儿童癌症后青少年和青年成人失眠的在线认知行为疗法效果：一项随机对照试验的结果

The effect of online cognitive behavioral therapy for insomnia in adolescents and young adults after childhood cancer: Results from a randomized controlled trial.

作者信息

van der Hoek Hinke, Peersmann Shosha H M, Maurice-Stam Heleen, Kaspers Gertjan J L, van den Bergh Esther M M, Tissing Wim J E, Kremer Leontien C M, Abbink Floor, de Vries Andrica C H, Loonen Jacqueline, van Straten Annemieke, Grootenhuis Martha A, van Litsenburg Raphaële R L

机构信息

Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.

Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.

出版信息

Cancer. 2025 Mar 15;131(6):e35796. doi: 10.1002/cncr.35796.

DOI:10.1002/cncr.35796

PMID:40045689

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11883199/

Abstract

BACKGROUND

Insomnia is common during and after childhood cancer and associated with negative health outcomes and impaired quality of life. Many adolescents and young adults do not receive treatment. Internet-delivered cognitive behavioral therapy for insomnia (iCBT-i) can fill this gap. This study assesses the effectiveness of the iCBT-i intervention "iSleep youth".

METHODS

Patients (12-30 years old) with an Insomnia Severity Index ≥8, ≥6 months after treatment, and <10 years after diagnosis were 1:1 randomized to iSleep youth or the wait list-control group. iSleep youth consists of five online sessions with a coach. Outcomes were sleep efficiency (actigraph-based), insomnia, fatigue, and health-related quality of life (HRQOL). Differences over time between iSleep youth and controls, 3 months (T3) and 6 months (T6) from baseline, were assessed with linear mixed models, controlling for age, sex, and time since end of treatment. iSleep youth also had a follow-up measurement after 12 months (T12).

RESULTS

Fifty-four (response rate, 49%) patients participated: 68.9% females, mean age, 18.5 years (SD = 3.5), and mean time since end of treatment 3.8 years (SD = 2.3). No significant effects between the two groups were found for sleep efficiency. However, iSleep youth had a beneficial effect on insomnia severity at T3 (β = -0.79) and T6 (β = -0.55), on fatigue at T3 (β = -1.08) and T6 (β = -0.52) and on HRQOL at T3 (β = 0.46) and T6 (β = 0.62). The scores did not change from T6 to T12 in iSleep youth.

CONCLUSIONS

iSleep youth is effective in treating insomnia and concurrent fatigue in adolescents and young adults after childhood cancer and should be implemented.

摘要

背景

失眠在儿童癌症期间及之后很常见，并且与负面健康结果及生活质量受损相关。许多青少年和年轻成年人未接受治疗。基于互联网的失眠认知行为疗法（iCBT-i）可以填补这一空白。本研究评估了iCBT-i干预措施“iSleep youth”的有效性。

方法

失眠严重程度指数≥8、治疗后≥6个月且诊断后<10年的患者（12 - 30岁）按1:1随机分为iSleep youth组或等待列表对照组。iSleep youth包括与一名指导教练进行的五次在线课程。结局指标为睡眠效率（基于活动记录仪）、失眠、疲劳及健康相关生活质量（HRQOL）。采用线性混合模型评估iSleep youth组与对照组在自基线起3个月（T3）和6个月（T6）时随时间的差异，并对年龄、性别及治疗结束后的时间进行控制。iSleep youth组在12个月（T12）后也进行了随访测量。

结果

54名（应答率49%）患者参与研究：68.9%为女性，平均年龄18.5岁（标准差=3.5），治疗结束后的平均时间为3.8年（标准差=2.3）。两组在睡眠效率方面未发现显著差异。然而，iSleep youth组在T3（β=-0.79）和T6（β=-0.55）时对失眠严重程度有有益影响，在T3（β=-1.08）和T6（β=-0.52）时对疲劳有有益影响，在T3（β=0.46）和T6（β=0.62）时对HRQOL有有益影响。iSleep youth组的得分从T6到T12未发生变化。