伴失眠的抑郁症患者睡眠认知特征及其对睡眠质量的影响

目的 了解伴失眠的抑郁症患者对睡眠的信念与态度，并探讨其对睡眠质量的影响。方法 纳入在首都医科大学附属北京安定医院就诊、符合《精神障碍诊断与统计手册（第4版）》（DSM-IV）诊断标准的伴失眠的抑郁症患者（n=61）和原发性失眠患者（n=62）为研究对象，并招募健康对照组（n=64）。三组被试均接受睡眠功能失调信念和态度量表（DBAS）及匹兹堡睡眠质量指数量表（PSQI）评定，伴失眠的抑郁症患者同时接受汉密尔顿抑郁量表17项版（HAMD-17）评定。采用协方差分析比较三组被试PSQI和DBAS评分。采用多元线性回归分析探讨伴失眠的抑郁症患者PSQI评分的影响因素。结果 伴失眠的抑郁症组和原发性失眠组PSQI评分均高于对照组（t=18.932、18.610，P均<0.01），两组DBAS评分均低于对照组（t=-5.561、-5.791，P均<0.01）。以伴失眠的抑郁症患者PSQI评分作为因变量，建立的多元线性回归方程具有统计学意义（F=14.095，R²=0.327，P<0.05），DBAS中对睡眠的预测与控制因子和年龄是患者睡眠质量的影响因素（B=-0.100、-0.279，P<0.05或0.01）。结论 伴失眠的抑郁症患者比正常人存在更多的睡眠相关负性认知，且不良认知可能是其睡眠质量的影响因素。     

老年慢性失眠患者睡眠质量与认知功能的相关性

目的 探讨老年慢性失眠患者睡眠质量与认知功能的相关性。方法 选取我院2019年8月～2020年8月收治的120例老年慢性失眠患者为观察组,选择同期健康体检老年群体120例为对照组。对比两组匹兹堡睡眠指数(PSQI)评分及蒙特利尔认知功能评估量表(MoCA)评分,分析老年慢性失眠患者PSQI评分与认知功能的相关性。结果 观察组睡眠效率、入睡时间、日间功能障碍、睡眠时间、睡眠障碍、睡眠质量、睡眠药物及总分均高于对照组(P0.05)。观察组抽象、注意、语言、视功能与执行功能、延迟回忆、命名、定向及总分均低于对照组(P0.05)。经Pearson检验,睡眠质量、睡眠时间、睡眠效率、入睡时间评分及PSQI总分与视功能与执行功能评分呈负相关(P0.05);睡眠效率、日间功能障碍评分及PSQI总分与命名评分呈负相关(P0.05);日间功能障碍评分及PSQI总分与注意评分呈负相关(P0.05);PSQI总分与语言评分呈负相关(P0.05);睡眠效率、入睡时间评分及PSQI总分与抽象评分呈负相关(P0.05);睡眠时间、日间功能障碍、睡眠障碍评分及PSQI总分与延迟回忆评分呈负相关(P0.05);睡眠药物、入睡时间、睡眠质量评分及PSQI总分与定向评分呈负相关(P0.05);睡眠时间、睡眠质量、睡眠药物、日间功能障碍、入睡时间、睡眠效率评分与MoCA总分呈负相关(P0.05)。结论 老年慢性失眠患者睡眠质量与认知功能存在一定相关性。     

正念疗法对老年患者非全身麻醉术后认知功能及睡眠质量的影响

背景 术后认知功能障碍（POCD）是术后常见的并发症之一,老年患者发病率较高。POCD对患者术后康复影响较大。目的 探讨正念疗法对老年患者非全身麻醉术后认知功能及睡眠质量的影响,为降低老年患者POCD发生风险、改善睡眠质量提供参考。方法 采用简单随机抽样法,选取2022年3月—2023年3月在绵阳市第三人民医院接受非全身麻醉手术的78例老年患者为研究对象,采用随机数字表法分为研究组和对照组各39例。两组均接受常规治疗及护理,研究组此基础上接受正念疗法干预。于术前1天以及术后第1、3、5天,采用简易精神状态量表（MMSE）评定患者的认知功能,于术前1天及术后第3天采用匹兹堡睡眠质量指数量表（PSQI）评定患者的睡眠质量。结果 两组MMSE评分的时间效应、组间效应以及时间与组间的交互效应均有统计学意义（F=78.251、197.071、371.915,P均<0.05）。进一步分析显示,术后第1、3、5天,研究组MMSE评分均高于对照组,差异均有统计学意义（t=-3.579、-1.764、-0.253,P均<0.05）。术后第1、3、5天,研究组POCD发生率均低于对照组,差异均有统计学意义（χ²=2.631、3.471、5.135,P均<0.05）。术后第3天,研究组PSQI总评分低于对照组（P<0.05）,且研究组PSQI总评分、睡眠潜伏期、主观睡眠质量、日间功能障碍以及催眠药物使用因子评分均低于术前（F=43.175、12.594、11.092、4.579、3.514,P均<0.01）。结论 正念疗法可能有助于降低老年患者非全身麻醉术POCD的发生率,并改善其睡眠质量。     

