睡眠相关信念障碍的改变与老年失眠退伍军人的睡眠及其他健康结果的改变相关：一项随机对照试验的结果。
Change in Dysfunctional Sleep-Related Beliefs is Associated with Changes in Sleep and Other Health Outcomes Among Older Veterans With Insomnia: Findings From a Randomized Controlled Trial.
机构信息
School of Nursing, University of California, Los Angeles, CA, USA.
Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, CAUSA.
出版信息
Ann Behav Med. 2022 Jan 1;56(1):35-49. doi: 10.1093/abm/kaab030.
BACKGROUND
Cognitive behavioral therapy for insomnia (CBTI) targets changing dysfunctional sleep-related beliefs. The impact of these changes on daytime functioning in older adults is unknown.
PURPOSE
We examined whether changes in sleep-related beliefs from pre- to post-CBTI predicted changes in sleep and other outcomes in older adults.
METHOD
Data included 144 older veterans with insomnia from a randomized controlled trial testing CBTI. Sleep-related beliefs were assessed with the Dysfunctional Beliefs and Attitudes about Sleep-16 (DBAS-16, subscales: Consequences, Worry/Helplessness, Sleep Expectations, Medication). Outcomes included sleep diary variables, actigraphy-measured sleep efficiency, Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Flinders Fatigue Scale (FFS), Patient Health Questionnaire-9, and health-related quality of life. Analyses compared slope of change in DBAS subscales from baseline to posttreatment between CBTI and control, and assessed the relationship between DBAS change and the slope of change in outcomes from baseline to 6 months.
RESULTS
Compared to controls, the CBTI group demonstrated stronger associations between improvement in DBAS-Consequences and subsequent improvement in PSQI, ISI, ESS, and FFS. The CBTI group also demonstrated stronger associations between improvement in DBAS-Worry/Helplessness and subsequent improvements in PSQI, ISI, and FFS; improvements in DBAS-Medication and PSQI; and improvements in DBAS-Sleep Expectations and wake after sleep onset (sleep diary) and FFS (all p < .05).
CONCLUSIONS
Significant reduction in dysfunctional sleep-related beliefs following CBTI in older adults predicted improvement in several outcomes of sleep and daytime functioning. This suggests the importance of addressing sleep-related beliefs for sustained improvement with CBTI in older veterans.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT00781963.
背景
针对失眠的认知行为疗法（CBTI）旨在改变与睡眠相关的功能失调性信念。这些变化对老年人日间功能的影响尚不清楚。
目的
我们研究了 CBTI 前后睡眠相关信念的变化是否可以预测老年人睡眠和其他结果的变化。
方法
数据来自一项针对 CBTI 的随机对照试验，共纳入 144 名患有失眠的老年退伍军人。采用睡眠相关信念量表（DBAS-16，子量表：后果、担忧/无助、睡眠期望、药物）评估睡眠相关信念。结果包括睡眠日记变量、活动记录仪测量的睡眠效率、匹兹堡睡眠质量指数（PSQI）、失眠严重程度指数（ISI）、艾普沃斯嗜睡量表（ESS）、弗林德斯疲劳量表（FFS）、患者健康问卷-9（PHQ-9）和健康相关生活质量。分析比较了 CBTI 和对照组从基线到治疗后 DBAS 子量表变化的斜率，并评估了 DBAS 变化与从基线到 6 个月期间结果变化斜率之间的关系。
结果
与对照组相比，CBTI 组在 DBAS-后果改善与 PSQI、ISI、ESS 和 FFS 随后改善之间表现出更强的关联。CBTI 组在 DBAS-担忧/无助改善与 PSQI、ISI 和 FFS 随后改善之间，DBAS-药物改善与 PSQI 改善之间，DBAS-睡眠期望改善与睡眠后觉醒（睡眠日记）和 FFS 改善之间也表现出更强的关联（均 p<.05）。
结论
在老年患者中，CBTI 后功能失调性睡眠相关信念的显著减少预测了多项睡眠和日间功能结果的改善。这表明，对于老年退伍军人 CBTI 的持续改善，解决睡眠相关信念非常重要。
试验注册
ClinicalTrials.gov 标识符：NCT00781963。
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