Department of Psychology, Sungshin University, Seongbuk-gu, Republic of Korea.
Behav Sleep Med. 2023 May-Jun;21(3):332-343. doi: 10.1080/15402002.2022.2093880. Epub 2022 Jun 27.
Sleep reactivity is the trait-like degree to which stress disrupts sleep, resulting in difficulty falling and staying asleep. Although previous studies have suggested that individuals who have high sleep reactivity may be resistant to cognitive-behavioral therapy for insomnia (CBT-I) effects, there have been no studies that have investigated this empirically. This study explored differential treatment responses in CBT-I based on sleep reactivity levels.
Participants for this study were nineteen insomnia patients who met DSM-5 criteria for insomnia disorder. All participants received four weekly sessions of structured cognitive-behavioral therapy for insomnia (CBT-I). Individuals completed the Insomnia Severity Index (ISI), Korean version of Center for Epidemiologic Studies Depression Scale-Revised (K-CESD-R), Ford Insomnia Response to Stress Test (FIRST), Dysfunctional Beliefs and Attitudes about Sleep Scale-16 (DBAS-16), the Daily Inventory of Stressful Events (DISE) and a sleep diary. Participants were classified into two groups based on sleep reactivity level (high and low sleep reactivity).
Following treatment, significant changes were found for ISI, K-CESD-R, DBAS-16 and FIRST scores, sleep onset latency, wake after sleep onset, sleep efficiency, number of awakenings, sleep quality and feeling refreshed upon awakening in both groups. Improvements in sleep efficiency was lower in the high sleep reactivity group compared to the low sleep reactivity group. No differences in ISI, K-CESD-R, DBAS-16 scores, and stress event frequency during the treatment duration were found between groups.
These findings suggest that sleep reactivity level may be an important factor that affects treatment outcome of CBT-I. Furthermore, the results may suggest that individual response to stress events are more important than the stressor itself.
睡眠反应性是指压力对睡眠的干扰程度，导致入睡和保持睡眠困难的特质。尽管先前的研究表明，睡眠反应性高的个体可能对认知行为疗法治疗失眠（CBT-I）的效果有抵抗力，但还没有研究从实证角度对此进行研究。本研究探讨了基于睡眠反应性水平的 CBT-I 的差异治疗反应。
本研究的参与者为 19 名符合 DSM-5 失眠障碍标准的失眠患者。所有参与者都接受了为期四周的结构化认知行为疗法治疗失眠（CBT-I）。个体完成了失眠严重程度指数（ISI）、韩国版流行病学研究抑郁量表修订版（K-CESD-R）、福特失眠应激反应测试（FIRST）、睡眠障碍信念和态度量表-16 版（DBAS-16）、每日应激事件清单（DISE）和睡眠日记。根据睡眠反应性水平（高和低睡眠反应性）将参与者分为两组。
治疗后，两组的 ISI、K-CESD-R、DBAS-16 和 FIRST 评分、入睡潜伏期、睡眠后觉醒、睡眠效率、觉醒次数、睡眠质量和醒来时的感觉均有显著变化。与低睡眠反应性组相比，高睡眠反应性组的睡眠效率改善较低。在治疗期间，两组之间的 ISI、K-CESD-R、DBAS-16 评分和应激事件频率没有差异。
这些发现表明，睡眠反应性水平可能是影响 CBT-I 治疗效果的一个重要因素。此外，结果可能表明，个体对应激事件的反应比应激源本身更为重要。
