Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
School of Nursing, Duke University, Durham, North Carolina.
Clin Gastroenterol Hepatol. 2022 Jan;20(1):96-104. doi: 10.1016/j.cgh.2020.09.047. Epub 2020 Sep 30.
BACKGROUND/AIMS: Sleep disturbances and fatigue are common symptoms amongst patients with Crohn's disease (CD). The aim of this study was to test the feasibility and effects of a pragmatic, stepped-care intervention for the treatment of poor sleep quality and fatigue in adolescents and young adults with CD.
This study is a two-phase open trial exploring interventions for sleep and fatigue. After the initial comprehensive assessment which included quantitative measures and an interview to evaluate sleep and physical and mental health, the 12-week intervention consisted of two sequential steps: 1) a brief behavioral therapy for sleep in inflammatory bowel disease (IBD) (BBTS-I; 4 weeks) and 2) adding the psychotropic medication, bupropion sustained release (BUP-SR; 8 weeks), for the subset of subjects continuing to experience fatigue.
232 CD patients (median age=24, median sex=female) were approached over 18 months, of whom 112 screened positive on the Pittsburgh Sleep Quality Index (PSQI) and multi-dimensional fatigue inventory (MFI), with 68 CD patients completing the more comprehensive baseline assessment. Of the 68 patients, 52 participated in Phase I of the BBTS-I intervention. Following 4-weeks of the BBTS-I, there were significant improvements in sleep quality (p < .001) and fatigue (p < .001). As part of Phase II, of the 52 patients who met fatigue threshold criteria, 33 patients participated in the BUP-SR+BBTS-I arm while 19 participated in the BBTS-I only intervention group. After 8 weeks of Phase II, both intervention groups saw significant further improvement in sleep, fatigue, anxiety and depressive symptoms, but without significant differences between the two intervention groups.
A stepped-care approach shows that we can improve sleep disturbance with BBTS-I in CD patients, but fatigue only partially improves. For a subset of patients who chose to add BUP-SR to their behavioral therapy, fatigue improves further but not to a statistically significant effect compared to behavioral therapy alone.
背景/目的：睡眠障碍和疲劳是克罗恩病（CD）患者的常见症状。本研究旨在测试一种实用的、分阶段的护理干预措施治疗 CD 青少年和年轻患者睡眠质量差和疲劳的可行性和效果。
这是一项两阶段开放试验，探讨了睡眠和疲劳的干预措施。在最初的全面评估后，包括定量测量和访谈评估睡眠和身心健康，为期 12 周的干预措施包括两个连续步骤：1）炎症性肠病（IBD）的简短行为疗法睡眠（BBTS-I；4 周）和 2）对于继续经历疲劳的受试者，添加精神药物，安非他酮缓释剂（BUP-SR；8 周）。
在 18 个月的时间里，共对 232 名 CD 患者（中位年龄=24 岁，中位性别=女性）进行了评估，其中 112 名患者在匹兹堡睡眠质量指数（PSQI）和多维疲劳量表（MFI）上呈阳性，68 名 CD 患者完成了更全面的基线评估。在 68 名患者中，有 52 名患者参加了 BBTS-I 一期干预。经过 4 周的 BBTS-I 治疗后，睡眠质量（p <.001）和疲劳（p <.001）均有显著改善。作为第二阶段的一部分，在符合疲劳阈值标准的 52 名患者中，有 33 名患者参加了 BUP-SR+BBTS-I 组，而 19 名患者参加了 BBTS-I 单独干预组。经过 8 周的第二阶段治疗后，两组患者的睡眠、疲劳、焦虑和抑郁症状均有显著进一步改善，但两组间无显著差异。
分阶段护理方法表明，我们可以通过 BBTS-I 改善 CD 患者的睡眠障碍，但疲劳仅部分改善。对于选择将 BUP-SR 添加到行为治疗中的一部分患者，疲劳进一步改善，但与单独行为治疗相比，无统计学意义。
