共病抑郁和失眠患者的客观睡眠时间和联合药物治疗与认知行为失眠治疗的反应：来自 TRIAD 研究的报告。

Objective sleep duration and response to combined pharmacotherapy and cognitive behavioral insomnia therapy among patients with comorbid depression and insomnia: a report from the TRIAD study.

机构信息

National Jewish Health, Denver, Colorado.

Duke University Medical Center, Durham, North Carolina.

出版信息

J Clin Sleep Med. 2023 Jun 1;19(6):1111-1120. doi: 10.5664/jcsm.10514.

DOI:10.5664/jcsm.10514

PMID:36798983

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10235719/

Abstract

STUDY OBJECTIVES

Several studies have shown that patients with short sleep duration show a poor response to cognitive behavioral therapy for insomnia (CBT-I), but such studies have not included patients with comorbid conditions. The current study was conducted to determine whether pretreatment sleep duration moderates the response of patients with major depression and insomnia disorders to a combined CBT-I and antidepressant medication treatment.

METHODS

This study comprised a secondary analysis of a larger randomized trial that tested combined CBT-I/antidepressant medication treatment of patients with major depression and insomnia. Participants (n = 99; 70 women; M = 47.712.4 years) completed pretreatment polysomnography and then were randomly assigned to a 12-week treatment with antidepressant medication combined with CBT-I or a sham therapy. Short and longer sleepers were defined using total sleep time cutoffs of < 5, < 6, and < 7 hours for short sleep. Insomnia and depression remission ascertained respectively from the Insomnia Severity Index and Hamilton Rating Scale for Depression were used to compare treatment responses of short and longer sleepers defined by the cutoffs mentioned.

RESULTS

Logistic regression analyses showed that statistically significant results were obtained only when the cutoff of < 5 hours of sleep was used to define "short sleep." Both the CBT-I recipients with < 5 hours of sleep (odds ratio = 0.053; 95% confidence interval = 0.006-0.499) and the sham-therapy group with ≥ 5 hours of sleep (odds ratio = 0.149; 95% confidence interval = 0.045-0.493) were significantly less likely to achieve insomnia remission than were CBT-I recipients with ≥ 5 hours of sleep. The shorter sleeping CBT-I group (odds ratio = 0.118; 95% confidence interval = 0.020-0.714) and longer sleeping sham-therapy group (odds ratio = 0.321; 95% confidence interval = 0.105-0.983) were also less likely to achieve insomnia and/or depression remission than was the longer sleeping CBT-I group with ≥ 5 hours of sleep.

CONCLUSIONS

Sleeping < 5 hours may dispose comorbid major depression/insomnia patients to a poor response to combined CBT-I/medication treatments for their insomnia and depression. Future studies to replicate these findings and explore mechanisms of treatment response seem warranted.

CLINICAL TRIAL REGISTRATION

Registry: ClinicalTrials.gov; Name: Treatment of Insomnia and Depression (TRIAD); URL: https://clinicaltrials.gov/ct2/show/results/NCT00767624; Identifier: NCT00767624.

CITATION

Edinger JD, Smith ED, Buysse DJ, et al. Objective sleep duration and response to combined pharmacotherapy and cognitive behavioral insomnia therapy among patients with comorbid depression and insomnia: a report from the TRIAD study. . 2023;19(6):1111-1120.

摘要

研究目的

多项研究表明，睡眠时间短的患者对失眠的认知行为疗法（CBT-I）反应不佳，但这些研究并未纳入合并症患者。本研究旨在确定主要抑郁症和失眠障碍患者的预处理睡眠时间是否会影响 CBT-I 和抗抑郁药物联合治疗的反应。

方法

这是一项更大的随机试验的二次分析，该试验测试了 CBT-I/抗抑郁药物联合治疗主要抑郁症和失眠症患者。参与者（n=99；70 名女性；M=47.71±2.4 岁）完成了预处理多导睡眠图检查，然后随机分配接受为期 12 周的抗抑郁药物联合 CBT-I 或假治疗。使用总睡眠时间的截止值<5、<6 和<7 小时来定义短睡眠者和长睡眠者，以分别确定从失眠严重程度指数和汉密尔顿抑郁评定量表中确定的失眠和抑郁缓解情况，以比较通过上述截止值定义的短睡眠者和长睡眠者的治疗反应。

结果

逻辑回归分析显示，仅当使用<5 小时的睡眠时间来定义“短睡眠”时，才会得到统计学上显著的结果。睡眠时间<5 小时的 CBT-I 治疗组（比值比=0.053；95%置信区间=0.006-0.499）和睡眠时间≥5 小时的假治疗组（比值比=0.149；95%置信区间=0.045-0.493）与睡眠时间≥5 小时的 CBT-I 治疗组相比，失眠缓解的可能性显著降低。睡眠时间较短的 CBT-I 组（比值比=0.118；95%置信区间=0.020-0.714）和睡眠时间较长的假治疗组（比值比=0.321；95%置信区间=0.105-0.983）与睡眠时间≥5 小时的 CBT-I 治疗组相比，失眠和/或抑郁缓解的可能性也较低。