Zhang Chenxi, Zeng Shufei, Xu Yan, Liu Shuai, Du Shixu, Fang Leqin, Lv Zhihong, Zhang Lili, Zhang Bin
Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Center of Sleep Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Gen Psychiatr. 2023 May 22;36(3):e101013. doi: 10.1136/gpsych-2023-101013. eCollection 2023.
Cognitive-behavioural therapy for insomnia (CBTi) is the first-line treatment for those with this sleep disorder. However, depressive and anxiety symptoms often co-occur with acute insomnia, which may affect the effectiveness of CBTi treatment.
This study aimed to determine the impact of depressive and anxiety symptoms on the efficacy of CBTi in treating acute insomnia.
A single-arm clinical trial was conducted among individuals who have acute insomnia. Participants underwent self-guided CBTi for 1-week. Their insomnia, depressive symptoms and anxiety symptoms were evaluated using the Insomnia Severity Index and the Hospital Anxiety and Depression Scale at baseline, post-treatment and 3-month follow-up. Repeated measures analysis of variance was used to assess the effectiveness of CBTi in treating insomnia, depressive symptoms and anxiety symptoms. A multivariate Cox regression model was used to determine the impact of depressive and anxiety symptoms on insomnia.
The study found significant reductions in insomnia, depressive symptoms and anxiety symptoms at both post-treatment and 3-month follow-up (F=17.45, p<0.001; F=36.37, p=0.001; and F=81.51, p<0.001, respectively). The duration of CBTi treatment had a positive impact on insomnia recovery (hazard ratio (HR)=0.94, p=0.018). However, baseline depressive symptoms (HR=1.83, p=0.004) and baseline anxiety symptoms (HR=1.99, p=0.001) had significant negative effects on insomnia recovery.
The study showed that a 1-week self-guided CBTi treatment is effective in treating acute insomnia and comorbid depressive and anxiety symptoms. However, baseline depressive and anxiety symptoms negatively impact treatment effectiveness. Therefore, clinicians should assess for depressive and anxiety symptoms before treating acute insomnia with monotherapy CBTi.
失眠的认知行为疗法（CBTi）是这种睡眠障碍患者的一线治疗方法。然而，抑郁和焦虑症状常与急性失眠同时出现，这可能会影响CBTi治疗的效果。
本研究旨在确定抑郁和焦虑症状对CBTi治疗急性失眠疗效的影响。
对患有急性失眠的个体进行了一项单臂临床试验。参与者接受了为期1周的自我指导CBTi治疗。在基线、治疗后和3个月随访时，使用失眠严重程度指数和医院焦虑抑郁量表评估他们的失眠、抑郁症状和焦虑症状。采用重复测量方差分析来评估CBTi治疗失眠、抑郁症状和焦虑症状的有效性。使用多变量Cox回归模型来确定抑郁和焦虑症状对失眠的影响。
研究发现，治疗后和3个月随访时，失眠、抑郁症状和焦虑症状均有显著减轻（分别为F = 17.45，p < 0.001；F = 36.37，p = 0.001；F = 81.51，p < 0.001）。CBTi治疗的持续时间对失眠恢复有积极影响（风险比（HR）= 0.94，p = 0.018）。然而，基线抑郁症状（HR = 1.83，p = 0.004）和基线焦虑症状（HR = 1.99，p = 0.001）对失眠恢复有显著负面影响。
研究表明，为期1周的自我指导CBTi治疗对治疗急性失眠以及合并的抑郁和焦虑症状有效。然而，基线抑郁和焦虑症状会对治疗效果产生负面影响。因此，临床医生在用CBTi单一疗法治疗急性失眠之前，应评估抑郁和焦虑症状。
