Theppornpitak Wongpitak, Hemrungrojn Solaphat, Thienwiwatnukul Krittapas, Muntham Dittapol, Chirakalwasan Naricha, Srisawart Puntarik
Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Front Neurol. 2023 Jun 2;14:1180339. doi: 10.3389/fneur.2023.1180339. eCollection 2023.
To study the effectiveness of the first internet-based cognitive behavioral therapy for insomnia (CBT-i) in Thailand, using the Nitra application, for chronic subthreshold to moderate insomnia treatment.
An interventional study without a control group was conducted between January and June 2022. Participants were adults aged 18 years old and older with subthreshold to moderate severity of chronic insomnia (insomnia severity index (ISI) of 8-21) and had mean sleep efficiency <85% from baseline sleep diaries. Baseline sleep characteristics were obtained from questionnaires and sleep diaries from the Nitra application for 2 weeks. Eligible participants continued using the Nitra application for 4 weeks during the intervention period. Interventions including sleep restriction, stimulus control, cognitive restructuring, relaxation techniques, and sleep hygiene education were implemented the pre-programmed Nitra application. Post-intervention sleep characteristics were also obtained from questionnaires and sleep diaries from the Nitra application for another 1 week.
A total of 40 participants completed the study. All participants had a baseline sleep efficiency of less than 85% with the majority of the participants having a sleep-onset insomnia problem (98%). For the primary outcome, sleep efficiency was significantly improved after using the Nitra application ( < 0.001). Self-reported total sleep time, sleep onset latency, wake after sleep onset, early morning awakening, ISI, Pittsburgh Sleep Quality Index (PSQI), and average subjective sleep quality were also significantly improved ( < 0.001 for all parameters except = 0.017 for total sleep time and = 0.018 for wake after sleep onset). Participants who had a low baseline ISI and went to bed and woke up within 30 minutes of a designated bedtime and wake-up time recommended by the Nitra application for ≥70% of all nights demonstrated an increased chance of achieving normal sleep efficiency after using the Nitra application.
This first internet-based CBT-i in Thailand, using the Nitra application, effectively improved sleep efficiency and other sleep parameters in chronic subthreshold to moderate insomnia.
使用Nitra应用程序，研究泰国首个基于互联网的失眠认知行为疗法（CBT-i）对慢性亚阈值至中度失眠治疗的有效性。
2022年1月至6月进行了一项无对照组的干预性研究。参与者为18岁及以上的成年人，患有慢性失眠的亚阈值至中度严重程度（失眠严重程度指数（ISI）为8 - 21），且根据基线睡眠日记，平均睡眠效率<85%。通过问卷和Nitra应用程序的睡眠日记获取2周的基线睡眠特征。符合条件的参与者在干预期继续使用Nitra应用程序4周。干预措施包括睡眠限制、刺激控制、认知重构、放松技巧和睡眠卫生教育，这些措施通过预先编程的Nitra应用程序实施。干预后，同样通过问卷和Nitra应用程序的睡眠日记获取另外1周的睡眠特征。
共有40名参与者完成了研究。所有参与者的基线睡眠效率均低于85%，大多数参与者存在入睡失眠问题（98%）。对于主要结局，使用Nitra应用程序后睡眠效率显著提高（<0.001）。自我报告的总睡眠时间、入睡潜伏期、睡眠中觉醒、早醒、ISI、匹兹堡睡眠质量指数（PSQI）和平均主观睡眠质量也显著改善（所有参数<0.001，除总睡眠时间=0.017和睡眠中觉醒=0.018）。基线ISI较低且在Nitra应用程序推荐的指定就寝时间和起床时间的30分钟内上床睡觉和起床的参与者，在≥70%的夜晚，使用Nitra应用程序后实现正常睡眠效率的机会增加。
泰国首个基于互联网的使用Nitra应用程序的CBT-i有效改善了慢性亚阈值至中度失眠患者的睡眠效率和其他睡眠参数。
