慢性阻塞性肺疾病合并失眠的成年人的行为干预与症状群变化
Behavioral interventions and symptom cluster change in adults with chronic obstructive pulmonary disease and insomnia.
作者信息
Jun Jeehye, Park Chang, Fritschi Cynthia, Balserak Bilgay, Martyn-Nemeth Pamela, Kuna Samuel, Kapella Mary
机构信息
Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea.
College of Nursing, University of Illinois Chicago, Chicago, IL, USA.
出版信息
Heart Lung. 2024 Mar-Apr;64:6-13. doi: 10.1016/j.hrtlng.2023.11.001. Epub 2023 Nov 15.
BACKGROUND
People with chronic obstructive pulmonary disease (COPD) and insomnia experience multiple co-occurring symptoms, but no studies have examined symptom cluster change over time in this population.
OBJECTIVES
This study explored longitudinal patterns of symptom cluster profiles for adults with COPD and insomnia and evaluated whether behavioral interventions were associated with changes in symptom cluster profiles.
METHODS
This study included 91 adults with COPD and insomnia who participated in a randomized trial of cognitive behavioral therapy for insomnia (CBT-I) and COPD education. The pre-specified symptom cluster included insomnia, dyspnea, fatigue, anxiety, and depression. Latent profile analysis identified participant groups with distinct symptom cluster profiles at baseline, immediately post-intervention, and at 3-month follow-up; latent transition analysis then estimated the probability of group membership change over time. Multinomial logistic regression was used to determine whether the interventions were associated with changes in symptom cluster profiles.
RESULTS
Three groups were identified at each of three time-points: Class 1 (low symptom burden), Class 2 (intermediate), and Class 3 (high). Classes 1 and 2 showed less movement to other classes (16 % and 38 %, respectively), whereas Class 3 showed greater transition (64 %). The CBT-I intervention was significantly associated with movement to a lower symptom burden group (Class 3 to 2 or 2 to 1).
CONCLUSIONS
CBT-I, with or without COPD education, shows promise as a tailored intervention to reduce symptom burden in the study population. Study findings will facilitate development of interventions to reduce the severity of multiple co-occurring symptoms in people with COPD and insomnia.
CLINICAL TRIAL REGISTRATION
Registry: ClinicalTrials.gov; Name: A Behavioral Therapy for Insomnia Co-existing with COPD; Identifier: NCT01973647.
背景
慢性阻塞性肺疾病（COPD）患者和失眠患者存在多种并发症状，但尚无研究考察该人群症状簇随时间的变化情况。
目的
本研究探讨了COPD合并失眠的成年人症状簇特征的纵向模式，并评估行为干预是否与症状簇特征的变化相关。
方法
本研究纳入了91名患有COPD和失眠的成年人，他们参与了一项针对失眠的认知行为疗法（CBT-I）和COPD教育的随机试验。预先设定的症状簇包括失眠、呼吸困难、疲劳、焦虑和抑郁。潜在剖面分析确定了在基线、干预后即刻和3个月随访时具有不同症状簇特征的参与者组；然后，潜在转换分析估计了随时间组归属变化的概率。多项逻辑回归用于确定干预措施是否与症状簇特征的变化相关。
结果
在三个时间点的每一个时间点都确定了三组：第1组（低症状负担）、第2组（中等）和第3组（高）。第1组和第2组向其他组的转变较少（分别为16%和38%），而第3组的转变较大（64%）。CBT-I干预与向症状负担较低的组（从第3组到第2组或从第2组到第1组）的转变显著相关。
结论
无论有无COPD教育，CBT-I都有望作为一种针对性干预措施，减轻研究人群的症状负担。研究结果将有助于开发干预措施，以减轻COPD合并失眠患者多种并发症状的严重程度。
临床试验注册
注册机构：ClinicalTrials.gov；名称：一种治疗与COPD并存的失眠的行为疗法；标识符：NCT01973647。
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