抑郁、焦虑和压力症状对共病失眠和睡眠呼吸暂停患者认知行为疗法治疗失眠反应的影响：一项随机对照试验。
Effect of depression, anxiety, and stress symptoms on response to cognitive behavioral therapy for insomnia in patients with comorbid insomnia and sleep apnea: a randomized controlled trial.
机构信息
The Adelaide Institute for Sleep Health: A Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.
College of Education Psychology and Social Work, Flinders University, Bedford Park, South Australia, Australia.
出版信息
J Clin Sleep Med. 2021 Mar 1;17(3):545-554. doi: 10.5664/jcsm.8944.
STUDY OBJECTIVES
Patients with comorbid insomnia and sleep apnea (COMISA) report increased severity of depression, anxiety, and stress symptoms compared to patients with either insomnia or sleep apnea alone. Although cognitive behavioral therapy for insomnia (CBTi) is an effective treatment for COMISA, previous research suggests a reduced response to CBTi by patients with insomnia and depression, anxiety, and stress symptoms. Therefore, we used randomized controlled trial data to investigate the impact of depression, anxiety, and stress symptoms before treatment on changes in insomnia after CBTi vs control in patients with COMISA.
METHODS
145 patients with COMISA (insomnia as defined by the International Classification of Sleep Disorders, third edition and apnea-hypopnea index ≥ 15 events/h) were randomized to CBTi (n = 72) or no-treatment control (n = 73). One-week sleep diaries and standardized questionnaire measures of insomnia, sleepiness, fatigue, depression, anxiety, and stress were completed pretreatment and posttreatment. Mixed models were used to examine interactions between depression, anxiety, and stress symptoms before treatment, intervention-group (CBTi, control), and time (pretreatment, posttreatment) on insomnia symptoms.
RESULTS
Approximately half of this COMISA sample reported at least mild symptoms of depression (57%), anxiety (53%), and stress (48%) before treatment. Patients reporting greater depression, anxiety, and stress symptoms before treatment also reported increased severity of insomnia, daytime fatigue, and sleepiness. Improvements in questionnaire and diary-measured insomnia symptoms improved during CBTi and were not moderated by severity of depression, anxiety, or stress symptoms before treatment (all interaction P ≥ .11).
CONCLUSIONS
We found no evidence that symptoms of depression, anxiety, or stress impair the effectiveness of CBTi in improving insomnia symptoms in patients with COMISA. Patients with COMISA and comorbid symptoms of depression, anxiety, and stress should be referred for CBTi to treat insomnia and improve subsequent management of their obstructive sleep apnea.
CLINICAL TRIAL REGISTRATION
Registry: Australian New Zealand Clinical Trials Registry; Name: Treating comorbid insomnia with obstructive sleep apnea (COMISA) study: A new treatment strategy for patients with combined insomnia and sleep apnea; URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365184; Identifier: ACTRN12613001178730.
研究目的
与单独患有失眠或睡眠呼吸暂停的患者相比，同时患有失眠和睡眠呼吸暂停（COMISA）的患者报告抑郁、焦虑和压力症状的严重程度更高。虽然失眠的认知行为疗法（CBTi）是 COMISA 的有效治疗方法，但先前的研究表明，失眠和抑郁、焦虑和压力症状的患者对 CBTi 的反应降低。因此，我们使用随机对照试验数据来研究 COMISA 患者治疗前抑郁、焦虑和压力症状对 CBTi 与对照组治疗后失眠变化的影响。
方法
145 名 COMISA 患者（失眠定义为国际睡眠障碍分类，第三版和呼吸暂停-低通气指数≥15 次/小时）被随机分配到 CBTi（n=72）或无治疗对照组（n=73）。治疗前和治疗后完成一周的睡眠日记和失眠、嗜睡、疲劳、抑郁、焦虑和压力的标准化问卷测量。混合模型用于检查治疗前、干预组（CBTi、对照组）和时间（治疗前、治疗后）之间抑郁、焦虑和压力症状与失眠症状之间的交互作用。
结果
COMISA 样本中约有一半的患者在治疗前报告至少有轻度的抑郁（57%）、焦虑（53%）和压力（48%）症状。治疗前报告抑郁、焦虑和压力症状更严重的患者报告失眠、白天疲劳和嗜睡症状更严重。CBTi 期间，问卷和日记测量的失眠症状改善，治疗前抑郁、焦虑或压力症状的严重程度并未调节（所有交互 P≥.11）。
结论
我们没有发现抑郁、焦虑或压力症状会削弱 CBTi 改善 COMISA 患者失眠症状的有效性的证据。患有 COMISA 和共病性抑郁、焦虑和压力症状的患者应转介接受 CBTi 治疗失眠，并改善其阻塞性睡眠呼吸暂停的后续管理。
临床实验注册
注册机构：澳大利亚和新西兰临床试验注册中心；名称：治疗合并阻塞性睡眠呼吸暂停的失眠（COMISA）研究：一种治疗合并失眠和睡眠呼吸暂停患者的新治疗策略；网址：https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365184；标识符：ACTRN12613001178730。
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