事件相关电位P300在颅脑损伤患者认知功能障碍评定中的应用

目的 探讨事件相关电位P300在颅脑损伤患者认知功能障碍评定中的应用价值。方法 选取2021年1月-9月在绵阳市第三人民医院神经外科保守治疗、并符合诊断标准的颅脑损伤患者36例作为研究组,同期在医院其他患者家属和护工中招募健康对照组共36名。采用Oddball范式对受试者进行事件相关电位P300检测,采用蒙特利尔认知评估量表（MoCA）和简易精神状态评价量表（MMSE）评定受试者的认知功能。比较两组P300的潜伏期、波幅以及MoCA和MMSE评分,比较P300潜伏期、MoCA和MMSE对颅脑损伤患者认知功能障碍的检出率。结果 研究组MoCA和MMSE评分均低于对照组［（18.08±4.29）分vs.（27.36±1.20）分,（22.53±3.54）分vs.（28.11±1.09）分,t=-12.510、-9.041,P均<0.05］;研究组P300潜伏期高于对照组［（406.08±26.95）ms vs.（367.08±22.50）ms,t=6.665,P<0.05］,波幅低于对照组［（7.76±0.90）μV vs.（9.87±0.99）μV,t=-9.459,P<0.05］。在研究组中,P300潜伏期阳性检出率和MoCA对认知功能障碍的检出率均高于MMSE对认知功能障碍的检出率（χ²=5.675、7.604,P均<0.05）。结论 事件相关电位P300或许可作为评估颅脑损伤患者认知功能障碍的客观临床指标。     

失眠认知行为治疗五大技术疗效因子及其治疗感受的质性研究

目的 研究失眠认知行为治疗（cognitive behavior therapy-insomnia, CBTI）中睡眠卫生教育、睡眠限制、刺激控制、放松训练以及认知疗法五大技术的疗效相关因素及治疗感受。方法 纳入21例失眠伴焦虑、抑郁症状患者开展连续8次CBTI，采用匹兹堡睡眠质量指数（Pittsburgh sleep quality index, PSQI）量表评估睡眠症状，运用质性研究方法，分别于第2、4、8次治疗后对患者进行关于治疗技术及自身感受的半结构式访谈，采用主题分析法对访谈资料进行编码和分析。结果 患者治疗后PSQI总分下降（13.55±1.97 vs. 6.91±2.43,P<0.05）。患者访谈表明CBTI五大技术对失眠症状均有改善效果。疗效相关因素包括：养成良好睡眠习惯，减少无效躺床时间，规律作息，建立正向联结，改变不良认知等。患者治疗感受包括：前期体验糟糕，难以离开床，需要长期坚持等。结论 CBTI治疗中的五大技术对睡眠均有帮助，患者会产生负面感受，需重视患者情绪变化及在执行过程中的困难。     

