Brückner Hanna A, Ell Johanna, Kalon Lina, Strahler Jana, Ducki Antje, Riemann Dieter, Buntrock Claudia, Spiegelhalder Kai, Lehr Dirk
Institute of Sustainability Psychology, Department of Health Psychology and Applied Biological Psychology, Leuphana University, Lüneburg, Germany.
Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Int J Nurs Stud. 2025 Sep;169:105112. doi: 10.1016/j.ijnurstu.2025.105112. Epub 2025 May 7.
Shift work is associated with many adverse effects on health and, in particular, affects sleep. In nurses, one of the most common forms of insomnia is shift work sleep disorder. Traditional face-to-face cognitive behavioral therapy for insomnia is often impractical for shift-working nurses due to irregular work schedules. Digital therapy presents a promising alternative to provide nurses with access to cognitive behavioral therapy for insomnia.
To investigate the effectiveness of the digital SleepCare intervention for reducing insomnia in nurses being affected by shift work sleep disorder.
Randomized controlled trial.
74 nurses affected by shift work sleep disorder.
In a two-armed randomized controlled trial, SleepCare was compared to shift work-specific psychoeducation published digitally by the German Sleep Society. The diagnosis of shift work sleep disorder was established through a clinical interview. The primary outcome was insomnia severity as measured by the Insomnia Severity Index at baseline before randomization, at 8 weeks, and 3 months after randomization. Further indicators of mental health and long-term hair cortisol concentration were evaluated as secondary endpoints.
Intention-to-treat analysis of covariance showed a greater reduction in insomnia severity in the intervention group versus psychoeducation, at both post-intervention (d = 1.11[0.7-1.6]) and follow-up (d = 0.97 [0.5-1.4]), corresponding to between-group differences of 5.0 and 5.3 points on the Insomnia Severity Index, respectively. 56 % completed at least five of the six sessions and results indicated larger effects for these intervention completers with d = 1.49 and d = 1.28, respectively. Statistically significant effects were observed for sleep-related, but not other mental health indicators, for example, stress and depression. Reduced hair cortisol levels were observed post-intervention in the SleepCare group (V = 82, p = .008; Δ = -1.8 pg/mg, 44 % reduction from baseline).
SleepCare was effective in reducing insomnia symptoms to a clinically meaningful extent and is one of the first digitally delivered programs to adapt cognitive behavioral therapy for insomnia with specific exercises to address nurses' needs for shift work. The development of effective strategies to promote treatment adherence seems necessary, as substantially larger effects were observed for intervention completers.
German Clinical Trials Register - DRKS; DRKS00027411 (https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00027411). Registration date: March 9, 2022. Start of recruitment: May 13, 2022.
轮班工作与许多对健康的不利影响相关，尤其会影响睡眠。在护士群体中，最常见的失眠形式之一是轮班工作睡眠障碍。由于工作时间表不规律，传统的面对面失眠认知行为疗法对从事轮班工作的护士来说往往不切实际。数字疗法为护士提供了获得失眠认知行为疗法的一个有前景的替代方案。
研究数字睡眠护理干预对减轻受轮班工作睡眠障碍影响的护士失眠症状的有效性。
随机对照试验。
74名受轮班工作睡眠障碍影响的护士。
在一项双臂随机对照试验中，将睡眠护理与德国睡眠协会以数字方式发布的针对轮班工作的心理教育进行比较。通过临床访谈确定轮班工作睡眠障碍的诊断。主要结局是失眠严重程度，通过随机分组前的基线、随机分组后8周和3个月时的失眠严重程度指数进行测量。心理健康的进一步指标和长期头发皮质醇浓度作为次要终点进行评估。
意向性分析协方差显示，干预组在干预后（d = 1.11[0.7 - 1.6]）和随访时（d = 0.97[0.5 - 1.4]）的失眠严重程度降低幅度均大于心理教育组分别对应失眠严重程度指数上的组间差异为5.0和5.3分。56%的参与者完成了六个疗程中的至少五个，结果表明这些干预完成者的效果更大，d值分别为1.49和1.28。在与睡眠相关的指标上观察到了统计学上的显著效果，但在其他心理健康指标（如压力和抑郁）上未观察到。睡眠护理组干预后观察到头发皮质醇水平降低（V = 82，p = 0.008；Δ = -1.8 pg/mg，较基线降低44%）。
睡眠护理在将失眠症状减轻到具有临床意义的程度方面是有效的，并且是首批通过特定练习来调整失眠认知行为疗法以满足护士轮班工作需求的数字交付项目之一。由于干预完成者观察到的效果显著更大，因此制定有效的策略以促进治疗依从性似乎是必要的。
德国临床试验注册中心 - DRKS；DRKS00027411（https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00027411）。注册日期：2022年3月9日。招募开始日期：2022年5月13日。
