
Neuropsychol Rehabil. 2021 Apr;31(3):345-368. doi: 10.1080/09602011.2019.1693404. Epub 2019 Nov 21.
Difficulties falling asleep or staying asleep (symptoms of insomnia) are common following paediatric traumatic brain injury (TBI). Yet, interventions to treat insomnia in this population have not yet been reported. This single-case series examined the feasibility and acceptability of cognitive behavioral treatment for insomnia (CBT-I) for adolescents ( = 5, aged 11-13 years) with TBI, and explored changes in sleep and fatigue post-treatment. Adolescents were randomly assigned to two conditions: a 7- or 14-days baseline, followed by 4 weeks of manualised CBT-I delivered individually. To assess and we compared recruitment and retention rates, and questionnaire scores to a-priori set criteria. We explored in sleep and fatigue from baseline to follow-up using structured visual analysis of time-series graphs, and reliable change indices or changes in clinical classification. Feasibility and acceptability indicators met a-priori criteria, but therapists noticed limited adolescent engagement in sessions. Clinically significant improvements were found in sleep, in 3 out of 4 cases, and fatigue, in all cases. Our study provides preliminary evidence that CBT-I is feasible for insomnia treatment in adolescents with TBI and provides directions for development of future treatment studies.
入睡或保持睡眠困难（失眠症状）在儿科创伤性脑损伤（TBI）后很常见。然而，针对该人群的失眠干预措施尚未得到报道。本单病例系列研究探讨了认知行为治疗失眠（CBT-I）对 TBI 青少年（ = 5，年龄 11-13 岁）的可行性和可接受性，并探讨了治疗后睡眠和疲劳的变化。青少年被随机分配到两种条件：7 天或 14 天基线，然后进行 4 周的个体化 CBT-I。为了评估招募和保留率，以及问卷评分是否符合预先设定的标准，我们将基线到随访的睡眠和疲劳数据与时间序列图的结构化视觉分析以及可靠变化指数或临床分类变化进行了比较。可行性和可接受性指标符合预先设定的标准，但治疗师注意到青少年在治疗过程中的参与度有限。在 4 例中有 3 例睡眠和所有病例的疲劳均出现了临床显著改善。我们的研究为 CBT-I 治疗 TBI 青少年失眠提供了初步证据，并为未来治疗研究的发展提供了方向。
