Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
J Sleep Res. 2020 Aug;29(4):e13018. doi: 10.1111/jsr.13018. Epub 2020 Feb 28.
Digital cognitive behavioural therapy (dCBT) is an effective treatment for chronic insomnia and also improves well-being and quality of life (QoL). We assessed whether these benefits are sustained and if the effects of dCBT extend to the use of sleep medication and healthcare. In total 1,711 adults (48.0 ± 13.8 years, 77.6% female) with complaints of chronic insomnia participated in a previously published randomized controlled trial (ISRCTN 60530898) comparing dCBT (n = 853) with sleep hygiene education (SHE, n = 858). At weeks 0, 4, 8, 24, 36 and 48, we assessed functional health (Patient-Reported Outcomes Measurement Information System: Global Health Scale); psychological well-being (Warwick-Edinburgh Mental Well-being Scale) and sleep-related QoL (Glasgow Sleep Impact Index), prescribed and non-prescribed sleep medication use, and healthcare utilization. At week 25, those who received SHE at baseline were offered dCBT. dCBT improved functional health (difference: 2.45, 95% confidence interval [CI]: 2.03; 2.88, Cohen's d: 0.50, p < .001), psychological well-being (difference: 4.34, 95% CI: 3.70; 4.98, Cohen's d: 0.55, p < .001) and sleep-related QoL (difference: -44.61, 95%CI: -47.17; -42.05, Cohen's d: -1.44, p < .001) at week 48 compared to baseline. At week 24 dCBT, compared to SHE, also reduced use of prescription and non-prescription sleep medication up to week 24 (adjusted rate ratio [RR]: 0.64, 95% CI: 0.42; 0.97, p = .037 and adjusted RR: 0.52, 95% CI: 0.37; 0.74, p < .0001, respectively), but not healthcare utilization. Uncontrolled follow-up suggests that these effects were sustained for non-prescribed sleep medication (RR: 0.52, 95% CI: 0.40; 0.67, p < .001). In conclusion, this study suggests that dCBT results in sustained benefits to insomnia and its daytime outcomes.
数字认知行为疗法（dCBT）是慢性失眠症的有效治疗方法，也可改善整体幸福感和生活质量（QoL）。我们评估了这些益处是否可持续，以及 dCBT 的效果是否扩展到睡眠药物和医疗保健的使用。共有 1711 名患有慢性失眠症的成年人（48.0±13.8 岁，77.6%为女性）参加了先前发表的一项随机对照试验（ISRCTN 60530898），比较了 dCBT（n=853）与睡眠卫生教育（SHE，n=858）。在第 0、4、8、24、36 和 48 周时，我们评估了功能健康（患者报告的结果测量信息系统：全球健康量表）；心理健康（华威-爱丁堡心理健康量表）和睡眠相关的 QoL（格拉斯哥睡眠影响指数）、处方和非处方睡眠药物的使用以及医疗保健的利用。在第 25 周，那些基线时接受 SHE 的人被提供 dCBT。dCBT 改善了功能健康（差异：2.45，95%置信区间[CI]：2.03；2.88，Cohen's d：0.50，p<.001）、心理健康（差异：4.34，95%CI：3.70；4.98，Cohen's d：0.55，p<.001）和睡眠相关的 QoL（差异：-44.61，95%CI：-47.17；-42.05，Cohen's d：-1.44，p<.001），与基线相比，在第 48 周。与 SHE 相比，在第 24 周时，dCBT 还降低了处方和非处方睡眠药物的使用，直至第 24 周（调整后的率比[RR]：0.64，95%CI：0.42；0.97，p=0.037 和调整后的 RR：0.52，95%CI：0.37；0.74，p<.0001），但不会影响医疗保健的利用。未控制的随访表明，这些效果在非处方睡眠药物方面持续存在（RR：0.52，95%CI：0.40；0.67，p<.001）。总之，本研究表明，dCBT 可使失眠症及其日间结果持续受益。