MATRICS成套神经认知测试在青少年双相障碍患者中的心理测量学特征

目的 检测MATRICS成套神经认知测试（MCCB）在青少年双相障碍患者中的心理测量学特征，以确定MCCB是否可用于青少年双相障碍患者的认知功能评估。方法 按照年龄、性别和受教育程度匹配的原则，纳入青少年双相障碍患者（n=38）、青少年重度抑郁发作患者（n=40）和健康对照组（n=41）。分别在基线期和2周后，对青少年双相障碍患者进行蒙特利尔认知评估量表（MoCA）和MCCB评定，其他研究对象仅接受基线期MCCB评定。采用Cronbach’s α系数评估MCCB内部一致性，使用Pearson相关分析考察重测信度与效标效度，通过协方差分析表示区分效度，使用验证性因子分析探讨MCCB的结构效度。结果 ①在对青少年双相障碍患者的评定结果中，MCCB基线期和2周后重测的Cronbach’s α系数分别为0.784、0.773。②青少年双相障碍患者2周后MCCB重测结果显示，MCCB各维度重测信度为0.630~0.812（P均<0.01）。③效标效度显示，MoCA的短期记忆维度评分与MCCB的信息处理速度以及言语学习和记忆维度评分均呈正相关（r=0.487、0.522，P<0.05或0.01）。④区分效度显示，青少年双相障碍组、青少年重度抑郁发作组和健康对照组在MCCB的信息处理速度、注意/警觉性、工作记忆、言语学习和记忆、视觉学习和记忆以及推理与问题解决能力六个维度的评分中，差异均有统计学意义（F=3.790~7.243，P均<0.01）。⑤探索性因子分析显示，MCCB中存在四个因子，累计方差解释率为71.65%。验证性因子分析提示理想7因子模型结构效度欠佳。结论 MCCB在青少年双相障碍患者中具有较好的内部一致性、重测信度以及可接受的效度。     

共病边缘型人格障碍的双相情感障碍患者认知功能状况

背景 双相情感障碍与边缘型人格障碍（BPD）共病率高,共病患者认知功能受损更严重。目的 探讨是否共病BPD的双相情感障碍患者认知功能的差异,为临床诊疗提供参考。方法 采用简单随机抽样,选取2021年4月-2022年4月在河北医科大学第一医院治疗的共病BPD的双相情感障碍患者60例（共病组）,其中双相抑郁患者33例,双相躁狂患者27例。同时选取双相情感障碍患者60例（未共病组）,其中双相抑郁35例,双相躁狂25例。采用中文版神经心理状态测验（RBANS）和Stroop色词测验评估患者的认知功能。结果 共病组RBANS中的即刻记忆、视觉广度、言语功能和总评分均低于未共病组,差异均有统计学意义（t=-2.356、-2.138、-3.306、-2.729,P<0.05或0.01）,Stroop色词测验中的单字时间、单色时间、双字时间和双色时间均长于未共病组,差异均有统计学意义（t=4.808、3.341、5.249、5.167,P均<0.01）。共病BPD的双相抑郁患者RBANS中的即刻记忆、视觉广度、言语功能和总评分均低于未共病BPD的双相抑郁患者（t=-2.446、-2.407、-2.231、-2.078,P均<0.05）,Stroop色词测验中的单字时间、单色时间、双字时间和双色时间均长于未共病组（t=3.652、3.035、4.406、5.016,P均<0.01）。共病组双相躁狂患者RBANS中的言语功能和总评分均高于未共病组（t=-2.777、-2.347,P<0.05或0.01）,Stroop色词测验中的单字时间、单色时间、双字时间和双色时间均长于未共病组（t=3.600、2.658、2.943、4.337,P<0.05或0.01）。结论 相较于未共病BPD的双相情感障碍患者,共病BPD的双相情感障碍患者认知功能受损更严重。     

五行健康操对改善住院老年精神分裂症患者日常生活能力和认知功能的效果

目的 探讨五行健康操对改善住院老年精神分裂症患者日常生活能力和认知功能的效果。方法 纳入2016年5月-2017年5月在厦门市仙岳医院住院治疗、符合《国际疾病分类（第10版）》（ICD-10）诊断标准的老年精神分裂症患者（n=80）为研究对象,采用随机数字表法分为研究组和对照组各40例。两组均接受常规药物治疗、精神科护理及康复治疗,研究组在此基础上进行五行健康操练习。于干预前、干预6个月和干预1年后,采用Barthel指数评定量表（BI）评定患者日常生活能力,采用简易精神状态评价量表（MMSE）评定认知功能;于干预前和干预1年后,采用护士用住院患者观察量表（NOSIE）评定患者行为及病情变化。结果 干预6个月和干预1年后,研究组BI评分（F=2.876、3.240,P<0.05或0.01）和MMSE评分（F=4.742、7.902,P<均0.01）均高于对照组,差异均有统计学意义。干预1年后,研究组NOSIE各因子评分及总评分均高于对照组,差异均有统计学意义（t=0.173~2.463,P均<0.05）。结论 在常规药物治疗及常规护理的基础上实施五行健康操,可能有助于改善住院老年精神分裂症患者的日常生活能力和认知功能。     

