认知行为疗法与健康教育对脑外伤后睡眠障碍和疲劳的作用比较：一项初步随机试验。

Cognitive behavioural therapy versus health education for sleep disturbance and fatigue after acquired brain injury: A pilot randomised trial.

机构信息

Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia; Monash Epworth Rehabilitation Research Centre, Melbourne, VIC, Australia; Department of Psychology, Epworth Rehabilitation, Melbourne, VIC, Australia.

出版信息

Ann Phys Rehabil Med. 2021 Sep;64(5):101560. doi: 10.1016/j.rehab.2021.101560. Epub 2021 Aug 5.

DOI:10.1016/j.rehab.2021.101560

PMID:34311119

Abstract

BACKGROUND

Sleep disturbance and fatigue are highly prevalent after acquired brain injury (ABI) and are associated with poor functional outcomes. Cognitive behavioural therapy (CBT) is a promising treatment for sleep and fatigue problems after ABI, although comparison with an active control is needed to establish efficacy.

OBJECTIVES

We compared CBT for sleep disturbance and fatigue (CBT-SF) with a health education (HE) intervention to control for non-specific therapy effects.

METHODS

In a parallel-group, pilot randomised controlled trial, 51 individuals with traumatic brain injury (n = 22) and stroke (n = 29) and clinically significant sleep and/or fatigue problems were randomised 2:1 to 8 weeks of a CBT-SF (n = 34) or HE intervention (n = 17), both adapted for cognitive impairments. Participants were assessed at baseline, post-treatment, and 2 and 4 months post-treatment. The primary outcome was the Pittsburgh Sleep Quality Index; secondary outcomes included measures of fatigue, sleepiness, mood, quality of life, activity levels, self-efficacy and actigraphy sleep measures.

RESULTS

The CBT-SF led to significantly greater improvements in sleep quality as compared with HE, during treatment and at 2 months [95% confidence interval (CI) -24.83; -7.71], as well as significant reductions in fatigue maintained at all time points, which were not evident with HE (95% CI -1.86; 0.23). HE led to delayed improvement in sleep quality at 4 months post-treatment and in depression (95% CI -1.37; -0.09) at 2 months post-treatment. CBT-SF led to significant gains in self-efficacy (95% CI 0.15; 0.53) and mental health (95% CI 1.82; 65.06).

CONCLUSIONS

CBT-SF can be an effective treatment option for sleep disturbance and fatigue after ABI, over and above HE. HE may provide delayed benefit for sleep, possibly by improving mood.

TRIAL REGISTRATION

Australia New Zealand Clinical Trials Registry: ACTRN12617000879369 (registered 15/06/2017) and ACTRN12617000878370 (registered 15/06/2017).

摘要

背景

脑损伤后睡眠障碍和疲劳非常普遍，与功能预后不良有关。认知行为疗法（CBT）是一种有前途的脑损伤后睡眠和疲劳问题的治疗方法，但需要与积极对照进行比较以确定疗效。

目的

我们比较了针对睡眠障碍和疲劳的认知行为疗法（CBT-SF）与健康教育（HE）干预，以控制非特异性治疗效果。

方法

在一项平行组、试点随机对照试验中，51 名创伤性脑损伤（n=22）和中风（n=29）患者和有临床意义的睡眠和/或疲劳问题的患者按 2:1 随机分为 8 周的 CBT-SF（n=34）或 HE 干预（n=17），两者均针对认知障碍进行了调整。参与者在基线、治疗后以及治疗后 2 个月和 4 个月进行评估。主要结局指标是匹兹堡睡眠质量指数；次要结局指标包括疲劳、嗜睡、情绪、生活质量、活动水平、自我效能和活动记录仪睡眠测量。

结果

与 HE 相比，CBT-SF 在治疗期间和治疗后 2 个月时显著改善了睡眠质量（95%置信区间 [CI] -24.83；-7.71），并且在所有时间点都显著减轻了疲劳，而 HE 则没有（95% CI -1.86；0.23）。HE 在治疗后 4 个月时睡眠质量改善延迟，在治疗后 2 个月时抑郁症状改善（95% CI -1.37；-0.09）。CBT-SF 显著提高了自我效能（95% CI 0.15；0.53）和心理健康（95% CI 1.82；65.06）。