Turkowitch David, Ludwig Rebecca, Nelson Eryen, Drerup Michelle, Siengsukon Catherine F
Department of Physical Therapy, Rehabilitation Science, And Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA.
Sleep Disorders Clinic, Cleveland Clinic, Cleveland, OH, USA.
Mult Scler Int. 2022 Mar 2;2022:7110582. doi: 10.1155/2022/7110582. eCollection 2022.
Over 50% of individuals with multiple sclerosis (MS) have moderate or severe sleep disturbances, insomnia being the most common. In-person cognitive behavioral therapy for insomnia (F2F-CBTi) is currently the first-line treatment for insomnia. However, given potential limitations to access including mobility difficulty, fatigue, or living in a rural area, telehealth-delivered CBT-I (tele-CBTi) has been considered as an alternative treatment. The purpose of this study was to assess the feasibility and treatment effect of tele-CBTi in people with MS and compare it to outcomes from a F2F-CBTi study in individuals with MS.
11 individuals with MS and symptoms of insomnia participated in 6 weekly CBT-I sessions with a trained CBT-I provider via live video. Insomnia severity (ISI), sleep quality (PSQI), and fatigue severity (FSS and MFIS) were assessed pre- and posttreatment as primary outcomes. Sleep onset latency (SOL), sleep efficiency (SE) and total sleep time (TST) from the PSQI, depression (PHQ-9), anxiety (GAD-7), sleep self-efficacy (SSES), and quality of life (MSIS-29) were also assessed pre- and posttreatment as secondary outcomes.
Participants resided in 9 different states. Retention and adherence rates were 100%. There were significant improvements in ISI, PSQI, MFIS, FSS, SOL, SSES, PHQ-9, and MSIS-29, but not SE, TST, or GAD-7. There were no significant differences between the F2F-CBTi group and tele-CBTi group for magnitude of change in the primary outcomes (ISI, PSQI, MFIS, and FSS) or the secondary outcomes (SOL, SE, TST, SSES, PHQ-9, GAD-7, and MSIS-29).
Tele-CBTi is feasible and has outcome measures that are similar to that of in-person CBT-I treatment. Tele-CBTi may increase access to insomnia treatment in individuals with MS.
超过50%的多发性硬化症（MS）患者存在中度或重度睡眠障碍，其中失眠最为常见。面对面认知行为疗法治疗失眠（F2F-CBTi）是目前治疗失眠的一线疗法。然而，鉴于包括行动不便、疲劳或居住在农村地区等获取治疗的潜在限制，远程医疗提供的CBT-I（远程CBTi）被视为一种替代治疗方法。本研究的目的是评估远程CBTi对MS患者的可行性和治疗效果，并将其与MS患者的F2F-CBTi研究结果进行比较。
11名患有MS且有失眠症状的患者通过实时视频与一名经过培训的CBT-I提供者参加了为期6周的CBT-I课程。治疗前和治疗后评估失眠严重程度（ISI）、睡眠质量（PSQI）和疲劳严重程度（FSS和MFIS）作为主要结局指标。还评估了PSQI中的入睡潜伏期（SOL）、睡眠效率（SE）和总睡眠时间（TST）、抑郁（PHQ-9）、焦虑（GAD-7）、睡眠自我效能感（SSES）和生活质量（MSIS-29）作为次要结局指标。
参与者居住在9个不同的州。保留率和依从率均为100%。ISI、PSQI、MFIS、FSS、SOL、SSES、PHQ-9和MSIS-29有显著改善，但SE、TST或GAD-7没有改善。F2F-CBTi组和远程CBTi组在主要结局指标（ISI、PSQI、MFIS和FSS）或次要结局指标（SOL、SE、TST、SSES、PHQ-9、GAD-7和MSIS-29）的变化幅度上没有显著差异。
远程CBTi是可行的，其结局指标与面对面CBT-I治疗相似。远程CBTi可能会增加MS患者获得失眠治疗的机会。