慢性失眠障碍患者认知功能与核磁共振波谱成像的研究

目的 探讨慢性失眠障碍(Chronic insomnia disorder,CID)患者的认知功能和海马氢质子磁共振波谱成像(Proton magnetic resonance spectroscopy,¹H-MRS)特点。方法 收集自2017年1月1日-2020年1月1日就诊于新疆医科大学第五附属医院睡眠障碍门诊的60例CID患者,对照组选取同期门诊体检的60例无睡眠障碍的健康人群; 采用匹兹堡睡眠质量指数量表(Pittsburgh sleep quality index,PSQI)评估2组研究对象的睡眠质量; 分别采用简易智力状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCA)评估2组研究对象的总体认知功能; 应用¹H-MRS技术检测2组双侧海马N-乙酰天门冬氨酸(NAA)、胆碱复合物(Cho)和肌酸(Cr)3种代谢物水平,并计算NAA/Cr和Cho/Cr比值。结果 CID组患者PSQI评分显著高于对照组(P<0.01); CID组MMSE评分与对照组比较无显著差异(P>0.05); CID组MoCA评分显著低于对照组(P<0.01),其中注意力、瞬时记忆、延时记忆以及视空间执行功能评分均显著低于对照组(P<0.01、0.01、0.01、0.05); CID组右侧海马NAA/Cr比值低于对照组(1.76±0.32 vs.2.06±0.48)(t=2.278,P=0.027); CID组双侧海马NAA/Cr比值无明显差异(t=1.425,P=0.168); C1D组患者PSQI总分及病程与MoCA评分呈负相关(r=-0.428,-0.355,P=0.006),与右侧海马NAA/Cr比值呈负相关(r=-0.352,-0.308,P=0.019)。结论 CID患者失眠严重程度及病程与MoCA评分、右侧海马NAA/Cr 比值有关,可能导致患者轻度认知功能障碍(MCI)及右侧海马可能存在神经元受损。     

团体认知行为治疗对广泛性焦虑障碍的临床疗效及其对患者执行功能的影响

背景 广泛性焦虑障碍（GAD）患者常存在执行功能损害。团体认知行为治疗（CBT）有助于改善GAD患者的负性情绪,但对执行功能的改善效果尚不明确。目的 探讨团体CBT对GAD患者焦虑症状和执行功能的影响,以期为GAD患者的康复治疗提供参考。方法 连续选取2021年3月—2022年8月在十堰市太和医院睡眠心身医学中心住院的、符合《精神障碍诊断与统计手册（第5版）》（DSM-5）中GAD诊断标准的80例患者为研究对象,采用随机数字表法分为研究组（n=40）和对照组（n=40）。两组均接受药物治疗及疾病健康教育,研究组在此基础上接受为期6周、每周1次、每次60~90 min的团体CBT。分别于治疗前和治疗6周后使用汉密尔顿焦虑量表（HAMA）评定焦虑症状,使用额叶功能评定量表（FAB）评定执行功能。结果 重复测量方差分析结果显示,两组HAMA评分的时间效应有统计学意义（F=1 870.320,P<0.01）,组间效应以及时间与组间的交互效应无统计学意义（F=1.254、0.293,P均>0.05）。两组FAB评分的时间效应、组间效应以及时间与组间的交互效应均有统计学意义（F=311.190、4.399、7.021,P<0.05或0.01）。进一步分析结果显示,治疗后,两组FAB评分均高于治疗前（t=200.569、115.401,P均<0.01）,且研究组FBA评分高于对照组（t=-3.211,P<0.01）。结论 团体CBT联合药物治疗可能有助于降低GAD患者焦虑水平,改善其执行功能。     

认知行为疗法治疗慢性失眠障碍的研究现状

本文目的是分析失眠的认知行为治疗(CBTI)对慢性失眠障碍的效果,以期为推动CBTI的临床运用提供理论依据,为我国慢性失眠障碍患者选用非药物治疗提供参考.慢性失眠障碍是常见的疾病,CBTI已成为慢性失眠障碍的首选治疗方法.本文主要从CBTI对慢性失眠障碍的生理机制及神经影像学方面研究现状、疗效、不良反应、面临的问题及处...     

