认知行为疗法对乳腺癌患者失眠治疗效果的系统评价

目的系统评价认知行为疗法对乳腺癌患者失眠的疗效。方法计算机检索CENTRAL（2011．4）、CochraneLibrary（2005～2011．11）、MEDLINE（1948～2011．11）、EMbase（1966．1—2011．11）、CINAHL（Cumulative Index to Nursing and Allied Health Literature，1982～2011．11）、CBM（1978—2011）和CNKI（1979～2011）中所有关于认知行为疗法治疗乳腺癌患者失眠的随机对照试验（RCT），根据纳入和排除标准筛选文献、提取资料和对纳入研究进行方法学质量评价后，采用RevMan5．0软件进行Meta分析。结果共纳入5个RCT。Meta分析结果显示：干预组患者接受认知行为治疗后经睡眠日记主观评价的睡眠效率高于对照组，睡眠潜伏期低于对照组；而两组患者经睡眠活动记录仪客观记录的睡眠效率、总睡眠时间、睡眠潜伏期和入睡后清醒时间的差异无统计学意义。结论认知行为治疗有助于改善乳腺癌患者主观评价的睡眠效率、睡眠潜伏期，但目前证据不能证明认知行为治疗对乳腺癌患者客观记录的睡眠参数的治疗效果。今后研究需加大样本含量、尽量采用盲法（如评价者盲）、明确分配隐藏方案、选用统一的睡眠活动记录仪进行测评，以提供更高级别的临床证据。

Effectiveness of Cognitive Behavioral Therapy Treating Insomnia in Patients with Breast Cancer: A Systematic Review

Objectives To evaluate the effectiveness of cognitive behavioral therapy （CBT） treating insomnia in patients with breast cancer. Methods Such databases as CENTRAL （April 2011）, The Cochrane Library （2005 to November 2011）, MEDLINE （1948 to April 2011）, EMbase （Junuary 1966 to April 2011）, CINAHL （Cumulative Index to Nursing and Allied Health Literature, 1982 to April 2011）, CBM （1978 to 2011） and CNKI （1979 to 2011） were searched to collect the randomized controlled trials （RCTs） about CBT treating insomnia in patients with breast cancer. Literature screening, data extraction and methodological quality assessment of the included studies were conducted according to the inclusion and exclusion criteria. Then RevMan 5.0 software was used for meta-analysis. Results A total of 5 RCTs were included. The results of meta-analysis showed that, compared with the control group, the CBT group was higher in the score of subjective sleep efficiency; however, it was lower in the subjective sleep onset latency. There were no significant differences between the two groups in the sleep efficiency, total sleep time, sleep onset latency and wake time after sleep onset measured by hypnocinematograph. Conclusion Cognitive behavioral therapy may improve the subjective sleep ef- ficiency and sleep quality, and shorten the sleep onset latency in patients with breast cancer. However, its effect of improving objective sleep quality is still unverifiable at present. It suggests the following measures should be taken for providing better evidences： increasing sample size, adopting blind methods, confirming allocation concealment, and using unified hypnocinematograph.