Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.
St Olavs University Hospital, Østmarka, Trondheim, Norway.
J Sleep Res. 2022 Oct;31(5):e13572. doi: 10.1111/jsr.13572. Epub 2022 Feb 27.
Using data from 1721 participants in a community-based randomized control trial of digital cognitive behavioural therapy for insomnia compared with patient education, we employed linear mixed modelling analyses to examine whether chronotype moderated the benefits of digital cognitive behavioural therapy for insomnia on self-reported levels of insomnia severity, fatigue and psychological distress. Baseline self-ratings on the reduced version of the Horne-Östberg Morningness-Eveningness Questionnaire were used to categorize the sample into three chronotypes: morning type (n = 345; 20%); intermediate type (n = 843; 49%); and evening type (n = 524; 30%). Insomnia Severity Index, Chalder Fatigue Questionnaire, and Hospital Anxiety and Depression Scale were assessed pre- and post-intervention (9 weeks). For individuals with self-reported morning or intermediate chronotypes, digital cognitive behavioural therapy for insomnia was superior to patient education on all ratings (Insomnia Severity Index, Chalder Fatigue Questionnaire, and Hospital Anxiety and Depression Scale) at follow-up (p-values ≤ 0.05). For individuals with self-reported evening chronotype, digital cognitive behavioural therapy for insomnia was superior to patient education for Insomnia Severity Index and Chalder Fatigue Questionnaire, but not on the Hospital Anxiety and Depression Scale (p = 0.139). There were significant differences in the treatment effects between the three chronotypes on the Insomnia Severity Index (p = 0.023) estimated difference between evening and morning type of -1.70, 95% confidence interval: -2.96 to -0.45, p = 0.008, and estimated difference between evening and intermediate type -1.53, 95% confidence interval: -3.04 to -0.03, p = 0.046. There were no significant differences in the treatment effects between the three chronotypes on the Chalder Fatigue Questionnaire (p = 0.488) or the Hospital Anxiety and Depression Scale (p = 0.536). We conclude that self-reported chronotype moderates the effects of digital cognitive behavioural therapy for insomnia on insomnia severity, but not on psychological distress or fatigue.
使用来自 1721 名参与基于社区的数字认知行为疗法治疗失眠的随机对照试验的数据，我们采用线性混合模型分析来研究时型是否调节了数字认知行为疗法治疗失眠对自我报告的失眠严重程度、疲劳和心理困扰的益处。使用简化版 Horne-Östberg 清晨-傍晚时型问卷的基线自我评估将样本分为三种时型：晨型（n=345；20%）；中间型（n=843；49%）；和晚型（n=524；30%）。在干预前（9 周）和干预后评估失眠严重程度指数、Chalder 疲劳问卷和医院焦虑和抑郁量表。对于自我报告的晨型或中间型个体，数字认知行为疗法治疗失眠在所有评分（失眠严重程度指数、Chalder 疲劳问卷和医院焦虑和抑郁量表）上均优于患者教育，在随访时（p 值≤0.05）。对于自我报告的晚型个体，数字认知行为疗法治疗失眠在失眠严重程度指数和 Chalder 疲劳问卷方面优于患者教育，但在医院焦虑和抑郁量表上则不然（p=0.139）。三种时型的治疗效果在失眠严重程度指数上存在显著差异（p=0.023），晚型与晨型之间的估计差异为-1.70，95%置信区间为-2.96 至-0.45，p=0.008，晚型与中间型之间的估计差异为-1.53，95%置信区间为-3.04 至-0.03，p=0.046。三种时型在 Chalder 疲劳问卷（p=0.488）或医院焦虑和抑郁量表（p=0.536）上的治疗效果没有显著差异。我们的结论是，自我报告的时型调节了数字认知行为疗法治疗失眠对失眠严重程度的影响，但对心理困扰或疲劳没有影响。
