Wei Jia, Song Mingfen, Mao Hong Jing, Qi Ruobing, Yang Lili, Xu You, Yan Pan, Hu Linlin
Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310013, People's Republic of China.
Sleep Medicine Center, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310013, People's Republic of China.
Nat Sci Sleep. 2024 Sep 13;16:1365-1376. doi: 10.2147/NSS.S486288. eCollection 2024.
The effectiveness of medication combined with smartphone-delivered cognitive behavioral therapy for insomnia (CBT-I) has been well verified, but there are few studies on the sequence of remission of insomnia symptoms. This study aims to understand the sequence of symptom improvement and the factors influencing the treatment effectiveness in patients with insomnia.
Smartphone-delivered CBT, as a form of Online CBT, allows for training through mobile devices at any time and place. We utilized the Good Sleep 365 app to conduct a survey, involving 2820 patients who met the baseline inclusion criteria. These patients were assessed using a general demographic questionnaire and the Pittsburgh Sleep Quality Index (PSQI) to evaluate general demographic information and insomnia symptoms, and subsequently underwent CBT training using the Good Sleep 365 app. A total of 1179 patients completed follow-ups at 4 weeks, 8 weeks, 16 weeks, and 24 weeks.
At 4 weeks and 8 weeks, the descending order of the reduction rates of PSQI components (excluding component 6: use of sleeping medication) was: sleep latency, subjective sleep quality, sleep efficiency, sleep disturbance, sleep maintenance, and daytime dysfunction. At 16 weeks and 24 weeks, the descending order was subjective sleep quality, sleep latency, sleep efficiency, daytime dysfunction, sleep maintenance, and sleep disturbance. There were significant differences in the reduction rates of PSQI components (excluding component 6: use of sleeping medication) both at the same follow-up times and at different follow-up times (all P<0.05). Multivariable logistic regression analysis showed that patients older than 30 years and those with a college degree or above had better treatment outcomes, whereas those with a disease duration of more than three years had worse outcomes.
The sequence of symptom improvement in patients with insomnia changes over time, and age, educational level, and duration of disease are factors influencing treatment outcomes.
药物联合通过智能手机提供的失眠认知行为疗法（CBT-I）的有效性已得到充分验证，但关于失眠症状缓解顺序的研究较少。本研究旨在了解失眠患者症状改善的顺序以及影响治疗效果的因素。
通过智能手机提供的CBT作为在线CBT的一种形式，允许在任何时间和地点通过移动设备进行训练。我们利用“好睡眠365”应用程序进行了一项调查，纳入了2820名符合基线纳入标准的患者。使用一般人口统计学问卷和匹兹堡睡眠质量指数（PSQI）对这些患者进行评估，以评估一般人口统计学信息和失眠症状，随后使用“好睡眠365”应用程序进行CBT训练。共有1179名患者在4周、8周、16周和24周完成了随访。
在4周和8周时，PSQI各成分（不包括成分6：使用睡眠药物）降低率的降序排列为：入睡潜伏期、主观睡眠质量、睡眠效率、睡眠障碍、睡眠维持和日间功能障碍。在16周和24周时，降序排列为主观睡眠质量、入睡潜伏期、睡眠效率、日间功能障碍、睡眠维持和睡眠障碍。在相同随访时间和不同随访时间，PSQI各成分（不包括成分6：使用睡眠药物）的降低率均有显著差异（均P<0.05）。多变量逻辑回归分析显示，年龄大于30岁和具有大专及以上学历的患者治疗效果较好，而病程超过三年的患者治疗效果较差。
失眠患者症状改善的顺序随时间变化，年龄、教育程度和病程是影响治疗效果的因素。
