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认知行为疗法治疗失眠症可减少共病失眠和重度抑郁症患者的活动记录仪和日记测量的睡眠差异：来自 TRIAD 研究的报告。

Cognitive behavioural therapy for insomnia reduces actigraphy and diary measured sleep discrepancy for individuals with comorbid insomnia and major depressive disorder: A report from the TRIAD study.

机构信息

Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia.

出版信息

Sleep Med. 2024 Feb;114:137-144. doi: 10.1016/j.sleep.2023.12.014. Epub 2023 Dec 24.

DOI:10.1016/j.sleep.2023.12.014

PMID:38183804

Abstract

OBJECTIVE/BACKGROUND: Discrepancies between sleep diaries and actigraphy occur among individuals with insomnia. Cognitive behavioural therapy for insomnia (CBT-I) improves insomnia but the impact on discrepancy is unclear. This study examined CBT-I's effects on actigraphy-diary discrepancy and explored sleep-related beliefs and attitudes as a mediator.

PATIENTS/METHODS: Participants were 108 (age M±SD = 47.23 ± 12.42, 67.60 % female) adults with insomnia and major depressive disorder from the Treatment of Insomnia and Depression study. They were randomized to 7 sessions of CBT-I or sham Quasi-Desensitization Therapy for Insomnia (DTI), plus 16 weeks of antidepressants. Two weeks of actigraphy and sleep diary were collected at baseline, mid-treatment, end-treatment. Differences between sleep diary and actigraphy total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), and sleep efficiency (SE) were calculated. Participants completed Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS) at baseline and mid-treatment.

RESULTS

At baseline, diary (versus actigraphy) TST was shorter (1.1 ± 1.41h), whilst SOL (21.64 ± 41.25min) and WASO (17.45 ± 61.99min) were longer. Mixed effects models using daily data showed that after adjusting for age and sex, participants in the CBT-I group (versus DTI) showed greater reduction in all actigraphy-diary discrepancy domains (all p-values<.01), reductions evident from mid-treatment. Group differences on actigraphy-diary discrepancy reductions in TST, SOL, and SE (not WASO) were mediated by changes in DBAS from baseline to mid-treatment (all p-values<.05). Changes in discrepancy did not mediate insomnia symptom changes (p-values>.39).

CONCLUSIONS

CBT-I reduced actigraphy-diary discrepancy in individuals with comorbid insomnia and depression; this reduction was associated with improved sleep-related attitudes, a therapeutic target of CBT-I.

CLINICAL TRIAL REGISTRATION

TRIAD (Treatment of Insomnia and Depression): Improving Depression Outcome by Adding Insomnia Therapy to Antidepressants. Prospectively registered with Clinical Trials (NCT00767624).

SUPPORT (IF ANY): MH078924, MH078961, MH079256.

摘要

目的/背景：在失眠患者中，睡眠日记和活动记录仪之间存在差异。失眠的认知行为疗法（CBT-I）可改善失眠，但对差异的影响尚不清楚。本研究旨在探讨 CBT-I 对活动记录仪-日记差异的影响，并探讨睡眠相关信念和态度作为中介因素。

患者/方法：共有 108 名（年龄 M±SD=47.23±12.42，67.60%为女性）患有失眠和重度抑郁症的成年人参加了失眠和抑郁症的治疗研究，他们被随机分为接受 7 次 CBT-I 或假性脱敏治疗失眠（DTI），加用 16 周抗抑郁药。基线、治疗中期和治疗结束时收集了两周的活动记录仪和睡眠日记。计算睡眠日记和活动记录仪总睡眠时间（TST）、睡眠潜伏期（SOL）、睡眠后觉醒（WASO）和睡眠效率（SE）的差异。参与者在基线和治疗中期完成了睡眠障碍信念和态度量表（DBAS）。

结果

基线时，日记（与活动记录仪相比）TST 较短（1.1±1.41h），而 SOL（21.64±41.25min）和 WASO（17.45±61.99min）较长。使用每日数据的混合效应模型表明，在调整年龄和性别后，CBT-I 组（与 DTI 组相比）在所有活动记录仪-日记差异领域的差异减少（均 p 值<.01），这种差异从治疗中期开始出现。在 TST、SOL 和 SE（而非 WASO）方面，从基线到治疗中期，DBAS 的变化介导了组间在活动记录仪-日记差异减少方面的差异（均 p 值<.05）。差异变化并未介导失眠症状的变化（p 值>.39）。