Sandahl Hinuga, Jennum Poul, Baandrup Lone, Lykke Mortensen Erik, Carlsson Jessica
Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services in the Capital Region of Denmark, Ballerup, Denmark.
Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
J Sleep Res. 2021 Aug;30(4):e13276. doi: 10.1111/jsr.13276. Epub 2021 Feb 2.
Sleep disturbances are frequently part of the symptomatology in refugees with post-traumatic stress disorder (PTSD). It has been suggested that targeting sleep disturbances may enhance the outcome of PTSD treatment. However, randomized studies on the effect of treatment focusing on sleep disturbances in refugees with PTSD are lacking. The aim of this study was to examine add-on treatment with imagery rehearsal therapy (IRT) and/or mianserin against treatment as usual (TAU) alone in a sample of trauma-affected refugees with PTSD at 8-12 months follow-up. In a randomized controlled trial, 219 adult refugees diagnosed with PTSD and suffering from sleep disturbances were randomized to four groups (1:1:1:1) receiving, respectively, TAU, TAU + mianserin, TAU + IRT, and TAU + IRT + mianserin. The primary outcome was subjective sleep quality (Pittsburgh Sleep Quality Index) and the secondary outcomes included PTSD and depression symptoms, level of functioning and subjective well-being. The data were analysed using mixed models. The only significant effect of IRT was on level of functioning (p = .040, ES 0.44), whereas there was no significant effect of mianserin on any of the measured outcomes. Low adherence to both IRT (39%) and mianserin (20%) was observed. Contrary to our hypothesis, we did not find IRT or mianserin to be superior to TAU. The low adherence may potentially cause an underestimation of the effect of IRT and mianserin and indicates a necessity to further analyse the complex factors that may impact the motivation and ability of trauma-affected refugees to participate in and profit from available treatment options.
睡眠障碍常常是创伤后应激障碍（PTSD）难民症状表现的一部分。有人提出，针对睡眠障碍进行治疗可能会提高PTSD的治疗效果。然而，目前缺乏关于聚焦睡眠障碍治疗对PTSD难民影响的随机研究。本研究的目的是在8至12个月的随访中，考察在接受常规治疗（TAU）基础上，加用意象重练疗法（IRT）和/或米安色林治疗受创伤难民PTSD样本的效果。在一项随机对照试验中，219名被诊断患有PTSD且存在睡眠障碍的成年难民被随机分为四组（1:1:1:1），分别接受TAU、TAU + 米安色林、TAU + IRT以及TAU + IRT + 米安色林治疗。主要结局指标为主观睡眠质量（匹兹堡睡眠质量指数），次要结局指标包括PTSD和抑郁症状、功能水平及主观幸福感。数据采用混合模型进行分析。IRT唯一显著的效果体现在功能水平方面（p = 0.040，效应量0.44），而米安色林对任何测量结局均无显著影响。观察到IRT（39%）和米安色林（20%）的依从性均较低。与我们的假设相反，我们并未发现IRT或米安色林优于TAU。低依从性可能会低估IRT和米安色林的效果，这表明有必要进一步分析可能影响受创伤难民参与并从现有治疗方案中获益的动机和能力的复杂因素。