Is digital cognitive behavioural therapy for insomnia effective in treating sub-threshold insomnia: a pilot RCT

Objective/BackgroundMany patients find cognitive behavioral therapy for insomnia (CBT-I) useful. However, it is currently unknown if those with sub-threshold insomnia also benefit. Here we assessed whether CBT-I is both feasible and acceptable in participants with sub-threshold insomnia. The primary aims were to evaluate participation rates and treatment acceptability, and to establish an effect size for symptom improvement.Patients/MethodsA total of 199 female participants (M_age 20 ± 5 years) took part. Following baseline assessments, participants were randomly allocated to either a six-week digital CBT-I intervention or a six-week control group receiving puzzles. Additional assessments were performed three-weeks, six-weeks, and six-months later.ResultsParticipation rates at each survey assessment wave did not differ between the groups (ps > 0.140), though adherence to completing each weekly task was lower in the CBT-I group, p = 0.02. Treatment acceptability was high (M (SD) = 33.61 (4.82), theoretical range 6–42). The CBT-I group showed greater improvement in insomnia symptoms at the end of the intervention compared to the control group (p = 0.013, d = 0.42), with significant variation in outcome (M = 4.69, SD = 5.41). Sub-threshold participants showed a similar pattern of results, whilst those meeting insomnia criteria showed a smaller between-group difference. CBT-I led to improvements in anxiety, paranoia and perceived stress between baseline and end of intervention. Changes in insomnia symptoms were mediated by cognitions about sleep and somatic pre-sleep arousal.ConclusionsCBT-I provides a benefit even in sub-threshold insomnia. CBT-I may be useful to tackle insomnia symptoms even when they are sub-threshold.     

Cognitive mechanisms of sleep outcomes in a randomized clinical trial of internet-based cognitive behavioral therapy for insomnia

ObjectiveThe aim of this study was to investigate in a randomized clinical trial the role of sleep-related cognitive variables in the long-term efficacy of an online, fully automated cognitive behavioral therapy intervention for insomnia (CBT-I) (Sleep Healthy Using the Internet [SHUTi]).MethodThree hundred and three participants (M_age = 43.3 years; SD = 11.6) were randomly assigned to SHUTi or an online patient education condition and assessed at baseline, postintervention (nine weeks after baseline), and six and 12 months after the intervention period. Cognitive variables were self-reported internal and chance sleep locus of control, dysfunctional beliefs and attitudes about sleep (DBAS), sleep specific self-efficacy, and insomnia knowledge. Primary outcomes were self-reported online ratings of insomnia severity (Insomnia Severity Index), and sleep onset latency and wake after sleep onset from online sleep diaries, collected 12 months after the intervention period.ResultsThose who received SHUTi had, at postassessment, higher levels of insomnia knowledge (95% confidence interval [CI] = 0.10–0.16) and internal sleep locus of control (95% CI = 0.04–0.55) as well as lower DBAS (95% CI = 1.52–2.39) and sleep locus of control attributed to chance (95% CI = 0.15–0.71). Insomnia knowledge, chance sleep locus of control, and DBAS mediated the relationship between condition and at least one 12-month postassessment sleep outcome. Within the SHUTi condition, changes in each cognitive variable (with the exception of internal sleep locus of control) predicted improvement in at least one sleep outcome one year later.ConclusionOnline CBT-I may reduce the enormous public health burden of insomnia by changing underlying cognitive variables that lead to long-term changes in sleep outcomes.     

认知行为自助疗法和唑吡坦治疗慢性失眠的对照研究

目的 比较电话指导下的认知行为自助疗法(CBTI-SH)和酒石酸唑吡坦对慢性失眠的疗效. 方法 选择自2011年7月至2012年10月中山大学附属三院精神心理科门诊慢性失眠患者60例,按奇偶数法分为研究组和对照组各30例.对照组给予睡眠卫生教育+剂量递减的酒石酸唑吡坦治疗:药物起始剂量为10 mg/d,每周递减1/4剂量,疗程4周;研究组给予睡眠卫生教育+CBTI-SH治疗:疗程4周,内容包括认知重建、睡眠限制、刺激控制、放松训练,将CBTI-SH的内容制成文字材料,由患者自助实施,第1、3周末分别给予15 min的电话指导.在基线时及第2、4、6周末应用匹茨堡睡眠质量指数量表(PSQI)、Epworth嗜睡量表(ESS)对睡眠情况进行评价;要求患者每天记录睡眠日志,评价指标包括入睡潜伏期、入睡后觉醒时间、睡眠时间、卧床时间、睡眠效率;要求患者进行依从性评价,即过去1周内有多少天按照要求执行了CBTI-SH或睡眠卫生教育的6种主要成分. 结果 重复测量的方差分析显示,研究组和对照组PSQI量表、ESS量表评分及入睡潜伏期、睡眠效率、睡眠时间、卧床时间、入睡后觉醒时间在治疗前后不同时间之间的差异均有统计学意义(P＜0.05),且研究组的改善明显优于对照组,效应量分别为1.93、0.04、1.00、0.98、0.11、0.57、0.43.研究组对“不在床上做其他事”和“不在床上担忧”的依从性高于对照组,而对“限制卧床时间”、“不能睡则离开床”的依从性低于对照组,差异均有统计学意义(P＜0.05). 结论 和应用剂量递减的酒石酸唑吡坦治疗策略相比,CBTI-SH治疗慢性失眠及伴随的日间思睡的疗效更优,但部分依从性有待提高.     

