Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK.
Sleep. 2020 Sep 14;43(9). doi: 10.1093/sleep/zsaa034.
We sought to examine the impact of digital cognitive behavioral therapy (dCBT) for insomnia on both self-reported cognitive impairment and objective cognitive performance.
The Defining the Impact of Sleep improvement on Cognitive Outcomes (DISCO) trial was an online, two-arm, single-blind, randomized clinical trial of dCBT versus wait-list control. Participants were aged 25 years and older, met DSM-5 diagnostic criteria for insomnia disorder, and reported difficulties with concentration or memory. Assessments were carried out online at baseline, and 10 and 24 weeks post-randomization. The primary outcome measure was self-reported cognitive impairment, assessed with the British Columbia Cognitive Complaints Inventory (BC-CCI). Secondary outcomes included tests of cognitive performance, insomnia symptoms, cognitive failures, fatigue, sleepiness, depression, and anxiety.
Four hundred and ten participants with insomnia were recruited and assigned to dCBT (N = 205) or wait-list control (N = 205). At 10 weeks post-randomization the estimated adjusted mean difference for the BC-CCI was -3.03 (95% CI: -3.60, -2.47; p < 0.0001, d = -0.86), indicating that participants in the dCBT group reported less cognitive impairment than the control group. These effects were maintained at 24 weeks (d = -0.96) and were mediated, in part, via reductions in insomnia severity and increased sleep efficiency. Treatment effects in favor of dCBT, at both 10 and 24 weeks, were found for insomnia severity, sleep efficiency, cognitive failures, fatigue, sleepiness, depression, and anxiety. We found no between-group differences in objective tests of cognitive performance.
Our study shows that dCBT robustly decreases self-reported cognitive impairment at post-treatment and these effects are maintained at 6 months.
我们旨在探讨针对失眠的数字认知行为疗法（dCBT）对自我报告的认知障碍和客观认知表现的影响。
定义睡眠改善对认知结果的影响（DISCO）试验是一项在线、双臂、单盲、随机临床试验，比较 dCBT 与等待名单对照。参与者年龄在 25 岁及以上，符合 DSM-5 失眠障碍诊断标准，并报告存在注意力或记忆力困难。评估在基线、随机分组后 10 周和 24 周时在线进行。主要结局测量指标是自我报告的认知障碍，使用不列颠哥伦比亚认知抱怨量表（BC-CCI）进行评估。次要结局包括认知表现测试、失眠症状、认知失误、疲劳、嗜睡、抑郁和焦虑。
共招募了 410 名失眠症患者，并分配至 dCBT 组（N=205）或等待名单对照组（N=205）。在随机分组后 10 周时，BC-CCI 的估计调整平均差值为-3.03（95%CI：-3.60，-2.47；p<0.0001，d=-0.86），表明 dCBT 组参与者报告的认知障碍少于对照组。这些效果在 24 周时保持（d=-0.96），部分通过降低失眠严重程度和提高睡眠效率来介导。在 10 周和 24 周时，dCBT 治疗对失眠严重程度、睡眠效率、认知失误、疲劳、嗜睡、抑郁和焦虑均有利。我们未发现两组间客观认知表现测试存在差异。
我们的研究表明，dCBT 在治疗后可显著降低自我报告的认知障碍，且这些效果在 6 个月时仍能维持。