伴失眠的缓解期抑郁症患者客观睡眠质量与认知功能的关系

目的 探讨伴失眠的缓解期抑郁症患者客观睡眠质量与认知功能的关系.方法 在北京回龙观医院筛选缓解期抑郁症患者47例,采用失眠严重程度指数量表(ISI)和匹兹堡睡眠质量指数量表(PSQI)前四项计算的睡眠效率对患者进行分组,最终伴失眠组22例,不伴失眠组25例.通过多导睡眠监测(PSG)评定患者客观睡眠情况,采用重复性成套...     

Impact of daytime sleepiness and insomnia on simple and complex cognitive task performances

ObjectiveTo examine the individual and combined effects of daytime sleepiness and insomnia disorder (ID) on measures of cognitive functioning.Design and settingThis study was conducted at a medical center using a cross-sectional research design.Participants35 persons with ID (Mage = 40.6 years; 25 women) and 54 normal sleepers (NS; Mage = 31.5 years; 38 women).Methods and measuresParticipants underwent two nights of home-based polysomnography (PSG) followed by daytime testing with a four-trial Multiple Sleep Latency Test (MSLT). Before each MSLT nap, they completed a computer-administered battery of reaction time tasks. Measures of response latencies and response accuracy were tabulated and used as dependent measures. The ID and NS groups were each subdivided into “alert” (eg, MSLT mean latency > 8 min) and “sleepy” (eg, MSLT mean latency ≤ 8 min) subgroups to identify hyperaroused persons with ID and allow for their comparisons with the other participant subgroups.ResultsMultivariate analyses of variance showed a significant main effect for level of daytime sleepiness (F [1, 84] = 8.52, p = 0.0045) on simpler performance tasks and a significant main effect for presence vs. absence of ID (F [1,84] = 6.62, p = 0.012) on complex tasks. A lack of significant participant type x MSLT alertness level interactions in study analyses suggested those ID participants with presumed hyperaousal were not relatively more impaired than the other participant subgroups.ConclusionsDaytime performance deficits on simple tasks seem most dependent on individuals’ levels of daytime sleepiness, whereas performance deficits on more complex tasks appears related to the presence of ID. Therefore, it seems best to use complex performance measures both to document cognitive deficits among those with ID and to determine if insomnia treatments reduce such impairments.Trial registrationClinicalTrials.gov Identifier: NCT02290405.     

Efficacy of digital cognitive behavioural therapy for insomnia: a meta-analysis of randomised controlled trials

ObjectivesAlthough cognitive behavioural therapy for insomnia (CBT-I) has been recommended the initial therapy for insomnia, its clinical usage remains limited due to the lack of therapists. Digital CBT-I (dCBT-I) can potentially circumvent this problem. This meta-analysis aims to evaluate the short-term and long-term efficacy of dCBT-I for adults with insomnia.MethodsSystematic search of PubMed, EMBASE, PsycINFO, and CENTRAL from inception till 5 March 2020 was conducted. Randomised controlled trials (RCTs) comparing dCBT-I with controls (wait-list/treatment-as-usual/online education) in adults with insomnia were eligible. The primary outcome was insomnia severity index (ISI) at post-intervention, short-term follow-up (ranging 4 weeks to 6 months) and 1-year follow-up. Mean differences were pooled using the random-effects model.Results94 articles were assessed full-text independently by two team members and 33 studies were included in this meta-analysis. 4719 and 4645 participants were randomised to dCBT-I and control respectively. dCBT-I significantly reduces ISI at post-intervention with mean difference −5.00 (95% CI −5.68 to −4.33, p < 0.0001) (I² = 79%) compared to control. The improvements were sustained at short-term follow-up, −3.99 (95% CI −4.82 to −3.16, p < 0.0001) and 1-year follow-up, −3.48 (95% CI −4.21 to −2.76, p < 0.0001). Compared to dCBT-I, face-to-face CBT-I produced greater improvement in ISI, 3.07 (95% CI 1.18 to 4.95, p = 0.001). However, this was within the non-inferiority interval of 4 points on ISI.ConclusionThis meta-analysis provides strong support for the effectiveness of dCBT-I in treating insomnia. dCBT-I has potential to revolutionise the delivery of CBT-I, improving the accessibility and availability of CBT-I content for insomnia patients worldwide.     

失眠的认知行为治疗在抑郁障碍共病失眠障碍患者中的应用进展

抑郁障碍共病失眠障碍的现象在临床中非常普遍.失眠的认知行为治疗(Cognitive Behavioral Therapy for Insomnia,CBT-I)作为一个基于证据的非药物治疗方法已经在治疗失眠障碍中广为接受.CBT-I也开始应用于抑郁障碍共病失眠障碍,并且获得一些证据的支持,但是尚需要增强CBT-I治疗抑郁障碍共病失眠障碍患者的依从性,从而提高疗效.     

Web- vs telehealth-based delivery of cognitive behavioral therapy for insomnia: a randomized controlled trial

ObjectivesThe purpose of our study was to evaluate and compare two methods of service delivery (web-based and telehealth-based) for chronic insomnia with regard to patient preference, clinical effectiveness, and patient satisfaction.MethodsOur study was a randomized controlled trial with manualized telehealth- and web-based delivery conditions (nonblinded). The sample comprised 73 adults with chronic insomnia. Participants received web-based delivery from their homes or telehealth-based delivery from a nearby clinic. Both interventions consisted of identical psychoeducation, sleep hygiene and stimulus control instruction, sleep restriction treatment, relaxation training, cognitive therapy, mindfulness meditation, and medication-tapering assistance.ResultsUsing a linear mixed model analysis, results showed that both delivery methods produced equivalent changes in insomnia severity, with large effect sizes. Attendance patterns favored telehealth, whereas homework adherence and preference data favored web-based delivery.ConclusionsWeb- and telehealth-based delivery are both helpful in treating chronic insomnia in rural-dwelling adults.     

Do symptoms of depression,anxiety or stress impair the effectiveness of cognitive behavioural therapy for insomnia? A chart-review of 455 patients with chronic insomnia

BackgroundCo-occurring insomnia and symptoms of depression, anxiety, and stress pose difficult diagnostic and treatment decisions for clinicians. Cognitive Behavioural Therapy for Insomnia (CBTi) is the recommended first-line insomnia treatment, however symptoms of depression, anxiety and stress may reduce the effectiveness of CBTi. We examined the effect of low, moderate, and severe symptoms of depression, anxiety, and stress on insomnia improvements during CBTi.MethodsWe undertook a chart-review of 455 patients (67% Female, Age M = 51.7, SD = 15.6) attending an outpatient CBTi program. Sleep diaries and questionnaire measures of insomnia, depression, anxiety, and stress symptoms were completed at pre-treatment, post-treatment and three-month follow up. We examined 1) the effect of low, moderate, and severe symptoms of depression, anxiety, and stress before treatment on changes in sleep diary and questionnaire measures of insomnia during CBTi, and 2) changes in symptoms of depression, anxiety, and stress during CBTi.ResultsSleep diary and questionnaire measures of insomnia severity showed moderate-to-large improvements during CBTi (d = 0.5–2.7, all p ≤ 0.001), and were not moderated by levels of depression, anxiety or stress before treatment (all interactions p > 0.05). Symptoms of depression, anxiety, and stress improved by three-month follow-up (M improvement = 41–43%; CI = 28–54, Cohen's d = 0.4–0.7).ConclusionsSymptoms of depression, anxiety, and stress do not impair the effectiveness of CBTi. Instead, CBTi was associated with moderate-to-large improvement of depression, anxiety, and stress symptoms in patients with insomnia disorder. Clinicians should refer patients with insomnia for CBTi even in the presence of comorbid symptoms of depression, anxiety, and stress.